This volume explores the ethical principles that guide institutions such as corporations, government agencies, and non-profit organizations. The author argues that institutional ethics must go beyond the traditional focus on individual morality, and instead address broader questions of social responsibility and accountability. 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. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Some health-care institutions have ethics committees. The experience of the Ethical Issues Committee at the Royal College of Physicians is described. Ethics committees in institutions may be reactive or creative, must determine an agenda and must deal with dissent.

My title may generate some perplexity. It is certainly not a familiar one. So I should make it plain at the outset that I shall not be talking about the ethics of organizations or associations or groups. I want to direct attention to the ethical and valuational questions associated with social institutions, and I distinguish institutions from associations and organizations. One question I am aiming at is whether the principles and standards applicable to moral judgments of actions and of (...) persons—call them individual principles—are also applicable, or applicable with only minor changes, to the judgment and critique and evaluation of institutions and practices. This is not the sole question of institutional ethics, but it is a main one. (shrink)

This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC (...) and the reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts. (shrink)

This text provides a comprehensive and timely examination of the most pertinent factors affecting institutional ethics committees, for ethicists, trustees, administrators, physicians, clergy, nurses, social workers, attorneys and others with an interest in ethics committees.

While the story of Stanislav Petrov – the Soviet Lieutenant Colonel who likely saved the world from nuclear holocaust in 1983 – is often trotted out to advocate for the view that human beings ought to be kept “in the loop” of automated weapons’ responses, I argue that the episode in fact belies this reading. By attending more closely to the features of this event – to Petrov’s professional background, to his familiarity with the warning system, and to his decisions (...) to defy his protocol – it becomes clear that Petrov was not seamlessly working “in his loop,” but reassessing it entirely. I claim that this exhibits a paradox intrinsic to all automated loops: namely, that their optimum function in fact rests on unforeseen human interventions that cannot be reliably codified ex ante, that is, that good judgment cannot simply be “programmed into” their protocols. This dependence, moreover, reveals automation’s ineluctable need for virtue ethics – not in the usual sense (whereby ethics deliberates about, say, possible damages and loss of life), but in the sense that ethical judgment, rightly understood, entails the reassessment of all of the conditions surrounding a decision, including whether a protocol should be followed at all. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, (...) effective ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their (...) class='Hi'>institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones—law, care and ethics—constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice. (shrink)

abstract Individuals tend to change their behaviour as a response to insurance. Such behavioural responses to insurance are commonly seen as ethically and morally problematic. This is especially true of effects on behaviour from social insurance. These effects have been seen as an ethical problem, associated with irresponsibility, fraud and an immoral character. This article discusses the relevance of four different types of reasons for claims that behavioural responses to social insurance are immoral. These reasons are independent reasons con‐tract related (...) reasons reasons related to fraud and reasons related to justice. I argue that reasons related to justice are most relevant, but that this type of reason does not render the individual morally blameworthy. Hence, insofar as behavioural responses to social insurance are an ethical problem it is a problem that concerns the institution, i.e. what incentives social insurance exhibits, rather than the individual, i.e. the morality of the individual responding to it. Insofar as behavioural responses to social insurance are an ethical problem it is a problem for political philosophy rather than individual ethics. (shrink)

Care ethics has a curious relationship to justice. Care theorists alternately portray justice as separate from yet at times intersecting with, parallel and distinct from, or falling within yet secondary to care. Theories of justice tend to imagine an ideal world, and reason about justice from an imagined universal position. Care ethics, on the other hand, respond to a philosophical history in which abstract universal reasoning occludes the particular needs and contributions of marginalized or oppressed groups. I argue (...) that care ethics is a kind of nonideal theory. I further argue that understanding care ethics as nonideal theory does two things. One, it draws care and justice into conversation with each other such that neither one is prior: both can be produced through practices of justice enacted through care, and care that responds to justice. Moreover, health care models the way in which care and justice must work in tandem. Two, care theory as nonideal theory invites an institutional ethic of care. An institutional ethic of care is modeled by, and at the same time can strengthen, existing health care practices. Such an ethic builds on the feminist scholarship deconstructing dichotomous binaries, including gendered dichotomies between justice and care. In conclusion, I raise the possibility that an institutional ethic of care might reveal a porous boundary between an ideal/nonideal theory binary. (shrink)

Clinical Study Agreements can have profound effects both on the protection of human subjects and on the independence of investigators to conduct research with scientific integrity. Sponsors, institutions, and even investigators may fail to give adequate attention to these issues in the negotiation of CSAs. Despite the key role of CSAs in structuring ethically important aspects of research, they remain largely unregulated and unreviewed for adherence to ethical norms. Academic institutions routinely enter into research contracts that fail to meet adequate (...) ethical standards. This is a failing that can have serious consequences.Accordingly, it is necessary that some independent body have the authority both to review research contracts for compliance with norms of subject protection and ethical integrity, and to reject studies that fail to meet ethical standards. Such review should take place prior to the start of research, not later. Because of its expertise and authority, the institutional ethics review board is the appropriate body to undertake such review. Much recent commentary has focused on contractual restrictions on the investigator’s freedom to publish research findings. The Olivieri experience, and that of other investigators, has brought freedom of publication issues into sharp focus. Clinical study agreements also raise a number of other ethical issues relating to human subjects and research integrity, however, including disclosures relating to patient safety, data analysis and reporting, budget, confidentiality, and premature termination of the study. This paper describes the ethical issues at stake in structuring such agreements and suggests ethical standards to guide institutional ethics review. (shrink)

This paper discusses a number of ethical issues that arise in the context of ethnographic research with people with severe intellectual disabilities and mental health problems living in closed institutions. These very vulnerable people have tended to live emotionally and physically deprived lives in segregated and bleak environments, and because they cannot communicate through speech, and often have seriously challenging behaviour, they have tended to become socially and physically isolated from society. Most research with people who do not communicate verbally (...) has been quantitative, or conducted through informal and formal carers. Ethnographic research, on the other hand, involves spending long periods of participant observation with people in their ‘natural’ settings, providing intensely qualitative material, in order to present data as far as possible from each individual's perspective. Such research provides rich and emotionally powerful material which is often distressing and even shocking. This raises a number of ethical issues in relation to the conduct of such research, including questions regarding consent – who can give consent for someone who does not have the capacity to give consent themselves? The ethics of publication of such research are also discussed. This paper outlines the reasons why such research, and its publication, is vital for the futures of institutionalized men and women with severe intellectual disabilities. (shrink)

This paper addresses what should be an important question for many institutional ethics committees: How might they justifiably trust external peer review of the scientific merit of research proposals under their consideration, since these committees are typically not constituted to review the science themselves?

: Originally presented during Ethic Rounds at the Dana-Farber Cancer Institute, this commentary on the case of a patient treated for life-threatening cancer explores the responsibilities of health care providers when addressing the patient's desire to adopt a child.

ZusammenfassungDer Begriff „Ethik“ wurde vor kurzem sowohl in die zahnmedizinische Musterberufsordnung 2014 als auch in den aktuellen „Nationalen Kompetenzbasierten Lernzielkatalog Zahnmedizin“ aufgenommen. Die hier vorgelegte Studie widmet sich der Frage, welche Bedeutung dies für die zahnmedizinische Profession und die Gesellschaft hat. Zu diesem Zweck werden die gesellschaftlichen Prozesse erörtert, die durch den autonom handhabbaren Handlungsspielraum der zahnmedizinischen Profession bedingt sind. Die sozialwissenschaftlichen Diskursfelder Profession, Vertrauen, Bildung, Expertise, Handlungspraxis und Sanktion werden hierzu in ihrer Anschlussfähigkeit zueinander und als struktureller Bedeutungsrahmen professionsethisch (...) reflektierten Handelns aufgearbeitet. Basis des professionellen Handlungsspielraums ist ein gesellschaftlicher Vertrauensvorschuss, der dem professionell Handelnden seitens der Gesellschaft und seitens des einzelnen Patienten entgegengebracht wird. Die Studie kommt zu dem Ergebnis, dass das jahrzehntelange Fehlen einer institutionell etablierten Vermittlung der ethischen Grundlagen des zahnmedizinischen Handelns ein schweres Versäumnis darstellt, da junge Zahnärzte nicht angeleitet werden, ihre fachliche Expertise in Bezug auf die zu lösenden Problemstellungen permanent zu reflektieren. Dieses Defizit ist nunmehr benannt worden. Eine institutionell getragene Struktur zur Bearbeitung ethischer Fragen im Rahmen der Zahnheilkunde ist hiernach zu fordern und sollte nunmehr dringend implementiert und umgesetzt werden. (shrink)

Cook and Hoas (2008) have identified and illustrated serious shortcomings in rural bioethics and healthcare decision-making. Some of the problems that the authors discuss are unique to the rural co...

This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC (...) and the reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts. (shrink)

The existential, experiential, ethical, pathic and pre-pathic dimensions of education are essential for the creative composition of subjectivities in institutional spaces, yet educational research and policy tend increasingly to privilege technical discourses and prescriptive approaches both when evaluating ‘what is effective in education’ and when determining educational policy. This essay explores those aspects of the educational experience and educational institutions that are often felt and sensed pre-cognitively by students, parents and teachers, but are seldom given further elaboration or articulation (...) in educational research. We will reflect on what is meant by the experience of education and experience in education, including the struggles to make sense of or understand something, the surprises that strike pre-reflectively, and the ways in which such moments are noticed, pursued, and explored rather than reflexively ‘evaluated’. We then explore the idea of experimentation in institutions, in particular in relation to the range of concepts that Jean Oury introduces in order to move our attention and awareness to questions of experience, existence, atmosphere, and the pathic—the way in which we undergo, sense and participate in the world prior to cognition and the desire for mastery and control of our encounters. Finally, we address the question of the ethics of institutions. (shrink)

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how (...) the 'medical consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.1 (2004) 47-54 [Access article in PDF] Ethical Guidelines for Human Embryonic Stem Cell Research*(A Recommended Manuscript) Adopted on 16 October 2001Revised on 20 August 2002 Ethics Committee of the Chinese National Human Genome Center at Shanghai, Shanghai 201203 Human embryonic stem cell (ES) research is a great project in the frontier of biomedical science for the twenty-first century. Be- cause the (...) research involves the use of human embryos, it triggers serious debate on ethical issues. Opponents consider the embryo to be an early form of human life that should be respected and not destroyed. However, the majority of scientists support embryonic stem cell research, believing that it offers good prospects for the treatment of diseases that have remained incurable until now and so will benefit humankind. The Ethics Committee of the Department of Ethical, Legal, and Social Implications of the Chinese National Human Genome Center at Shanghai seriously discussed the ethical debate initiated by embryonic stem cell research. We concluded that we should support the scientists of our country in actively carrying out human embryonic stem cell research for the noble cause of "medicine being a beneficent art." For the healthy and orderly development of human embryonic stem cell research in our country, we put forward the following recommended Ethical Guidelines for Human Embryonic Stem Cell Research as a reference for leaders, administrative departments, and related scientists. Preface Article 1. Human embryonic stem cells are the primitive cells that play the main role in the growth and development of a human body. These [End Page 47] primitive cells have the potential for infinite proliferation, self-renewal, and multi-directional differentiation. If scientists can discover the mechanism of differentiation of human embryonic stem cells, it will be possible to induce differentiation of human embryonic stem cells to form various types of human cells for clinical cell therapy. If human embryonic stem cell research can be integrated with modern biomedical engineering techniques, it also will be possible to make repair and replacement of human tissues and organs a reality. Article 2. There are two ways to classify human embryonic stem cells. One way is to classify them according to their potential for differentiation. There could be three kinds of stem cells: totipotent stem cells, pluripotent stem cells, and unipotent stem cells.A totipotent stem cell has the potential to develop into a whole individual. It can differentiate into the more than 200 cell types in the whole body, construct any tissue or organ of the body, and finally develop into a whole individual. The fertilized egg and the cleavage cells at the very early stage of embryonic development are totipotent stem cells.A pluripotent stem cell has the potential to differentiate into many cell types derived from the three embryonic layers. However, it has lost the capacity to develop into a complete organism.A unipotent stem cell is derived from the further differentiation of the pluripotent stem cell. It can differentiate only into one cell type such as a hematopoietic stem cell, neural stem cell, and others.The other way is to classify human stem cells according to their source. There could be two kinds of human stem cells: embryonic stem cells and tissue stem cells (also called adult stem cells). The former involves experimentation with embryos, which has serious ethical implications. Ethical issues associated with the latter are mainly expressed in the various opinions regarding the allocation of health resources. Article 3. Human embryonic stem cells are the group of cells called the blastocyst inner cell mass during the early stage of embryonic development. They are the main source of totipotent stem cells, and hence the focal and hot point in stem cell research. Studies on the clinical application of embryonic stem cells probably will involve use of the somatic cell nucleus transfer (SCNT) technique, which destroys the early human embryo. At present, the ethical and moral debate is very serious in human embryonic stem cell research regarding whether the research will develop... (shrink)

Business, Institutions, and Ethics: A Text with Cases and Readings is the first text to use the analysis of social institutions to examine business ethics. It explains fundamental concepts in ethics and how to apply them to business and economics. The author shows how social institutions are constituted by an integrated set of ethical, economic, and legal principles, and then uses these principles to study the ethics of commerce at the individual, organizational, and market levels. This (...) unique work features thirty-four cases and articles that are organized into economic categories, providing a conceptual unity and flexibility not found in similar texts. The first half of the text focuses on theory, beginning with a case study that illustrates and unifies the theoretical discussions that follow. It examines market institutions, organizational structure, and individual decision making; interprets moral development as a process within institutional settings; and explains egoism, care, utilitarianism, right, and pluralistic ethical theories. It also discusses how economic analyses of markets and firms incorporate ethical principles, and argues that law reinforces ethical and economic aspects of social institutions important to the continued existence and well-being of society. The second half of the text consists of cases and articles organized by the economic categories of property, risk-reward relationships, information, and competition. Topics covered include corporate control, workplace dangers, marketing, and manufacturing relocation. Applicable in both business schools and philosophy departments, Business, Institutions, and Ethics shows how ethical principles can help us gather, sort, and interpret information necessary for making sound business decisions. Ideal for courses in business ethics and business and society, it is also a valuable reference for business professionals and philosophers. (shrink)

The Handbook of Bioethical Decisions Volume II addresses and analyzes the most important ethical concerns and moral quandaries related to scientific integrity and institutional ethics. It counts on two parts, Part One: Research Ethics, which addresses issues related to Scientific Integrity, Research Misconduct and Conducting Ethical Research, and Part Two: Institutional Ethics and Bioethics Committees, which explores Institutional Ethics issues, Ethics and Bioethics Committees’ roles and scopes, and Bioethical Issues in Institutional (...) Ethics. Consequently, the Handbook, Vol. II, offers a remarkable collection of works by outstanding international experts on institutional and research ethics, in order for bioethics practitioners to obtain better elements to address key issues related to integrity in research as well as to decision-making processes. In this fashion, this volume is a valuable resource for professionals working on different bioethical and biomedical fields, such as, ethics and bioethics committees, health care institutions, biomedical and pharmacological companies, and academic settings, among others. Chapter 26 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com. (shrink)

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple factors. Human (...) misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery. (shrink)

Institutional ethics committees in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed lECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel (...) Noddings, is an unacknowledged basis for /EC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for lECs. (shrink)

Institutions are a kind of social infrastructure that facilitates – or hinders – human co-ordination and allocation of resources. Thus they function as a rationality context, which simultaneously emerges from and governs human interactions. Business institutions, as they are related to human expectations, should promote the values of their stakeholders and, consequently, they are subjects of social and ethical accounting, auditing and reporting procedures. Ethical institutions make the good of their stakeholder groups part of the institution’s own good. They have (...) a clear vision and picture of integrity throughout the institution which is owned and embodied by top management, over time. Such a practice presumes that business institutions, e.g. corporations, are social cultures with character, which can exercise good or bad influence, depending on goals, policies structures, strategies that formalize relations among the individuals who build up corporations. For developing an ethical culture, corporations need a large scale of instruments as codes of ethics and other kinds of support structures throughout the organization to insure their adequate communication, oversight, enforcement, adjudication, and review. Between all these instruments, a special role could be played by the ethics officer and the ethics committee, ethics trainings, ethics audits but also by the implementation of responsibility and participatory decision making at lower levels in the organisation. (shrink)

In recent years, applied ethics has taken on board the various dimensions of public reason that can no longer be reduced to the political construction of a common will. While the question of a just society has traditionally been found in the political dimension, the state and its institutions, current globalization has broken this state monopoly over what is public, opening the way for other institutional actors with the same or greater power to intervene in the public space, (...) actors that have little or nothing to do with representation, majority rule, etc. As the current financial downturn clearly demonstrates, states are pandering to the markets, striving to ‘get their houses in order’ to meet the demands imposed by the global financial magnates. It seems, at least to most citizens, that public politics, like the state’s capacity to deal with social and economic rights, no longer depends on either governments or their ability to govern. So should they be left out of a public reason that is capable of explaining whether they are just or otherwise? The ethical perspective –known to be a critical perspective– cannot remain silent about this new scenario. The present proposal attempts to combine applied ethics, which takes in the logic of social practices, with new contributions from institutional design theories that set out to analyse the power and responsibility of these institutions from ‘inside’, as institutional actors. In this short paper my analysis focuses on the ethical dimension of institutional design, specifically in a proposal for an institutional ethics that is a fundamental part of any applied ethics. The paper aims to explain in what way we can speak of an institutional morality to demonstrate that these civil society institutional actors hold some of the responsibility for facing the problems of defining and managing what is public. (shrink)