In the context of debates on psychiatry issues pertaining to moral dimensions of psychiatric health care are frequently discussed. These debates invite reflection on the question whether forensic practitioners have a role in stimulating patients’ moral development and moral growth in the context of forensic psychiatric and psychological treatment and care. We conducted a qualitative study to examine to what extent forensic practitioners consider moral development and moral growth to be a part of their current professional practices and (...) to what extent they think that stimulating moral development is a legitimate objective in the context of forensic psychiatric treatment. In addition, we asked how forensic practitioners balance pubic safety and risk management concerns with the interests and wellbeing of the individual patient. We conclude that: elements of moral development and moral growth in forensic psychiatric care practices are to a certain extent inevitable and not necessarily questionable or undesirable; yet, as in similar debates these elements need to be made explicit in order to discuss the accompanying ethical challenges and boundaries. An open academic, professional and public debate on aspects of stimulating moral betterment within current practices is therefore desirable. (shrink)

Understanding of organizational ethics phenomena requires complex understanding of organizational practices in their real world contexts. We can try to understand and build theory about these complex real world practices from the points of view of: a traditional deductive, ethics literature-based, literature gap formulation approach; or, an inductive, practitioner-based literature gap formulation approach. This consideration of inductive, practitioner-based versus deductive, literature-based literature gap formulation is related to the discussion concerning “engaged scholarship” and relationships and gaps between theory and practice in (...) organization studies [Van De Ven, 2007, Engaged Scholarship: A Guide for Organizational and Research Knowledge ]. However, there is an important difference with respect to the key issue of ethics literature versus practitioner-based literature gap formulation. This article offers examples of the two different approaches and makes comparisons between them. Implications for practice-based organizational ethics theory building, Ph.D. education, and public intellectual work are considered. (shrink)

BackgroundThe ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity (...) they are trained to.MethodsWe surveyed all GP trainees of “Ile de France”. The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients’ care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days.Results525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient’s (210 answers, 40%) and relative’s communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in “at risk” hospital settings.ConclusionSelf-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life. (shrink)

There is very little literature on the actual decision-making frameworks used by general practitioners with respect to ethical issues and virtually none on the impact of personal experiences of illness on this. This study aimed to investigate what these frameworks might be and if and how they were altered by doctors’ own illness experience. Twenty general practitioners were recruited, 10 having had a previous serious medical illness and 10 having no such history. They participated in a semi-structured interview, (...) including case vignettes, recorded and analysed using qualitative thematic analysis. Being a patient themselves altered general practitioners’ decision-making by enhancing physician empathy, increasing ease at discussing difficult topics, having a greater willingness to support patient choice and a wider ability to provide a greater diversity of therapeutic strategies, with the role of empathy being the most noticeable difference between the groups. Doctors who had not had a severe personal illnes... (shrink)

Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing (...) a line, finding a way without crossing the line, and evaluating actions. The NPs varied in their awareness and the discord encountered in conflict, and in clarity, flexibility and justification of the line drawn. A critical juncture occurred when NPs evaluated how well integrity had been maintained. Some experienced no distress while others experienced self-doubt, regret, outrage and frustration at external constraints, and attempted to reconcile through avoiding, convincing themselves, and compensating. (shrink)

This paper presents a reflective account of my teaching practice with health practitioners who work as school nurses in the secondary education system in regional Victoria, Australia. It highlights some of the issues and dilemmas that emerged during my experiences, as a social work educator, facilitating workshops about critically reflective learning as a cross-disciplinary enterprise. Using critical reflection, this paper also raises questions regarding how we might respond to some of the challenges to improve future approaches to teaching critical (...) reflection. (shrink)

Over two decades ago, Davids et al. (1994) and Handford et al. (1997) raised theoretical concerns associated with traditional, reductionist, and mechanistic perspectives of movement coordination and skill acquisition for sport scientists interested in practical applications for training designs. These seminal papers advocated an emerging consciousness grounded in an ecological approach, signaling the need for sports practitioners to appreciate the constraints-led, deeply entangled, and non-linear reciprocity between the organism (performer), task, and environment subsystems. Over two decades later, the areas (...) of skill acquisition, practice and training design, performance analysis and preparation, and talent development in sport science have never been so vibrant in terms of theoretical modeling, knowledge generation and innovation, and technological deployment. Viewed at an ecological level of analysis, the work of sports practitioners has progressively transitioned toward the facilitation of an evolving relationship between an organism (athlete and team) and its environment (sports competition). This commentary sets out to explore how these original ideas from Davids et al. (1994) and Handford et al. (1997) have been advanced through the theoretical lens of ecological dynamics. Concurrently, we provide case study exemplars, from applied practice in high-performance sports organizations, to illustrate how these contemporary perspectives are shaping the work of sports practitioners (sport ecology designers) in practice and in performance preparation. (shrink)

The potential for the occurrence of multiple-role relationships is increased when professors also consult with athletic teams on their campuses. Such multiple-role relationships have potential ethical implications that are unclear and largely unexplored, and consultants may find multiple-role relationships both difficult to deal with and unavoidable. Therefore, the purpose of this study was to explore the nature of teacher-practitioner multiple-role relationships. Participants (N = 35) were recruited from Association for the Advancement of Applied Sport Psychology (AAASP) certified consultants (CCs) who (...) were also affiliated with a university (N = 68). All participants completed a 28-item survey exploring the incidence and relevant issues pertaining to multiple-role relationships. Chi-square analyses revealed that licensed mental health practitioners (i.e., psychologists and counselors) were more likely than nonlicensed AAASP CCs to believe that multiple-role relationships were never appropriate in sport psychology, 2(1, N = 30) = 12.80, p < .001, and to have never taken part in a multiple-role relationship, 2(1, N = 33) = 12.44, p < .001. Independent samples t tests revealed that mental health practitioners also reported that they would have higher levels of concern for both the practitioner, t(30) = -2.77, p = .009, and the client, t(30) = -2.50, p = .018, in such a relationship. (shrink)

This book argues that we can only understand transformations of nature studies in the Scientific Revolution if we take seriously the interaction between practitioners and scholars. These are not in opposition, however. Theory and practice are end points on a continuum, with some participants interested only in the practical, others only in the theoretical, and most in the murky intellectual and material world in between. It is this borderland where influence, appropriation, and collaboration have the potential to lead to (...) new methods, new subjects of enquiry, and new social structures of natural philosophy and science. The case for connection between theory and practice can be most persuasively drawn in the area of mathematics, which is the focus of this book. Practical mathematics was a growing field in early modern Europe and these essays are organised into three parts which contribute to the debate about the role of mathematical practice in the Scientific Revolution. First, they demonstrate the variability of the identity of practical mathematicians, and of the practices involved in their activities in early modern Europe. Second, readers are invited to consider what practical mathematics looked like and that although practical mathematical knowledge was transmitted and circulated in a wide variety of ways, participants were able to recognize them all as practical mathematics. Third, the authors show how differences and nuances in practical mathematics typically depended on the different contexts in which it was practiced: social, cultural, political, and economic particularities matter. Historians of science, especially those interested in the Scientific Revolution period and the history of mathematics will find this book and its ground-breaking approach of particular interest. (shrink)

This paper examines youth practitioner professionality responses to neo-liberal policy changes in youth work and the youth support sector in the UK, from New Labour to Conservative-led administrations. Using a narrative inquiry approach, six early career practitioners explore and recount their experiences of moving into the field during changing political times. The narratives reveal differentiated responses to a climate of increasing managerialism and performativity but point to the value of narrative capital as a personalised resource.

Ethical sensitivity triggers the entire ethical decision-making process (i.e., recognition of ethical content in work situations). In this article, five factors are examined that affect tax practitioners' professional ethical sensitivity. The five factors that were examined include role conflict, role ambiguity, job satisfaction, professional commitment, and ethical orientation. Ethical content in work situations is examined in relation to professional ethics as enumerated by the American Institute of Certified Public Accountant's (AICPA) Statements on Responsibilities in Tax Practice (SRTP). Utilizing Hunt (...) and Vitell's (1986, 1993) General Theory of Ethics, a model of ethical sensitivity was constructed and empirically tested. Role conflict negatively and job satisfaction positively influenced tax practitioners' ethical sensitivity. Also, the covariates of the tax practitioner's professional risk level and type of employer were found to be significant. The significant factors are job specific. The tax firm may have the best opportunity to positively change a tax practitioner's ethical recognition abilities. Professional accounting organizations may need to evaluate if resources should be used to formulate, maintain, and publicize codes of conduct because of the lack of significance of professional commitment. (shrink)

Summary A new culture of mathematics was developed in sixteenth-century England, the culture of ?the mathematicalls?. Its representatives were the self-styled mathematical practitioners who presented their art as a practical and worldly activity. The careers of two practitioners, Thomas Bedwell and Thomas Hood, are used as case studies to examine the establishment of this culture of the mathematicalls. Both practitioners self-consciously used mathematical instruments as key resources in negotiating their own roles. Bedwell defined his role in contrast (...) to mechanicians and he secured patronage in military engineering and the service of the commonwealth; Hood worked in the commercial setting of London as a teacher, author, chartmaker, and retailer. Working in new contexts and dealing with new audiences of gentlemen and mechanicians, Bedwell and Hood used instruments to construct a public consensus on the status and aims of mathematics. (shrink)

The potential for the occurrence of multiple-role relationships is increased when professors also consult with athletic teams on their campuses. Such multiple-role relationships have potential ethical implications that are unclear and largely unexplored, and consultants may find multiple-role relationships both difficult to deal with and unavoidable. Therefore, the purpose of this study was to explore the nature of teacher–practitioner multiple-role relationships. Participants (N = 35) were recruited from Association for the Advancement of Applied Sport Psychology (AAASP) certified consultants (CCs) who (...) were also affiliated with a university (N = 68). All participants completed a 28-item survey exploring the incidence and relevant issues pertaining to multiple-role relationships. Chi-square analyses revealed that licensed mental health practitioners (i.e., psychologists and counselors) were more likely than nonlicensed AAASP CCs to believe that multiple-role relationships were never appropriate in sport psychology, χ2(1, N = 30) = 12.80, p <.001, and to have never taken part in a multiple-role relationship, χ2(1, N = 33) = 12.44, p <.001. Independent samples t tests revealed that mental health practitioners also reported that they would have higher levels of concern for both the practitioner, t(30) = –2.77, p =.009, and the client, t(30) = –2.50, p =.018, in such a relationship. (shrink)

This article proposes a re-reading of the chromolithographic algorithm on the front cover of Fox Talbot’s seminal photographic work Pencil of Nature, 1844. The wet and dry of analogue and digital photography are proposed to both be in fact unfixed. A third, fluid, intermediary state is identified. The practitioner in this alternate zone is receptive to the isomorphic potential of the elements and is able to utilize a form of remote viewing – or rather remote perception – to both upload (...) and download. (shrink)

Companies seeking to effectively manage the ethical dimensions of their business have created formal and informal practices, including those with the labels “ethics and compliance” and “corporate social responsibility” (CSR). However, there is little research describing how practitioners who create and implement these practices understand their meaning and relationship. Leveraging a communities of practice theoretical perspective, this qualitative study proposes that these practices can be studied as artifacts of managerial learning. Thematic analysis of interviews with senior managers suggests that (...) practices have diverse meaning, with only informal relationships between them in most cases. Theoretically, this research offers a new lens through which to view compliance and CSR practices as socially negotiated, contextual, and dynamic. Practically, it suggests that there may be new opportunities for learning if managers create practices through an intentional exploration of shared meaning. (shrink)

A survey was conducted on the advertising practitioners in Taiwan concerning their experiences of ethical challenges at work. Among 120 respondents, while 32.5 percent responded that ethical problems did not exist, 67.5 percent admitted that ethical problem was a commonplace at work. According to these respondents, the most frequently mentioned ethical problems area representing unethical products or services, the message of advertisements, agency-client relationship, the creditability of research, undertable rebate, and the quality of service. Suggestions for international advertising managers (...) were also provided by comparing the finding from the present study with earlier studies in the United States. However, due to its preliminary nature, the present study should be considered exploratory and descriptive rather than conclusive, with the hope to inspire more research on advertising ethics in Taiwan as well as in other countries in the world. (shrink)

In this issue of the Hastings Center Report, Ann Hamric, John Arras, and Margaret Mohrmann highlight how contemporary accounts of the virtue of courage in health care often gloss over deeper problems in the underlying health care systems themselves. They express particular concerns about the appropriateness and personal costs of exhortations to health professionals to take courageous action in circumstances where this is “required only because of unethical institutional structures” (p. 39). They offer valuable points that are not adequately recognized (...) in discussions of courage as a professional virtue in health care practice. The call for more judicious appeals to health professionals to exercise courage in health care practice should clearly be heeded. A sole reliance on practitioner courage for exposing unethical workplace practices would be misguided. Nevertheless, there is still a legitimate place for encouraging health professionals to develop and act on courage. (shrink)

Significant efforts have been made to define ethical responsibilities for professionals engaged in nanotechnology innovation. Rosalyn Berne delineated three ethical dimensions of nanotechnological innovation: non-negotiable concerns, negotiable socio-cultural claims, and tacitly ingrained norms. Braden Allenby demarcated three levels of responsibility: the individual, professional societies (e.g. engineering codes), and the macro-ethical. This article will explore how these definitions of responsibility map onto practitioners’ understanding of their responsibilities and the responsibilities of others using the nanotechnology innovation community of the greater Phoenix (...) area, which includes academic researchers, investors, entrepreneurs, manufacturers, insurers, attorneys, buyers, and media. To do this we develop a three-by-three matrix that combines Berne’s three dimensions and Allenby’s three levels. We then categorize the ethical responsibilities expressed by forty-five practitioners in semi-structured interviews using these published dimensions and levels. Two questions guide the research: (i) what responsibilities do actors express as theirs and/or assign to other actors and; (ii) can those responsibilities be mapped to the presented ethical frameworks? We found that most of the responsibilities outlined by our respondents concentrate at the professional society + non-negotiable and professional + negotiable intersections. The study moves from a philosophical exploration of ethics to an empirical analysis, exploring strengths, weaknesses, and gaps in the existing nanotechnology innovation network. This opens the door for new practitioners to be introduced in an effort to address responsibilities that are not currently recognized. (shrink)

Medical practice has always involved at least three roles, three complimentary identities. Practitioners have been at once clinicians dedicated to a patient’s care, members of a professional organization promoting medicine, and informed citizens engaged in public debates on health issues. Beginning in the 1970s, a series of social and technological changes affected, and in many cases restricted, the practitioner’s ability to function equally in these three identities. While others have discussed the changing realities of medical practice in recent decades, (...) none have commented on their effect on their effect on rights of practitioners as citizens. Here several cases begin an analysis of the manner in which those changes have limited the physician’s right to act conscientiously and speak publicly in the face of organizational agendas and political priorities. (shrink)

One of the principles of health care ethics is the principle of justice. An important expression of justice is equity. The provision of basic primary health care services to all people is the key to eliminating the gross inequities in health status existing in many countries. For many years nurses in developing countries have ‘led the way’ in bringing these essential services to poor rural communities, including the diagnosis and treatment of illnesses, and the prescribing and dispensing of medications. Nurses (...) are the most appropriate health workers for this role, but most have not been prepared adequately for it. This is unsafe for patients and puts nurses at legal risk. Justice requires that patients should obtain access to safe health care and that nurses should receive appropriate education. Nurse practitioner programmes are being established to prepare nurses for this advanced practice role, but here again ethical considerations apply. Justice will be served only if nurse practitioner programmes are accessible to the nurses who are most likely to work in medically underserved communities where the need is greatest. (shrink)

This conceptual paper explores the role that wisdom plays in social work. In the literature, this topic is primarily discussed in terms of ‘Practice Wisdom’, a kind of implicit and intuitive-based body of knowledge that is acquired through practice experience. After reviewing some formulations of it, we argue that practice wisdom faces a number of difficulties and is a misguided approach. To replace it, we propose a novel framework called ‘Practitioner Wisdom’, which emphasises that the proper subject of wisdom is (...) not some sub-personal construct like a body of knowledge or a set of skills but the social work practitioner. Drawing from virtue theory in philosophy, we theorise that being a wise practitioner is a matter of acquiring and cultivating a character that is constituted by the relevant social work virtues and values. We conclude by discussing some benefits of practitioner wisdom, including how it can be taught to social work students and entrants, and suggest some future areas of research. (shrink)

This paper compares the ethical decisions and attitudes of business students and practitioners. Recent unpublished data from a national study of over 1600 students are contrasted with information reported previously. Students are found consistently to make less ethical choices than practitioners, and there is some indication that students are making less ethical choices in the 1980s than in the 1960s. In addition, both students and practitioners agree that buyers should beware, view the role of business more narrowly, (...) and find fewer incentives to behave ethically over time. Codes of ethics appear to be less influential than the individual''s strong personal value system and one''s superiors behaving ethically; support for codes is declining. The paper concludes with observations about the limitations and possibilities for survey research in this area drawing on other studies that used the same instrument utilized for this paper. Some implications for future research are suggested. (shrink)

This paper1 aims to develop a model of practitioner narrative competence specifically for mental health care. I begin by considering the status of narratives as a form of evidence. Following Rita Charon and Cheryl Misak, I claim that there is no distinction to be made between evidence-based medicine and narrative medicine. I then explore Charon’s model of practitioner narrative competence, and suggest that it can be fruitfully adapted for mental health care contexts, a project for which I employ Jennifer Radden (...) and John Z. Sadler’s psychiatric ethics. This project brings together two independently promising accounts to develop what I refer to as the adapted model of... (shrink)

There is growing interest in the contribution of practitioner research towards bodies of knowledge and practice change. A practitioner or group of practitioners may carry out inquiry in order to better understand their own practice and client groups and to assess or improve service effectiveness. There is also increased interest in the place of ethical review (typically encapsulated within requirements to submit to a formal ethics committee) and broader processes of research governance. Drawing on the field of social work (...) this paper seeks to explore how practitioner research should respond to calls for ethical review and greater formal consideration of research projects. We adopt a four-fold discussion. First, we explore the meaning of practitioner research and sketch its progress and the ethical implications thereof within social work; second, we trace the factors accounting for growing interest in ethics review and committees; third, we outline issues raised by practitioner research vis-à-vis ethical review, the role of ethics committees, and processes of research governance. Finally, we suggest how procedures and practices can ensure that ethical principles are considered whilst also fostering practitioner research developments. (shrink)

Theorists and practitioners in the fields of both Corporate Responsibility and Corporate Reputation have recently stressed the importance of taking a stakeholderperspective when researching the nature, development and impact of these concepts. While models of Corporate Reputation, such as the Reputation Quotient and SPIRIT were developed by actively engaging stakeholders in research, models of Corporate Responsibility have been developed in a more theoretical manner. There have thus been calls for the research approaches taken in reputation research to be applied (...) to the field of responsibility. This paper answers these calls and thereby provides two related outcomes: First, a conceptualisation of Corporate Responsibility is developed that draws directly upon stakeholder perceptions (in this case customers and employees of a financial institution). Secondly, a comparison between this conceptualisation and two existing models of Corporate Reputation is conducted. A formal comparison between the model of Corporate Responsibility developed in this paper and the RQ and SPIRIT models of Corporate Reputation suggests that there are considerable similarities between stakeholder conceptualisations of responsibility and models of reputation.Stakeholders may therefore not view responsibility separate from reputation, but rather as a largely overlapping concept. Questions about the causal relationship between the two concepts are also discussed. (shrink)

BackgroundEvolving medical technology, advancing biomedical and drug research, and changing laws and legislation impact patients’ healthcare options and influence healthcare practitioners’ (HCPs’) practices. Conscientious objection policy confusion and variability can arise as it may occasionally be unclear what underpins non-participation. Our objective was to identify, analyze, and synthesize the factors that influenced HCPs who did not participate in ethically complex, legally available healthcare.MethodsWe used Arksey and O’Malley’s framework while considering Levac et al.’s enhancements, and qualitatively synthesized the evidence. We (...) searched Medline, CINAHL, JSTOR, EMBASE, PsychINFO, Sociological Abstracts, and ProQuest Dissertations and Theses Global from January 1, 1998, to January 15, 2020, and reviewed the references of the final articles. We included articles written in English that discussed the factors that influenced physicians and registered nurses (RNs) who did not participate in end-of-life (EOL), reproductive technology and health, genetic testing, and organ or tissue donation healthcare areas. Using Covidence, we conducted title and abstract screening, followed by full-text screening against our eligibility criteria. We extracted the article’s data into a spreadsheet, analyzed the articles, and completed a qualitative content analysis using NVivo12.ResultsWe identified 10,664 articles through the search, and after the screening, 16 articles were included. The articles sampled RNs (n = 5) and physicians (n = 11) and encompassed qualitative (n = 7), quantitative (n = 7), and mixed (n = 2) methodologies. The care areas included reproductive technology and health (n = 11), EOL (n = 3), organ procurement (n = 1), and genetic testing (n = 1). One article included two care areas; EOL and reproductive health. The themed factors that influenced HCPs who did not participate in healthcare were: (1) HCPs’ characteristics, (2) personal beliefs, (3) professional ethos, 4) emotional labour considerations, and (5) system and clinical practice considerations.ConclusionThe factors that influenced HCPs’ who did not participate in ethically complex, legally available care are diverse. There is a need to recognize conscientious objection to healthcare as a separate construct from non-participation in healthcare for reasons other than conscience. Understanding these separate constructs will support HCPs’ specific to the underlying factors influencing their practice participation. (shrink)

How tax practitioners approach ethical dilemmas remains generally unexplored in academic literature. We use here Rest’s original Defining Issues Test (Development in judging moral issues. Minneapolis: University of Minnesota Press, 1979; Moral development. Advances in research and theory. New York: Praeger Publishers, 1986), combined with a tax context-specific test and in conjunction with a control group of non-tax specialists, to examine tax practitioners’ moral reasoning in a social and tax context. We investigate: (i) the effect of a tax (...) context on issues raised (finding that practitioners generally reason at lower levels than in social scenarios); (ii) whether the profession attracts people who reason at certain levels (finding that it does not); and (iii) whether practitioners are affected by training/socialization in their professional context (finding that that they are). (shrink)

Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive (...) biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers’ accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population. (shrink)

Historically, the care of hospitalized children has evolved from being performed in isolation from parents to a situation where the parents and the child are regarded as a unit, and parents and nurses as equal partners in the child’s care. Parents are totally dependent on professionals’ knowledge and expertise, while nurses are dependent on the children’s emotional connection with their parents in order to provide optimal care. Even when interdependency exists, nurses as professionals hold the power to decide whether and (...) to what extent parents should be involved in their child’s care. This article focuses on nurses’ responsibility to act ethically and reflectively in a collaborative partnership with parents. To illuminate the issue of nurses as moral practitioners, we present an observation of contemporary child care, and discuss it from the perspective of the Danish moral philosopher KE Løgstrup and his book The ethical demand. (shrink)

This study viewed students majoring in public relations as prospective public relations practitioners and explored their perceptions about corporate social responsibility (CSR) as their job attraction condition. The results showed that the students perceived CSR to be an important ethical fit condition of a company. One of the significant findings is that CSR can be an effective reputation management strategy for prospective employees, particularly when a company’s business is suffering. In examining the effect of CSR efforts on attitudinal and (...) behavioral outcomes, person–organization (P–O) fit appeared to serve as a mediator between CSR performances and organizational attractiveness. (shrink)

This study examines the self-reported ethics of both current and future advertising practitioners, and compares their responses to four scenarios and 17 statements on advertising ethics. Stepwise discriminant analysis was used to determine the extent to which both groups applied the classical ethical theory of deontology to the scenarios and statements. Results indicate significant differences between both groups. For example, current advertising practitioners are significantly less likely than future practitioners to apply deontology to decision making. The implications (...) of these results are discussed and suggestions for future research are outlined. (shrink)

Background In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and—as advised by Belgian Medical Deontology—in the context of a trusted patient–physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. Aim To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). Results Although GPs can (...) understand a patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. Conclusions Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and—if they grant it—to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law. (shrink)

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) (...) inhibitors (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

‘Medically unexplained symptoms’, through the lens of the biopsychosocial model, are understood in mainstream psy disciplines and related literature as a primarily psychosocial phenomenon perpetuated by ‘dysfunctional’ psychology on the part of people labelled with such. Biopsychosocial discourse and practice in this field, underpinned by little empirical foundation and lacking theoretical coherency, are associated with harms sustained by people labelled with MUS. Yet, little attention is paid to the psychology of social actors and institutions whose practice and policy derives from (...) biopsychosocial theorising, or whose vested interests produce such theorising. This article contends that lack of reflexivity among psy practitioners and other social actors on individual, institutional and structural levels furthers biopsychosocial hegemony and contributes to harms. Non-reflexive behaviour on the part of practitioners within clinical and ‘therapeutic’ encounters and on the part of social actors within institutions and broader power structures is examined, and possible psychological underpinnings of non-reflexivity are explored. Notably, the concept of gain, drawn from dominant discourse around MUS, is applied broadly to explore what might be gained from eschewing reflexivity and from adhering to biopsychosocial narratives. Implications for practice, supervision, training and research are discussed, notably highlighting a need for critical reflexivity in all domains. (shrink)

The World Professional Association for Transgender Health guidelines Standards of Care 8 draw on ethical arguments based on individual autonomy, to argue that healthcare and other professionals should be advocates for trans people. Such guidelines presume the presence of medical services for trans people and a degree of consensus on medical ethics. Very little is known, however, about the ethical challenges associated with both providing and accessing trans healthcare, including gender affirmation, in the Global South. In light of the challenges (...) associated with medical and legal gender affirmation in Indonesia, we conducted a qualitative study to understand the views of trans people, healthcare providers, and legal practitioners. In this qualitative study, we drew on a participatory methodology to conduct 46 semi-structured interviews between October and December 2023, with trans people (10 trans feminine people and 10 trans masculine people, each interviewed twice) and key informants (three healthcare providers and three lawyers and paralegals). Trans people were a central part of the research team from inception through to analysis and writing. Participants were recruited via community-led sampling. Data analysis of interview data took place through an immersion/crystallisation technique and preliminary inductive coding which highlighted key quotes. We focused on an inductive analysis using participant narratives to identify key concepts in the ethics of gender affirmation in Indonesia. We characterize the ethics of supportive healthcare workers, community members, and family members, as that akin to “accomplices,” a concept of ethics used in theories of racial justice which evaluate a willingness to support people to navigate laws and regulations which perpetuate injustices and violence. Overall, both trans people and key informants shared an understanding that the legal status of gender-affirming medical care was particularly ambiguous in Indonesia due to a lack of clarity in both laws and regulations. For trans participants, ethical arguments for the validity of legal and medical gender affirmation was premised on evidence that their gender identity and expression was already recognized within society, even if limited to immediate friends and family. Given that all participants expressed a desire for gender affirmation, but such services were widely unavailable, accomplices played a crucial role in supporting trans people to access healthcare. An empirical study based on an “ethics from below” helps to show that arguments grounded in autonomy, or based on biomedical evidence, are unlikely to alter unjust laws or facilitate a change to pathologizing guidelines governing understanding of trans people’s healthcare and legal needs in Indonesia. We provide an analysis that is sensitive to the ethics of facilitating gender affirmation in a context where that process is inherently social, and often articulated in relation to a prevailing religious morality. (shrink)

Traditionally the study of computer ethics involves taking students who are not philosophically trained, exposing them to action-guiding theories, presenting them with the codes of ethics of several companies and professional organizations and asking them to make ethical decisions in scenario-based cases. This approach is deliberately action-based and focuses on doing. "What would you do?" is the traditional question we ask our students. While this pedagogical methodology forces them to examine situations and argue from a particular point of view, it (...) does little to influence their character. They see the utilitarian or deontologist as someone other than themselves. There seems to be very little internalization of these action-based theories.Virtue Ethics offers character-forming theory that has been more successful with my students than the action-based theories of computer ethics texts. Why? Virtue Ethics is directed toward character development. The focus is on being rather than doing. It presents a good heuristic or approach to the problem of moral agency. Virtue ethics offers a way of teaching self-reflection through narratives that focus on core values, heroes and moral exemplars. It is grounded in practical wisdom. It is experiential, learning to care about the self, others, the community, living the good life, flourishing and striving for moral excellence. It offers a model for the development of character and personal ethics which will lead to professional ethics. Yet, the strict Virtue Ethics espoused by Aristotle has its limitations. This paper will explore the need for a more integrative approach to contemporary moral theory, one that may be found by revisiting the virtues through the works of Aristotle and Kant. It will offer insight into translating theory into practice for students of computer science and information technology. (shrink)

This chapter provides a brief introductory history of biomedical practitioners’ efforts at self-regulation though oaths, codes, and statements of ethical principle, tracing them from ancient oaths through the nineteenth-century transition to codes of medical ethics. The more recent foundation for modern biomedical ethics was laid in post-World-War II oaths and codes written in the aftermath of the Holocaust, and later modified in response to animal rights and patients’ rights movements that promoted principles and practices enforced by semi-self-regulatory acronym-laden ethics (...) committees— HECs, IACUCs, IRBs/REBs/RECs. The last section of this chapter discusses the modern origins of self-regulatory ethical principles for benchside biomedicine and biomedical publications. (shrink)

This series helps practitioners to redefine and recreate their daily practice in ways that are healthier for both patients and practitioners. The books provide a welcome antidote to demoralisation and burn-out amongst practitioners, reversing cynicism and reviving our feeling of pride in health practice. The fifth book in this series, The Integrated Practitioner: Food for Thought, written for readers who prefer a more academic and reflective understanding of the themes of books 1-4. It incorporates the theoretical background (...) for each of the concepts discussed in the first four workbooks, giving context to, and providing an underpinning of, modern medical practice. (shrink)

The paper analyzes managers’ stance toward the ethical responsibility of those who work for multinational garment retailers. Most are charged with the social compliance policies affecting relationships with subcontractors. This study is based on interviews conducted with major European and American retailers. Our research question is: what is the normative stance of our respondents? We find that they reject the ideological way in which the normative debate on sweatshops has been conducted by business ethicists during the last decades. These executives’ (...) implicit conception and scope of their moral responsibility is much more in line with Iris Young’s (2006) conception of ‘political responsibility’. This managerial ethical position has not been adequately captured by earlier writings on this topic. In general, the managerial ethical framing of issues like child labor, minimally decent labor conditions, a living wage, etc. is at odds with how these issues are usually treated in the philosophical debates around sweatshops. Examining both visions allows us to better grasp the pragmatic normative stance of business practitioners as well as the dynamics of social compliance policies. In the conclusion, we draw both management lessons and research implications for more ethical interactions with suppliers. (shrink)

The potential for the occurrence of multiple-role relationships is increased when professors also consult with athletic teams on their campuses. Such multiple-role relationships have potential ethical implications that are unclear and largely unexplored, and consultants may find multiple-role relationships both difficult to deal with and unavoidable. Therefore, the purpose of this study was to explore the nature of teacher-practitioner multiple-role relationships. Participants (N=35) were recruited from Association for the Advancement of Applied Sport Psychology (AAASP) certified consultants (CCs) who were also (...) affiliated with a university (N=68). All participants completed a 28-item survey exploring the incidence and relevant issues pertaining to multiple-role relationships. Chi-square analyses revealed that licensed mental health practitioners (i.e., psychologists and counselors) were more likely than nonlicensed AAASP CCs to believe that multiple-role relationships were never appropriate in sport psychology, ?²(1,N= 30) = 12.80, p <.001, and to have never taken part in a multiple-role relationship, ?²(1, N= 33) = 12.44, p<.001. Independent samples t tests revealed that mental health practitioners also reported that they would have higher levels of concern for both the practitioner, r(30) = -2.77, p = .009, and the client, f(30) = -2.50, p = .018, in such a relationship. (PsycINFO Database Record (c) 2008 APA, all rights reserved). (shrink)

The “participatory turn” cutting across technical approaches for appraising environment, risk, science, and technology has been accompanied by intense debates over the desired nature, extent, and quality of public engagement in science. Burgeoning work evaluating the effectiveness of such processes and the social study of science in society more generally is notable, however, for lacking systematic understanding of the very actors shaping these new forms science-society interaction. This paper addresses this lacuna by drawing on United Kingdom based in-depth empirical research (...) that made space for participatory appraisal experts to reflect on effective practice and novel questions of competence, expertise, and citizen-specialist relations within analytic-deliberative processes. Emerging practitioner principles warn that existing participatory models have not sufficiently considered constructivist perspectives on knowledge, analysis, and deliberation. Effective participatory appraisal under uncertainty needs to guard against the “technocracy of participation” by opening up to diversity, difference, antagonism, and uncertainties/indeterminacies. (shrink)

While much of the empirical accounting literature suggests that, if differences do exist, Big Four employees are more ethical than non-Big Four employees, this trend has not been evident in the recent media coverage of Big Four tax practitioners acting for multinationals accused of aggressive tax avoidance behaviour. However, there has been little exploration in the literature to date specifically of the relationship between firm size and ethics in tax practice. We aim here to address this gap, initially exploring (...) tax practitioners’ perceptions of the impact of firm size on ethics in tax practice using interview data in order to identify the salient issues involved. We then proceed to assess quantitatively whether employer firm size has an impact on the ethical reasoning of tax practitioners, using a tax context-specific adaptation of a well-known and validated psychometric instrument, the Defining Issues Test. (shrink)

Cognitive Task Analysis (CTA) helps researchers understand how cognitive skills and strategies make it possible for people to act effectively and get things done. CTA can yield information people needemployers faced with personnel issues, market researchers who want to understand the thought processes of consumers, trainers and others who design instructional systems, health care professionals who want to apply lessons learned from errors and accidents, systems analysts developing user specifications, and many other professionals. CTA can show what makes the workplace (...) workand what keeps it from working as well as it might.Working Minds is a true handbook, offering a set of tools for doing CTA: methods for collecting data about cognitive processes and events, analyzing them, and communicating them effectively. It covers both the "why" and the "how" of CTA methods, providing examples, guidance, and stories from the authors' own experiences as CTA practitioners. Because effective use of CTA depends on some conceptual grounding in cognitive theory and researchon knowing what a cognitive perspective can offerthe book also offers an overview of current research on cognition.The book provides detailed guidance for planning and carrying out CTA, with chapters on capturing knowledge and capturing the way people reason. It discusses studying cognition in real-world settings and the challenges of rapidly changing technology. And it describes key issues in applying CTA findings in a variety of fields. Working Minds makes the methodology of CTA accessible and the skills involved attainable. (shrink)

Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health‐centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to integrate theory, practice and art, and (...) facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision‐makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework. (shrink)

This exploratory study is focused on the perceptions of science communication practitioners about the activities of scientists and the audiences of the marine sciences outreach in Portugal. Using the qualitative method of thematic analysis and collecting data through semistructured interviews of 14 practitioners of diverse professions, backgrounds, ages, and stages of career, it was found that the role of marine scientists in this area is traditionally viewed as reduced, but with a slight improvement in the past 5 to (...) 10 years. Despite having a historical connection with and curiosity about the sea, audiences were considered to have a mostly utilitarian interest in the marine sciences. Most practitioners had a view of science communication connected to the knowledge deficit model, with a minority articulating a more dialogical model. Although there are signs of conflict between science communicators and scientists, the proliferation of training opportunities in science communication at the national level, the perceived increase of interest and participation of marine scientists in public communication in the past years, and the consolidation of science communicators as part of the scientific community offer positive prospects for the future of outreach of marine sciences in Portugal. (shrink)

ABSTRACT:COVID-19 revealed health-care systems in crisis. Intersecting crises of stress, overwork, and poor working conditions have led to workforce strain, under-staffing, and high rates of job turnover. Bioethics researchers have responded to these conditions by investigating the ethical challenges of pandemic response for individuals, institutions, and health systems. This essay draws on pandemic findings to explore how empirical bioethics can inform post-pandemic translational bioethics. Borrowing from the concept of translational science in medicine, this essay proposes that translational bioethics should communicate (...) knowledge about ethical challenges in health-care work to support health systems change. The authors draw from their experience with the Study to Examine Physicians' Pandemic Stress (STEPPS), an interdisciplinary research project that investigates physicians' experiences at the front lines of the COVID-19 pandemic. Using STEPPS as an example of empirical bioethics with potential for translation, the authors review their research and discuss the ongoing process for translating their findings, focusing on how bioethics research and practice can contribute to supporting the health-care workforce. (shrink)

In 1988, the control of the American Psychological Association shifted to those advocating the interests of professional practice and a substantial segment of the scientific community in psychology seceded to form the American Psychological Society, devoted to scientific psychology and scientific-based practice. In this climate, it has become increasingly difficult for scientists and practitioners to maintain analytical discussions of the philosophical and methodological issues that divide these two groups. For over 25 years, the authors have been fortunate to have (...) the professional and intellectual luxury of just such a discussion, and present here a dialogue that attempts to capture their initial stark differences in perspective and the process by which differences have been clarified, and areas of agreement established. 2012 APA, all rights reserved). (shrink)