In lieu of an abstract, here is a brief excerpt of the content:Active Euthanasia and Assisted SuicidePat Milmoe McCarrick (bio)Although the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its 1983 report, Deciding to Forego Life-Sustaining Treatment, described the words and terms "euthanasia," "right to die," and "death with dignity" as slogans or code words—"empty rhetoric," (I, p. 24), the literature reviewed for this Scope Note continues to use these terms. Therefore, to (...) discuss the termination of a patient's life by a physician at the patient's request, the phrase active euthanasia is used, and the supplying of a means by a physician whereby a patient can end his or her life is referred to as assisted suicide.Euthanasia, either as the "good death" from classical Greek or "mercy killing" to end unbearable suffering in the dying, has long been a topic of interest in western civilization (III, Brody 1989). In recent years, public awareness of this discussion about control over the time of one's death has been informed by a series of well-publicized events. They include the November 1991 rejection by a vote of 54 percent to 46 percent of the Washington state Initiative 119, which would have allowed the option of requesting one's physician to "aid-in-dying" for adult patients in a "medically terminal condition" (V, Gross 1991); two medical journal articles describing physician's actions in helping bring death to two patients (V, Anonymous 1988; V, Quill 1991); Dr. Jack Kevorkian's assistance in the suicide of three women (V, Belkin 1990; V, Wilkerson 1991); and the best seller status of a how-to book on committing suicide with opiates obtained from a physician (III, Humphry 1991).For the most part, material included in the annotated bibliography in Scope Note 18 has been chosen from works published in the four years since "It's Over, Debbie" (V, Anonymous 1988) appeared in early January 1988 in the Journal of the American Medical Association.Dr. Edmund D. Pellegrino (V, 1991, pp. 3118-19) presented opposing views about active voluntary euthanasia as follows:Those who favor voluntary euthanasia argue that it is a beneficent and compassionate act; it respects autonomy by preserving the patient's control of the manner, method, [End Page 79] and timing of death; it takes the matter outside the reach of "medical power" (accessed in this Scope Note's bibliography at V, Fletcher 1973; V, Nowell-Smith 1989) and scrupulosity; and it prevents the injustice that allows some patients to choose death by refusal of life-support measures, while denying others the right to do so by active euthanasia....The opponents of active euthanasia argue that it undermines the value of, and respect for, all human life (V, Kass 1989; V, Coyle 1990; V, Singer 1990). They fear that guidelines cannot avoid sliding down the "slippery slope" to involuntary euthanasia and selective devaluation of the lives of the most vulnerable among us.... If euthanasia is legal, it is predicted that patients will feel subtle pressure to conform so as to relieve the economic and emotional burdens they impose on family and friends.Euthanasia, its opponents further argue, is socially destructive: it undermines trust in physicians, desensitizes society to killing, and imperils the ground already gained in legitimating passive euthanasia(IV, Wolf 1989).Physicians were not particularly involved with a patient's death until after World War II when participation grew in proportion to the growth of technology. Since the complex, life-sustaining equipment that could forestall death was located in a hospital, death itself became almost completely medicalized (V, Dagi 1991). For terminally ill persons who would like to die a painless death, either by their own hand or with assistance, physicians have almost a monopoly on obtaining strong drugs for distribution to patients (V, Abrams 1990).Active euthanasia for human beings is not legalized anywhere in the world (V, VonDrehle 1991). It is classified as homicide or murder in all fifty states and in Great Britain, Canada, Australia, and the Phillippines (V, Nerland 1989). Twentysix states in the United States prohibit assisted suicide by statute (V, Rosenblum 1990).In 1969 in the Netherlands, a physician named Jan Hendrik van... (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

Is freedom and capability enough to sustain our well-being? For human flourishing to progress, defer, and avoid decline, managers as persons must grow in virtue to transcend to the ultimate source of the good. In our definition of a person we develop an anthropology of gift through the communication of one self to another and whose form is love, the willing the good of the other. We ask four questions about the humanistic manager as a person: what is the goal, (...) end, good; what form, structure guides the manager; what materials, resources, technology, and context does the manager use within the structure to meet the end and exceed the goals, what is the means of effecting the change needed to meet the manager’s goals. Each of these questions form the basis to construct a philosophical anthropology of humanistic management. To these four questions we add three types of finality: the usual absolute terminal and horizontally immanent finalities plus the vertical finality of every growing and developing person among other persons in community. The need for a philosophical anthropology derives from a concomitant ethical requirement of what does and ought the manager, as person, undertake. What and how the person knows, wills, acts on provides the reality within which the manager, as person, operates. Along the way we will visit topics of transcendence, secularism, vulnerability, authentic personhood, and virtue. We conclude with a description, which is a dynamically evolving scheme of the meaning of a manager in the world, the social, and perhaps, the terminal goods of order. We move far from the _homo farber_ of a technology-led world whose thought conforms being. We have begun to extend our manager into the species _homo transcendens_ where being conforms thought and responsible action. We conclude with a sketch on the emerging role of spirituality in the workplace with connections to compassionate leadership, organizations as sites for healing and growth, and examples from the experience of humanistic organization who seem to have survived and thrived centuries of global operations. From an anthropology of gift we can identify several implications for managers. Humanistic management education would subsume the rational choice hegemony of economic modeling to a technological subset of tools, subject to the goals and nature of human persons. The scientism of thinking that psychology, sociology, political science, and economics would suitably describe, explain, and model human decisions would be replaced by an overarching framework leading to higher levels of knowledge, especially wisdom based educational experiences and content based on the natural integrity of human beings as learners. Since all technology follows, rather than leads, persons in an anthropology of gift, workplace practices would be founded in the structures immanent in persons and communities of persons. This would imply practices which transcend appraisal and assessment of performance to heights of contemplation and implementation of meaning in every task. Instead of beginning with a deficit of “what’s in it for me?” practices can begin with the surplus “how can I help you?” Proposed are practices which impound wisdom-based attributes of compassion, active listening, alterity, mercy, companionate and agapic love in decision analyses, interpretations of results, and incentives. The objective of the humanistically managed organization under the aegis of an anthropology of gift would be to minimize the maximum grief for the the most vulnerable. The objective would be applied as a policy across all authorities delegated by jurisdictions over organizations, and by boards, oversight groups, over decisions within organizations. This view from an anthropology of gift is consonant with emerging definitions of organizations as healing spaces where a balance of solidarity and subsidiarity guide decisions as opposed to simplistically applying supply and demand trade-offs. (shrink)

In the present paper, we discuss the ethics of compassionate psychedelic psychotherapy and argue that it can be morally permissible. When talking about psychedelics, we mean specifically two substances: psilocybin and MDMA. When administered under supportive conditions and in conjunction with psychotherapy, therapies assisted by these substances show promising results. However, given the publicly controversial nature of psychedelics, compassionate psychedelic psychotherapy calls for ethical justification. We thus review the safety and efficacy of psilocybin- and MDMA-assisted therapies and claim (...) that it can be rational for some patients to try psychedelic therapy. We think it can be rational despite the uncertainty of outcomes associated with compassionate use as an unproven treatment regime, as the expected value of psychedelic psychotherapy can be assessed and can outweigh the expected value of routine care, palliative care, or no care at all. Furthermore, we respond to the objection that psychedelic psychotherapy is morally impermissible because it is epistemically harmful. We argue that given the current level of understanding of psychedelics, this objection is unsubstantiated for a number of reasons, but mainly because there is no experimental evidence to suggest that epistemic harm actually takes place. (shrink)

I defend the principle of Phenomenal Conservatism, on which appearances of all kinds generate at least some justification for belief. I argue that there is no reason for privileging introspection or intuition over perceptual experience as a source of justified belief; that those who deny Phenomenal Conservatism are in a self-defeating position, in that their view cannot be both true and justified; and that thedemand for a metajustification for Phenomenal Conservatism either is an easily met demand, or is an unfair (...) or question-begging one. (shrink)

This study tested whether compassionate goals to support others and self-image goals to maintain and defend desired self-images: 1) are equivalent constructs across three cultures ; 2) overlap with interdependent self-construal; and 3) predict relationships and growth measures similarly in each country. We re-analyzed data from American and Japanese students, reported in Niiya et al., along with new data from Poland. Single and multiple group confirmatory analyses showed that the two-factor structure holds across the three cultures. Interdependence correlated with (...) compassionate and self-image goals only in Japan. In all three samples, compassionate goals correlated with non-zero-sum belief, feeling close, growth-seeking, self-compassion, and learning from failures, whereas self-image goals correlated with defensive responses to conflicts and validation-seeking. Our results suggest that compassionate and self-image goals may serve similar functions in relationships and growth across cultures. (shrink)

Compassionate care: a moral dimension of nursingThis paper focuses on the concept of compassion and its meaning for nursing practice. Compassion is often considered to be an essential component of nursing care; however, it is difficult to identify what exactly comprises compassionate care. To begin with, there is a general discussion of the meaning of compassion and an examination of its common usage. An argument then is presented that compassion is more than just a natural response to suffering, (...) rather that it is a moral choice. The paper outlines the extent to which this concept has implications for nursing care, highlighting some of the obstacles that nurses need to overcome in order to maintain this essential moral value of the caring role. (shrink)

Background: Compassion has long been advocated as a fundamental element in nursing practice and education. However, defining and translating compassion into caring practice by nursing students who are new to the clinical practice environment as part of their educational journey remain unclear. Objectives: The aim of this study was to explore how Chinese baccalaureate nursing students define and characterize compassionate care as they participate in their clinical practice. Methods: A descriptive qualitative study design was used involving a semi-structured in-depth (...) interview method and qualitative content analysis. Twenty senior year baccalaureate nursing students were interviewed during their clinical practicum experience at four teaching hospitals. Ethical considerations: Permission to conduct the study was received from the Institutional Review Boards and the participating hospitals. Results: Baccalaureate nursing students defined and characterized compassionate care as a union of “empathy” related to a nurse’s desire to “alleviate patients’ suffering,” “address individualized care needs,” “use therapeutic communication,” and “promote mutual benefits with patients.” Students recognized that the “practice environment” was characterized by nurse leaders’ interpersonal relations, role modeling by nurses and workloads which influenced the practice of compassionate care by nursing personnel. Conclusion: Compassionate care is crucial for patients, nurses, and students in their professional development as well as the development of the nursing profession. In order to provide compassionate care, a positive practice environment promoted by hospital administrators is needed. This also includes having an adequate workforce of nurses who can role model compassionate care to students in their preceptor role while meeting the needs of their patients. (shrink)

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the (...) nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses’ ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses’ ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research. (shrink)

Background eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic. Purpose to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals working to (...) contain the COVID-19 pandemic. Methods A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually. Ethical considerations Permission to conduct the study was obtained from the Institutional Review Board. Results Participants stated that “eHealth enabled compassionate care during the pandemic” by ensuring patient care availability and accessibility. They shared experiences of “communicating compassionate care via eHealth” with suggestions of addressing patients’ needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended “setting realistic mutual expectations” considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered “low eHealth literacy hinders compassion.” Additionally, they recommended the need for “institutional/system-level support to foster compassionate care.” Conclusion Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients. (shrink)

_In today's hyperconnected world, global supply chains underpin international trade and economic prosperity. However, these complex networks are inherently vulnerable to disruptions, exposing businesses and societies to significant risks. This article delves into the concept of global supply chain resilience, exploring its importance, key principles, and practical risk management strategies. Drawing upon diverse perspectives from social sciences, it analyzes the economic, political, and environmental factors that contribute to supply chain fragility, highlighting the need for multi-faceted approaches to (...) building resilience._. (shrink)

(1997). Compassionate postmodernism: An introduction to postmodern Jewish philosophy. The European Legacy: Vol. 2, Fourth International Conference of the International Society for the Study of European Ideas, pp. 74-79.

Background: The feeding modalities used in school meal programs—such as breakfast, lunch, dinner, snacks, and take-home rations—are influenced by various factors, including supply chain constraints and technical challenges in food distribution. The methods of supply sourcing, whether through domestic or foreign food reserves via in-kind donations or purchases, play a critical role in shaping the feeding options provided. Aim: This study aims to examine the association between supply-sourcing strategies, i.e., domestic and foreign in-kind donations and national-international purchases, (...) with the feeding modalities applied in school meal programs. Methods: The Bayesian Mindsponge Framework, combining the reasoning strengths of Mindsponge Theory and inference advantages of Bayesian analysis, was employed on a dataset of government representatives who manage large-scale school meal programs across 126 countries. Results: The findings revealed that sourcing supplies through in-kind donations from neighboring or distant countries showed a highly reliable negative association with the feeding modalities of school meal programs, while those from the national bodies showed an ambiguous relationship. The purchasing methods—whether domestic or foreign—tended to exhibit positive associations with feeding modalities, though these associations were only weakly reliable. Conclusions: The findings reveal substantial rooms to improve the effectiveness of supply purchasing strategies in enhancing school meal program feeding modalities. Further research is needed to examine the impact of sourcing supplies through domestic in-kind donations on feeding outcomes. Additionally, developing strategic plans to optimize the use of in-kind donations from international organizations is strongly recommended to avoid its negative consequences and further enhance program effectiveness. (shrink)

The compassionate treatment of animals has been the focal point of speeches and writings by one of the most influential Buddhist cleric-scholars on the Tibetan plateau today, Khenpo Tsultrim Lodrö of Larung Buddhist Academy. This essay surveys the Khenpo's broad-based advocacy for animal welfare and details his discrete appeals to nomads in eastern Tibet to forgo selling livestock for slaughter, to eat a vegetarian diet on religious holidays, to relinquish wearing animal fur, to protect wildlife habitat, and to liberate (...) the lives of animals. I focus on the modernist “this worldly” dimension of his advocacy, calling attention to how Tsultrim Lodrö goes beyond traditional scare tactics that emphasize the karmic effects of negative deeds in future lives and instead invokes compassion by attending to the lived experience and suffering of animals. In doing so, the Khenpo positions Buddhism as a civilizing force in order to reform certain Tibetan customs and mitigate the influence of Chinese modernity and state marketization policies. I argue that his strategy of “reverse orientalism” appropriates state civilizational discourse and reverses its terms. (shrink)

It is inevitable that some inmates in large state prison systems will suffer from terminal conditions and die while incarcerated. But how those inmates experience that event is primarily controlled by correctional policies and by the prison medical and correctional staff assigned to their care. Compassion for inmates who are dying cannot be legislated or mandated, but humane and compassionate care for the dying can be facilitated or thwarted by legislative and correctional policies, and by the manner in which (...) correctional personnel interpret those policies.Death in New York State prisons is a frequent event, occurring at a rate substantially higher than that in most other states. With a prison population that has risen to 70,000 inmates and with the nation’s highest rate of human immunodeficiency virus infection, more than 2,817 inmates died in New York prisons during the period 1990-1998. In April 1992, in the face of an ever-increasing death rate in its prisons, the New York State legislature passed the Medical Parole Law, a measure designed to permit dying inmates to be released on parole prior to their normal release eligibility date. (shrink)

The view that charity consists in an expansion of existing interpersonal relations is rather misleading. We need to see it as a radical transformation, of existing relations, even if this suspension is only temporary. In charity we see a person as someone who is no longer capable of reacting appropriately. Someone who is no longer capable of behaving as a „person‟ nevertheless continues to be a person. She does not lose her personal sanctity or dignity even if she has lost (...) a practical grasp on controlling and guiding the course of her life. Today we often tend to reduce charity to a compassionate form of helping, or aid-giving, such as when materials, doctors and psychologists are sent to regions that are torn apart by war or famine. It is much easier to understand charity when it can be measured against the reduction of physical and emotional distress. It is much more difficult to understand charity in cases where aid proves to be powerless, when there is no measurable return or change that is brought about. While ethics cannot teach us what to do once compassion, benevolence and forgiveness fail to make any difference, prayer can help us to move forward. Praying for others, more specifically, the long-suffering involved in prayer, is a particularly important form of charity. It has the power to lift us above our inability to do anything helpful. We pray at the very moment when we experience our powerlessness to help. (shrink)

Teachers can’t add more minutes to a school day, but with mindfulness they can add depth to the moments they do have with students in their classroom. Compassionate Critical Thinking demonstrates how to use mindfulness with instructional effectiveness to increase student participation and decrease classroom stress, and it turns the act of teaching into a transformational practice. Many books teach mindfulness, but few provide a model for teaching critical thinking and integrating it across the curriculum. The purpose of this (...) book is to show teachers how to create a classroom culture of compassionate critical thinking. When students feel a lack of meaning and purpose in their school lives, they resist learning. Using a Socratic style of inquiry, Rabois changes the classroom dynamic to encourage self-reflection, insight, and empathy. Vignettes capture dialogue between teacher and students to illustrate how mindfulness practices elicit essential questions which stimulate inquiry and direct discovery. What bigger mystery is there, what more interesting and relevant story, than the story of one’s own mind and heart and how they relate us to the world? (shrink)

Compassionate Moral Realism, by MarshallColin. New York: Oxford University Press, 2018. Pp. 265 + xi.

Decisions made by supply chain managers have a far-reaching impact on the economic, environmental, and social performance of entire supply chains, even though many activities in the supply chain occur beyond the direct control of those managers. Some firms establish a line of moral disengagement, beyond which they distance themselves from the impact of the activities of the supply chain. This research addresses the question of why some managers choose to take responsibility for the sustainability of (...) their supply chain, while others do not. We argue that the ethical predisposition and moral complexity of the individual employee moderates the interpretation of the drivers of sustainability, increasing or decreasing their ability to build a business case for supply chain responsibility. We also argue that ethical predisposition moderates the likelihood of a business case being enacted. We then discuss theoretical and managerial implications resulting from this finding. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

Corporate social responsibility (CSR) is a dramatically expanding area of activity for managers and academics. Consumer demand for responsibly produced and fair trade goods is swelling, resulting in increased demands for CSR activity and information. Assets under professional management and invested with a social responsibility focus have also grown dramatically over the last 10 years. Investors choosing social responsibility investment strategies require access to information not provided through traditional financial statements and analyses. At the same time, a group of mainstream (...) institutional investors has encouraged a movement to incorporate environmental, social, and governance information into equity analysis, and multi-stakeholder groups have supported enhanced business reporting on these issues. The majority of research in this area has been performed on European and Australian firms. We expand on this literature by exploring the CSR disclosure practices of a size- and industry-stratified sample of 50 publicly traded U.S. firms, performing a content analysis on the complete identifiable public information portfolio provided by these firms during 2004. CSR activity was disclosed by most firms in the sample, and was included in nearly half of public disclosures made during that year by the sample firms. Areas of particular emphasis are community matters, health and safety, diversity and human resources (HR) matters, and environmental programs. The primary venues of disclosure are mass media releases such as corporate websites and press releases, followed closely by disclosures contained in mandatory filings. Consistent with prior research, we identify industry effects in terms of content, emphasis, and reporting format choices. Unlike prior research, we can offer only mixed evidence on the existence of a size effect. The disclosure frequency and emphasis is significantly different for the largest one-fifth of the firms, but no identifiable trends are present within the rest of the sample. There are, however, identifiable size effects with respect to reporting format choice. Use of websites is positively related to firm size, while the use of mandatory filings is negatively related to firm size. Finally, and also consistent with prior literature, we document a generally self-laudatory tone in the content of CSR disclosures for the sample firms. (shrink)

Servant leadership is increasingly gaining interest inside and outside academia. This article builds and extends current theorizing by describing the process that introduces compassionate love as a practical translation for the need to serve, which was positioned by Greenleaf as the core of servant leadership. This article takes a virtues perspective and shows how servant leadership may encourage a more meaningful and optimal human functioning with a strong sense of community to current-day organizations. In essence, we propose that a (...) leader’s propensity for compassionate love will encourage a virtuous attitude in terms of humility, gratitude, forgiveness and altruism. This virtuous attitude will give rise to servant leadership behavior in terms of empowerment, authenticity, stewardship and providing direction. (shrink)

AimThis study aims to translate the Compassionate Engagement and Action Scales into Turkish and to test their subsequent validity, reliability, and psychometric properties. Turkey is one of the blended cultures with eastern and western elements under the influence of traditional religion. This cultural diversity brings about a rich context to study compassion and its relationship to mental health. The scales assess the ability to be sensitive to suffering and engage and then take helpful actions in compassion. The motivation for (...) compassionate engagement and action is measured at three ‘flows’ as follows: compassion for others; compassion from others; and compassion for self.MethodsThe sample consists of 525 college students aged 18 years or older. The participants completed the CEAS Turkish Form for Others, Self and from Others, Self-Compassion Scale Short Form, Compassionate Love Scale, and Self-Criticism Scale.ResultsThe confirmatory factor analyses were conducted using AMOS version 27 to examine the validity of the three scales with two different factor structures each. All the three models show good fits to the data. The Cronbach’s alpha coefficient for the CEAS for Others and for Self and from Others are good to excellent. Compassion for self, compassion for others, and compassion from others correlated modestly.ConclusionIt can be concluded that the Turkish version of the Compassionate Engagement and Action Scales for Others and Self and from Others has sufficient psychometric properties and can be used as a reliable and valid measure to assess compassionate engagement and action. (shrink)

In a world of limited resources, it could be argued that companies that aspire to be good corporate citizens need to focus on making best use of resources. User value and environmental harm are created in supply chains and it could therefore be argued that company business ethics should be extended from the company to the entire value chain from the first supplier to the last customer. Starting with a delineation of the linkages between business ethics, corporate sustainability, and (...) the stakeholder concept, this article argues that supply chains generally have a great innovation potential for sustainable development. This potential could be highlighted with system thinking and the use of change management knowledge, promoting not only innovations within technology but also within organizational improvement. We propose process models and performance indicators as means of highlighting improvement potential and thus breaking down normative business ethics' requirements to an opertionalizable corporate level: Good business ethics should focus on maximizing stakeholder value in relation to harm done. Our results indicate that focusing on supply chains reveals previously unknown innovation potential that seems to be related to limited system understanding. The assumption is that increased visibility of opportunities will act as a driver for change. Results also highlight the importance of focusing on sustainability effects of the core business and clearly relating value created to harm done. (shrink)

Background: Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units. Objectives: The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal. Design: The study employed a qualitative approach conducting secondary analysis of an original data set. (...) In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care. Ethical considerations: The primary study was approved by the local Research Ethics Committee and the hospital’s Research and Development services. Findings: Compassionate care was mostly directed to the patient’s family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient’s dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus. Conclusion: This study’s findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians’ roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this. (shrink)

This book offers a ground-up defense of objective morality, drawing inspiration from a wide range of philosophers, including John Locke, Arthur Schopenhauer, Iris Murdoch, Nel Noddings, and David Lewis. The core claim is compassion is our capacity to perceive other creatures' pains, pleasures, and desires. Non-compassionate people are therefore perceptually lacking, regardless of how much factual knowledge they might have. Marshall argues that people who do have this form of compassion thereby fit a familiar paradigm of moral goodness. His (...) argument involves the identification of an epistemic good which Marshall dubs "being in touch". To be in touch with some property of a thing requires experiencing it in a way that reveals that property - that is, experiencing it as it is in itself. Only compassion, Marshall argues, lets us be in touch with others' motivational mental properties. -/- This conclusion about compassion has two important metaethical consequences. First, it generates an answer to the question ";Why be moral?", which has been a central philosophical concern since Plato. Second, it provides the keystone for a novel form of moral realism. This form of moral realism has a distinctive set of virtues: it is anti-relativist, naturalist, and able to identify a necessary connection between moral representation and motivation. The view also implies that there is an epistemic asymmetry between virtuous and vicious agents, according to which only morally good people can fully face reality. (shrink)

Background: Compassionate care is an international priority of healthcare professionals. There is little understanding about how workplace issues impact provision of compassionate care in nursing practice. Therefore, it is important to address the workplace issues and organizational factors which may hinder compassionate care delivery within nursing practice. Objective: The aim of this study was to explore workplace and organizational barriers to compassionate care from the nurses’ perspective. Research design: The study used a qualitative exploratory design, and (...) data were analyzed by conventional content analysis. Participants and research context: A total of 15 nurses working in different fields of nursing were recruited from four hospitals at northwest of Iran. Participants were selected by purposive sampling. Semistructured interviews were conducted for data collection. Ethical consideration: Ethical approval of this study was gained from the Ethical Review Board of Tabriz University of Medical Sciences. Findings: The main theme which emerged from data analysis was “unsupportive organizational culture.” This theme had two main categories including “excessive workload alongside inadequate staffing” and “the lack of value on compassionate care.” Discussion: Organizational barriers to development of compassionate in clinical practice were identified in this study. A closer examination of these barriers is required to move compassionate practice from an individual responsibility to a collective responsibility that is owned and shared by organizations. Conclusion: For compassionate care to flourish, policy makers, managers, and healthcare providers must foster an organizational atmosphere conducive to compassionate care. (shrink)

The article proposes that the modern notion of the spiritual in art, which was theorized at the beginning of the twentieth century, although remains pivotal to the discourse of art and the spiritual, has radically shifted as a result of changing attitudes to the body–mind relations instigated by popular trends of contemporary spiritualities. This cultural tendency is demonstrated by the analysis of the networked art form of Moon Ribas, e.g., dance with earthquakes. Ribas performs a cyborg body and consciousness that, (...) as contended, could be holistically enhanced and develop a unique compassionate awareness. In addition, I reflect on two examples from my performative practice of Networked Rites that interplay with speculative metaphors, spiritual and shamanic techniques, networked aesthetic forms and technologies. The first invokes communitas as a collective, non-local, networked noetic field. The second utilizes a decision-making app as a mediating device between the body and mind for the making of a prototype cyborg noetic field instilled with auspicious resonance. The article mainly implies that spiritual art continues to evolve through technoetic aesthetics fusing emerging technologies, science and shamanic, spiritual insight. Current trends may develop into benevolent and experiential applications based on the interrelations of human and cyborg body and consciousness. (shrink)

This book presents the case for Compassionate Reasoning as a moral and psychosocial skill for the positive transformation of individuals and societies. It has been developed from a reservoir of moral philosophical, cultural, and religious wisdom traditions over the centuries. These have been derived from a careful combination of classical schools of ethical thought that are artfully combined with compassion neuroscience, contemporary approaches to conflict resolution, public health methodologies, and positive psychological approaches to social change. There is an urgent (...) need for human civilization to invest in the broad-based cultivation of compassionate thoughts, feelings, and especially habits. This skill is then combined with moral reasoning to move the self and others toward less anger and fear, more joy and care in the pursuit of reasonable policies that build peaceful families, communities, and societies. There are many people across the planet who work every day for the sake of others but who are ensconced in exhausting work with dangerous and difficult situations of conflict. These people are often heroic bridge-builders and creators of peaceful societies, and they have a common set of cultivated moral character traits and psychosocial skills. They tend to be kinder, more reasonable, more self-controlled, and more goal-oriented to peace. They are united by a particular set of moral values and the emotional skills to put those values into practice. The aim of this book is to articulate the best combination of those values and skills that lead to personal and communal sustainability, not burnout and self-destruction. The book pivots on the observable difference in the mind-and proven in neuroscience imaging experiments-between destructive empathic distress, on the one hand, and, on the other, joyful, constructive, compassionate care. Facing existential threats to life on the planet, humans can and must make such skills universally sustainable and ingrained. (shrink)

This article proposes a retrospective analysis of a compassionate use, using a case study of request for Avelumab for a patient suffering from Merkel Cell Carcinoma. The study is the result of a discussion within a Provincial Ethics Committee following the finding of a high number of requests for CU program. The primary objective of the study is to illustrate the specific ethical and clinical profiles that emerge from the compassionate use program issue. The secondary goals are: a) (...) to promote a moral reflection among physicians who require approval for the CUP and b) provide the basis for recommendations on how to request CUP. The instruments for carrying out the analysis of the case study and the discussion are as follows: Analysis of the audio-recording of the EC meeting regarding the selected Case study. In-depth discussion of topics that emerged during the meeting by means of administration of 5 semi-structured interviews with 2 doctors involved in the case and with 3 components of the EC who played a major role in the EC internal discussion. In an exploration of emerging clinical and ethical issues, four primary themes arise: 1. efficacy, safety of the treatment and patient’s quality of life; 2. clear, realistic, adequate communication; 3. right to hope; 4. simultaneous Palliative Care approach. The results of ethical analysis carried out concern two areas: 1) ethical profiles relating to the use of CUP; 2) the role of the EC concerning the compassionate use of drugs and the need to provide recommendations on how to request CUP. With the aim of implementing these conclusions, the provincial EC of Reggio Emilia chose to steer the request for drugs for compassionate use through recommendations for good clinical and ethical practice based on the following assumptions: 1) the “simultaneous care” approach must be preferred. Secondly, 2) the EC’s assessment must be part of the decision-making process that the care team conducts before proposing compassionate use to the patient. (shrink)

Public health strategies recommend isolating patients with SARS-CoV-2 infection. But compassionate care in the intensive care unit (ICU) is an ethical obligation of modern medicine that cannot be justified by the risk of infection or the lack of personal protective equipment. This article describes the experiences of clinicians in ICUs in the south of Spain promoted by the Andalusian Society of Intensive Care SAMIUC, in the hope it will serve to improve the conditions in which these patients die, and (...) to help their families who suffer when they cannot say good-bye to their loved ones.In the south of Spain, healthcare professionals use daily videoconferencing to improve communication between clinicians, patients, and their relatives who cannot visit them in the ICU. This close communication allows families to see their loved ones and extends communication between healthcare professionals, patients, and their relatives. To allow family members to accompany patients at the end of life, it is possible to adapt public health rules to the epidemic situation. (shrink)

The most powerful objection to political obligations based on the principle of fairness concerns alternative supply of necessary public goods. According to this line of argument, if the subject prefers not to receive particular benefits from the state, then he need not incur obligations through their provision. However, as the discussion in Ch. 2 shows, for certain essential public goods, there is no alternative to state provision. Moreover, the fact that a subject prefers that goods be provided in a (...) different form or by a mechanism other than the state is not ordinarily sufficient to dissolve obligations that they would otherwise incur. (shrink)

The concept of circular economy entails the reduction of resource inputs and the reclamation of waste in order to tackle the environmental, economic, and social challenges that sprang from the persistence of the linear economic model. Implementing a circular economy certainly has its own challenges. One of which is to find a sustainable supply chain. Sustainable supply chains are designed and man¬aged by combining practices responsible for the environment and society throughout the life cycle of a product or (...) service. This is possible to achieve through good collaboration between supply chains and having a supply chain design with a sustainable concept. Thus, this research discusses the effect of sustainable supply chain management on circular economy performance mediated by circular economy capability. The objects of this research are 82 courier service companies on Java Island. This research employed quantitative design. The data collection method involved distributing online questionnaires to middle – top managers as respondents. The results show that sustainable supply chain management has a positive effect on environmental performance, then sustainable supply chain management has a positive effect on financial performance. Furthermore, circular economy capability partially mediates the correlation between sustainable supply chain management and environmental performance, and partially mediates the correlation between sustainable supply chain management and financial performance. This research conveys the direction of further research in the same re¬search context. (shrink)

Principlism appears to be the prevailing applied ethical framework in bioethics. Despite the view’s various strengths, critics point out that since the principles are ad hoc, conflicts indubitably emerge leading to inconsistency. There is debate around whether principlism can provide definitive action-guiding moral prescriptions or only help structure intelligent analyses and justifications of moral choices. In this paper, I contend that applying concepts of moral symmetry and moral asymmetry allows us to modify one of principlism’s principles—the principle of beneficence—into what (...) I will call the principle of compassion. I argue that the principle of compassion can function as an arbitrating or primary principle within the principlist framework. The result is a view we might call compassionate principlism. Arguably, compassionate principlism leads to fewer inconsistencies and provides more acceptable action-guiding moral prescriptions than traditional principlism. (shrink)

Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; (...) internet platforms enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

Governance is one of the core concepts underlying sustainable supply chain (SC). Although governance practices are widely acknowledged and implemented, literature discussing those practices is not as thoroughly organized. The purpose of this paper is therefore to investigate the forms, dynamics, and development of sustainable supply chain governance (SSCG). We reviewed a total of 126 articles in operations and SC management peer-reviewed journals spanning 15 years of recent research. Our literature analysis unveils several key themes concerning the popularity (...) of contractual and relational governance, the role of SC lead firms, the network perspective, and the dynamics of governance mechanisms. At a higher conceptual level, we conclude that there exists a mutually dependent relationship between SSCG and SC complexity. The study summarizes and conceptualizes the recent scholarly conversations about SSCG and offers an agenda for further research. (shrink)

This article examines corporate responsibility in the supply chains of four of the largest Scandinavian multinational corporations - IKEA, Nokia, Novo Nordisk, and StatoilHydro - and offers two key findings. First, these Scandinavian companies have all implemented responsible supply chain practices where suppliers in developing nations, and the communities of these suppliers, are engaged as key stakeholders and treated as partners. Second, these supply chain practices all share the common bond of having honesty and the establishment of (...) trust-based relationships at their foundation. As a result, these Scandinavian companies have developed a "cooperative advantage" in their ability to form successful, long-term partnerships in their respective supply chains. (shrink)

Unlike the compassionate conservatism of George Bush, Compassionate Utilitarianism is not a confusing concept. Nor is it a newly minted version of Utilitarianism given that it is embedded in the writings of Jeremy Bentham, writings that have come to light only with the Oxford University Press publication of his Deontology in 1983 as edited by me. Bentham's An Introduction to the Principles of Morals and Legislation expresses the standard interpretation of Hedonistic Utilitarianism. What he said in Deontology serves (...) as the basis of Compassionate Utilitarianism. (shrink)