The present study aimed to develop effective moral educational interventions based on social psychology by using stories of moral exemplars. We tested whether motivation to engage in voluntary service as a form of moral behavior was better promoted by attainable and relevant exemplars or by unattainable and irrelevant exemplars. First, experiment 1, conducted in a lab, showed that stories of attainable exemplars more effectively promoted voluntary service activity engagement among undergraduate students compared with stories of unattainable exemplars and (...) non-moral stories. Second, experiment 2, a middle school classroom-level experiment with a quasi-experimental design, demonstrated that peer exemplars, who are perceived to be attainable and relevant to students, better promoted service engagement compared with historic figures in moral education classes. (shrink)

Incremental implicit theories are associated with a belief regarding it is possible to improve one’s intelligence or ability through efforts. Previous studies have demonstrated that incremental implicit theories contributed to better academic achievement and positive youth development. Our study aimed to examine whether incremental implicit theories of morality significantly influenced change in students’ engagement in voluntary service activities. In our study, 54 Korean college students for Study 1 and 180 Korean 8th graders for Study 2 were recruited to conduct (...) two two-wave studies. We surveyed participants’ implicit theories of morality and participation in voluntary service activities. The effect of implicit theories of morality on change in service engagement was analyzed through regression analysis. In Study 1, the moral growth mindset significantly moderated longitudinal change in service engagement. In Study 2, the moral growth mindset significantly influenced engagement in art-related activities, while it significantly moderated change in engagement in youth-related activities. (shrink)

Military activities with the framework of the IDF [Israel Defense Force] is carried out by citizens in a variety of positions. In addition to the ordinary positions of career officers and NCOs, the IDF consists of conscripted men and women as well as reservists. Some of the latter serve under an ordinary command to serve for a certain relatively short period. Other reservists, including pilots and special forces officers have served since they volunteered to serve. Facing the political clash between (...) the government, who have been viewed as trying to change the democratic nature of the state, and the popular opposition, who have tried to protect the judiciary and other elements of democracy, many officers who belong to the latter reservist group have suspended their voluntary service or even retired. Their decision has raised the obvious issue of whether such decisions can be justified, morally, ethically, and democratically. This is the topic of the present paper. (shrink)

We argue that voluntary mental health registries integrated into the 9-1-1 system, where patients and caregivers can establish a repository of this information, will help fill this information gap by enabling first responders to quickly understand the context of a call for service with a mental health component, and to make better informed decisions. Despite valid concerns about privacy, stigma, and the potential misuse of protected health information, such registries, if carefully designed and administered, can improve the health outcomes (...) of 9-1-1 calls for service involving mental health-related crises. (shrink)

Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the (...) ethical and practical impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff. (shrink)

Public healthcare systems are increasingly refusing (temporarily) to reimburse newly approved medical treatments of insufficient or uncertain cost-effectiveness. As both patient demand for these treatments and their list prices increase, a market might arise for voluntary additional health insurance (VHI) that covers effective but (very) expensive medical treatments. In this paper, we evaluate such potential future practices of VHI in public healthcare systems from a justice perspective. We find that direct (telic) egalitarian objections to unequal access to expensive treatments (...) based on different ability to afford VHI do not stand up to scrutiny. However, such unequal access might lead to loss of self-respect among individuals, or loss of fraternity within society, rendering it more difficult for citizens to interact on equal moral footing. This would be problematic from a relational egalitarian perspective. Moreover, the introduction of VHI might turn out to have negative consequences for the comprehensiveness and/or the quality of the public healthcare services that are offered to all patients equally through basic health insurance. These consequences must be weighed against potential health gains and the value of liberty. We conclude that governments should be careful when considering the introduction of VHI in public healthcare systems. (shrink)

Bill 20, An Act to Enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, was introduced to reduce costs associated with Québec’s healthcare in general and in vitro fertilisation in particular. Passed in November 2015, the new law introduces a number of exclusion criteria for access to and funding for IVF treatment. Remarkably, one exclusion criterion—prior voluntary sterilisation—has prompted little critical commentary. The two justifications (...) offered for restricting funding for IVF on the basis of voluntary sterilisation are that there are cheaper options than IVF for sterilised individuals who want children, and society should not have to pay for IVF for persons who are infertile by choice. I argue that both of these justifications are unsatisfactory, insofar as they contravene the chief value underlying, and current practices of, Canadian healthcare, and rely on problematic ascriptions of personal responsibility for health. (shrink)

This article analyzes the institutionalization of the global organic agriculture field and sheds new light on the conventionalization debate. The institutions that shape the field form a tripartite standards regime of governance that links standard-setting, certification, and accreditation activities, in a layering of markets for services that are additional to the market for certified organic products. At each of the three poles of the TSR, i.e., for standard-setting, certification, and accreditation, we describe how the corresponding markets were constructed over (...) time and the role of the different actors in their evolution. We analyze the politics at stake among the actors at each pole, their competing or cooperative interests and visions, and the tensions between them in the promotion of markets. Through the lens of the TSR heuristic, we show that the institutionalization of the organic field beginning in the 1990s and its de facto inclusion in the broader sustainability field beginning in the 2000s contribute to a progressive distancing between the organic movement and its initial political project of alterity, to which public and private actors both contribute actively. As a set of interlinked market institutions, the TSR orients and narrows the scope of debate, which becomes restricted to “market-compatible” dimensions and objects. We conclude that the TSR is a promising heuristic for analyzing contemporary global regulation. (shrink)

Despite exponential growth in the past decades, most aspects of the assisted reproductive technology industry remain largely unregulated; recently, pressure has been mounting for coordinated study and regulation of this developing industry. On March 28, 2008, lawyers, health care professionals, representatives from sperm banks, consumers of ART services, and other stakeholders in ART industry gathered at DePaul University College of Law for its Health Law Institute’s symposium titled “Tracking Change: The Feasibility of a Voluntary Gamete Donor Registry in (...) the United States.” The implementation of a registry would mark the first effort in the United States to centralize, maintain, and disseminate information about gamete donors by collecting and storing genetic and identifying information about egg and sperm donors. Establishing a registry requires balancing the interests of donor-conceived individuals, their parents, gamete donors, health care professionals, and society as a whole, as well as ensuring the privacy and safety of all involved. (shrink)

BackgroundDealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) (...) recognizes the inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process.MethodsSeventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically.ResultsOur results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants.ConclusionThe broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately. (shrink)

The informal business sector has made enormous contributions to Nigeria's economic growth and development, but this sector is not given the necessary attention to transforming these businesses toward sustainability. This study explores the depth of informal business sector practices in Nigeria. It underscores the inputs of stakeholders in the transformation of businesses in the Nigerian informal sector to increase tax remittances and employment generation for job security in the Nigerian economy. Also, it underpins value chain performances to transform the informal (...) sector and rescue it from liquidation through voluntary company arrangements, administration, merger, takeover, and acquisition schemes. The study adopts a conceptual review. The research relies on extant literature relating to the antecedence of informal business sector activities in Nigeria. It relies on reports from tertiary data sources such as academic articles, books, newspapers, the Internet, and website sources. It further explores the views of researchers, covering the informal sector development and the support of the provisions of the social services in Nigeria. There is the absence of a model for the transformation and sustainability of the informal sector enterprises in Nigeria. This study recommends a model approach to address informal sector enterprises' issues and challenges necessary to transform the businesses into a formal status while supporting their sustainability and resilience. (shrink)

This article endeavors to establish the moral force behind the worker’s claim to a compensatory wage in return for the labor burdens she endures. The apparent incompatibility between compensation and voluntary losses suggests that the only reason for providing a compensatory wage is the need to entice a valued service. In response, the article considers and rejects attempts to ground the compensatory wage on duress, mutual trade, and desert. Instead, it argues that the worker is not responsible for her (...) loss of well-being because she would not have incurred it in the absence of the employer’s promise to compensate. Key Words: compensatory wage • contributory wage • detrimental reliance • desert • labor burdens • promises • responsibility. (shrink)

BackgroundIn June 2019, the Australian state of Victoria joined the growing number of jurisdictions around the world to have legalised some form of voluntary assisted dying. A discourse of safety was prominent during the implementation of the Victorian legislation.Main textIn this paper, we analyse the ethical relationship between legislative “safeguards” and equal access. Drawing primarily on Ruger’s model of equal access to health care services, we analyse the Victorian approach to voluntary assisted dying in terms of four (...) dimensions: horizontal equity, patient agency, high quality care, and supportive social norms. We argue that some provisions framed as safeguards in the legislation create significant barriers to equal access for eligible patients.ConclusionsWhile safety is undoubtedly ethically important, we caution against an overemphasis on safeguarding in voluntary assisted dying legislation given the implications for equal access. (shrink)

Voluntary Consensus Standards are commerce-related documents developed by interested volunteers under due-process procedures which ensure that the concerns of all parties are fairly taken into account. Standards are beneficial to society because they promote commerce and lower the costs of and barriers to doing business. Because of this, conformance to a standard can confer significant competitive advantage.Vigorous, democratic competition between ideas leads to a high- quality standard. Some participants in the standards-development process will, against the general interest, attempt to (...) skew a standard to favor a specific product, service, or practice. In order prevent this sort of abuse, rules are written to prevent any common-interest block from overwhelming the general interest. Unfettered debate is fostered by having no rules defining volunteer-member misconduct, eliminating any possibility that a majority will improperly use such rules to silence a minority. This unfortunately permits the rare but not-hypothetical situation where those unscrupulous and determined, or those out of control, are able to engage in obstructionism and misconduct without any possibility of penalty. (shrink)

This study was conducted from May to June 2005 to describe the demographic characteristics and factors that affect the VCT acceptance as well as the HIV prevalence among youth VCT acceptors in Addis Ababa. Both quantitative and qualitative methods of data collection were employed. The quantitative data was generated from a two years (October 2002 to December 2004) VCT service utilization data obtained from four youth centers located in Addis Ababa. The data was analysed using univariate and multivariate analysis and (...) results were presented in the form of text, table and figures. The significance and level of associations between independent and dependant variables was computed using X2 tests and odds ratios with 95% confidence interval. The qualitative data was presented in a form of narrations using excerpts. During the period a total of 3220, youth age 15 - 24 years have sought VCT service from the four youth centres VCT service outlets. Higher proportions of females (60.2%) and youth in the age category of 20 – 24 years (58.0%) have accessed the service. The major reasons given for seeking VCT were found to be similar for male and female acceptors. About 71.2% said that they sought for VCT service because they wanted to know their HIV status, 9.5% reported because they were suspicious of being infected with HIV and 5.0% tested because they wanted to go aboard. The HIV prevalence rate is found to be significantly higher, (p = 0.00), among females 9.2 % than in males 1.7 %. Gender segregated multivariate analysis of risk factors indicated significant association of HIV infection with lack of formal education for both males and female: for males P= 0.045, OR = 18.3, 95% CI: 1.1 – 317.7 and for females P=0.00, OR=19.4, 95 % CI: 5.1 – 73.8. Additionally for females HIV infection is markedly associated with being widowed and commercial sex worker. The most common barrier for youth in Addis from accessing VCT were found to be: fear of being emotionally affected if found out HIV positive, stigma and discrimination, lack of money to pay for VCT service, absence of care and support services for people who are already infected. The challenges encountered by youth VCT counsellors were stress, absence of medical care for PLWHA, inadequacy of budget, lack of counsellors and supportive supervision. This study showed high burden of HIV infection among female youth and the risk factors associated with it. Formal education for both females and males is strongly recommended. Female focused HIV prevention interventions are indicated. Additional recommendations are also made in relation to barriers to access youth VCT and for the challenges encountered by youth VCT service providers. (shrink)

The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element of (...) assistance cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die. (shrink)

Compulsory (health) service contracts have recently received considerable attention in the normative literature. The service contracts are considered and offered as a permissible and liberal alternative to emigration restrictions if individuals relinquish their right to exit via contract in exchange for the state‐funded tertiary education. To that end, the recent normative literature on the service programmes has particularly focused on discussing the circumstances or conditions in which the contracts should be signed, so that they are morally binding on the part (...) of the skilled workers. However, little attention is devoted to the relevance of the right to exit for the debate on compulsory service programmes. In this paper, I argue that even if the service contracts are voluntary, and thus the would‐be medical students voluntarily relinquish their right to exit, the reasons behind the right should be taken into account for the contracts to be morally valid. A clear understanding of the right to exit is a must in order not to breach its basic components and for the service contracts to be morally binding. To that end, I provide two accounts of the reasons to value the right to exit by presenting Patti Lenard's discussion of the right to exit and by reconstructing James Griffin's account of human rights. I conclude by offering brief ethical considerations for compulsory health service programmes grounded in the reasons to value the right to exit. (shrink)

Machine generated contents note: Introduction. -- Acknowledgments. -- The Author. -- 1 Ethical Theories and Bioethics in a Global Perspective. -- Theories of Ethics. -- Are Theories of Ethics Global? -- Can Theories of Ethics Encourage People to Do the Right Thing? -- 2 Autonomy and Informed Consent in Global Perspective. -- Ethical Principles and Practical Issues of Informed Consent. -- Does Informed Consent Really Matter to Patients? -- Is Informed Consent a Universal Principle or a Cultural Value? -- 3 (...) Withholding or Withdrawing Treatment and Physician-Assisted Suicide. -- Withholding or Withdrawing Treatment at the End of Life. -- Assisting Patients in Committing Suicide. -- 4 Ethical Issues in Reproductive Health. -- Ethics of Abortion in Different Times, Places, and Cultures. -- Current Ethical Issues in Abortion. -- Assisted Reproductive Technology and Stem Cell Research. -- Emergency Contraception. -- Ethics of Imposing Conditions on Funding. -- 5 Ethical Issues of Female Genital Mutilation. -- The Facts About FGM. -- FGM as a Challenge to Ethical Relativism. -- Ethics of FGM for Adult Women. -- 6 Ethical Issues of Research with Human Subjects. -- Background Information and the Belmont Report. -- Autonomy and Voluntary Informed Consent. -- Beneficence and Cost-Benefit Analysis. -- Issues of Justice and Fairness for Human Subjects. -- 7 The Right to Health Care, and Ethical Obligations to Provide Care. -- Is There an Ethical Right to Health Care? -- Ethical Obligations of Health Care Professionals. -- Ethical Obligations of for-Profit Health Care Providers. -- 8 Ethical Issues in Rationing and Allocation of Limited Resources. -- Levels of Allocating Resources. -- Methods of Rationing Health Resources. -- Comparative Effectiveness Research and Cost-Effectiveness Analysis. -- 9 Ethical Issues of Health Insurance and Health System Reform. -- Ethical Issues in Financing Health Services and Designing Insurance Systems. -- Fundamental Values of Health Systems. -- 10 Ethical Issues in the Movement of Patients Across National Borders. -- Ethical Duties to Provide Health Care to Undocumented Aliens. -- Ethical Issues in Medical Tourism. -- 11 Ethical Issues in the Movement of Health Care Professionals Across National Borders. -- Ethical Issues in the Migration of Health Professionals. -- Proposed Solutions and Their Ethical Implications. -- Fair Treatment of Health Care Workers from Other Countries. -- 12 Corruption and Informal Payments in Health Systems. -- Payment of Informal Fees by Patients and Their Families. -- Is Corruption Bad for Your (and Other People's) Health? -- References. -- Index. (shrink)

Despite the prominence of healthcare-relatedconcerns in public debate, the ground remainsinfertile for the idea of conscripting citizensinto medical research. Reluctance to entertainthe thought of a system where nearly everyonecould be selected for service might reflectuncertainty about what the project wouldinvolve. There might also be a fear that themore crucial issue is how to protect researchsubjects within current, voluntary systems. Nodoubt reluctance to explore a system ofuniversal service results from the common hopethat each of us might avoid research in anycapacity (...) besides researcher. A system of fullcivic participation might, however, avoid manyof the usual objections. Ethics regulations,including informed-consent guidelines, couldfor the most part remain in force. Though thesystem would compel people to serve, it couldremain responsive to principles of autonomy andjustice if it centered on broad publiceducation, community representation, and alottery-type selection process. The systemcould draw from the largest possiblecross-section of society, and offer conscriptsthe widest possible range of service. In thisway, a compulsory system might reconcile theexpectations about healthcare with researchneeds. (shrink)

The functioning of hospice institutions may be considered based on three fundamental, functions accomplished by it, i.e. existential, social and economic ones. Holistic evaluation of hospice care requires taking into account actual and potential advantages, possible to achieve both through society represented by all citizens, and through the economy. The article has a survey character – the literature is based on critical analysis within the scope ofthe subject raised. The work was made rich from two-year own experience of volunteer work. (...) For the purpose of realization of the subject raised, empirical examinations were also conducted based on the method of shadow prices and logical matrix. In this paper, the implementation of the function of an existential volunteer hospice is considered on the basis of its ability to alleviate the suffering of patients’ mental and spiritual capacity and give them practical help by volunteers. The usefulness of hospices, which is a part of their social function, was studied by considering the point of existence and functioning of palliative and long-term care centres. In order to define the economic function of a voluntary service, micro and macroeconomic types of analysis were used. One should, however, emphasise that these examinations should have an interdisciplinary character. (shrink)

In 2002, I wrote an editorial in this Journal arguing that it was time to review the structure and function of ethics committees in the USA, Australia and the UK.1 This followed the deaths of Ellen Roche and Jesse Gelsinger, which were at least in significant part due to the poor functioning of research ethics committees in the USA.2 In the case of Ellen Roche, it was the failure to require a systematic review of the existing literature which led to (...) her death. Iain Chalmers and I had previously documented in 1996 the failure of ethics committees to require systematic review.3 In 1998, at the time of revising the previous guidelines and forming the first Australian National Statement on Research Ethics, I made a public submission to the Australian Health Ethics Committee arguing that the new guidelines for RECs should include a person with skills in conducting systematic reviews of the literature and that the requirement to have a religious representative on the committee be replaced with the requirement to have an ethicist. Neither of these changes was made. I argued, ‘It is time to ask whether institutional RECs should be abandoned in favour of expert committees that cover many institutions—suprainstitutional specialist committees. Supraregional specialist ethics committees could specialise—for example, in genetic research, cancer clinical trials, dermatology, respiratory physiology and each of the specialist areas of medical research. An example of such a committee is provided by the Thoracic Society of Australia and New Zealand research ethics committee, which reviews multicentre trials of respiratory drugs’.4 Around that time, I was involved ‘at the coal face’ as Chair of the Department of Human Services Ethics Committee in Victoria. In a public presentation, I arguedThere are two philosophical views of what ethics review is. On the …. (shrink)

The expression oikoi stratiōtikoi, used in Constantine VII Porphyrogenitus as opposed to oikoi politikoi, designates all those families who were bound to military service. They, in the tenth century, were listed in various enlistment registers that were periodically updated, among which one was kept in Constantinople. There is solid evidence to argue that such an administrative practice originated in the eighth century, coinciding with a significant transformation in the enrolment of soldiers and their maintenance. A conscription procedure was devised in (...) the age of the Isaurians, which, although it is not known whether it was on a voluntary or compulsory basis, entailed the entry in the military records (in Constantinople and the provinces) of every person in charge (oikodespotēs) of the family that had assumed the military burden. This implied in later periods a strong uncertainty in the relationship between service and its performance because registration rested on an ambiguous vocabulary. The ambiguity, in fact, was rooted in the polysemy of the concept of oikos, family unit, home and patrimony at the same time. While such a notion allowed the recruitment in thematic armies to function flexibly through the wide network of the family’s cognate and agnatic structure, precisely because the oikos was also a set of economic interests, it exposed the landed patrimony of military families to splitting and erosion. This ambiguity ended with Constantine VII’s famous law of 949, which regulated the property regime of the stratiōtikoi oikoi, a regime that, as the same provision explicitly states in several points, already existed previously throughout the empire. The law provided a precise economic quantification of the assets needed for each ‘military family’ to perform the service. Historiography has generally interpreted Constantine VII’s measure as an act breaking with the previous tradition, since military service appears in it much more markedly connoted as a patrimonial burden, rather than as a personal one. However, this ‘oppositional’ interpretation does not seem adequate for understanding the concept of oikos stratiōtikos, which from the outset must have implied a profound interrelationship between the personality of the service and its patrimonial basis, since the one did not exist without the other. (shrink)

The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as “procedural ethics” and the identification and handling of ethical issues by researchers during the research process as “ethics in practice.” While some authors dispute and other authors (...) defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the solutions we found in relation to the potential vulnerability of research participants, the voluntariness of consent, the increase of participant access and the heterogeneity of the sample, the protection of privacy and internal confidentiality, and the consideration of personal and contextual factors. (shrink)

In this article, we explore the world's response to the increasing impact of carbon emissions on the sobering threat posed by global warming: the carbon offset market. Though the market is a relatively new one, numerous offset providers have quickly emerged under both regulated and voluntary regimes. Owing to the lack of technical literacy of some stakeholders who participate in the market, no common quality or certification structure has yet emerged for providers. To the contrary, the media warns that (...) a relative "cowboy" atmosphere prevails in the current environment, and that there are "widespread instances of people and organizations buying worthless credits that do not yield any reductions in carbon emissions" (Harvey and Fidler, Financial Times, 2007). At this point in the evolution of the market, only a handful of offset provider-rating schemes exist; and, even these systems leave consumers with few answers when they seek to find a means by which to ensure that the said systems are having their intended impact. The purpose of this article is, first, to provide a grounded understanding of the nature of the offset market, a tendency toward carbon neutrality as a possible point of equilibrium, and the ethical tensions that surround it from the perspective of the consuming public. Second, we outline the standards environment for offset providers to illustrate most effectively the need for a single set of criteria among providers that is readily understandable by the common consumer stakeholder. We then explore the differences among the providers and articulate the specific criteria upon which providers may be evaluated by this particular stakeholder constituency, by bringing together best practices based on currently available analyses. Finally, we share the results of preliminary data collection in connection with 117 offset providers and highlight early findings. These findings allow us comparing providers effectively and efficiently on a common scale that services both providers, who thereby have greater guidance for self-assessment purposes, as well as consumer stakeholders, who then have the ability to make useful and more informed choices about carbon emission reduction in the future. (shrink)

Fragile states and developing countries increasingly contract out health services to non-state providers (NSPs) (such as non-governmental organisations, voluntary sector and private sector). The paper identifies ethical issues when contracts involve devolution of health services to NSPs and proposes procedures to prevent or resolve these ethical dilemmas. Ethical issues were identified by examining processes of contracting out. Health needs could be used to select areas to be contracted out and to identify service needs. Health needs comprise “disease-burden-related (...) needs”, “health-service needs”, and “urgency of health-service needs”. The mix of services should include an analysis of cost-effectiveness. NSPs should be selected fairly, without bias, and conflicts of interest during their work must be avoided. The population’s views must be respected and accountability structures established. Devolved health services should ensure equity of access to healthcare. The services ought to be sustainable and evaluated objectively. Of these issues, conflicts of interest among NSPs and sustainability of health services have not attracted attention in the literature on ethics of health policy. Fair procedures could address these ethical issues—for example, public consultation on issues; decisions based on the public consultation and made on evidence; principles of decisions stated and reasonable; decisions given adequate publicity; a mechanism established to challenge decisions; assurance that mechanisms meet the above conditions; and regular review of the policies. These procedures are complemented by improving self-governance of NSPs, countries’ development of guidelines for devolving health services, and measures to educate the public of the client countries on these issues. (shrink)

During the past thirty years a high proportion of all long stay hospital beds have been closed. The responsibility for those who would have occupied those beds previously has to a large extent been transferred from health to social services departments, or to family, voluntary and private care. The overall effect has been to prioritize acute medical care, and to expose the public provision and funding of long term residential care, whether medical or social, to the direct determination (...) of political and economic forces. These policy changes have been introduced under the banner of community care, but are dependent on complex concepts which are morally contentious and often obscure. The purpose of this paper is to analyse these processes as a prerequisite to devising better policies in future. (shrink)

The creation of new technologies that serve humanity holds the potential to help end global poverty. Unfortunately, relatively little is done in engineering education to support engineers’ humanitarian efforts. Here, various strategies are introduced to augment the teaching of engineering ethics with the goal of encouraging engineers to serve as effective volunteers for community service. First, codes of ethics, moral frameworks, and comparative analysis of professional service standards lay the foundation for expectations for voluntary service in the engineering profession. (...) Second, standard coverage of global issues in engineering ethics educates humanitarian engineers about aspects of the community that influence technical design constraints encountered in practice. Sample assignments on volunteerism are provided, including a prototypical design problem that integrates community constraints into a technical design problem in a novel way. Third, it is shown how extracurricular engineering organizations can provide a theory-practice approach to education in volunteerism. Sample completed projects are described for both undergraduates and graduate students. The student organization approach is contrasted with the service-learning approach. Finally, long-term goals for establishing better infrastructure are identified for educating the humanitarian engineer in the university, and supporting life-long activities of humanitarian engineers. (shrink)

The American Catholic Church has attempted to apply and extend the social teachings of the Universal Church in light of American conditions and political culture, most recently in the 1986 Pastoral Letter on Catholic Social Teaching and the U.S. Economy, promulgated after six: years of analysis, debate, and amendment. Moving from an emphasis on government responsibilities for economic well-being and social welfare to a family-centered social vision stressing mediating groups and voluntary service, the American Church asserted a perennial social (...) doctrine reaffirmed and extended in Pope John Paul II's Centesimus Annus. The latter calls on a century of experience that has demonstrated the failures of the bureaucratic state and "real socialism," the utility of a market economy in allocating resources efficiently, and the shift from a land-based social economy to one founded on knowledge and skill. (shrink)

Nelson, Russ Paul's letter to the Romans highlights the significance of volunteers to the mission of Jesus in the church. Acts 18 introduces a married couple, Priscilla and Aquila, late of Rome and now of Corinth. Initially they house and employ Paul, thereby giving voluntary service to Paul. Priscilla and Aquila's generosity remains a feature of contemporary Catholicism, clearly identifiable in the parishes. As an everyday part of church life, volunteering is worthy of recognition and nurture. Contemporary ministers might (...) reflect on the development of Priscilla and Aquila as volunteers as first mentioned in the Acts of the Apostles. Perhaps these two lay people were instructed by Paul around the meal table during the eighteen months they were together. Priscilla and Aquila provide an example of volunteering and the focus of this paper is on the formation of volunteers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Christians and Buddhists: Together in HopeCardinal Francis ArinzeDear Buddhist Friends,1. On the occasion of Vesakh, which celebrates important events in the life of Buddha, I wish to express to you, in my capacity as president of the Pontifical Council for Interreligious Dialogue, the best wishes of Catholics throughout the world.2. I am happy to say that ongoing dialogue between Buddhists and Christians is distinguished by efforts to meet at (...) the level of religious experience. Both Buddhism and Christianity emphasize the “contemplative dimension” in their practice of religion. Since 1979, through the “Intermonastic Spiritual Exchange” and the “Monastic Hospitality Programme,” Buddhists and Christians who are committed to a contemplative life through their respective monastic disciplines have engaged in encounters where in-depth dialogue is possible. This effort is truly commendable.3. It is hope of new life that has been at the source of our dialogue, although our understanding of this new life differs. For us Christians, the new life is to be sought and found only in Jesus Christ. Jesus indicated the way when he said: “I am the way, the truth and the life” (John 14:6). He taught us not only not to engage in revenge, but to defeat evil with good. He said: “You have learnt how it was said: Eye for eye and tooth for tooth. But I say this to you: offer the wicked man no resistance. On the contrary, if anyone hits you on the right creek, offer him the other as well” (Matthew 5:38–39). This makes me think of Ven. Maha Ghosananda’s rendering of one of the teachings of Buddha: “When we are wronged, we must set aside all resentment and say, ‘My mind will not be disturbed. Not one angry word will escape from my lips; I will remain kind and friendly, with loving thoughts and no secret malice.’”4. Hope rescues us from discouragement. We are enabled to begin anew by perceiving around us numerous “signs of hope”: the growing solidarity among people in our time, especially with the poor and destitute, the desire for justice and peace, voluntary service, the return of the search for transcendence, an awareness of human dignity and of the rights that flow from it, attention to the environment, and so on. I wish to mention here a particular sign of hope, which Pope John Paul II has underlined—namely, interreligious dialogue.5. People of hope are, at the same time, realists who do not close their eyes to reality with all its positive and negative aspects. We cannot turn a blind eye to the [End Page 199] dramatic crises of our world: the wars between different countries, civil wars, terrorism in all its forms, injustice that is forever widening the gap between rich and poor, hunger, the lack of shelter, unemployment—especially among the youth, globalization without solidarity, the heavy burden of external debt, the problem of drugs, immorality, abortion. The list could be extended. Nevertheless, the small lamp of hope must always remain alight, shining on the paths leading humanity to a better future.6. We Christians and Buddhists, embarked on our respective spiritual paths, can work together to give increased hope to humanity. Yet first we must accept our differences and show each other mutual respect and true love. This will render us more credible, and we shall be for humanity a further sign of hope in addition to those that exist already.7. It is in this spirit that I convey to you once again, dear Buddhist friends, my best wishes for the feast of Vesakh.Cardinal Francis ArinzePontifical Council for Interreligious DialogueCopyright © 1999 The University of Hawai’i Press... (shrink)

Background Voluntary assisted dying became lawful in Victoria, the first Australian state to permit this practice, in 2019 via the Voluntary Assisted Dying Act 2017 (Vic). While conscientious objection by individual health professionals is protected by the Victorian legislation, objections by institutions are governed by policy. No research has been conducted in Victoria, and very little research conducted internationally, on how institutional objection is experienced by patients seeking assisted dying. Methods 28 semi-structured interviews were conducted with 32 family (...) caregivers and one patient about the experience of 28 patients who sought assisted dying. Participants were interviewed during August-November 2021. Data from the 17 interviews (all with family caregivers) which reported institutional objection were analysed thematically. Results Participants reported institutional objection affecting eligibility assessments, medication access, and taking the medication or having it administered. Institutional objection occurred across health settings and was sometimes communicated obliquely. These objections resulted in delays, transfers, and choices between progressing an assisted dying application and receiving palliative or other care. Participants also reported objections causing adverse emotional experiences and distrust of objecting institutions. Six mediating influences on institutional objections were identified: staff views within objecting institutions; support of external medical practitioners and pharmacists providing assisted dying services; nature of a patient’s illness; progression or state of a patient’s illness; patient’s geographical location; and the capability and assertiveness of a patient and/or caregiver. Conclusions Institutional objection to assisted dying is much-debated yet empirically understudied. This research found that in Victoria, objections were regularly reported by participants and adversely affected access to assisted dying and the wider end-of-life experience for patients and caregivers. This barrier arises in an assisted dying system that is already procedurally challenging, particularly given the limited window patients have to apply. Better regulation may be needed as Victoria’s existing policy approach appears to preference institutional positions over patient’s choice given existing power dynamics. (shrink)

Numerosos cambios se suceden a nivel mundial. El ocio, como elemento social y cultural, no permanece ajeno a tal evolución y, a su vez, contribuye desde el punto de vista personal, social y económico, a la configuración de determinados hábitos, estilos de vida, formas diferentes de entender el descanso y desarrollo recreativo de nuevas actividades. En este artículo se plantea el uso del ocio, tiempo libre y voluntariado, desde el colectivo de las personas mayores, destacando la importancia de su participación (...) a través de distintas tareas. Esto supone una importante inversión de tiempo, conocimientos y apoyo afectivo, que no siempre es reconocido ni valorado por el resto de la sociedad. Concluimos destacando cómo la acción educativa a través de programas de ocio ha modificado su concepción y se define a través de parámetros que hacen referencia a la autonomía, desarrollo, relación, participación y creatividad, también en las personas de más edad. (shrink)

In a health service with limited resources we must make decisions about who to treat first. In this paper I develop a version of the restoration argument according to which those whose need for resources is a consequence of their voluntary choices should receive lower priority when it comes to health care. I then consider three possible problems for this argument based on those that have been raised against other theories of this type: that we don't know in a (...) particular case that the illness is self-inflicted, that it seems that all illness is self-inflicted in the sense used in my argument, and finally that this type of approach incorporates an unacceptable moralising element if it is to avoid giving those like fire-fighters a lower priority for treatment. I argue that the position outlined here has the resources to respond to each of these objections. (shrink)

Far from being indiscriminately critical of the ideas he associated with the morality system, Bernard Williams offered vindicatory explanations of its crucial building blocks, such as the moral/non-moral distinction, the idea of obligation, the voluntary/involuntary distinction, and the practice of blame. The rationale for these concessive moves, I argue, is that understanding what these ideas do for us when they are not in the service of the system is just as important to leading us out of the system as (...) the critique of that system. I then show how regarding the aspiration to shelter life from luck as the system’s organizing ambition explains why the system elaborates and combines these building blocks in the way it does. Finally, I argue that the ultimate problem with the resulting construction is its frictionless purity. It robs valuable concepts of their grip on the world we live in, and, by insisting on purity from contingency, threatens to issue in nihilism about value and scepticism about agency. (shrink)

Over the last decades, consistent research showed that voluntary work could be considered as a tool for professional development and concrete employment: volunteering could be either experienced as a desire to improve career opportunities or to acquire new skills. The study aimed to investigate voluntary work as a context of informal and non-formal workplace learning and vocational guidance, useful to develop skills and abilities, namely the capital of personal and social resources, that could promote future employability. Participants were (...) 38 young volunteers who experienced the Universal Civil Service, a national Italian program addressed to young people aged up to 28 years, giving them both the opportunity to engage in social activities useful for the community and have the first contact with a working context. In line with the objectives of the study, participants were invited to describe their volunteering experience in a diary, highlighting if and to what extent this context contributed to enhancing their employability capital, namely the asset of skills, knowledge, and networks acquired, that they could transfer to a future professional domain. The narrative data collected were examined through diatextual analysis, a specific address of discourse analysis designed to catch the relationship between enunciators, text, and context of the talk. This qualitative analysis allowed us to investigate the meanings young people attributed to these activities. In light of these results, the paper contributed to investigate volunteers’ perceptions about the conditions that could best foster this specific kind of workplace informal and non-formal learning and at proposing a qualitative perspective on the analysis of the employability capital they developed. (shrink)

The main indicators of assistance activity in the insurance market in Ukraine have been analyzed. Beneficial and negative trends of its development have been shown. The dynamics of the insurers' liquidation expenses structure and the payment of services expenses of the assistance establishments have been highlighted. Their structure has been shown due to the types of voluntary and compulsory insurance. The main problems hindering the effective development of the assistance services market have been characterized and the prospects (...) of its development have been offered. The aim of the research is to carry out comprehensive analysis of the current market of assistance services, to identify the main problems of their implementation and to point out the prospects of insurance market development. The dynamics of insurance bonuses and benefits including insurance compensation and services and the insurers' operating expenses concerning the payment of services of the assistance establishments has been analyzed on the basis of a sample survey of the main indicators of insurance market development due to the statistic data of National Committee of Financial Services. It has been revealed that majority of the insurance services provide settlement of insurance claims by offering assistance service. Alongside increasing of the share of insurance payment due to the contract providing the insurance service, allows the majority of insurance claims to be settled due to the payment of insurance compensation. Expenses on assistance services were the highest and the court expenses were the lowest in the structure of the insurer's liquidation expenses during 2011-2014. Expenses on services of the non-residential assistance establishments are low but they are increasing. It shows that emergency assistance to our citizens in the country and outside is being increased. Structure of assistance services in the voluntary and compulsory insurance market has been analyzed; main trends of assistance activity development according to the separate insurance services have been highlighted. In particular it was found out that the greatest amount of assistance services were provided due to the voluntary medical insurance, medical costs insurance, land transport insurance and compulsory insurance of civil liability of the owners of vehicles. On the basis of conducted analysis, we can draw a conclusion about the low level of assistance services market development. It is affected by negative trends of economic and political crisis, low solvency of insurers and the quality of insurance services, a lack of guaranties to provide emergency assistance in time, imperfect state regulation of assistance services provision, and a low level of institutional support. We offer to intensify the interaction between the insurers and assistance companies while providing insurance services including additional ones, insurance compensation, and settlement of insurance claims by ensuring emergency assistance in monetary and natural-material form. This will promote the increasing of quality of the insurance protection. (shrink)

Voluntary participation is connected to cultural, political, religious and social contexts. Social and societal factors can provide opportunities, expectations and requirements for voluntary activity, as well as influence the values and norms promoting this. These contexts are especially central in the case of voluntary participation among students as they are often responding to the societal demands for building a career and qualifying for future assignments and/or government requirements for completing community service. This article questions how cultural values (...) affect attitudes towards volunteerism, using data from an empirical research project on student volunteering activity in 13 countries in North America, Europe, the Middle East, and the Asia Pacific region. The findings indicate that there are differences in motivation between countries which represent different cultural values. This article sets these findings in context by comparing structural and cultural factors which may influence volunteerism within each country. (shrink)

In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26·4%), low knowledge of HIV status and a total fertility rate of 3·5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15–49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their (...) need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services. Copyright © Cambridge University Press 2008. (shrink)

Responsible Care is a voluntary code of conduct developed, enforced, and monitored by the Chemical Manufacturers Association. Voluntary codes could be designed and enforced by regulators, nonprofit groups, industry associations, and individual firms. They could vary in their scope, focusing on firms around the globe, in a given region, within a country, or in a given industry. This article focuses on Responsible Care’s self-regulatory services that pertain to establishing, monitoring, and enforcing industry-wide environmental, health, and safety standards. (...) Employing insights from the club theory, stakeholder theory, institutionalist theory, and the corporate social performance perspective, it examines the demand and supply sides of voluntary codes. Finally, it discusses theoretical implications and the key challenges faced by Responsible Care in the future. (shrink)

When clinical services aspire to quality improvement, creative and innovative approaches to old problems are needed to drive such change. Whilst new ef orts should be applauded, information on this topic can be somewhat grey from an ethical and research point of view. Within the mental health profession there is currently an expectation to routinely evaluate care and disseminate i ndings. The notion of service enhancements under the guise of routine practice is an interesting and untested ethical issue. Should (...) clinical innovation continue to enjoy such impunity as patient autonomy is often compromised as they are often compelled to accept treatment under the coercion of mental health legislation? We believe that it should not. All involvement in any form of research is voluntary, thus patients should also have the right to decline participation in quality projects if they wish to do so. (shrink)

This article reflects on the skills required in trades services to people dedicated to coordinate services in complex clinical situations because of their multidimensionality and chronicity. All human activity requires for its proper effectuation, the coordination of interdependencies between actors. Coordination of interdependencies is done in ordinary mode, in everyday activities, but also in dedicated mode, that is to say, through a practice that has a primary mandate to manage them in a conscious, voluntary and accountable for (...) intervention situations whose complexity is high. This passage from the ordinary form in the form of dedicated coordination undertakes a transformation of skills and professional knowledge mobilized in the professional gesture. Further skills and knowledge relating to the disciplinary control of clinical objects, the case manager or professional figure who best embodies this form of coordination, should mobilize expertise and procedural knowledge (assessment, planning, communication, negotiation, activation networks, etc..) required to control the interfaces between technical systems and professional and organizational actors, posing as the interdependence of actants primary purpose in work. For this he must do it in a time of temporality combining organizational project in clinical time. e présent article réfléchit aux compétences requises dans les métiers de services aux personnes dédiés à coordonner les services dans les situations cliniques complexes en raison de leur multi-dimensionnalité et leur chronicité. Toute activité humaine exige, pour sa bonne effectuation, la coordination des interdépendances entre les acteurs concernés. La coordination des interdépendances se réalise en mode ordinaire, dans les activités de tous les jours, mais aussi en mode dédié, c’est-à-dire à travers une pratique qui a pour mandat principal de les gérer de manière consciente, volontaire et imputable pour les situations d’intervention dont la complexité est grande. Ce passage de la forme ordinaire à la forme dédiée de coordination engage une transformation des compétences et savoirs professionnels mobilisés dans le geste professionnel. En outre des compétences et savoirs relatifs à la maîtrise des objets cliniques disciplinaires, le gestionnaire de cas, soit la figure professionnelle qui incarne le mieux cette modalité de coordination, doit mobiliser des compétences et savoirs procéduraux (évaluation, planification, communication, négociation, activation de réseaux, etc.) requis à la maîtrise des interfaces entre systèmes techniques et acteurs professionnels et organisationnels, en posant l’interdépendance des actants comme objet premier de son action professionnelle. Pour cela, il doit effectuer cette dernière dans une temporalité conjuguant le temps du projet organisationnel au temps clinique. (shrink)

Background Healthcare services are increasingly being shifted to home settings for patients nearing end-of-life. Consequently, the burden on family caregivers is significant. Their vulnerable situation remains poorly understood and there is little information available regarding their experiences of dignity. Aim This study seeks to understand the experiences of family caregivers related to dignity and loss of dignity, aiming to provide a deeper insight into their situation when caring for a home-dwelling family member nearing end-of-life. Research design and participants This (...) exploratory study consists of a second analysis combining data from two primary studies, including 24 family caregivers of a family member nearing end-of-life, and is founded upon Gadamer’s philosophical hermeneutics. Ethical considerations Approval was obtained from the Norwegian Agency for Shared Services in Education and Research and was based on voluntary participation, informed consent, and confidentiality. Results The following three main themes were identified: Having a meaningful existence within the living environment, being seen and valued as a family caregiver in relation with others and suffering in a space of loneliness. These contextual, relational, and existential perspectives were found to be closely interrelated. Conclusion and final considerations The dignity of family caregivers was closely tied to being seen as unique individuals, not merely caregivers, thereby requiring healthcare professionals (HCPs) to understand their personal needs. This study highlights the emotional distress and loneliness family caregivers feel in their dual role within the healthcare system, thereby calling for HCPs to adopt an attitude of gentleness and recognition to impart dignity-preserving care in homecare practices. (shrink)

Mental health research and care in the twenty first century faces a series of conceptual and ethical challenges arising from unprecedented advances in the neurosciences, combined with radical cultural and organisational change. The Oxford Textbook of Philosophy of Psychiatry is aimed at all those responding to these challenges, from professionals in health and social care, managers, lawyers and policy makers; service users, informal carers and others in the voluntary sector; through to philosophers, neuroscientists and clinical researchers. Organised around a (...) series of case studies in five key topic areas - concepts of disorder, the philosophical history of psychopathology, philosophy of science, ethics and philosophical value theory, and philosophy of mind - the book provides a detailed introduction to the field and a framework for study and skill development. Each case study is supported by selected readings from both philosophy and mental health, thinking skills exercises, self-test questions, key learning points and detailed guides to further reading. There is an introduction for philosophers to classification and descriptive psychopathology, and for practitioners to philosophical methods (including logic). The philosophical topics covered include philosophical methods (analytic and Continental); phenomenology, hermeneutics and existentialism, logical empiricism and its successors; idealism and realism; reasons and causes; and modern theories of mind and brain, free will and personal identity. Topics from mental health include psychiatry and 'anti-psychiatry'; Jaspers' psychopathology and the new neurosciences; the future of psychiatric classifications; strengths-based approaches, recovery practice, social inclusion and diversity; and key topics in psychopathology, such as delusion, autism, disorders of volition, thought insertion and other experiences in schizophrenia. The Oxford Textbook of Philosophy of Psychiatry aims to secure the skills-base of the discipline by bringing philosophers closer to the realities of practice in mental health, and mental health practitioners closer to the resources of philosophy as a partner to the sciences in responding to the challenges of twenty-first century mental health and social care. (shrink)

Background: In accordance with ethical guidelines for nurses, leaders for nurse services in general are responsible for facilitating professional development and ethical reflection and to use ethical guidelines as a management tool. Research describes a gap between employees’ and nurse leaders’ perceptions of priorities. Objective: The purpose of this article is to gain deeper insight into how nurses as leaders in somatic hospitals describe ethical challenges. Design and method: We conducted individual, quality interview with 10 nurse leaders, nine females (...) and one male nurse aged 34–64 years. We used a hermeneutical approach to analyse the data. Ethical considerations: The participants received oral and written information about the study. Participation in the study was voluntary, and the participants were given the opportunity to withdraw. All of them gave written consent. The Norwegian Centre for Research Data approved the research project. In addition, the head of the hospitals gave permission to conduct our study. Findings: Four main areas were identified: deficient ethical language, conflicting demands on nurse leaders regarding staff management, concerns regarding young nurses’ ethical consciousness and restricting factors on the creation of a climate of ethics. The nurse leaders experienced considerable pressure. An unexpected finding was the lack of – and even disregard for – an ethical language. Discussion and conclusion: It is crucial to recognise ethics in all types of nursing approaches and to make it explicit. Ethical language must be implemented in nursing education. It must be recognised and used in clinical practice. Recommendations: We recommend further research be conducted into how nurses understand the concept of ethics and how to incorporate ethical principles into clinical nursing and nurse leadership. (shrink)

Background Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals’ handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools. Research aim This study aimed to explore healthcare leaders’ expectations of using a digital tool for ethical reflection among their home nursing care staff. Research design A qualitative research design with vignettes and focus group interviews (...) was used. The data were analyzed using reflexive thematic analysis. Participants and Research Context The sample comprised ten healthcare leaders from municipal long-term care in Norway. Ethical Considerations Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study. Findings The analysis resulted in the development of three themes representing leaders’ expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling. Discussion Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees’ activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool’s potential to ensure continuity in ethics work requires considerable organizational and leader involvement. Conclusions This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified. (shrink)

Earth’s life-support system is facing megaproblems of sustainability. One important way of how these problems can be addressed is through innovation. This paper argues that responsible innovation that contributes to sustainable development consists of three dimensions: innovations avoid harming people and the planet, innovations ‘do good’ by offering new products, services, or technologies that foster SD, and global governance schemes are in place that facilitate innovations that avoid harm and ‘do good.’ The paper discusses global governance schemes based on (...) deliberation as a means to foster such responsible innovation. These schemes can provide voluntary soft-law regulations that complement and extend national and international hard-law regulations and facilitate collective innovation that contributes to SD goals. The article addresses the facilitative role of governments and international organizations in overcoming problems of deliberation and offers illustrative examples of such governance schemes. (shrink)

Background In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences. Objectives This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations. Research design A cross-sectional survey was conducted among care providers who (...) worked in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ). Ethical considerations Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data. Results Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score. Discussion Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection. Conclusions The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes. (shrink)

For most of the problems that economists consider, the assumption that agents are self-interested works well enough, generating predictions that are broadly consistent with observation. In some significant cases, however, we find economic behavior that seems to be inconsistent with self-interest. In particular, we find that some public goods and some charitable ventures are financed by the independent voluntary contributions of many thousands of individuals. In Britain, for example, the lifeboat service is entirely financed by voluntary contributions. In (...) all rich countries, charitable appeals raise large amounts of money for famine relief in the Third World. The willingness of individuals to contribute to such projects is an economic fact that requires an explanation. (shrink)

Background: Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents’ recovery. However, many studies have been conducted on exploring the concept of the patients’ dignity from the adult patients and fewer studies still have explored the dignity of young people. Objective: This study explores the (...) hospitalized adolescents’ perception about dignity. Research design: A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents’ dignity. Participants and research context: Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13). Ethical considerations: Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees. Findings: Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication. Discussion and conclusion: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent’s identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses. (shrink)