This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases’ powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on (...) humans by foreign micro‐organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical‐ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)

Commentators often claim that medical research subjects are coerced into participating in clinical studies. In recent years, such claims have appeared especially frequently in ethical discussions of research in developing countries. Medical research ethics is more important than ever as we move into the 21st century because worldwide the pharmaceutical industry has grown so much and shows no sign of slowing its growth. This means that more people are involved in medical research today than ever before, and in the future (...) even more will be involved. However, despite the pressing need for reflection on research ethics, it is important to carefully identify the concerns we have about research. Otherwise we run the risk that the moral language we use, and which we hear other people use, may do our moral thinking for us. We argue that many recent claims about the occurrence of coercion in medical research are misguided and misuse the word "coercion." We try to identify the real problems, and urge people to attend carefully to the implications of their descriptions of moral problems in research. (shrink)

This book was inspired originally by the debates at the turn of the century about placebo controlled trials of antiretrovirals in HIV positive pregnant women in developing countries. Moving forward from this one limited example, the book includes several additional controversial cases of clinical research conducted in developing countries, and asks probing philosophical questions about the ethics of such trials. All clinical research by its very nature uses people to acquire generalizable knowledge to help future people. But what sorts of (...) "use" are morally permissible? What is it to exploit people? Suppose that a trial conducted in a developing country would not be ethically permissible in the developed world. Can we automatically conclude from this that the trial is unethical, that some sort of morally problematic double standard is in operation? Or might the differences in the two settings justify differences in trial design? This collection of philosophical essays examines these important questions about what exploitation is and when clinical research counts as exploitative. -/- "This is an outstanding contribution to the growing literature on the ethics of research with human subjects and a fine example of what bioethics can offer at its best. Anyone with a serious interest in these issues will need to read this book from start to finish." -Daniel Wikler, Harvard School of Public Health "This book contributes significantly to the literature on exploitation in clinical research conducted in the developing world."--Patricia Marshall, Case Western Reserve University . (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Discrete choice experiments—selecting the best and/or worst from a set of options—are increasingly used to provide more efficient and valid measurement of attitudes or preferences than conventional methods such as Likert scales. Discrete choice data have traditionally been analyzed with random utility models that have good measurement properties but provide limited insight into cognitive processes. We extend a well-established cognitive model, which has successfully explained both choices and response times for simple decision tasks, to complex, multi-attribute discrete choice data. The (...) fits, and parameters, of the extended model for two sets of choice data (involving patient preferences for dermatology appointments, and consumer attitudes toward mobile phones) agree with those of standard choice models. The extended model also accounts for choice and response time data in a perceptual judgment task designed in a manner analogous to best–worst discrete choice experiments. We conclude that several research fields might benefit from discrete choice experiments, and that the particular accumulator-based models of decision making used in response time research can also provide process-level instantiations for random utility models. (shrink)

PREFACE. THE Author of this very practical treatise on Scotch Loch - Fishing desires clearly that it may be of use to all who had it. He does not pretend to have written anything new, but to have attempted to put what he has to say in as readable a form as possible. Everything in the way of the history and habits of fish has been studiously avoided, and technicalities have been used as sparingly as possible. The writing of this (...) book has afforded him pleasure in his leisure moments, and that pleasure would be much increased if he knew that the perusal of it would create any bond of sympathy between himself and the angling community in general. This section is interleaved with blank shects for the readers notes. The Author need hardly say that any suggestions addressed to the case of the publishers, will meet with consideration in a future edition. We do not pretend to write or enlarge upon a new subject. Much has been said and written-and well said and written too on the art of fishing but loch-fishing has been rather looked upon as a second-rate performance, and to dispel this idea is one of the objects for which this present treatise has been written. Far be it from us to say anything against fishing, lawfully practised in any form but many pent up in our large towns will bear us out when me say that, on the whole, a days loch-fishing is the most convenient. One great matter is, that the loch-fisher is depend- ent on nothing but enough wind to curl the water, -and on a large loch it is very seldom that a dead calm prevails all day, -and can make his arrangements for a day, weeks beforehand whereas the stream- fisher is dependent for a good take on the state of the water and however pleasant and easy it may be for one living near the banks of a good trout stream or river, it is quite another matter to arrange for a days river-fishing, if one is looking forward to a holiday at a date some weeks ahead. Providence may favour the expectant angler with a good day, and the water in order but experience has taught most of us that the good days are in the minority, and that, as is the case with our rapid running streams, -such as many of our northern streams are, -the water is either too large or too small, unless, as previously remarked, you live near at hand, and can catch it at its best. A common belief in regard to loch-fishing is, that the tyro and the experienced angler have nearly the same chance in fishing, -the one from the stern and the other from the bow of the same boat. Of all the absurd beliefs as to loch-fishing, this is one of the most absurd. Try it. Give the tyro either end of the boat he likes give him a cast of ally flies he may fancy, or even a cast similar to those which a crack may be using and if he catches one for every three the other has, he may consider himself very lucky. Of course there are lochs where the fish are not abundant, and a beginner may come across as many as an older fisher but we speak of lochs where there are fish to be caught, and where each has a fair chance. Again, it is said that the boatman has as much to do with catching trout in a loch as the angler. Well, we dont deny that. In an untried loch it is necessary to have the guidance of a good boatman but the same argument holds good as to stream-fishing... (shrink)

The government purchasing market constitutes the largest business sector in the world. While marketers would benefit from a deep understanding of both sectors, how the two sectors differ in terms of ethics and strategy largely remains unknown. The purpose of this research, therefore, is to explore differences between the for-profit and not-for-profit sectors on two critical aspects of business-to-business procurement: ethics and strategy. Using survey data from a sample of 328 procurement professionals in the for-profit and not-for-profit sectors, key differences (...) are explored. Findings suggest that buyers in the for-profit sector are more likely to behave opportunistically. Conversely, the buyers’ leaders in the not-for-profit sector behave more opportunistically and are more willing to turn a blind eye to their subordinate buyers’ opportunistic behaviors. In addition, key differences in procurement strategy are unveiled suggesting that not-for-profit procurement practices have some room for improvement. Based on the findings, theoretical and managerial implications are drawn, and a future research agenda is proposed. (shrink)

Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic (...) medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

Ethical guidance for genomic research is increasingly sought and perceived to be necessary. Although there are pressing ethical issues in genomic research – concerning for example the recruitment of patients/participants; the process of taking consent; data sharing; and returning results to patients/participants – there is still limited useful guidance available for researchers/clinicians or for the research ethics committees who review such projects. This report outlines the ethical principles and guidance for genomic research co-produced with stakeholders during two workshops which took (...) place in the UK between November 2016 and May 2017. The stakeholders involved in these workshops included: healthcare professionals, genomic research teams, academics, patients, biobank managers, and representatives from the Health Research Authority, NHS Research Ethics Committees, patient support groups, pharmaceutical industry, and health policy think tanks. The co-produced principles and guidance are specifical... (shrink)

How do teachers learn about what learners already know? How do learners aid teachers by providing them with information about their background knowledge and what they find confusing? We formalize this collaborative reasoning process using a hierarchical Bayesian model of pedagogy. We then evaluate this model in two online behavioral experiments (N = 312 adults). In Experiment 1, we show that teachers select examples that account for learners' background knowledge, and adjust their examples based on learners' feedback. In Experiment 2, (...) we show that learners strategically provide more feedback when teachers' examples deviate from their background knowledge. These findings provide a foundation for extending computational accounts of pedagogy to richer interactive settings. (shrink)