Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA (...) Nneka O. Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

A crucial problem of conflict management is that whatever happens in negotiations will be interpreted and framed by stakeholders based on their different belief-value systems and world views. This problem will be discussed in the first part of this article as the main cognitive problem of conflict management. The second part develops a general semiotic solution of this problem, based on Charles Peirce's concept of "diagrammatic reasoning." The basic idea is that by representing one 's thought (...) in diagrams, the conditions that determine interpretations can become visible, we can "experiment" with them, and we can change them eventually. The third part, finally, focuses on a concrete tool, called Logical Argument Mapping , that can be used in conflict management to perform such diagrammatic reasoning and to cope with the cognitive problems discussed in the first part. The Israeli-Palestinian conflict on the sovereignty over Jerusalem will be used as an example to show how LAM could work in practice. (shrink)

This paper explores the concept of anticipation of future interaction (AFI) in Computer?Mediated Communication (CMC) with conflict management. Specifically, the tenet of the current paper is to determine whether CMC is suitable for conflict management. This central question was address drawing on anticipation of future interaction. Along this line, the issue of task, identity, self?presentations are discussed relative to the role of anticipation of future interaction in CMC encounters. Specific propositions are presented. The discussion addresses implications (...) for group conflict management process in general while paying attention to the key stages of conflict management. (shrink)

This study explores the dual role of educational practitioners as leaders and educators in the education sector, focusing on conflict management through mindfulness, ten principles of Buddhist governance, and transformational leadership. The research, involving 116 Buddhist monks and nuns with leadership experience in Indonesian Buddhist education institutions, employed statistical analysis techniques such as descriptive statistics, parametric inferential statistics, and SPSS 27. The findings indicate that transformational leadership directly impacts conflict management, while mindfulness and the ten principles (...) of Buddhist governance have indirect effects mediated by transformational leadership. Additionally, mindfulness has a direct influence on conflict management, as do the ten principles of Buddhist governance. The study underscores the importance of developing mindfulness, incorporating Buddhist principles, and fostering transformational leadership among educational leaders and practitioners to enhance conflict management skills. (shrink)

Institutions worldwide respond to the need to recognise the value of educating children and young people to handle or solve conflicts in communication. But how do they or we know that an event is correctly interpreted as a conflict? How can people analyse the quality of deliberation when handling or solving conflicts in communication in education? I discuss these questions and argue that the notion of conflict cannot be defined only in terms of incompatibility, clash, opposition and/or disagreement; (...) it also has to encompass negativity in the approach to the other. I also argue that the quality of deliberation can be analysed through a deliberative pedagogical approach, which takes into account structural features of deliberation and required dispositions of the participants, and that our knowledge of conflicts emerges holistically and is interpersonal and objective. I begin by giving an account of some institutional responses to conflicts. Then I discuss the notion of conflict and define it, inter alia, in terms of incompatibility, disagreement and negativity. Finally, I discuss ideas for analysing the quality of deliberation in communication when handling or solving conflicts in education. (shrink)

This synthesis of 5 prominent conflict management paradigms uses power differential as the single most contributing variable to their process and outcome of conflict. Efforts of scholars to integrate or synthesize conflict paradigms have been unsuccessful or clumsy by the scholars’ own assessments. The 5 selected paradigms represent an interdisciplinary set of normative and descriptive paradigms from different social contexts and intellectual frameworks. The 5 share the common traits of rival goals, three levels of socially constructed (...) power differential, and outcomes relative to the total value of the rival goal. An inverse relationship between power differential and the total value of conflict outcomes is supported by all 5 paradigms and empirical data. Explanatory metatheory is the methodology used for synthesis. An increase in power differential results in a decrease in total value of the rival goal. Power differential is constructed using Max Weber’s ideal-type method. The power differentials are abstracted from the paradigms themselves. Empirical work form secondary sources and case studies complete the analysis. (shrink)

This research study investigates the implementation of the Conflict Management Socialization and Mapping of Conflict Prone Areas program by the National Unity and Political Affairs Agency (Bakesbangpol) in Kuningan Regency, Indonesia. Using qualitative methods, including interviews and a literature review, the study examines how Bakesbangpol Kuningan detects and manages potential conflicts to maintain regional stability. Findings reveal that the program effectively utilizes early detection initiatives and community engagement forums such as Focus Group Discussions (FGDs) and collaborates with (...) various stakeholders, including local authorities and community organizations. Creating a conflict-prone area map in 2017 is a vital tool for proactive conflict prevention and policy formulation. However, the study identifies areas for enhancement, including further staff training, robust administrative support systems development, and more decisive leadership in program execution. This research highlights the significance of systematic program implementation and collaborative efforts in managing social conflicts and ensuring sustained regional harmony. It contributes to the field by providing insights into effective conflict management strategies at the local level in Indonesia, particularly in diverse and potentially conflict-prone regions like Kuningan. (shrink)

Even more precious perhaps is the tradition that works against Â… that misuse of language which consists in pseudo-arguments and propaganda. This is the tradition and discipline of clear speaking..

The purpose of this paper is twofold: firstly, to explore the emotional aspects underlying classroom conflict management, and secondly, to apply these notions to the contrasted analysis of two case studies. Our findings underscore the importance of examining teachers’ emotional regulation to better understand their performance when dealing with conflicts that affect classroom climate. In the final section, we make suggestions for introducing this perspective into initial teacher training through the use of Virtual Reality, a scenario that would (...) allow pre-service teachers to experiment, record and reflect on affective and attitudinal issues that are decisive for effective classroom conflict management. (shrink)

To elucidate the distinct effects of relationship conflict and task conflict, we investigated the intensity of the two types of conflict on emotional exhaustion and work engagement. Furthermore, we examined how cooperative vs. competitive conflict-handling styles moderate the relationship between the two types of conflict and emotional exhaustion and work engagement. We also examined the role of emotion regulation as a covariate to control its effects on the study variables. Utilizing two separate 2 × 2 (...) between-subject experimental designs, we recruited 120 employees from several companies in Austria. The results suggest that higher levels of both RC and TC are positively related to emotional exhaustion and negatively to work engagement. A cooperative conflict management style moderated the effects of both RC and TC on work engagement. The results suggest decoupling RC and TC and examining the interplay between the intensity of intragroup conflict types and conflict management styles provides insights into the connection between the levels of conflict, conflict management, emotional exhaustion, and work engagement. Additionally, it supports the usage of distraction as a viable regulation strategy for managing the effects of high levels of RC on emotional exhaustion. (shrink)

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new spaces for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for clinical ethics conflict coaching can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

Vladimir Putin’s legitimation of Russia’s brutal war of aggression against Ukraine raises questions about traditional understandings of nation and empire. Should we contrast the two in terms of values and practices? In this case, Putin uses both nationalist and Imperialist rhetoric to justify his actions. My essay questions how we understand nation and empire using the example of the Austro-Hungarian Empire. How did this empire develop laws, institutions and administrative practices to manage conflicts and claims around language use and nationalism? (...) How did Austria’s governments rule a multi-lingual, multi-confessional society effectively, without resorting to brutal policies of nationalization? When nationalist conflicts arose in different settings, how and why did they originate? I conclude that in European terms, Imperial Austria and even nationalist Hungary apparently managed daily-life issues around diverse language use and religious practice far more humanely and effectively than did the successor nation states after 1918. (shrink)

This essay responds to criticisms of and reflections on A Theory of Truces offered by Keith Breen, David Lyons, Colleen Murphy and Thaddeus Metz. I focus on the place of truces within just war theory, the permissibility of making truces with particularly unsavory actors, the tension between present and future considerations in truce making, and Truce Thinking as an instance of non-ideal theory.

Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken (...) down. The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties’ respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place. (shrink)

Conflicts of interest in the university context are receiving growing attention, but the focus has been largely on problematic financial COI arising from university-industry relations, which clearly need to be avoided. The result, unfortunately, is a pejorative perception of COI as being equivalent to fraud and thus an issue of academic misconduct. In this paper, the aim is to show that while some financial and non-financial COI are particularly problematic and so should be avoided, many are pervasive and actually the (...) norm in academia even if they are still largely ignored and misunderstood. Through a reflection on my own experiences as a university professor, I describe a diversity of common financial, non-financial and institutional COI of varying degrees of risk, that arise in the day-to-day activities of a professor, in order to then consider how these COI can and should be managed in practice. It is essential to attend to the full range of COI and to think about appropriate policies, procedures, or guidelines to prohibit some COI and mitigate the risks of others; but these “hard” mechanisms are only part of the solution. This paper will focus on elucidating the various “soft” mechanisms – such as education, self-awareness, humility, and dialogue – that can empower professors to manage those COI that cannot be prevented or avoided. (shrink)

Social enterprises are hybrid organizations that primarily pursue social missions while also seeking economic gains. Drawing on workplace diversity and conflict theories, this article addresses recent calls for further research to explore how employees within social enterprises experience internal conflicts arising from the organizational pursuit of dual, competing missions (i.e., social and economic), and how social enterprises manage, and potentially overcome, these challenges. In the context of Korean social enterprise, we conducted a quantitative study that built on an initial (...) explorative qualitative study. Our research examined whether perceived participatory human resource management practices and diversity climate increase employees’ affective commitment by reducing their relational conflict. We further explored a boundary condition, perceived social impact, which strengthened this mediation relationship. Our results offer significant insights into social enterprise, business ethics, and broader management literature. Implications for future research and practice are also discussed. (shrink)

Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global (...) protocols for dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways. (shrink)

Conflict handling by managers gives rise to significant emotional and cognitive experiences for affected employees and has far-reaching effects on the effectiveness of a group and an organization. In this conceptual paper, we argue that despite many claims made by managers in their self-reports that they engage in either dominant or compromising conflict-handling strategies when managing conflict within a group, they may be perceived by employees as adopting neglect or avoidance behaviors. We examine how such perceived managers' (...) avoidance styles could influence employees' perceptions with regard to justice, trust, and politics within an organization. (shrink)

In this paper, we undertake a genealogical study to illustrate how Karl Marx derives his concept of class conflict from Adam Smith’s theory of social order. Based on these findings, we argue that both Smith’s and Marx’s political economies should be interpreted in relation to each other – from the perspective of social philosophy, in particular their shared concepts of social order and necessary opposition of class interests. By appeal to process philosophy, we also argue that this reinterpretation needs (...) to take into account two other ideas shared by Smith and Marx, namely the social individual as person-in-community, and the pursuit of desirable social forms from a humanistic perspective. We conclude by contending that business management practice would benefit from understanding the role of class tensions and social order in stakeholder relations. Specifically, management and organization scholarship should focus on philosophical examinations of the influence of social order on economic activities in an organization in a way that is far more appreciative of the social relations of individuals as being the primary, rather than a secondary, concern. (shrink)

Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to universities (...) and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research. (shrink)

The reliability of clinical practice guidelines has been disputed because guideline panel members are often burdened with financial conflicts of interest. Current recommendations for COI regulation advise not only detailed declaration but also active management of conflicts. To continuously assess COI declaration and management in German guidelines we established the public database LeitlinienWatch. We analyzed all German guidelines at the highest methodological level that included recommendations for pharmacological therapy according to five criteria: declaration and assessment of COI, composition (...) of the guideline development group, independence of the coordinators and lead authors, imposed abstentions because of COI and public external review. Each criterion was assessed using predefined outcome categories. Most guidelines contained a detailed declaration of COI. However, none of the guidelines provided full transparency of COI assessment results. The guideline group was composed of a majority of participants with COI in 55% of the guidelines, no guideline was free of participants with COI. Only 9% of guidelines had coordinators and lead authors without any financial COI. Most guidelines did not provide a rule for abstentions for participants with COI. In 21% of guidelines there was a rule, but abstentions were either not practiced or not documented, whereas in 7% partial abstentions and in 2% complete abstentions were documented. Two thirds of the guideline drafts were not externally reviewed via a public website. COI are usually documented in detail in German guidelines of the highest methodological level. However, considerable improvement is needed regarding active management of COI, including recruitment of independent experts for guideline projects, abstention from voting for participants with COI and external review of the guideline draft. We assume that the publicly available ratings on GuidelineWatch will improve the handling of conflicts of interest in guideline development. (shrink)

In the last decade, there has been increased recognition of the importance of disclosing and managing non-financial conflicts of interests to safeguard the objectivity, integrity, and trustworthiness of scientific research. While funding agencies and academic institutions have had policies for addressing non-financial interests in grant peer review and research oversight since the 1990s, scientific journals have been only recently begun to develop such policies. An impediment to the formulation of effective journal policies is that non-financial interests can be difficult to (...) recognize and define. Journals can overcome this problem by providing guidance concerning the types of non-financial interests that should be disclosed, including direct research interests, direct professional interests, expert testimony, involvement in litigation, holding a leadership position in a non-governmental organization, providing technical or scientific advice to a non-governmental organization, and personal or professional relationships. The guidance should apply to authors, editors, and reviewers. (shrink)

Does managed care represent the death knell for the ethical provision of medical care? Much of the current literature suggests as much. In this essay I argue that the types of ethical conflicts brought on by managed care are, in fact, similar to those long faced by physicians and by other professionals. Managed care presents new, but not fundamentally different, factors to be considered in medical decision making. I also suggest ways of better understanding and resolving these conflicts, in part (...) by distinguishing among conflicts of interest, of bias and of obligation. (shrink)

Although managers spend over twenty percent of their time in conflict management, organization theorists have provided very few guidelines to help them do their job ethically. This paper attempts to provide some guidelines so that organizational members can use the styles of handling interpersonal conflict, such as integrating, obliging, dominating, avoiding, and compromising, with their superiors, subordinates, and peers ethically and effectively. It has been argued in this paper that, in general, each style of handling interpersonal (...) class='Hi'>conflict is appropriate if it is used to attain organization''s proper end. (shrink)

The policy changes governing the relations between the pharmaceutical, medical device and service industries and academic clinical research physicians, recommended by the Institute of Medicine,1 the American Academy of Medical Colleges,2 and much discussed in the media and on our campuses, aim to create some protective ethical firewalls. However, some potentially critical consequences of these steps are missed if we do not acknowledge what else is on the table, and who is sitting at it. By only reacting defensively to the (...) juggernaut of righteous indignation over the loss of purity in a faculty physician's approach to medical problem solving, we are allowing the process to blind us to the difficulties in establishing fair and equitable management of all of the potential conflicts of commitment and conflicts of interest we incur, not only as faculty members, but also as departments and academic medical centres . Critically, this involves all sources of revenue—private, commercial and public—that support our professional and institutional commitments as well as our personal finances.i To counter the present crackdown on inappropriate financial relationships effectively, we will need to reframe the questions, and convince all stakeholders to the process that there is more to this crisis than can be resolved through our public confessions of commercial largesse obliged. The Phrma Code guidelines3 have resulted in what is believed to be a defensible, if as yet legally untested, compartmentalisation of the commercial sector's marketing, medical education and research sponsorship activities. We at the AMC are a long way from understanding how those same missions, as they emanate from our multifarious commitments, can be isolated and individually managed. Defining the parameters for establishing institutional conflicts of interest and commitment are beyond our essay's scope, but with the very public emphasis on capitalist subversion of …. (shrink)

This is a study of how ambiguous identities are interactionally managed in network marketing discourse. Network marketing, as an enterprise `using' friendship to promote products, has been notorious for its exploitative use of interpersonal meaning. In this study, the interactions between supervisors and subordinates in network marketing firms have been studied and their relationship was found to be ambiguous and conflicting. On the one hand, they are `friends' because of the strong emphasis on rapport and harmony in the philosophy of (...) network marketing; on the other hand, the supervisors have to regulate their downlines, which unfortunately lacks the legitimacy found in traditional business firms, as neither of them is an employee of their company. These ambiguous and conflicting identities motivate the participants to mobilize pertinent identities so as to manage conflicts, justify themselves and resume control. Previous research has shown that identities are both interactionally and retrospectively constructed. This study adds to our understanding that identities are not only products of interactions but that they are also interactional resources, which can be mobilized by participants to achieve their goals, although the identity mobilization does not always result in harmony owing to the inherent incompatiblity of the identities invoked. Implications for identity formation in contemporary firms are also drawn. (shrink)

The bioethics literature on managed care has devoted significant attention to a broad range of conflicts that managed care is perceived to have introduced into the practice of medicine. In the first part of this paper we discuss three kinds of conflict of interest: conflicts of economic incentives, conflicts with patient and physician autonomy, and conflicts with the fiduciary character of the physician–patient relationship. We argue that the conflicts are either not as serious as they are often alleged to (...) be or not unique to managed care. In part two we argue that managed care represents a new paradigm for medical care that features a new concept of management. We discuss three types or levels of management that managed care highlights, namely, administrative, clinical, and resource, which together offer a more sophisticated vantage point from which to assess patient care. We do not endorse managed care, but attempt to highlight some of the positive changes brought by managed care that were difficult to attain under traditional reimbursement systems. (shrink)

It is often claimed that managed care organizations involve physicians in conflicts of interest by creating financial incentives for physicians to refrain from ordering treatments or making referrals. Such incentives, the argument goes, force the physician to balance the patient's health interests against the MCO's interests and the physician's own financial interest. I assume, for the sake of argument, that such arrangements at least provide reason to believe that physicians in MCOs are involved in conflicts of interest. Two approaches have (...) evolved for dealing with these conflicts. On one approach, MCOs disclose the financial arrangements under which their physicians work so that patients can consent to the managed care plan and thereby to the plan's limitations. The chief proponent of this approach is Mark Hall, whose recent book Making Medical Spending Decisions applies prior consent to a variety of decisions regarding medical financing and allocation. The other approach is simply to forbid conflicts of interest through regulations. (shrink)

This study examines the effects of ethical pressure on management accountants' perceptions of organizational-professional conflict, and related work outcomes. It was hypothesized that organizational pressure to engage in unethical behavior would increase perceived organizational-professional conflict, and that this perceived conflict would reduce organizational commitment and job satisfaction, and increase the likelihood of employee turnover. A survey was mailed to a random sample of Certified Management Accountants to assess perceptions of the relevant variables. The results of (...) a structural equations model indicated that, as hypothesized, ethical pressure was associated with higher levels of perceived organizational-professional conflict. Also as hypothesized, higher levels of conflict were associated with lower levels of organizational commitment and job satisfaction. Finally, lower levels of commitment and satisfaction were associated with higher turnover intentions. (shrink)

This paper synthesises the research related to managing conflict of interests in professional accounting firms. The main purpose is to provide information about the current state of knowledge on this topic and to highlight the areas requiring further research. The extant research has been reviewed by developing a framework through the integration of Risk Management Framework by ISO 31000:2009 and the International Code of Ethics for Professional Accountants. Specifically, literature has been classified across the establishment of context, assessment, (...) treatment, control and monitoring of conflict of interests. The literature reveals that there is a lack of understanding about how the conflict of interests operates at the level of an individual accounting professional. Addressing this gap will help to develop behavioural interventions for strengthening the professionals’ independence in fact and, thereby, facilitating the management of conflict of interests. The key message this synthesised research provides for professional accounting firms and the regulators is that, for effective management of conflict of interests, behavioural interventions should be informed by the professionals’ unconscious as well as their conscious cognitive processes. This study is the first one to view the conflict of interests in a professional accounting environment through the lens of behavioural risk management. Moreover, the framework adopted for reviewing the extant literature provides a comprehensive view of the issues surrounding the ineffective management of the conflict of interests. (shrink)

Understanding stakeholders’ perceptions and motivations is of significant importance in relation to conservation and protected area projects. The importance of stakeholder analysis is widely recognized as a necessary means for gaining insight into the complex systemic interactions between natural processes, management policies, and local people depending on the resource. Today, community and group-based participatory inquiry approaches are widely used for this purpose. Recently, participatory approaches have been critiqued for not considering power relations and conflict internal to the community. (...) In this article, we suggest that the five-step Rapid Stakeholder and Conflict Assessment (RSCA) methodology addresses this critique. The objective of the methodology is to provide a facilitator with a comprehensive foundation on which to plan and conduct subsequent participatory project development. The RSCA integrates elements of soft systems and critical systems thinking. Qualitative research interviews and cognitive mapping of stakeholders’ mental models are used for collection of empirical material and analysis. The RSCA methodology is demonstrated in a case study concerning buffer zone management in the coastal wetlands of southern Vietnam. The case study shows that the RSCA methodology can provide an efficient way of obtaining a holistic and critical understanding of a complex resource management situation, thus potentially enhancing project performance in an instrumental as well as an ethical sense. (shrink)

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies’ internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical (...) companies’ ethics materials and describe shortcomings in the companies’ existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs. (shrink)

The increased competition for a share of the market of insured patients, which arose in the wake of failed comprehensive health care reform, has provoked questions about what, if any, standards will govern new “competitive” health care organizations. Managed care arrangements, which typically shift to providers and patients some or all of the financial risk for patient care, are of special concern because they can create incentives to withhold beneficial care from patients. Of course, fee-for-service medical practice creates incentives to (...) provide unnecessary services, and managed care can avoid that type of harm. Still, as Edmund Pellegrino has noted, “managed care, by its nature, places the good of the patient into conflict with … the good of all the other patients served by the plan; the good of the plan and the organization, themselves…; and the self-interest of the physician. (shrink)