Ethical Case Research Articles

Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care.

Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees' experiences of implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed.

The Ethical Case for Decentralized Clinical Trials.

The recent pandemic spurred interest in innovative design for clinical trials. In particular, constraints on the public's ability to gather led to an increase in remote or decentralized clinical trials (DCTs). DCTs present an opportunity to extend the benefits of research to underserved populations, decrease burdens, increase access to trials, and fill knowledge gaps surrounding rare conditions, though they are not without their own unique challenges and risks. These risks are far from irremediable, and the advantages are significant enough to merit attention. There is a scientific and moral case to increase the use of DCTs beyond the context of public health emergencies.

Advancing AI Data Ethics in Nursing: Future Directions for Nursing Practice, Research, and Education.

The ethics of artificial intelligence (AI) are increasingly recognized due to concerns such as algorithmic bias, opacity, trust issues, data security, and fairness. Specifically, machine learning algorithms, central to AI technologies, are essential in striving for ethically sound systems that mimic human intelligence. These technologies rely heavily on data, which often remain obscured within complex systems and must be prioritized for ethical collection, processing, and usage. The significance of data ethics in achieving responsible AI was first highlighted in the broader context of health care and subsequently in nursing. This viewpoint explores the principles of data ethics, drawing on relevant frameworks and strategies identified through a formal literature review. These principles apply to real-world and synthetic data in AI and machine-learning contexts. Additionally, the data-centric AI paradigm is briefly examined, emphasizing its focus on data quality and the ethical development of AI solutions that integrate human-centered domain expertise. The ethical considerations specific to nursing are addressed, including 4 recommendations for future directions in nursing practice, research, and education and 2 hypothetical nurse-focused ethical case studies. The primary objectives are to position nurses to actively participate in AI and data ethics, thereby contributing to creating high-quality and relevant data for machine learning applications.

The impact of varying levels of compassion in ethics education case studies on students’ moral reasoning

ABSTRACT Previous research has revealed that including emotional content in ethics cases may improve students’ learning. However, there remain concerns as to whether the emotional content will also impact students’ moral reasoning. There is evidence that incorporating compassion-related emotional content into ethics cases through the implicit induction method increased the intensity of compassion without influencing the moral reasoning of participants. However, the impact of a higher intensity of compassion on moral reasoning remained unclear. Thus, in this experimental study, after using two (explicit expression and descriptions of severe consequences) methods of generating a higher intensity of compassion in ethics cases, we investigated whether this higher emotional intensity impacted the moral reasoning schemas activated in participants (N = 299). Our findings indicated that there was no evident impact. This research suggests there are now multiple strategies to integrate compassion into ethics cases at multiple levels of intensity without distorting moral reasoning.

Ethical empowerment: Examining the impact of business education in Indian universities through the lens of international standards and CIPP model

This study assessed the effectiveness of Indian postgraduate business education in addressing ethical challenges, integrating International Education Standards (IES) and the Context, Input, Process, and Product (CIPP) model. Using a positivist approach, a cross-sectional survey was conducted, focusing on 233 postgraduate business students through various sampling methods. Data analysis employed descriptive (frequency, percentage, mean, and standard deviation) and inferential (multiple linear regression) statistics. Findings revealed a significant 75% alignment with IES 4 in surveyed universities' business programs. Participative teaching methods were found to be used often in ethics instruction, particularly in accounting courses. Students perceived the program as highly effective in meeting ethical requirements, influenced by age, religiosity, and to a lesser extent, gender. Future research should explore components affecting ethical preparedness, considering content, teaching methods, case studies, long-term impacts, and cultural variations. The study, which was constrained by self-reported data and student perspectives, highlights the need for diverse viewpoints and methods in future cross-cultural research.

On dementia, duties, and daughters. An ethical analysis of healthcare professionals being confronted with conflicts regarding filial duties in informal dementia care.

Existing literature on moral conflicts that healthcare professionals encounter in dementia care has explored, amongst others, issues related to autonomy, decision-making capacity, privacy, and more. Notably, conflicts related to healthcare professionals who support informal dementia caregiving and who are confronted with family members being overburdened with their care responsibly remains an underexplored topic in the current literature, particularly in the context of Low-and Middle-Income Countries. The present paper introduces such an encounter, presenting an ethical case analysis of a conflict that occurred during a larger research project conducted in North Macedonia. Due to the absence of formal care services that could have relieved an overburdened family caregiver, healthcare professionals felt compelled to reach out to the uninvolved adult daughters, requesting them to participate in their parents' care. Wondering about whether their reaching out to the daughters might count as an attempt of pressure and undue interference, professionals conflicted over the appropriateness of their action. This paper follows up on their concern, ethically assessing the professionals' action. To answer the question on whether the healthcare professionals acted appropriately or not, and to what extent, theories of filial duties are applied, embedding their action in the larger context of dementia care in North Macedonia. It is argued that the lack of formal care services in North Macedonia is of utmost relevance to the conflict. Thus, the conclusion is that the ethical inappropriateness of the case is to be located not so much with the action of the healthcare professionals but with the state because of its failure to provide professional care services that allow healthcare professionals to take ethically sound actions to counteract overarching burdens that family members face when providing informal dementia care.

The political logic of just transition policies

ABSTRACT A ‘just transition’ calls for compensations to fossil fuel workers whose jobs will be lost because of the clean energy transition. The ethical case for a just transition acknowledges the hardship of vulnerable workers. In contrast, I examine the political case for a just transition. The logic of such a case remains hazy and under-theorized. I draw on the insights of ultimatum games to understand the strategic dimension of the relation between governments and fossil fuel workers. In a successful just transition, the government compensates workers in exchange for their exit from the fossil fuel industry. This ensures a faster clean energy transition. Yet the prospects of such an agreement depend on several parameters: the quality of outside options available to workers, their cost of mobilization, and the climatic benefits that the government obtain from a fossil fuel phaseout. I show that a government's credibility is also critical. This theoretical exercise helps make sense of several otherwise puzzling patterns in just transition policies and offers guidance on critical policy issues. Key policy insights Just transition policies can break the carbon deadlock by incentivizing the exit of fossil fuel workers. The ability of the government to induce the exit of labour depends on climatic benefits, fossil fuel wages, outside option wages, and anti-government mobilization costs. Lack of government credibility, which can be caused by political risks, capacity constraints, or low trust, reduce the prospects of phaseouts and increase their cost. Unions play an ambiguous role: they increase wages and reduce mobilization costs, but can improve outside options, solve coordination failures, and reduce transaction costs. Fossil fuel firms can and do use financial and non-financial strategies to reduce the mobility of their workers.

The clinical case in medical ethics

The clinical case in medical ethics

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.

A VIRTUE ETHICS FOR HISTORIANS: PROSPECTS AND LIMITATIONS

ABSTRACTHow feasible would it be to develop a virtue ethics for historians that is analogous or similar to virtue‐ethical approaches to research integrity that have been proposed for other areas of academic inquiry? The field of history is an interesting one, as few disciplines have an equally well‐documented history of thinking, talking, and writing about virtues. This history merits ethicists’ attention, as it offers a unique opportunity for grounding ethical reflection in the lived realities of historical research and teaching. In the spirit of a “history and philosophy of history,” this article contributes to such a project by staging a conversation between virtue ethics and the history of historiography. Drawing on a range of nineteenth‐ and twentieth‐century examples, it argues that much of what applied virtue ethicists are recommending scholars to do has a long pedigree in the history of historiography. Critical virtue ethics, too, is a project to which historians can easily relate, especially insofar as they are committed to virtues of truthfulness in an age of post‐truth. If this suggests that there is room, or perhaps even a need, for a virtue ethics for historians, the cases examined in this article also prompt critical questions, especially ones regarding the teachability of virtue, the potential of virtue talk to be misused for polemical and exclusionary purposes, and the sort of tasks that a virtue ethics is capable of addressing. In light of these considerations, the article calls for reflection on the “affordances” of virtue. It claims that the case for a virtue ethics will be strongest if it is grounded in a realistic understanding not only of the beneficial uses to which categories of virtue can be put but also of unintended uses to which virtue talk is susceptible and of tasks for which virtue thinking is less prepared.

Ethical case discussions before compulsory medication in psychiatry

Ethical case discussions in psychiatric hospitals are particularly useful when amoral conflict between respect for the patient's autonomy and well-being becomes apparent when considering the legitimacy of coercive treatment. To date, there is hardly any data on the procedure and the results of such case discussions. We therefore present data from alarge psychiatric clinic. We retrospectively analyzed ethical case discussions prior to compulsory medication in aquantitative and qualitative manner. The study analyzed the protocols of all ethical case discussions over a2-year period. They used the method of principle-based ethical case discussion. The qualitative analysis of selected cases was supplemented by reference to case records. An advance care directive was not available in any of the cases, so that the presumed will was used generally to assess the autonomy perspective. It proved quite complex to address danger to third parties when assessing the beneficence and nonmaleficence perspective. In 5 out of 35 consultations, the compulsory medication was not recommended from an ethical perspective. Ethical case discussions enable aholistic individual examination of moral obligations. They contribute to well-founded decisions and can help to reduce the frequency of coercive medications, suggesting routine use of ethics counselling.

Growth Through Ethical Role Identity Work: The Case of Ethics and Compliance Officers

Growth Through Ethical Role Identity Work: The Case of Ethics and Compliance Officers

The Participants

While universities increasingly offer institutional support for academic filmmaking, in the specific case of ethics this support can sometimes become an impediment to creativity. The requirement to follow comprehensive university ethical procedures - which are usually developed with great care and attention to the needs of researchers but with little or no focus on creative practice research - might stymie the artistic practice of filmmakers. My video The Participants: a reflection on the ethics of smartphone filmmaking as research aims to offer a provocation intended to challenge university practitioner-researchers to consider the ethics of their practice, but also, at the same time, a provocation to university ethics protocols and procedures. Specifically, the films seeks to encourage the viewer to reflect on the ways in which filmmaker researchers working in in public places might better consider the ethical issues raised by their practice, especially when subsequently employing (and manipulating) footage of individuals who have not given their consent to be filmed. For The Participants I used an iPhone 11 to capture video images of tourists videoing with their smartphones at Grand Central Station, New York.

The additional photographed lesion in a teledermatology clinic for urgent suspected skin cancer.

This is an ethical dilemma case that discusses how to manage an additional photographed lesion in a teledermatology clinic for urgent suspected skin cancer. We discuss the ethical issues around maintaining the duty of care to the patient while operating within the scope of the service, respecting patient autonomy and upholding professional standards.

Case‐Based Reasoning in Educational Ethics: Phronēsis and Epistemic Blinders

AbstractIn this paper Michael Vazquez and Dustin Webster consider the practice of deliberating about ethical case studies as a means to contribute to the professional development of educators. An ongoing debate is whether or not the study of ethical theory should be included in this practice. Vazquez and Webster argue that a popular strategy, known as the Phronetic Approach, is vulnerable to what they call “epistemic blinders” that arise in the absence of the scaffolding provided by theory. They then sketch an alternative approach to case‐based reasoning inspired by Barbara Herman's notion of middle theory. The middle theory approach naturally suggests a balanced method for using case studies in teacher professional development: expose educators to some theory, but only to the degree and at the level appropriate for the specific audience and in light of how frequent interactions with that audience will be.

Injuries and deaths following Covid-19 vaccination: The ethical and legal case for compensation.

In April 2024, in a class action suit for compensation to families of persons suffering injury or death after vaccination with AstraZeneca's (AZ) Covid-19 vaccine [1], the manufacturer admitted in a UK court that the Oxford-AZ Covid-19 vaccine could cause a rare and potentially fatal blood clotting disorder ("thrombosis with thrombocytopenia syndrome" or TTS, which when triggered by a vaccine is called "vaccine induced thrombocytopenia and thrombosis, or VITT) [2]. The AZ Covid-19 vaccine is a chimpanzee adenovirus vectored vaccine encoding the SARS-CoV2 spike protein (ChAdOx1-S) marketed under the names Covishield and Vaxzevria.

Ethical and Legal Model of the Cybermedia: Case Study in North Sumatra, Indonesia

In the new media era, most violations cases of press ethics and law are made by cybermedia in Indonesia. At the same time, cybermedia is one of the factors driving national stability, as well as a factor encouraging democratization. This study aimed to determine the ethical and legal model indicators of cybermedia from the Indonesia Cybermedia Union (SMSI) of North Sumatra case study. The research is a mixed-method approach that combines qualitative and quantitative research approaches. Data were collected from interviews with 39 journalists through questionnaires and focus group discussions (FGD) with two press experts, two North Sumatra SMSI administrators and an honorary board member of the press organization. The results of this study indicated that five problems were indicators of models for implementing press ethics and law in cybermedia. First, increasing the competence of journalists in several ways, such as encouraging journalists to take the journalist competency tests and conducting training; second, encouraging cybermedia verification by the Press Council; third, providing legal assistance for journalists who were caught in the law; fourth, following the existing rules of press ethics and law. This was done because cybermedia did not have its own rules of ethics and press law; fifth, conducting an interaction model with stakeholders through journalist competency test activities.

Incorporating an Analytical Approach to Ethical Reasoning into an Ethics Case Conference for Residents

Incorporating an Analytical Approach to Ethical Reasoning into an Ethics Case Conference for Residents

Philosophy of gardening and a sense for scents. An environmental ethics perspective

This article investigates the role of gardening (as human practice) and gardens (as locations) from the perspective of a ‘deep’ anthropocentric environmental ethics. On conceptual grounds, it outlines the concepts of gardens and gardening, defines some essential traits of gardens, and presents a typology of gardens. In its methodology, the article combines archaeology, hermeneutics, and semiotics with phenomenology of nature and ethics. A focus is given to eudemonic values of gardens, and special interest is devoted to garden scents. Garden scents are a fugitive, but intense sensual attraction which stimulates (non-moral) reverence for plant life. The ethical case for ‘good’ gardening is given in the conclusion.

Healthcare without borders: Creating a shared medical decision-making model to support global patients at Northwestern Memorial Hospital

Individuals from across the globe increasingly elect to travel to the USA for the primary purpose of receiving healthcare. These border crossings create opportunities for rich cultural exchange, as well as for direct conflict between the basic values and preferences of global patients and their healthcare team(s). A series of ethics cases at Northwestern Memorial Hospital, where clinicians were morally distressed by the request of families of global patients to withhold medical information about life-threatening disease from the patient, led to a new partnership between the International Health and Medical Ethics teams. This paper describes the development, implementation and outcome of that creative collaboration: an innovative upstream preventive ethics initiative that honours the primary obligation of Western healthcare providers to uphold informed consent and patient autonomy while honouring a wide scope of preferences in communication and decision making identified among this patient population.