Ethical Decision Research Articles

Ethical boundary decisions in intensive care medicine

Ethical decision-making is acornerstone of intensive care and emergency medicine. In acute scenarios, clinicians often face rapid, high-stakes decisions concerning life and death, made more challenging by time constraints and incomplete information. These decisions are further complicated by economic constraints, limited resources, and evolving technological capabilities. What decision-making aids and factors can be employed in ethical borderline cases within intensive care medicine? Fundamental ethical principles such as patient autonomy, beneficence, non-maleficence, and justice form the basis for medical treatment decisions. Evaluating the patient's will through advanced directives or proxy consensus is crucial, although advanced directives can be ambiguous. Assessing quality of life is increasingly important, with instruments such as the Clinical Frailty Scale (CFS) being utilized. For older patients, aholistic approach is recommended, focusing on overall health rather than chronological age. In patients with advanced underlying diseases, amultidisciplinary dialogue is essential. Decision-making in intensive care medicine requires careful consideration of medical, ethical, and individual factors. Despite advances in artificial intelligence and prognostic models, human judgment remains crucial. During periods of resource scarcity, ethically sound triage protocols are required. The challenge lies in applying these principles and factors in clinical practice while respecting the individuality of each patient.

Ethics Project Mata Kuliah Etika Kristen dalam Meningkatkan Keterampilan Berpikir Kritis Mahasiswa Indonesia

The project shows that Christian ethical principles provide a strong foundation for Indonesian students to understand values such as 1) love, 2) justice, and 3) responsibility, which can help Indonesian students improve their critical thinking skills. The purpose of this study is to explore the impact of the ethics project in the Christian Ethics course on improving the critical thinking skills of Indonesian students. The methods used include active learning through discussions, case studies, and social projects that integrate Christian ethical values. As such, the results of the evaluation showed that there was a significant improvement in Indonesian students' ability to analyze and formulate ethical decisions. Thus, this project contributes to the formation of a generation of students who are more sensitive to ethical and social issues in societ.

Spirit at work: a panacea for ethical problems caused by marketing managers’ love of money

Purpose Limited research has investigated how spirit at work, functioning as a “good barrel,” fosters ethical decision-making (EDM) even in the presence of unethical managerial behavior (“bad apples”). Therefore, this study aims to investigate the spirit at work, a situational variable, as a moderating variable in the relationship between the love of money (LoM), an individual-level factor, and EDM. Design/methodology/approach A time-lagged survey of the members of the Marketing Association of Pakistan was conducted. The data were analyzed using partial least square structural equation modeling. Findings Adding to much of the existing research, which finds that LoM can influence ethical intention directly, this research finds that LoM influences ethical intention only through ethical judgment. Moreover, the spirit at work tempers the negative relationship between LoM and ethical judgment, thereby mitigating LoM’s detrimental effects not only on ethical judgment but also its downstream effects on ethical intention. Practical implications Organizations, by planting the seeds of spirit at work, can institutionalize good barrels, which can alleviate the negative effects of the marketing managers’ LoM, the root cause of unethical behavior. This way, this study establishes a business case for spirit at work. Originality/value The novelty of this study is the development and investigation of a holistic conceptual framework for EDM of marketing professionals that incorporates LoM as an antecedent, ethical judgment as an underlying mechanism, ethical intention as an outcome variable and spirit at work as a boundary condition.

Flipping the script: Assessing clinical judgement in student-led clinical evaluation

Introduction and background: Strong clinical judgement and reflective thinking and practice are imperative to make safe, ethical clinical decisions, particularly in today’s complex healthcare environment. Yet clinical judgement and underlying thinking are challenging to assess in post-licensure specialty nursing clinical education due to their complexity and invisibility.Methods: Problem: Clinical evaluation can be subjective, based on observed behaviours rather than on assessment of thinking processes and clinical judgement underlying students’ clinical decisions and actions. Approach: The BCIT Clinical Evaluation Tool (CET) and Evaluation Process (CET-EP) were developed using a shared accountability approach that shifts responsibility for demonstration of learning from instructor/preceptor to student, and facilitates the reflective thinking and practice necessary to develop clinical judgment.Conclusions: Use of this CET-EP in post-licensure specialty certificate programs has assisted instructors, preceptors, and students to reach insights into learners’ thinking, tailor learning interventions, and promote reflective practice, as well as provided greater objectivity in clinical evaluation.

Using the moral intensity framework to examine whether colleges should have reopened in late 2020 for in-person learning: an in-depth analysis of data from the United States with global implications for higher education

ABSTRACT The decision whether to reopen universities for in-person learning in late 2020 relied on ethical decision-making where the consequences were dire to the mission of the institution, health of the community, financial well-being of the institution and employees, and had political ramifications. The risks that universities faced worldwide included health risks to students, faculty, staff, and the community; financial risks to the institution and employees; and mission risks of the institution. Each of these risks had ethical implications. University reopening decisions were made in the United States as the number of COVID-19 cases and deaths were surging globally. Applying a moral intensity framework that assesses the in-person learning decision against six dimensions and using data collected from 62 universities, we show that social consensus and risk mitigation measures designed to reduce the magnitude of consequences and temporal immediacy were important factors in deciding to offer in-person classes. An ex-post facto analysis of COVID-19 infection and death data suggests that university administrators made an ethical decision. When facing a similar crisis management scenario in the future, a moral intensity framework could help university administrators worldwide understand the issues and allow them to make an ethical decision.

Ethical Decision Dilemma for Tax Consultants in Tax Planning

Tax consultants contribute to assisting taxpayers in overcoming difficulties caused by the complexity of tax rules. Reliable tax consultants tend to provide aggressive advice. Tax consultants as professionals must uphold the code of ethics and applicable tax rules. In this condition, tax consultants are faced with a dilemma in making ethical decisions. This study aims to interpret more deeply how the integrity of tax consultants in facing ethical decision dilemmas in conducting tax planning using a transcendental phenomenological approach. The results of this study show that tax consultants face several dilemmas, including: ethical decision dilemmas due to unclear regulations and client interest factors and responsibility to the state for tax revenue. Experienced tax consultants can overcome the dilemma by continuing to exercise good self-control, and still adhere to the rules and code of professional ethics.

Overview of Ethical Reasoning in Nursing: A Scoping Review

Introduction: Nurses are anticipated to address diverse human needs, leading to the emergence of numerous ethical challenges in their daily practice. Contemporary nursing requires proficiency not only in advanced medical-technical skills but also competence in focusing on the ethical dimensions, including ethical reasoning and decision-making, inherent in-patient care. Negotiating the ethical intricacies of treatment in practical scenarios presents a significant challenge for nurses. Despite the complexity, ongoing review and improvement are necessary to uphold professional standards and prioritize patient well-being.Aim: The objective of this scoping review is to describe the landscape of nurses' ethical reasoning and the process of ethical reasoning in nursing practice.Methods: A scoping review was conducted based on the Arksey and O'Malley framework, spanning publications released from 1990 to 2023, utilizing electronic databases including PubMed, ScienceDirect, Google Scholar, and CINAHL. Diverse keywords were employed to optimize the search strategy. The review process encompassed examining 21 finalized articles selected using the PRISMA guideline, comprising qualitative, quantitative, and mixed-methods studies.Findings: This review identified two main domains: Factors for ethical reasoning in nursing and the ethical frameworks utilized. Nurses employ individual-related and profession-related factors to navigate ethical reasoning. Ethical frameworks, including principle-based approaches, ethical decision-making models, ethical theories; deontology, and utilitarianism, provide structured methods for ethical reasoning.Conclusions: The scoping review highlights the importance of ethical reasoning and frameworks in nursing, identifying key approaches, principle-based methods, and ethical decision-making models. It underscores the need for practical application and integration of ethical reasoning education in nursing to enhance quality patient care and decision-making.

Respect for history: an important dimension of contemporary obstetrics & gynecology.

"Those who cannot remember the past are condemned to repeat it." This maxim underscores the importance of historical awareness in medicine, particularly for obstetricians and gynecologists (ObGyns). ObGyns significantly impact societal health through their care for pregnant women, fetuses, and newborns, uniquely positioning themto advocate for health initiatives with lasting societal benefits. Despite its importance, the history of medicine is underrepresented in medical curricula, missing opportunities to foster critical thinking and ethical decision-making. In today's climate of threatened reproductive rights, vaccine misinformation, and harmful ideologies, it is imperative for ObGyns to champion comprehensive historical education. The history of medicine, particularly in relation to societal issues- such as racism, discrimination, genocides, pandemics, and wars- provides valuable context for addressing challenges like maternal mortality, reproductive rights, vaccine hesitancy, and ethical issues. Understanding historical milestones and notable ethical breaches, such as the Tuskegee Study and the thalidomide tragedy, informs better practices and safeguards patient rights. Technological advancements in hygiene, antibiotics, vaccines, and prenatal care have revolutionized the field, yet contemporary ObGyns must remain vigilant about lessons learned from past challenges and successes. Integrating historical knowledge into medical training enhances clinical proficiency and ethical responsibility, fostering innovation and improving health outcomes. By reflecting on historical achievements and their impacts, current and future ObGyns can advance the field, ensuring comprehensive and ethically sound approaches to patient care. This paper highlights the crucial role of historical knowledge in shaping modern ObGyn practices, advocating for its integration into medical education to address contemporary health challenges and ethical considerations.

Social media and the ordinary: Marginalized voices in neo/non-liberal China

Thirty years into China’s internet development, much recent scholarship has focused on rather daunting forces—big data, algorithmic control, surveillance, and platformization, to name a few. This article centers the “small,” or how social media is articulated to the ordinary practices, pursuits, feelings, passions, ethical decisions, and struggles for voice of people who are socially, economically, and/or politically marginalized. I focus on these processes and practices among marginalized young creatives and domestic workers in a context I call “neo/non-liberal China,” which manifests as an amplification of prior discourses regarding self-responsibilization, happiness, and harmony along with greater social stratification, platformization, repression, and an emphasis on creativity and innovation. The analysis is grounded in theories of “ordinary affects,” or the inarticulable energies, passions, and forces that move bodies, and “ordinary ethics,” or the ethical aspects of practices, choices, and judgments that make up daily life and, thus, selfhood. I argue that centering diverse marginalized individuals’ passions, feelings, and ordinary ethical decisions, as these are articulated to social media, enables deeper insight into their dreams and goals and the challenges and obstacles they face in achieving these. Their experiences also speak to larger ongoing transformations in China.

Ethical Decision-making Using Trauma-Informed Principles: A Case Example.

Ethical Decision-making Using Trauma-Informed Principles: A Case Example.

Good/bad apples and good barrels: the interactive effect of religiosity and ethics institutionalization on ethical decision-making

Good/bad apples and good barrels: the interactive effect of religiosity and ethics institutionalization on ethical decision-making

Use of AI in Pediatric Occupational Therapy: A Review

The utilization of artificial intelligence (AI) in pediatric occupational therapy (OT) has emerged as a promising avenue for enhancing assessment, intervention, and outcomes for children with diverse developmental needs. This paper provides a comprehensive review of the current state of AI applications in pediatric OT, highlighting key findings, benefits, challenges, and future directions. AI technologies, including machine learning algorithms, computer vision systems, and wearable sensors, offer innovative approaches to assess children's motor skills, sensory responses, and cognitive functions objectively and efficiently. AI-driven intervention strategies, such as personalized treatment planning, adaptive task selection, virtual reality environments, and gamified activities, promote engagement, motivation, and skill acquisition among pediatric patients. AI can be helpful in early diagnosis as well as early intervention. Additionally, AI-powered telehealth platforms enable remote delivery of OT services, real-time monitoring of patient progress, and access to care for underserved populations. However, challenges related to data privacy, ethical decision-making, disparities in access, and therapist education must be addressed to ensure the ethical, effective, and equitable integration of AI into pediatric OT practice. By embracing ongoing research, collaboration, and innovation, pediatric OT practitioners can harness the transformative potential of AI to improve outcomes and quality of life for children and families worldwide.

Inverse relationships between cultural sustainability and human rights: the counterintuitive cases of Nigerian Avu Udu dance and white-power music

ABSTRACT This article examines ethical complexities of sustaining and safeguarding intangible cultural practices. Could safeguarding efforts violate human rights? In what circumstances could allowing a practice to die out be more ethically defensible than seeking to sustain it? And when, if ever, might it be ethically defensible to attempt to ‘kill’ a cultural practice? Presenting and employing a conceptual matrix to theorise the relationships between cultural sustainability and human rights, we examine two contrasting and counterintuitive contemporary cases where sustaining or safeguarding a cultural practice and acting ethically are not, or not necessarily, coincident: the Nigerian Igbo pot drum dance Avu Udu, and white-power music. These cases underscore the breadth and ethical complexities of the links between cultural sustainability and human rights, raise ethically consequential questions for safeguarding policy and practice, and offer insights that could help cultural stakeholders make more ethical decisions about safeguarding.

Developing Servant Leadership through Experience and Practice: A Case Study in Service Learning.

Servant leadership is characterized by a core altruistic calling and central attributes of genuine caring, humility, and empathy, and in recent years, has become a style of leadership recommended to be addressed in sports management classrooms because of its associated positive outcomes and emphasis on ethical behavior and decision-making. As the relevance and popularity of servant leadership continue to grow, it gives rise to matters of how this approach to leadership can be better studied and taught to current and aspirant sports professionals. Thus, the purpose of this qualitative case study is to analyze a community-based service-learning project as a mode for developing servant leaders as part of a college sports management curriculum. Nineteen upper-level college sports management students participated in this study by serving as mentors in an after-school program for underprivileged elementary school students for 12 h across the course of six weeks. Participants then completed a written reflection upon the conclusion of the service project. Content analysis of these reflections suggests that service learning may be a positive method for developing servant leaders. The article closes with a discussion of findings, proposed future research questions, as well as ideas for future service-learning projects aimed at developing servant leaders.

Balancing constraints and requirements in an application process

ObjectivesDeveloping a rigorous application process for linked data within the UK Longitudinal Linkage Collaboration’s Trusted Research Environment (TRE) included balancing the requirements of >20 longitudinal studies and several data providers with the need to provision data to researchers in a safe, ethical and efficient manner. ApproachUK LLC was commissioned as a resource to enable the investigation of COVID-19 questions: a secure setting where longitudinal population studies (LPS) can be linked efficiently to regularly refreshed NHS electronic health records, and then accessed by researchers. UK LLC received funding to continue as a resource for any research in public good and to link to the administrative records (education, occupation, tax and benefits). To accommodate the constraints imposed by a new set of data controllers and to account for wide variety of proposals expected, we expanded our data access process. ResultsUK LLC has a three-stage application and review process. The addition of administrative data meant that there is additional review for those applications requesting that data (Stage 4) and need to align processes with the UK Statistics Authority. There is also need to review complexity of the data requests and ethical implications of any application to access the data. We have developed an ethics decision tree to help guide the decision making around ethics requirements. ConclusionOur process is evolving as we are trying to meet the challenge of balancing the needs of >20 studies, stakeholders, applicants, and participant/public contributors, to create a process that can handle complex needs and requirements.

Unveiling Ancient Wisdom: The Bhagavad Gita’s Influence on Modern Management and Leadership

The Bhagavad Gita offers deep insights into human behaviour, ethics, and leadership, promoting principles such as selfawareness, ethical decision-making, resilience, and the pursuit of excellence. Objectives: This paper aims to synthesize spiritual principles from the Bhagavad Gita with practical management strategies to inspire leaders to cultivate a deeper understanding of themselves, their teams, and their organizations, fostering a culture of purpose, integrity, and holistic growth. Methodology: A qualitative approach is used, analyzing the Bhagavad Gita’s teachings through the lens of contemporary management theories, involving a literature review and thematic analysis. Findings: Key themes from the Bhagavad Gita applicable to modern leadership include self-awareness, ethical decision-making, resilience, and the pursuit of excellence. Results: Integrating these principles into management practices enhances leadership effectiveness, improves team dynamics, and fosters a cohesive organizational culture, inspiring trust and driving sustainable success. Social Implications: Incorporating the wisdom of the Bhagavad Gita can create workplaces that prioritize well-being, ethical conduct, and personal growth, transforming organizational environments to be more inclusive and purposedriven. Conclusion: The Bhagavad Gita offers timeless principles that, when combined with modern management practices, can enhance leadership effectiveness, providing a framework for navigating the ever-changing business landscape with authenticity, integrity, and purpose.

Theoretical foundations of clinical ethics consultation in psychiatry

Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice. Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare. Conceptual and ethical analyses. After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed. Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants.

Gender Differences in the Perception of Ethics and Civic Moral Disengagement in Medical Doctors

The present study aims to find the gender differences in the perception of doctors while making ethical decisions and their level of civic morality. A simple distinction between ethics and morality would be that ethics are in reference to an external source, they come from the work environment. A comparative research design has been used in this study for which a Purposive sampling strategy was selected. The participants of the study selected were 75 male and 75 female doctors aged 25-40 years, practicing in Jinnah Hospital and Services Hospital, Lahore. Ethics Position Questionnaire (EPQ) and Moral Disengagement Scale (MDS) were utilized to collect the data. To identify the differences among the variables Independent Sample T-test was administered on the collected data. The results of the study revealed that there is no significant difference in the perception of ethics and civic moral disengagement, this brought to the view that gender alone does not influence one’s ethics, pro-social reasoning, and behavior. The findings of this current research state that there are no differences among doctors working in two different locations, among genders, or between ethics and civic moral disengagement. This would be helpful to know because doctors constantly face questions regarding ethics and have to make fast, effective decisions that will affect their patient's life.

Coaching doctors to improve ethical decision-making in adult hospitalized patients potentially receiving excessive treatment. The CODE stepped-wedge cluster randomized controlled trial.

The aim of this study was to assess whether coaching doctors to enhance ethical decision-making in teams improves (1) goal-oriented care operationalized via written do-not-intubate and do-not attempt cardiopulmonary resuscitation (DNI-DNACPR) orders in adult patients potentially receiving excessive treatment (PET) during their first hospital stay and (2) the quality of the ethical climate. We carried out a stepped-wedge cluster randomized controlled trial in the medical intensive care unit (ICU) and 9 referring internal medicine departments of Ghent University Hospital between February 2022 and February 2023. Doctors and nurses in charge of hospitalized patients filled out the ethical decision-making climate questionnaire (ethical decision-making climate questionnaire, EDMCQ) before and after the study, and anonymously identified PET via an electronic alert during the entire study period. All departments were randomly assigned to a 4-month coaching. At least one month of coaching was compared to less than one month coaching and usual care. The first primary endpoint was the incidence of written DNI-DNACPR decisions. The second primary endpoint was the EDMCQ before and after the study period.Because clinicians identified less PET than required to detect a difference in written DNI-DNACPR decisions, a post-hoc analysis on the overall population was performed. To reduce type I errors, we further restricted the analysis to one of our predefined secondary endpoints (mortality up to 1year). Of the 442 and 423 clinicians working before and after the study period, respectively 270 (61%) and 261 (61.7%) filled out the EDMCQ. Fifty of the 93 (53.7%) doctors participated in the coaching for a mean (standard deviation [SD]) of 4.36 (2.55) sessions. Of the 7254 patients, 125 (1.7%) were identified as PET, with 16 missing outcome data. Twenty-six of the PET and 624 of the overall population already had a written DNI-DNACPR decision at study entry, resulting in 83 and 6614 patients who were included in the main and post hoc analysis, respectively. The estimated incidence of written DNI-DNACPR decisions in the intervention vs. control arm was, respectively, 29.7% vs. 19.6% (odds ratio 4.24, 95% confidence interval 4.21-4.27; P < 0.001) in PET and 3.4% vs. 1.9% (1.65, 1.12-2.43; P = 0.011) in the overall study population. The estimated mortality at one year was respectively 85% vs. 83.7% (hazard ratio 2.76, 1.26-6.04; P = 0.011) and 14.5% vs. 15.1% (0.89, 0.72-1.09; P = 0.251). The mean difference in EDMCQ before and after the study period was 0.02 points (- 0.18 to 0.23; P = 0.815). This study suggests that coaching doctors regarding ethical decision-making in teams safely improves goal-oriented care operationalized via written DNI-DNACPR decisions in hospitalized patients, however without concomitantly improving the quality of the ethical climate.

Enhancing Transparency in Healthcare Machine Learning Models Using Shap and Deeplift a Methodological Approach

This paper intends to provide a better understanding of how these models produce predictions, particularly in complex medical diagnoses, and at the same time bridging the gap between technical model outputs and clinical applications. This study addresses the critical problem of transparency of machine learning (ML) models in health care where interpretability is an essential aspect for ethical decision making and trust building.The goal of this paper is to present a clearer understanding of how these models generate predictions, especially in important fields like complex medical diagnoses, thereby bridging the gap between technical model outputs and clinical applications. The crucial issue of transparency in machine learning (ML) models within healthcare is addressed in this study where interpretability plays a vital role in ethical decision-making and fostering trust. The focus of the research is enhancing model transparency by using SHapley Additive exPlanations (SHAP) and Deep Learning Important FeaTures (DeepLIFT), two crucial methods that are designed to elucidate the decision-making processes of ML models.This mode of approach helps to have more distributed comprehension of the decision pathways by models thus aiding in knowing how each feature contributed to the last prediction. It is this method that has been employed to showcase the efficiency of predicting melanoma and also diabetic retinopathy which are two vital medical diagnostic areas. In healthcare, SHAP along with DeepLIFT has improved the models’ explainability and trustworthiness significantly and hence making them easy for those in the field. The advanced interpretability methods presented in this document enhances ML model transparency especially when dealing with health issues. As a result, interpretability becomes an even bigger issue and they are supposed to be able to use these tools for reliable and open decisions when it comes to medical specialists.