Recent developments in neuroscience have enabled technological advances to modulate cognitive functions of the brain. Despite ethical concerns about cognitive enhancement, both individuals and society as a whole can benefit greatly from these technologies, depending on how we regulate their use. To date, regulatory analyses of neuromodulation technologies have focused on a technology itself – for instance, the U.S. Food and Drug Administration regulation of a brain stimulation device – rather than the use of a technology, such as the use (...) of a brain stimulation device at work or school. Given that some forms of cognitive enhancement have already started to penetrate the general public’s everyday life, we should begin our discussion on potential regulatory issues regarding their use in various real-world situations. The goal of the article is to fill the gap by providing an analytic framework to examine these regulatory issues. More specifically, it aims to illustrate the issues around respecting autonomy and preventing coercive use of cognitive enhancement. The proposed framework categories the real-world settings where a neuromodulation technology can be used for cognitive enhancement based on two criteria – who is subjected to cognitive enhancement and who imposes cognitive enhancement. Based on this framework, the article analyzes regulatory issues arising out of every combination of subject/imposing party by taking one example case. Focusing on the regulations in the U.S., this analysis shows the current lack of adequate safeguards against the coercive use and calls for more attention from government agencies and researchers to develop sound policies regarding current and potentially more widespread use of cognitive enhancement. (shrink)

Advances in neurotechnologies, artificial intelligence (AI) and Big Data analytics are allowing interpretation of patterns from brain data to identify and even predict and manipulate mental states. Furthermore, there are avenues through which brain data can move into the consumer sphere, be reidentified and brokered. In response to these developments, there have been a number of approaches proposed to strengthen protections of brain data. To better understand the landscape of brain data protection discussions, we conducted a scoping review to identify (...) the rationales for establishing brain data protections and the proposals for protecting brain data offered in the ethics and neuroscience literature. To draw comparisons, we also surveyed the rationales given in the literature for the protection of sensitive behavioral inferences drawn from other types of personal data and associated approaches to achieving protection. This systematic examination of the rationale behind heightened protection for brain data should be useful to clarify the functional and conceptual bases given for brain data protection and to provide a better grounding for evaluating how the different approaches to brain data protection address these concerns. (shrink)

This letter replies to the letter “Colonial and Neocolonial Barriers to Companion Digital Humans in Africa,” by Luís Cordeiro‐Rodrigues, in the same, May‐June 2024, issue of the Hastings Center Report.

It has become increasingly difficult for individuals to exercise meaningful control over the personal data they disclose to companies or to understand and track the ways in which that data is exchanged and used. These developments have led to an emerging consensus that existing privacy and data protection laws offer individuals insufficient protections against harms stemming from current data practices. However, an effective and ethically justified way forward remains elusive. To inform policy in this area, we propose the Ethical Data (...) Practices framework. The framework outlines six principles relevant to the collection and use of personal data—minimizing harm, fairly distributing benefits and burdens, respecting autonomy, transparency, accountability, and inclusion—and translates these principles into action-guiding practical imperatives for companies that process personal data. In addition to informing policy, the practical imperatives can be voluntarily adopted by companies to promote ethical data practices. (shrink)

The Buddhist Jātaka tells the tale of a hare lounging under a palm tree who becomes convinced the Earth is coming to an end when a ripe bael fruit falls on its head. Soon all the hares are running; other animals join them, forming a stampede of deer, boar, elk, buffalo, wild oxen, rhinoceros, tigers and elephants, loudly proclaiming the earth is ending.1 In the American retelling, the hare is ‘chicken little,’ and the exaggerated fear is that the sky is (...) falling. The story offers a cautionary tale for considering the trend towards calamity thinking in artificial intelligence (AI). A growing chorus of tech leaders has warned that AI poses existential risk (X-Risk) that could result in the extinction of the human species, the collapse of civilisation, or a colossal decline in human potential and culture. In 2014, Hawking told the Washington Post that AI, ‘could spell the end of the human race’.2 Musk has repeatedly warned about AI’s perils, calling AI, ‘more dangerous than nukes’, recommending colonising Mars to ensure ‘a bolt-hole if AI goes rogue and turns on humanity’,3 and donating 10 million dollars to the Future of Life Institute to jumpstart research on AI’s X-Risk. Gates has stated, ‘I am in the camp…concerned about super intelligence…I agree with … Musk and some others on this and don’t understand why some people are not concerned’.4 Altman, CEO of OpenAI, has fretted that technologies OpenAI was building could endanger humanity—‘even destroying the world as we know it’.5 This paper offers a critical appraisal of the rise of calamity thinking in the scholarly AI ethics literature. It cautions against viewing X-Risk in isolation and highlights ethical considerations sidelined when X-Risk takes centre stage. Section I introduces a working definition of X-Risk, considers its likelihood and …. (shrink)

Depression is a widespread concern in the United States. Neuromodulation treatments are becoming more common but there is emerging concern for racial disparities in neuromodulation treatment utilization. This study focuses on Transcranial Magnetic Stimulation (TMS), a treatment for depression, and the structural and attitudinal barriers that racialized individuals face in accessing it. In January 2023 participants from the Twin Cities, Minnesota engaged in focus groups, coupled with an educational video intervention. Individuals self identified as non-white who had no previous TMS (...) exposure but had tried at least one treatment for their depression. Results revealed that the intervention did not notably change knowledge or stigma about TMS, but attitudes surrounding traveling for treatment changed. Notably, barriers like affordability, frequency of treatment, and lack of knowledge persist. Participants expressed a desire for more information, personal connection, and a tailored educational approach. The study suggests a need for multifaceted strategies to reduce disparities, focusing on education, community-based resources, and policy interventions. Immediate actions that can be taken include the creation of a TMS education program focused on patient engagement and awareness about TMS. (shrink)

Corporate America is institutionalizing ethics through a variety of structures, systems, and processes. This study sought to identify managerial perceptions regarding the institutionalization of ethics in organizations. Eighty-six corporate level marketing and human resource managers of American multi-national corporations responded to a mail survey regarding the various implicit and explicit ways by which corporations institutionalize ethics. The results revealed that managers found ethics to be good for the bottom line of the organizations, they did not perceive the need for additional (...) formalization of ethics, and that they perceived implicit forms of institutionalizing ethics (e.g., leadership, corporate culture, top management support) to be more effective than the explicit forms of institutionalizing ethics (e.g., ethics ombudspeople, ethics committees, ethics newsletters). Implications of the survey and future research directions conclude the paper. (shrink)

The Spring 1999 issue of CambridgeQuarterly adds to the growing body of academic inquiry into the goals of neonatal intensive care practices. Muraskas and colleagues thoughtfully presented the possibility of nontreatment for neonates born at or under 24 weeks gestation. Jain, Thomasma, and Ragas explained that quality of future life must not be ignored in clinical deliberation. And Hefferman and Heilig described once again the dilemmas nurses face when caring for potentially devastated neonates kept alive by technology. These authors take (...) brave steps by publicly questioning the trend of intensive medical support for most every American-born product of conception. But many questions addressing the goals of neonatal intensive care remain, and few authors have actually tried to distill these goals. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

The essays in this volume present versions of feminism that are explicitly liberal, or versions of liberalism that are explicitly feminist. By bringing together some of the most respected and well-known scholars in mainstream political philosophy today, Amy R. Baehr challenges the reader to reconsider the dominant view that liberalism and feminism are 'incompatible.'.

Social isolation and loneliness are growing concerns around the globe that put people at increased risk of disease and early death. One much‐touted approach to addressing them is deploying artificially intelligent agents to serve as companions for socially isolated and lonely people. Focusing on digital humans, we consider evidence and ethical arguments for and against this approach. We set forth and defend public health policies that respond to concerns about replacing humans, establishing inferior relationships, algorithmic bias, distributive justice, and data (...) privacy. (shrink)

We appreciate the helpful commentaries on our paper, ‘AI and the falling sky: interrogating X-Risk’.1 We agree with many points commentators raise, which opened our eyes to concerns we had not previously considered. This reply focuses on the tension many commentators noted between AI’s existential risks (X-Risks) and justice here and now. In ‘Existential risk and the justice turn in bioethics’, Corsico frames the tension between AI X-Risk and justice here and now as part of a larger shift within bioethics.2 (...) They think the field is increasingly turning away from ‘big picture’ questions new technologies raise and focusing on narrower justice concerns of less significance. They compare our paper’s emphasis on justly transitioning to more AI-centred societies with the approach of environmentalists fretting about human protection against climate change while losing sight of the need to protect the planet and all living things. Corsico doubts there is much point to pressing for ‘justice on a dead planet’, so too Corsico questions our concern with just transitions. Presumably, that matters little if intelligent life on Earth is destroyed. Corsico’s recommends bioethicists return to big questions, like: ‘Should we develop AI at all, given AI X-Risk?’. Yet this question is increasingly moot. The genie is already out of the bottle. The Future of Life Institute’s 2023 call for a temporary pause on training AI systems more powerful than ChatGPT fell on deaf ears, in part because freely accessible source codes enable anyone to train systems and create AI applications.3 The focus now must be managing the genie. While we take AI X-Risk seriously, …. (shrink)

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or eszopiclone (...) between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

Healthcare ethics consultants in the Veterans Health Administration (VHA) document consults in an enterprise-wide web-based database entitled IEWeb, serving as a system of record for healthcare ethics documentation at 1300 VA facilities. The need arose to evolve the database from an ethics process training resource into a more streamlined documentation repository that captures essential consult elements. A VHA National Center for Ethics in Health Care (NCEHC) Improvement Team convened for three tasks: (1) Specify and prioritize IEWeb changes (occurred via six (...) focus groups composed of “new user” and “super user” cohorts with analysis of existing documentation patterns); (2) Pilot the changes regionally (via regional communication, training, and reviews of pre-post use patterns); and (3) Measure the impact of national change implementation on user perspectives (via pre-and post-change implementation polls). Focus groups identified six implementable priority areas for ethics consult documentation improvement, including the development of a usable consult summary note for ready conversion from IEWeb fields into the electronic health record. Post-IEWeb updates showed an increased number of consults documented, a reduction in “time to consult documentation closure” by a mean of 4.5 days, and a clinically-meaningful improvement in the quality of documentation (78% of ethics questions scored “above-bar” on the validation tool pre- vs. 89% scored “above-bar” post-IEWeb changes, n = 140). According to national survey findings, the number of consultants documenting “all” consults in IEWeb increased, satisfaction increased, and perception of documentation difficulty decreased. IEWeb simplification enabled ethics consultants to re-focus their documentation completion efforts by decreasing perception of documentation burden while improving documentation frequency and quality in a clinically-meaningful way. (shrink)

Theories of language production propose that utterances are constructed by a mechanism that separates linguistic content from linguistic structure, Linguistic content is retrieved from the mental lexicon, and is then inserted into slots in linguistic structures or frames. Support for this kind of model at the phonological level comes from patterns of phonological speech errors. W present an alternative account of these patterns using a connectionist or parallel distributed proceesing (PDP) model that learns to produce sequences of phonological features. The (...) model's errors exhibit some of the properties of human speech errors, specifically, properties that have been attributed to the action of phonological rules, frames, or other structural generalizations. (shrink)

Anita Chari revives the concept of reification from Marx and the Frankfurt School to spotlight the resistance to neoliberal capitalism now forming at the level of political economy and at the more sensate, experiential level of subjective transformation. Reading art by Oliver Ressler, Zanny Begg, Claire Fontaine, Jason Lazarus, and Mika Rottenberg, as well as the politics of Occupy Wall Street, Chari identifies practices through which artists and activists have challenged neoliberalism's social and political logics, exposing its inherent tensions (...) and contradictions. (shrink)

Volume 19, Issue 10, October 2019, Page 52-54.

Medical researchers must continue to develop and test non-blood oxygen-transport products. Resources provided by the Jehovah's Witness Hospital Assistance Line must be consulted. Sickle cell researchers must continue to test non-blood treatment. Information about non-blood treatments must be disbursed. Ways to enhance parental comport as the laws further and further support children's best interest must be provided. Information regarding cultural diversity must be disseminated. Hospitals and healthcare agencies that have not done so must institute the use of ethics consulting or (...) ethics committees. Nurse ethicists must continue development of the role of educating staff; mediation, arbitration and negotiation; problem solving; obtaining legal opinion; providing patient, family, or staff advocacy; and helping to reduce suffering on the part of the providers. Difficult ethical decisions should continue to be debated.Were the staff at X Med Center correct in overriding parental wishes and breaking tenets of their faith? In the doctor's, nurse's lawyer's, and judge's view they were. The child, now eight years old, is alive and well. The stroke resolved, and imminent death averted. The parents' and child's views are not presently available. Whether the family is suffering from the child's loss of his relationship with God, or are secretly relieved in their hearts that they are not, like Rita Swan, mourning their dead son, is unknown. What is known, is that this was a difficult case for all involved, and that such cases will continue to present themselves in the future. (shrink)

As ambient assisted living technologies continue to evolve, ethics consultants should be prepared to address questions about their proper use. In this issue, we address a scenario in a dementia car...

The Gricean account of language is at the center of much current work in the philosophy of language and the philosophy of mind. Anita Avramides maintains that Grice's paradigm can be used to defend very different conceptions of mind and of meaning. In this clearly argued book she describes Grice's analysis of meaning and proposes two interpretations of it, one reductive and one nonreductive. Much current work in cognitive science assumes that the content of words and thoughts can be (...) explained in naturalistic terms. A leading idea (advanced mainly by Stephen Schiffer and Brian Loar) is that the naturalistic account of content will proceed in two stages: a reduction of the semantic features of word; to the contents of propositional attitudes and then a reduction of the latter to physical or functional notions. The appeal of Grice's work on meaning to this two stage reductionist strategy is that Gricean definitions seem to provide the only way of reducing the semantic to the psychological, a reduction that is required for a naturalistic account of intentionality. While Avramides defends the method of analysis as one suited to the concept of meaning, she rejects a reductive interpretation of the analysis. She argues that any attempt to reduce the semantic to the psychological leads to a mistaken conception of mind. She exposes the assumptions behind the reductive interpretation and offers fresh and original arguments for the antireductionist position. Against the reductive Gricean she defends the idea that there is a deep epistemological symmetry between semantic and propositional attitude notions, a result of which is that semantically characterized linguistic behavior is central to our concept of belief. Anita Avramides is Lecturer in Philosophy at The Queens College, The University of Oxfor. A Bradford Book. (shrink)

The COVID-19 pandemic has triggered much-needed reflection on family caregiver burden. This is unsurprising, given U.S. dependence on acute health care delivery and long-standing t...

Artificial intelligence (AI) has garnered tremendous attention in health care, and many hope that AI can enhance our health system’s ability to care for people with chronic and degenerative conditions, including Parkinson’s Disease (PD). This paper reports the themes and lessons derived from a qualitative study with people living with PD, family caregivers, and health care providers regarding the ethical dimensions of using AI to monitor, assess, and predict PD symptoms and progression. Thematic analysis identified ethical concerns at four intersecting (...) levels: personal, interpersonal, professional/institutional, and societal levels. Reflecting on potential benefits of predictive algorithms that can continuously collect and process longitudinal data, participants expressed a desire for more timely, ongoing, and accurate information that could enhance management of day-to-day fluctuations and facilitate clinical and personal care as their disease progresses. Nonetheless, they voiced concerns about intersecting ethical questions around evolving illness identities, familial and professional care relationships, privacy, and data ownership/governance. The multi-layer analysis provides a helpful way to understand the ethics of using AI in monitoring and managing PD and other chronic/degenerative conditions. (shrink)

ABSTRACT In 1730, shortly before his death, the Paris anatomist Joseph‐Guichard Duverney wrote his will, leaving his anatomical specimens to the Académie des Sciences, of which he was a member. But the will was disputed by Pierre Chirac, supervisor of the Jardin du Roi where Duverney, as professor of anatomy, had performed most of the dissections that produced the specimens. The ensuing debate between Chirac and René‐Antoine Ferchault de Réaumur, arguing for the Académie, reveals the tensions surrounding both the concept (...) of intellectual property in this period and the collective enterprise in natural philosophy. The differing roles and audiences of the Académie and the Jardin were central to this debate. In addition, this essay explores the origins and significance of the anatomical specimens themselves and their changing role in instruction and display, as well as the transition from the cabinet of curiosities to the natural history museum. (shrink)

Summary This essay explores the place of natural philosophy among the patronage projects of Louis XIV, focusing on the Mémoires pour servir à l'histoire naturelle des animaux (or Histoire des animaux) of the 1670s, one of a number of works of natural philosophy to issue from Louis XIV's printing house. Questions particular to the Histoire des animaux include the interaction between text and image, the credibility and authority of images of exotic animals, and the relationship between comparative anatomy and natural (...) history, and between human and animal anatomy. At the same time that the Histoire des animaux contributed to Jean-Baptiste Colbert's management of patronage and of Louis's image, it was a work of natural philosophy, representing the collaborative efforts of the new Paris Academy of Sciences. It examined natural history and comparative anatomy in new ways, and its illustrations broke new ground in their depiction of animals in a natural setting. However, the lavishly formatted books were presentation volumes and did not gain wide circulation until their republication in 1733. Sources consulted include Colbert's manuscript memoires on the royal printers and engravers. (shrink)

Akabayashi and Slingsby's (2006) article reminds us that the North American emphasis on individualistic autonomy is not universal. As the authors explain, personal identity in Japan is not construc...

'Anita L. Allen breaks new ground...A stunning indictment of women's status in contemporary society, her book provides vital original scholarly research and insight.' |s-NEW DIRECTIONS FOR WOMEN.

This article is a close reading of Józef Tischner's Historia filozofii po góralsku [History of Philosophy in Góral], considered alongside Barbara Cassin's Vocabulaire européen des philosophies [European Vocabulary of Philosophies] and in the context of European unification. Written in the Góral dialect of Polish and recounting the history of philosophy as if it belonged to Górals, Tischner's book re-imagines Europe as a space of reciprocity, equality, and freedom. This gesture is inseparable from the mode of as if, a mode that (...) translation, literature, reading, and the future anterior tense all hold in common. (shrink)

The analysis of the operation of tourism companies will provide valid information for the design of policies to reactivate the tourism industry, which has been strongly affected during the pandemic generated by COVID-19. The objective of this paper is to use soft computing techniques to analyse tourism companies in Ecuador. First of all, dimensionality reduction methods are applied: principal component analysis, isometric feature mapping and locally linear embedding, on data of tourism enterprises in Ecuador for the year 2015. In addition, (...) to verify the trend of operational variables, the data of tourism companies in Ecuador in 2019 and 2020 are analysed with dimensionality reduction methods that improve the interpretation by minimizing the loss of information. The data sets are analysed with k-means, k-medoids and Hierarchical Clustering, generating groups according to similar characteristics. The optimal number of clusters is determined with the following: Elbow Method, Silhouette Coefficient, Davies-Bouldin Index and Dunn Index. In addition, an analysis of the operation of tourism companies in the year 2020 concerning previous years is included. The study allows exploring Soft Computing techniques to identify important information for the definition of strategies that contribute to an effective reactivation of the tourist industry of Ecuador. (shrink)

While the domestic effect of structural racism and other social vulnerabilities on Covid‐19 mortality in the United States has received some attention, there has been much less discussion (with some notable exceptions) of how structural global inequalities will further exacerbate Covid‐related health disparity across the world. This may be partially due to the delayed availability of accurate and comparable data from overwhelmed systems, particularly in low‐ and middle‐income countries. However, early methods to procure and develop treatments and vaccines by some (...) high‐income countries reflect ongoing protectionist and nationalistic attitudes that can systemically exclude access for people in regions with weaker health systems. What's needed is a global coordinated effort, based on the principle of solidarity, to foster equitable health care access. (shrink)

Although Christian spirituality includes a long tradition of suspicion of humour, humour can express and further holiness in several ways. Humour serves holiness in religious satire; it can also communicate the self-transcendent perspective of holy women and men. Humour and holiness can also illuminate each other because both are inherently relational. Christian holiness consists primarily in right relationship to the Holy One and, thus, to others. Humour's complex relational nature is examined with the help of Ted Cohen's analysis of joke-telling (...) and evolutionary and cognitive research. Humour and its primary expression, laughter, are inherently ambiguous, capable of expressing and creating a range of attitudes and relationships; consequently, they can both conduce to and hinder holiness. Finally, humour can contribute to the religious imagination, and thus to holiness, by challenging established images of the holy, inviting fresh theological reflection, and inspiring ethical action. Both holiness and humour require openness to that which is beyond us and agility in responding to the other. (shrink)

William Scoresby Jnr spent the first years of his working life as a whaler, and then became an ordained minister of the Church of England. His early writings on the environment of the Greenland Sea gained him a reputation as an Arctic scientist. In the later part of his life he turned to the investigation of magnetism as it concerned the ship's compass, trying to find the best form of needle, and how the compass was affected by the magnetism of (...) the ship itself.Though he lived in various parts of the country, Scoresby kept his attachment to Whitby and bequeathed his papers, books and apparatus to its Literary and Philosophical Society. In this catalogue the apparatus and material relics are related to published accounts of his work.In the text, [S] numbers refer to Scoresby's publications and [C] numbers to the catalogue. (shrink)

People freely disclose vast quantities of personal and personally identifiable information. The central question of this Meador Lecture in Morality is whether they have a moral (or ethical) obligation (or duty) to withhold information about themselves or otherwise to protect information about themselves from disclosure. Moreover, could protecting one’s own information privacy be called for by important moral virtues, as well as obligations or duties? Safeguarding others’ privacy is widely understood to be a responsibility of government, business, and individuals. The (...) “virtue” of fairness and the “duty” or “obligation” of respect for persons arguably ground other-regarding responsibilities of confidentiality and data security. But is anyone ethically required—not just prudentially advised—to protect his or her own privacy? If so, how might a requirement to protect one’s own privacy and to display ethical virtues of reserve, modesty and temperance properly influence everyday choices, public policy, or the law? I test the idea of an ethical mandate to protect one’s own privacy, while identifying the practical and philosophical problems that bear adversely on the case. I consider “conceptual” and “libertarian” objections to the view that each individual indeed has a moral obligation to safeguard his or her own privacy. Government and industry are not off the hook if privacy is a duty of self-care and self-respect: they have responsibilities and are freshly viewed as partners in moral agents’ quest for ethical goodness. (shrink)

The algebraic proof of Craig's interpolation lemma for m-valued logic was given by Rasiowa in [1]. We present here a constructive proof of this lemma, based on a Gentzen type formalization.

This paper relates Donaldson and Dunfee’s Integrative Social Contracts Theory to the problem of gender discrimination. We make the assumption that multinational managers might seek some guidance from ISCT to resolve ethical issues of gender discrimination in countries indifferent or hostile to gender equaIity. The role of Donaldson and Dunfee’s “hypernorms” seems especially cruciaI, and we find that, under their writings thus far, no “hypernorms” exist to make unethical the most blatant acts of sex discrimination in a host country whose (...) local norms tolerate such discrimination. The genesis of “hypernorms” as “global moral minimums” is recounted, and specific application of ISCT to a familiar ethics case (“A Foreign Assignment”) is provided. (shrink)

Background: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today’s hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual’s dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses’ options to act on the basis of ethical and (...) moral grounds in the individual care situation. Aim: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. Method: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Results: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse–patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. Conclusion: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses’ professional decision-making and forcing them to compromise basic nursing values. (shrink)