Background: Healthcare organizations are now challenged to retain nurses’ generation and understand why they are leaving their nursing career prematurely. Acquiring knowledge about the effect of ethical work climate and level of perceived organizational support can help organizational leaders to deal effectively with dysfunctional behaviors and make a difference in enhancing nurses’ dedication, commitment, satisfaction, and loyalty to their organization. Purpose: This study aims to determine the relationship between ethical work climate, and perceived organizational support and nurses’ organizational (...) commitment, job satisfaction, and turnover intention. Methods: A descriptive correlational research design was conducted in all inpatient care units at three major hospitals affiliated to different health sectors at Alexandria governorate. All nurses working in these previous hospitals were included in the study (N = 500). Ethical Climate Questionnaire, Survey of Perceived Organizational Support, Organizational Commitment Questionnaire, Index of Job Satisfaction, and Intention to Turnover scale were used to measure study variables. Ethical considerations: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection. Findings: The result revealed positive significant correlations between nurses’ perception of overall ethical work climate and each of perceived organizational support, commitment, as well as their job satisfaction. However, negative significant correlations were found between nurses’ turnover intention and each of these variables. Also, approximately 33% of the explained variance of turnover intention is accounted by ethical work climate, organizational support, organizational commitment, and job satisfaction, and these variables independently contributed significantly in the prediction of turnover intention. Recommendation: Strategies to foster and enhance ethical and supportive work climates as well as job-related benefits are considered significant factors in increasing nurses’ commitment and satisfaction and decreasing their turnover intention. (shrink)

Contemporary medical diagnostics has a dynamic moral landscape, which includes a variety of agents, factors, and components. A significant part of this landscape is composed of information technologies that play a vital role in doctors’ decision-making. This paper focuses on the so-called Intelligent Decision-Support System that is widely implemented in the domain of contemporary medical diagnosis. The purpose of this article is twofold. First, I will show that the IDSS may be considered a moral agent in the practice of (...) medicine today. To develop this idea I will introduce the approach to artificial agency provided by Luciano Floridi. Simultaneously, I will situate this approach in the context of contemporary discussions regarding the nature of artificial agency. It is argued here that the IDSS possesses a specific sort of agency, includes several agent features (e.g. autonomy, interactivity, adaptability), and hence, performs an autonomous behavior, which may have a substantial moral impact on the patient’s well-being. It follows that, through the technology of artificial neural networks combined with ‘deep learning’ mechanisms, the IDSS tool achieves a specific sort of independence (autonomy) and may possess a certain type of moral agency. Second, I will provide a conceptual framework for the ethical evaluation of the moral impact that the IDSS may have on the doctor’s decision-making and, consequently, on the patient’s wellbeing. This framework is the Object-Oriented Model of Moral Action developed by Luciano Floridi. Although this model appears in many contemporary discussions in the field of information and computer ethics, it has not yet been applied to the medical domain. This paper addresses this gap and seeks to reveal the hidden potentialities of the OOP model for the field of medical diagnosis. (shrink)

In the last decade, the cases of breast and cervical cancer have been positioned at the top rank of cancer statistics worldwide. Consequently, many husbands become family caregivers (FCGs) and get the burden of cancer caregiving. Being blind and incompetent, they need supportive care from healthcare professionals (HCPs). To support them, HCPs provide various healthcare information to meet their needs. Further, their demand for a specific type of healthcare information may reflect their need for emotional support from the (...) HCPs to reduce the burden. This study aims to examine the predictors of the need for emotional support among FCGs of female cancer patients by analyzing the demanded healthcare information. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 husbands and 12 significant others in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, the demanded cancer-specific information and information on cancer physical needs significantly predict the need for emotional support among respondents. Meanwhile, FCGs with a higher demand for information on alternative therapies are less likely to need emotional support. Other types of information have ambiguous effects on the need for emotional support. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, and information on cancer physical needs must be prioritized in information disclosure to meet the needs for emotional support among FCGs of female cancer patients. (shrink)

Background Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder. Objectives To validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and investigate characteristics for adherence to medication measured via smartphones. Methods Patients with BD evaluated adherence to medication daily for 6–9 months via smartphones. The Medication Adherence Rating Scale and the Rogers’ Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional (...) Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials. Findings During the study 90.50% of the days were evaluated as ‘medication taken’, 6.91% as ‘medication taken with changes’ and 2.59% as ‘medication not taken’. Adherence to medication measured via smartphones was valid compared with the MARS. Younger age and longer illness duration were significant predictors for non-adherence to medication. Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence. Conclusions Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence. Clinical implications Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings. Trial registration number NCT01446406 and NCT02221336. (shrink)

Evaluating clinical ethics support services has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. In this paper, we argue that a first necessary step for progress is to better understand the intervention in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, (...) we introduce principles of “complex intervention research” and show how CESS fulfil the criteria of “complex interventions”. In a second step, we develop a generic “conceptual framework” for “ethics consultation on request” as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of “bioethics mediation” to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: “proactive ethics consultation” and “moral case deliberation” and discuss implications for evaluating both types of CESS. To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer “good” CESS. (shrink)

In this paper I respond to Marcello Di Bello’s criticisms of the ‘normic account’ of the criminal standard of proof. In so doing, I further elaborate on what the normic account predicts about certain significant legal categories of evidence, including DNA and fingerprint evidence and eyewitness identifications.

Objective—To identify and describe the current state of clinical ethics support services in the UK.Design—A series of questionnaire surveys of key individuals in National Health Service (NHS) trusts, health authorities, health boards, local research ethics committees and health professional organisations. Interviews with chairmen/women of clinical ethics committees identified in the surveys.Setting—The UK National Health Service.Results—Responses to the questionnaires were received from all but one NHS trust and all but one health authority/board. A variety of models of clinical ethics (...) class='Hi'>support were identified including twenty formal clinical ethics committees (CECs). A further twenty NHS trusts expressed an intention to establish a CEC within the next twelve months. Most CECs in the UK have been in existence less than five years and are still defining their role. The chairmen identified education of committee members and contact with other ethics committees as important requirements for committee development. Problems were identified around lack of support for the committee and with raising the profile of the committee within the institution. There has been little evaluation of clinical ethics support services either in the UK or in other countries with longer established services. What evaluation has occurred has focused on process rather than outcome measures.Conclusions—Clinical ethics support services are developing in the UK. A number of issues have been identified that need to be addressed if such support services are to develop effectively. (shrink)

Background Artificial intelligence (AI) has revolutionized various healthcare domains, where AI algorithms sometimes even outperform human specialists. However, the field of clinical ethics has remained largely untouched by AI advances. This study explores the attitudes of anesthesiologists and internists towards the use of AI-driven preference prediction tools to support ethical decision-making for incapacitated patients. Methods A questionnaire was developed and pretested among medical students. The questionnaire was distributed to 200 German anesthesiologists and 200 German internists, thereby focusing on physicians (...) who often encounter patients lacking decision-making capacity. The questionnaire covered attitudes toward AI-driven preference prediction, availability and utilization of Clinical Ethics Support Services (CESS), and experiences with ethically challenging situations. Descriptive statistics and bivariate analysis was performed. Qualitative responses were analyzed using content analysis in a mixed inductive-deductive approach. Results Participants were predominantly male (69.3%), with ages ranging from 27 to 77. Most worked in nonacademic hospitals (82%). Physicians generally showed hesitance toward AI-driven preference prediction, citing concerns about the loss of individuality and humanity, lack of explicability in AI results, and doubts about AI’s ability to encompass the ethical deliberation process. In contrast, physicians had a more positive opinion of CESS. Availability of CESS varied, with 81.8% of participants reporting access. Among those without access, 91.8% expressed a desire for CESS. Physicians' reluctance toward AI-driven preference prediction aligns with concerns about transparency, individuality, and human-machine interaction. While AI could enhance the accuracy of predictions and reduce surrogate burden, concerns about potential biases, de-humanisation, and lack of explicability persist. Conclusions German physicians frequently encountering incapacitated patients exhibit hesitance toward AI-driven preference prediction but hold a higher esteem for CESS. Addressing concerns about individuality, explicability, and human-machine roles may facilitate the acceptance of AI in clinical ethics. Further research into patient and surrogate perspectives is needed to ensure AI aligns with patient preferences and values in complex medical decisions. (shrink)

With the rise and public accessibility of AI-enabled decision-support systems, individuals outsource increasingly more of their decisions, even those that carry ethical dimensions. Considering this trend, scholars have highlighted that uncritical deference to these systems would be problematic and consequently called for investigations of the impact of pertinent technology on humans’ ethical decision-making. To this end, this article conducts a systematic review of existing scholarship and derives an integrated framework that demonstrates how intelligent decision-support systems (IDSSs) shape humans’ (...) ethical decision-making. In particular, we identify resulting consequences on an individual level (i.e., deliberation enhancement, motivation enhancement, autonomy enhancement and action enhancement) and on a societal level (i.e., moral deskilling, restricted moral progress and moral responsibility gaps). We carve out two distinct methods/operation types (i.e., processoriented and outcome-oriented navigation) that decision-support systems can deploy and postulate that these determine to what extent the previously stated consequences materialize. Overall, this study holds important theoretical and practical implications by establishing clarity in the conceptions, underlying mechanisms and (directions of) influences that can be expected when using particular IDSSs for ethical decisions. (shrink)

This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are (...) available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a “bottom-up” perspective might give healthcare personnel opportunities to think and reflect more than a “top-down” perspective. A “bottom-up” approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a “top-down” approach risks removing such moral responsibility. (shrink)

In today’s pluralistic society, clinical ethics consultation cannot count on a pre-given set of rules and principles to be applied to a specific situation, because such an approach would deny the existence of different and divergent backgrounds by imposing a dogmatic and transcultural morality. Clinical ethics support (CES) needs to overcome this lack of foundations and conjugate the respect for the difference at stake with the necessity to find shared and workable solutions for ethical issues encountered in clinical practice. (...) We argue that a pragmatist approach to CES, based on the philosophical theories of William James, John Dewey, and Charles Sanders Peirce, can help to achieve the goal of reaching practical solutions for moral problems in the context of today’s clinical environment, characterized by ethical pluralism. In this article, we outline a pragmatist theoretical framework for CES. Furthermore, we will show that moral case deliberation, making use of the dilemma method, can be regarded an example of a pragmatist approach to CES. (shrink)

Transplantation programs commonly rely on clinicians’ judgments about patients’ social support (care from friends or family) when deciding whether to list them for organ transplantation. We examine whether using social support to make listing decisions for adults seeking transplantation is morally legitimate, drawing on recent data about the evidence-base, implementation, and potential impacts of the criterion on underserved and diverse populations. We demonstrate that the rationale for the social support criterion, based in the principle of utility, is (...) undermined by its reliance on tenuous evidence. Moreover, social support requirements may reinforce transplant inequities, interfere in patients’ personal relationships, and contribute to biased and inconsistent listing procedures. As such, accommodating the needs of patients with limited social support would better balance ethical commitments to equity, utility, and respect for persons in transplantation. We suggest steps for researchers, transplantation programs, and policymakers to improve fair use of social support in transplantation. (shrink)

BackgroundClinical ethics support aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization.MethodsThis integrative approach was developed in an iterative process, combining actual experiences in a (...) case study in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences.ResultsIn this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design.ConclusionsIn the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES. (shrink)

According to so-called epistemic theories of conditionals, the assertability/acceptability/acceptance of a conditional requires the existence of an epistemically significant relation between the conditional’s antecedent and its consequent. This paper points to some linguistic data that our current best theories of the foregoing type appear unable to explain. Further, it presents a new theory of the same type that does not have that shortcoming. The theory is then defended against some seemingly obvious objections.

It is well known that probabilistic support is not transitive. But it can be shown that probabilistic support is transitive provided the intermediary proposition screens off the original evidence with respect to the hypothesis in question. This has the consequence that probabilistic support is transitive when the original evidence is testimonial, memorial or perceptual (i.e., to the effect that such and such was testified to, remembered, or perceived), and the intermediary proposition is its representational content (i.e., to (...) the effect that the such and such occurred). (shrink)

Rapid developments in Artificial Intelligence are leading to an increasing human reliance on machine decision making. Even in collaborative efforts with Decision Support Systems (DSSs), where a human expert is expected to make the final decisions, it can be hard to keep the expert actively involved throughout the decision process. DSSs suggest their own solutions and thus invite passive decision making. To keep humans actively ‘on’ the decision-making loop and counter overreliance on machines, we propose a ‘reflection machine’ (RM). (...) This system asks users questions about their decision strategy and thereby prompts them to evaluate their own decisions critically. We discuss what forms RMs can take and present a proof-of-concept implementation of a RM that can produce feedback on users’ decisions in the medical and law domains. We show that the prototype requires very little domain knowledge to create reasonably intelligent critiquing questions. With this prototype, we demonstrate the technical feasibility to develop RMs and hope to pave the way for future research into their effectiveness and value. (shrink)

While the agricultural knowledges and practices of Black, Indigenous, and People of Color and women have shaped agriculture in the US, these knowledges have been colonized, exploited, and appropriated, cleaving space for the presently dominant white male agricultural narrative. Simultaneously, these knowledges and practices have been transformed to fit within a society that values individualism, production, efficiency, and profit. The authors use a decolonial Feminist Political Ecology framework to highlight the ways in which the knowledges of Indigenous, Black, and women (...) farmers have been and are being colonized; a tradition that makes alternative agriculture a predominantly white space. The authors interviewed 10 BIPOC and women farmers in Colorado to understand what values and knowledges were shaping their often-appropriated agricultural practices. Three themes emerged: people, place, and patterns. By centering these values, farmers create relational agricultural practices that support the well-being of human and more-than-human beings. To support the widespread implementation of these practices, food systems practitioners must elevate the voices and knowledges of historically excluded farmers. Only then can truly just and equitable alternative agricultural practices be realized in the US. (shrink)

Building on the human resource management behavioral and organizational climate literature, this study explores the linkage between socially responsible HRM and employee support for perceived external corporate social responsibility and the underlying social and psychological process. Multilevel analysis of data gathered over two separate periods confirmed that the relationship between SRHRM and employee support for external CSR initiatives of the employing organization is mediated by the organizational CSR climate. Moreover, the indirect effect is contingent on perceived internal CSR. (...) This study extends CSR research into the HRM domain and develops a better understanding of the micro-foundations of CSR by integrating the micro- and macro-perspectives of CSR. Based on the study findings, this paper also discusses theoretical contributions and future research directions. (shrink)

The article deals with the question whether an unconditional basic income (UBI) is part of an ideal liberal-egalitarian welfare regime. Analyzing UBI from an ideal-theoretical perspective requires a comparison of the justice performance of ideal welfare regimes instead of comparing isolated institutional designs. This holistic perspective allows for a more systematic consideration of issues like institutional complementarity. I compare three potential ideal welfare regimes from a liberal-egalitarian perspective of justice: An ideal social democratic regime, a mixed regime containing a moderate (...) UBI and a maximal UBI regime where UBI replaces most of the welfare state. These regimes are evaluated with respect to three aspects of justice performance: the scope and neutrality of opportunities provided, institutional complementarities with a dynamic, globalized economy and the policy feedback effects on the political stability of liberal-egalitarian political coalitions. I conclude that the overall performance of a mixed regime is superior to the other regimes. (shrink)

Generally, online support groups are viewed as low-threshold services. We challenge this assumption with an investigation, based on Conversation Analysis and Membership Categorization Analysis, of contributions to an online support group on eating disorders. In this analysis we show how a new member interacts with existing members in order to display legitimacy for membership of the group. The group operates as a Community of Practice, since membership is organized as joined participation in a writing practice. It becomes clear (...) that becoming a member involves subscribing to normative requirements, centrally, displaying the insight that you are ill. In the case we focus on, this involves the requirement to leave pro-anorexia as a membership category behind. The novice does not yet seem ready to subscribe to this norm and thus the threshold for seeking support is heightened. (shrink)

The pace of change and, indeed, the sheer number of clinical ethics committees has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. The recent case of Great Ormond Street (...) Hospital for Children NHS Foundation Trust v MX, FX and X, [21]–[23] and [58]) has highlighted the importance of patient/family representation at clinical ethics committee meetings. The court viewed these meetings as making decisions about such treatment. We argue that this misunderstands the role of ethics support, with treatment decisions remaining with the clinical team and those providing their consent. The considered review by clinical ethics committees of the moral issues surrounding complex treatment decisions is not a matter of determining a single ethical course of action. In this article, we consider current legal understandings of clinical ethics committees, explore current concepts of ethics support and suggest how they may evolve, considering the various mechanisms of the inclusion of patients and their representatives in ethics meetings which is not standard in the UK. (shrink)

Corporate social responsibility functions as a positive signal to stakeholders that a firm is a responsible corporate citizen. However, CSR is increasingly becoming an ambiguous signal of organizational goodwill because many companies engage in CSR purely out of self-interest, rather than genuine altruism. In this paper, we integrate attribution theory with signaling theory to explore how stakeholders react when they receive additional signals that contradict the company’s intended positive CSR signal. Specifically, we argue that morally questionable CEO ethics in the (...) media negatively influences stakeholders’ CSR motive attributions, which in turn results in increased cynicism that ultimately impacts CSR support intentions and behaviors. We find support for our hypotheses in a quasi-experimental study of stakeholder media exposure to different types of CEOs. Our findings demonstrate that stakeholders consider CEO ethics an important signal of CSR motives, and will shun the CSR initiatives of morally questionable CEOs. (shrink)

ABSTRACTIn this paper, I critique one way of arguing for global democracy on grounds of affected interests and defend another. A famous argument for global democracy, which I call the Demos-Based Argument, attempts to justify global democracy based on the claim that affected interests vindicate individual claims to democratic participation or representation. I analyze and evaluate the Demos-Based Argument and consider different ways of interpreting and justifying its crucial premise: the Principle of Affected Interests. The result is that the argument (...) fails. One lesson of the discussion of the Demos-Based Argument is that the most promising, though eventually unsuccessful, justification of the Principle of Affected Interests is utilitarian. Given the failure of the Demos-Based Argument, the question suggests itself if there is another way to argue for global democracy on utilitarian grounds. I will outline a promising alternative argument for global democracy, which I call the Direct Argument. Like the De... (shrink)

The psychedelic psilocybin has shown promise both as treatment for psychiatric conditions and as a means of improving well-being in healthy individuals. In some jurisdictions (e.g., Oregon, USA), psilocybin use for both purposes is or will soon be allowed and yet, public attitudes toward this shift are understudied. We asked a nationally representative sample of 795 US Americans to evaluate the moral status of psilocybin use in an appropriately licensed setting for either treatment of a psychiatric condition or well-being enhancement. (...) Showing strong bipartisan support, participants rated the individual’s decision as morally positive in both contexts. These results can inform effective policy-making decisions around supervised psilocybin use, given robust public attitudes as elicited in the context of an innovative regulatory model. We did not explore attitudes to psilocybin use in unsupervised or non-licensed community or social settings. (shrink)

Byrne & Russon propose that priming can account for the imitation of simple actions, but they fail to explain how the behavior of another can prime the observer's own behavior. They also propose that imitation of complex skills requires a sequence of acts tied together by a program, but they fail to rule out the role of trial-and-error learning and perceptual/motivational mechanisms in such task acquisition.

Artificial intelligence (AI) has long been recognised as a challenge to responsibility. Much of this discourse has been framed around robots, such as autonomous weapons or self-driving cars, where we arguably lack control over a machine’s behaviour and therefore struggle to identify an agent that can be held accountable. However, most of today’s AI is based on machine-learning technology that does not act on its own, but rather serves as a decision-support tool, automatically analysing data to help human agents (...) make better decisions. I argue that decision-support tools pose a challenge to responsibility that goes beyond the familiar problem of finding someone to blame or punish for the behaviour of agent-like systems. Namely, they pose a problem for what we might call “decision ownership”: they make it difficult to identify human agents to whom we can attribute value-judgements that are reflected in decisions. Drawing on recent philosophical literature on responsibility and its various facets, I argue that this is primarily a problem of attributability rather than of accountability. This particular responsibility problem comes in different forms and degrees, most obviously when an AI provides direct recommendations for actions, but also, less obviously, when it provides mere descriptive information on the basis of which a decision is made. (shrink)

An intuitively appealing argument for pluralism in economics can be made on the grounds that schools of economic thought complement one another. Let us call this the complementarity-based argument for pluralism (CAP). The concepts of complementarity, pluralism, and school of thought are scrutinized in this paper to evaluate this argument. I argue that the complementarity of schools is relative to scientific goals, which implies that discussing complementarity of schools of economic thought requires discussing the goals of economic research. I also (...) distinguish weak from strong complementarity and show that some alleged complementarity relations between schools are weak and thus provide little support for CAP. However, if strong complementarity relations, relative to a valuable goal, can be demonstrated to exist between specific schools, this is a strong reason for pluralism about those schools. Finally, I provide suggestions on how to distinguish strong from weak complementarity. (shrink)

Drawing on social exchange theory, we examine the conditions under which employees’ good intentions motivate them to engage in unethical pro-organizational behavior (UPB) and the psychological mechanism behind this behavioral decision. Findings from a time-lagged field study and a scenario study indicate (1) an interactive effect between perceived organizational support and employee performance on UPB; (2) that low performers who perceive high levels of organizational support are more likely to engage in UPB; and (3) that feelings of indebtedness (...) to the organization mediate the interactive effect on UPB. Therefore, the paper highlights the importance of conditional factors in motivating UPB by combining employee ‘good intentions’ and ‘disadvantageous situations’ to understand the UPB decision process. The paper concludes with theoretical and practical implications. (shrink)

Drawing on social exchange theory, the present study seeks to understand how ethical leaders channel followers’ responses to positive treatment from the organization into a dutiful mindset, resulting in in-role and extra-role performance. Specifically, it examines the influence of perceived organizational support on both followers’ job performance and organizational citizenship behaviors, and the mediating effects of duty orientation on such relationships. In addition, it examines whether the mediated effects are contingent on the ethical leadership exhibited by the team leader. (...) Based on multi-source, multi-level data obtained from 233 employees in 60 teams from the Chinese public sector, we found that ethical leadership moderated the mediated relationship between perceived organizational support and follower work behaviors through duty orientation, such that this relationship was stronger in the presence of higher ethical leadership. (shrink)

Volume 19, Issue 11, November 2019, Page 39-41.

Human interactions are often improvised rather than scripted, which suggests that efficient coordination can emerge even when collective plans are largely underspecified. One possibility is that such forms of coordination primarily rely on mutual influences between interactive partners, and on perception–action couplings such as entrainment or mimicry. Yet some forms of improvised joint actions appear difficult to explain solely by appealing to these emergent mechanisms. Here, we focus on collective free improvisation, a form of highly unplanned creative practice where both (...) agents' subjective reports and the complexity of their interactions suggest that shared intentions may sometimes emerge to support coordination during the course of the improvisation, even in the absence of verbal communication. In four experiments, we show that shared intentions spontaneously emerge during collective musical improvisations, and that they foster coordination on multiple levels, over and beyond the mere influence of shared information. We also show that musicians deploy communicative strategies to manifest and propagate their intentions within the group, and that this predicts better coordination. Overall, our results suggest that improvised and scripted joint actions are more continuous with one another than it first seems, and that they differ merely in the extent to which they rely on emergent or planned coordination mechanisms. (shrink)

When information is transformed from what has traditionally been a paper-based format into digitized elements with meaning associated to them, new and intriguing discussions begin surrounding proper and improper uses of this codified and easily transmittable information. As these discussions continue, some health care providers, insurers, laboratories, pharmacies, and other healthcare stakeholders are creating and retroactively digitizing our medical information with the unambiguous endorsement of the federal government.Some argue that these enormous databases of medical information offer improved access to timely (...) information, evidence-based treatments, and complete records from which to provide care. To the extent that these claims are true, it would seem that this is a valuable asset that offers immeasurable benefit to all. Others believe this digitization to be an egregious invasion of privacy. In this article, I investigate the broad research questions of whether the public good aspect of capturing private health information outweighs individual interests and whether it is ethical to mandate participation in health information exchanges by all individuals who use the U.S. health system. (shrink)

The world’s current model for economic development is unsustainable. It encourages high levels of resource extraction, consumption, and waste that undermine positive environmental outcomes. Transitioning to a circular economy (CE) model of development has been proposed as a sustainable alternative. Artificial intelligence (AI) is a crucial enabler for CE. It can aid in designing robust and sustainable products, facilitate new circular business models, and support the broader infrastructures needed to scale circularity. However, to date, considerations of the ethical implications (...) of using AI to achieve a transition to CE have been limited. This article addresses this gap. It outlines how AI is and can be used to transition towards CE, analyzes the ethical risks associated with using AI for this purpose, and supports some recommendations to policymakers and industry on how to minimise these risks. (shrink)

In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to (...) define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example. (shrink)

Entrepreneurship success is the ultimate goal pursued by entrepreneurs, and entrepreneurial passion is also considered an indispensable and important element on the road to entrepreneurial success. However, the internal influence mechanism of entrepreneurial passion on entrepreneurial success is still insufficient in academic circles. In view of this, based on the theory of social information processing, this research analyses the internal mechanism of entrepreneurial passion through individual psychological capital on entrepreneurial success and the promotion of external entrepreneurial policy support. Through (...) a multi-time and multi-source questionnaire survey of 455 entrepreneurs in entrepreneurship parks and entrepreneurship centers in Wuhan, Guangdong, Shanghai, and other places, the research results show that entrepreneurial passion can increase individual psychological capital and positively affect entrepreneurial success; psychological capital mediates the relationship between individual entrepreneurial passion and entrepreneurial success. Entrepreneurship policy support at the environmental level can promote the effect of entrepreneurial passion on the accumulation of psychological capital, and promote the transformation of entrepreneurial passion into entrepreneurial success through psychological capital. The above research results are helpful to the accumulation of entrepreneurs’ psychological capital and provide a useful reference for entrepreneurial success. (shrink)

The Australian state of Victoria legalised voluntary assisted dying in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation (...) has received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law’s operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession’s opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years. (shrink)

Although prior research has demonstrated that switching schools poses a risk for academic and behavioral functioning among adolescents, relatively little is known about their emotional adjustment, or how it affects emotional well-being. Moreover, the cumulative effects of multiple risk and protective factors on their emotional well-being are even less covered in the existing literature. Guided by a risk and resilience ecological framework, the current study compared emotional well-being, operationalized as positive affect and negative affect, between Chinese adolescents who had switched (...) schools and their non-switch counterparts, and examined the direct and interactive effects of teacher autonomy support and two facets of grit (i.e., perseverance and consistency) on emotional well-being in both groups. A propensity score matching analysis was used to balance the two groups in terms of sociodemographic characteristics (i.e., age, gender, and socioeconomic status). A total of 371 adolescents who had switched schools and 742 non-switch counterparts aged from 13 to 18 years were involved in this study. Results indicated that adolescents who had switched schools reported higher levels of negative affect than their non-switch counterparts. Moreover, for adolescents who had switched schools, those who possessed higher levels of perseverance had a significantly negative association between teacher autonomy support and negative affect; however, the corresponding association was independent of perseverance for their non-switch counterparts. The current findings indicate that switching schools is a disadvantage for adolescents’ emotional states. However, teacher autonomy support and perseverance can protect adolescents who switch schools as critical stress-buffering factors against these negative feelings. (shrink)

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision support service, (...) based on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital. (shrink)

In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of ‘theory’ and show how it is interwoven with ‘practice’ as we go along. First, we look at theory in its foundational role: in our case ‘narrative ethics’ and ‘philosophical hermeneutics’ provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of (...) theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like ‘story’, ‘responsibility’, or ‘vulnerability’ to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa. (shrink)

According to the Argument from Disagreement (AD) widespread and persistent disagreement on ethical issues indicates that our moral opinions are not influenced by moral facts, either because there are no such facts or because there are such facts but they fail to influence our moral opinions. In an innovative paper, Gustafsson and Peterson (Synthese, published online 16 October, 2010) study the argument by means of computer simulation of opinion dynamics, relying on the well-known model of Hegselmann and Krause (J Artif (...) Soc Soc Simul 5(3):1–33, 2002; J Artif Soc Soc Simul 9(3):1–28, 2006). Their simulations indicate that if our moral opinions were influenced at least slightly by moral facts, we would quickly have reached consensus, even if our moral opinions were also affected by additional factors such as false authorities, external political shifts and random processes. Gustafsson and Peterson conclude that since no such consensus has been reached in real life, the simulation gives us increased reason to take seriously the AD. Our main claim in this paper is that these results are not as robust as Gustafsson and Peterson seem to think they are. If we run similar simulations in the alternative Laputa simulation environment developed by Angere and Olsson (Angere, Synthese, forthcoming and Olsson, Episteme 8(2):127–143, 2011) considerably less support for the AD is forthcoming. (shrink)

Objective: Based on the theory of perceived organizational support (POS), conservation of resource (COR) and job demands-resources (JD-R) model, this study establishes a moderated mediation model to test the role of job satisfaction in mediating the relationship between perceived organizational support and job burnout, as well as the role of regulatory emotional self-efficacy in moderating the above mediating process. Method: A total of 784 police officers were surveyed with the Perceived Organizational Support Scale, the Job Burnout Questionnaire, (...) the Regulatory Emotional Self-Efficacy Scale, and the Minnesota Job Satisfaction Questionnaire. Results: (1) After controlling for gender, seniority, age, police classification, education, and marital status, regression analysis showed a significant negative correlation between perceived organizational support and burnout (r = -0.42, p < 0.01), and the former had a significant negative predictive effect on job burnout (β = -0.42, p < 0.001). (2) The mediating effect test shows that job satisfaction plays a partial role in mediating the relationship between perceived organizational support and job burnout. (3) Through the analysis of the moderated mediation model test, regulatory emotional self-efficacy moderates the first half of the path of “perceived organizational support → job satisfaction → job burnout". Conclusion: Perceived organizational support not only directly affects police job burnout but also indirectly affects police job burnout through job satisfaction. Regulatory emotional self-efficacy enhances the influence of organizational support on job satisfaction. This study indicates the combined effect of perceived organizational support, job satisfaction and regulatory emotional self-efficacy on job burnout and has certain guiding significance for alleviating police job burnout. Keywords: Perceived organizational support, Job burnout, Job satisfaction, Regulatory emotional self-efficacy, Moderated mediation. (shrink)

This article investigates the effects of perceived supervisor support on ethical and unethical employee behavior using a multi-method approach. Specifically, we test the mediating mechanism and a boundary condition that moderate the relationship between support and ethical employee behaviors. We find that supervisor-based self-esteem fully mediates the relationship between supervisor support and ethical employee behavior and that employee task satisfaction intensifies the relationship between supervisor support and supervisor-based self-esteem.

BackgroundMachine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians’ practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians’ competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation (...) theory as an analytical lens for investigating how medical action at the micro level and the physician–patient relationship might be affected by the employment of ML_CDSS.Main textProfessionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient’s concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics.ConclusionsUsing ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient’s personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient’s concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making. (shrink)