Moral Case Research Articles

Bulgaria at the onset of clinical ethics consultation.

Over the years, Bulgarian bioethics has been mainly an academic enterprise and fallen short of providing health professionals with skills for ethical decision-making. Clinical ethics support (CES) was piloted by the author through two bottom-up models - METAP (Modular, Ethical, Treatment, Allocation of resources, Process) and MCD (Moral Case Deliberation). This paper aims to present and analyse developments in the area of clinical ethics and the first experiences in CES in Bulgaria. The project reported here included a review of relevant literature on CES methods and evaluation and a documentary review of data from two CES pilot projects: METAP and MCD. Most of the 69 METAP ethics meetings reviewed were first time meetings (88,4%); the average duration was 36min and the average number of participants was four (44,9%). The meetings were organized in response to cases of severely or critically ill patients. The ethical dilemmas included choice of treatment (31,9%) and conflicts with the patient or their relatives (23,2%). Consensus was achieved in 34,8% of the cases. The situation was clarified with the patient (27,5%) and within the team (15,9%). The rights and obligations of both sides were discussed in 7,2% of the cases. The experience of the members of the Bulgarian Association of Bioethics and Clinical Ethics (BABCE) with MCD was also presented to justify the inference about the applicability of the two CES models in a Bulgarian context. Among Eastern European countries Bulgaria has made progress in CES. Both METAP and MCD have been found to be useful methods.

Clifford's Consequentialism

AbstractIt is morally negligent or reckless to believe without sufficient evidence. The foregoing proposition follows from a rule that is a modified expression of W. K. Clifford's ethics of belief. Clifford attempted to prove that it is always wrong to believe without sufficient evidence by advancing a doxastic counterpart to an act utilitarian argument. Contrary to various commentators, his argument is neither purely nor primarily epistemic, he is not a non-consequentialist, and he does not use stoicism to make his case. Clifford's conclusion is a universal generalisation that is in a precarious position because of potential counterexamples. But the counterexamples do not preclude a rule against going beyond the available evidence and it is worthwhile making a moral case for such a rule.

An Analysis of Moral Value in "Imperfect" Movie

Today’s moral education is so important in view of the many moral cases that have taken place until bullying has affected psychological victims. This research discusses the moral values of the characters in the “Imperfect” movie. The purpose of this research is to identify the types of moral values in the “Imperfect” movie and to analyze the types of moral values that occur in the “Imperfect” movie. The research was conducted by applying descriptive qualitative research. The data sources are taken from the entire “Imperfect” movie and the transcript in “Imperfect” movie which focuses on the use of moral values and the types of moral values. The findings of this research in the “Imperfect” movie found 12 types of moral values that occur in it. There were; 4 data for responsibility, 16 data for respect, 2 data for justice, 7 data for tolerance, 8 data for wisdom, 2 data for democracy, 7 data for altruism, 12 data for love and loyalty, 9 data for self-discipline, 6 data for courage, 7 data for help each other and 4 data for never give up. From this research, the researcher hopes that after reading this, the reader understands moral values.

A two-center pilot study on the effects of clinical ethics support on coercive measures in psychiatry

BackgroundThe use of formal coercion such as seclusion, mechanical restraint, and forced medication is one of the most challenging and complex issues in mental health care, on the clinical, the legal, and the ethical level. Clinical ethics support aims at assisting healthcare practitioners in determining the morally most justifiable course of action in these situations. However, the effectiveness of clinical ethics support has hardly been studied so far.MethodsMonthly moral case deliberation (MCD) was implemented in two acute wards of two different psychiatric hospitals in Switzerland. Frequency and intensity of coercion was measured on ward level (npatients = 405), and the Moral Attentiveness Scale, Knowledge on Coercion Scale, and Staff Attitudes towards Coercion Scale were applied on healthcare practitioner level (nHP = 46). Pre-post-comparisons were conducted using multi-level modeling where appropriate.ResultsAfter implementation of MCD, formal coercion was less frequent (particularly seclusion, small effect size; 9.6 vs. 16.7%, p = .034, Cramér’s V = .105) and less intense (particularly mechanical restraint, large effect size; 86.8 ± 45.3 vs. 14.5 ± 12.1 h, exact p = .019, r = -.74), and approval for coercive measures among healthcare practitioners was lower when controlling for the number of MCD sessions attended.ConclusionsClinical ethics support such as MCD may be a hitherto underutilized service for the reduction of coercion, complementing existing strategies and programs. Implementing clinical ethics support may help improve quality of care for persons suffering from severe mental illness.

Morisprudence: a theoretical framework for studying the relationship linking moral case deliberation, organisational learning and quality improvement

There is a claim that clinical ethics support services (CESS) improve healthcare quality within healthcare organisations. However, there is lack of strong evidence supporting this claim. Rather, the current focus...

Justifying (Non)Discrimination Against Disabled Workers in Emerging Economies: Managerial Choice, Business Versus Moral Case Arguments and Home Versus Host Country Effects

AbstractIt is widely known that disabled people face discrimination in all walks of life, including employment. Unfortunately, legal protection often does not work as well as hoped, especially in emerging markets. This leads to the core objective of this study: to understand why firms might not discriminate against disabled people. Rather than simply identifying islands of non‐discrimination or best practice, we seek to better understand what has made them so and how much this might be replicable, taking account of legal regulation, firm policy and managerial choice. The qualitative findings reveal how non‐discrimination is underpinned by an interplay between business and moral case influences and interaction between country of domicile and origin structural effects. Building on transaction cost economics, theoretical insights are afforded on this dynamic process. Although it is often assumed that multinational enterprises infuse best practices from abroad, non‐discrimination in most instances followed country of domicile managerial choice, which in turn represented a mix of altruism and expediency. We posit that a lack of direction from headquarters might be because disability rights were assigned a somewhat low priority at central organizational level.

Demokratik ve Çok Kültürlü Nijerya Devletinde Eğitim: Bir Değerlendirme

The work highlighted a multicultural approach to ethical issues in school, as Nigerian in its heterogeneous nature and democratic tenets will stand a better position to fight ethnocentrism and racism that often result from ignorance of other people’s and culture. The essence of multicultural education can be seen from the perspective of cultural tolerance and complementarity. By a way of recommendation, the paper made a strong moral case for inclusive disclosure of different ethical viewpoints of different cultures in Nigeria as a democratic society. Such an approach fosters respect for the values and beliefs of other people and respect is generally accepted by most culture as a moral value. All these should be reflected in the school.

The First Baby Born After Polygenic Embryo Screening

The First Baby Born After Polygenic Embryo Screening

How to teach ethics to the undergraduates in clinical context?

Teaching ethics to undergraduates is no more a part of hidden curriculum rather it is a norm to be incorporated in the formal curriculum. Regarding instructional strategies, the consensus is stagerry and mainly based on the institutional choices. To develop moral reasoning and address the social value system, Cognitive part is delivered through lecturing while affection part is discussed via reflective practices in small group settings through deliberate moral case teachings and portfolio note book writings. However the outcome of such practices is yet to be known. However we suggest that the ethical curriculum should base on the reflective practices, social constructivism and experiential learning. Further customization could be done assessing potential ethical conflicts and legal accountability specific to our profession. We cannot merely focus on student preparation but also must focus on the organizational culture to be conducive for ethical practice and quality to match with what is being preached.

The Moral Case for the Development and Use of Autonomous Weapon Systems

ABSTRACT Autonomous Weapon Systems (AWS) are artificial intelligence systems that can make and act on decisions concerning the termination of enemy soldiers and installations without direct intervention from a human being. In this article, I provide the positive moral case for the development and use of supervised and fully autonomous weapons that can reliably adhere to the laws of war. Two strong, prima facie obligations make up the positive case. First, we have a strong moral reason to deploy AWS (in an otherwise just war) because such systems decrease the psychological and moral risk of soldiers and would-be soldiers. Drones protect against lethal risk, AWS protect against psychological and moral risk in addition to lethal risk. Second, we have a prima facie obligation to develop such technologies because, once developed, we could employ forms of non-lethal warfare that would substantially reduce the risk of suffering and death for enemy combatants and civilians alike. These two arguments, covering both sides of a conflict, represent the normative hill that those in favor of a ban on autonomous weapons must overcome. Finally, I demonstrate that two recent objections to AWS fail because they misconstrue the way in which technology is used and conceptualized in modern warfare.

Diversity, media and racial capitalism: a case study on publishing

ABSTRACT This article demonstrates the ambivalence of diversity in the cultural industries, and racial capitalism more broadly. Based upon an empirical study of the production of writers of colour in UK trade publishing, the article highlights how diversity acts as a form of racial governance but is also a source of anxiety for the dominant culture. Opening with an overview of critical approaches to diversity, we then introduce the study, based upon in-depth interviews with 113 people, which explores how publishers make sense of diversity, which includes moral and economic arguments. While publishers are convinced that both the moral and economic cases for diversity are aligned, we argue that they exist in a tension, which results in mostly reductive outcomes for minoritized authors. But the article also highlights how diversity potentially disrupts the liberal sensibilities of the dominant culture, especially their sense of publishing as meritocratic.

Conceptualizing the impact of moral case deliberation: a multiple-case study in a health care institution for people with intellectual disabilities

BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences.

Gender Diversity and Stock Performance: Business Case or Moral Case for Investors? – International Evidence

Gender Diversity and Stock Performance: Business Case or Moral Case for Investors? – International Evidence

Tech Companies and Social Justice: The Pandemic Race for Diversity, Access and Inclusion Moves Online

The year, 2020, was a wakeup call to corporate America to make unprecedented progress on diversity and inclusion, with the Covid-19 crisis exposing astronomical racial health disparities, and the murder of George Floyd, prompting global protests against racism. The reckoning over race in the U.S. prompted a growing number of leaders to adopt a moral case for communicating a stronger commitment to diversity, but stakeholders are demanding to see real change. The purpose of this study is to outline the actions that CEOs are taking to communicate about diversity commitment and accountability as defined by the literature, among tech organizations, making the Diversity Inc. 2021 Top 50 Companies for Diversity list. A qualitative content analysis of CEO diversity statements publicly published by four tech companies cited for ‘diversity,’ identifies leadership diversity actions as building trust, actively working against discrimination and subordination, embracing a wide range of styles and voice, and making cultural differences a resource for learning. These CEO statements were coded for moral legitimacy or the lack thereof. The author found symbolic evidence of moral legitimacy, four leadership perspectives on behavioral change and cultural shift, as well as, similarities and differences in communication practices. These findings will help practitioners craft diversity statements that offer substantive expressions of inclusive actions.

DAMPAK PENDIDIKAN PESANTREN TERHADAP MORAL BERMASYARAKAT SANTRI PONDOK PESANTREN TASHILUL HUDA KAUMAN, WIRADESA, PEKALONGAN

The ever increase of moral degradation cases has proven the inability of Indonesian modern educational institutions to create students with good character. On the contrary, Islamic boarding school educational institutions are one of the institutions that are expected to be able to change the morals of the community, especially students to socialize through programs, regulations, and habits of students in Islamic boarding schools. This study aims to see the impact of the Taslihul Huda Islamic Boarding School education on the morals of the santri community through existing activities, programs, and regulations. The researcher used interviews and observations to find data from the head and boarding school administrators, the community, and the students who were there, then the researchers analysed and processed the data by triangulation. From the results of the study, it can be said that the existing programs and regulations at the Taslihul Huda Islamic boarding school are effective in shaping the morals of the santri and the community's ability to provide positive responses to students in engaging with the community.

Guest Editorial: Venting and the Moral Case for Fossil Fuels

For more than a century, the oil industry magnificently improved the lives and health of humankind. That fact lies beyond debate. Our industry simultaneously expanded and made profits yet progressively protected water, land, people, and air from its potent products. Those gains help support a moral case to expand some use of fossil fuels but not to release them. Now it is time to lean in to solving the last step of our direct emissions. The oil industry has long lived and grown under tightening demands. In 1919, just a handful of months after Texas empowered its Railroad Commission (RRC) to regulate oil and gas, the agency promulgated its first well-spacing rule. Wells were to be spread apart not on principles of efficient recovery but on protection of groundwater and against fires. Four years later, the same state made it a crime to pollute surface water with oil. It even held corporate officers personally responsible for the pollution. As effects accumulated, so did protections of surface and subsurface—from oil down rivers to oil in dirt pits, in lined pits, in covered pits, and in closed tanks. At this point, any release of oil more than a couple of barrels requires public reporting in most jurisdictions. In Texas, for example, just half a barrel of oil released from an onshore storage tank mandates a public report, and US federal waters require reporting of any release that makes sheen on the water. By the 1950s, most US states required cementing casing through the fresh-water table, and modern plugging regulations date from the 1960s. Perhaps belatedly, the health and safety of workers became a buzz word and then a corporate imperative but now an easy habit. Notwithstanding the pandemic of “temporary” flaring in recent years, decades of both punitive and positive policies aimed to reduce air pollution. Our predecessors often did not welcome the new obligations, but they thrived even as they conformed, cajoled, and adapted. Generations ago, the first serious efforts by the RRC to impose basic regulation on the oil industry sparked an epic legal battle ostensibly and oddly over the 14th Amendment to the US Constitution. It seems that all industry, not just oil, lives in strife with regulators. Still, our predecessors’ lack of initiative followed first by resistance then lackluster diligence contributed to public disdain over the decades. Their track record set up kneejerk and passionate distrust when the shale revolution began. Although controversy faded as fracturing contracted, more than 60% of Americans still believe that fracking harms the environment. Among 25 industries tracked by Gallup, the oil industry enjoys the fourth-highest disapproval rating among Americans, down from the number one slot a handful of years ago. College enrollment in fossil fuel programs has plummeted as, among other reasons, the youngest generation eschews our reputation ironically as we have become the cleanest version of ourselves yet. We improved protections for every-thing our products could pollute. Now, our communities’ standards ask us to address the last, smallest, and least visible of our direct releases, namely fugitive natural gas. And there is no reason not to do it aggressively. Venting offers no righteous credit.

Perkembangan Moral Siswa SMP Tentang Permasalahan Pertanian Pasang Surut di Kabupaten Banjar Melalui Penyelesaian Masalah

Moral is the ability to understand the values in society about the views of good-bad, right-wrong, what individuals should and should not do in community groups. The moral development of adolescents is more mature and more familiar with moral values or the concept of morality compared to the age of children. The problem of tidal agriculture was raised as a moral dilemma case, so that the stages and characteristics of students' moral development in solving problems were obtained. The purpose of this study was to describe the stages of moral development of the students of SMP Negeri 1 Gambut on the problems of tidal agriculture in Banjar Regency. The research method used is a qualitative approach and the type of descriptive research. The research aid instrument was in the form of an early test of moral development using the Defining Issue Test (DIT), written assignments, and interviews. The results showed that the stages of moral development of junior high school students regarding tidal agricultural problems in Banjar Regency through problem solving were in stages 2, 3, and 4.

CRIMINAL RESPONSIBILITIES OF PHYSICIANS IN MEDICAL MALPRACTICE

The aim of this study is to determine the criminal responsibilities of health workers in the relevant laws on medical malpractice in the health sector and to reveal the factors in the formation of medical malpractice. This study is a descriptive study. With the information obtained as a result of the Turkish Penal Code No. 5237, the Law No. 1219 on the Practice of the Style of Medicine and Medical Arts, the Law No. 1593 on Public Health, the Law on the Turkish Medical Association No. 6023, the Turkish Code of Obligations, the Patient Rights Regulation and literature reviews, the medical malpractice of health workers criminal liability has been compiled. In recent years, serious educational studies have been carried out on the subject of medical malpractice and information activities have been carried out on this subject both to health workers and patients. Especially when the awareness about medical malpractice started to increase in patients and their relatives, serious lawsuits were filed against health personnel due to simple mistakes made. Health workers have to defend themselves in the face of these lawsuits. Because serious steps have not been taken yet on Medical Malpractice in the Turkish Penal Code. For this reason, both the court committee, the patient, the health institution and its employees face some difficulties in this process. In particular, healthcare professionals are faced with a serious lack of knowledge about the criminal liability of medical malpractice. Since the laws regarding the health law in our country are not fully regulated, these cases can only be heard in a lawsuit to be opened due to the fault of the health personnel, according to the provisions of the Turkish Penal Code and the Code of Obligations. These lawsuits are carried out in the form of criminal cases, material and moral compensation cases. Therefore, the litigation process may take longer. For this reason, special arrangements to be made regarding medical malpractice in the field of health law will be important in concluding such cases as soon as possible by ensuring that such cases are handled more objectively in terms of the defendant and the plaintiff. It is necessary to determine the rights and duties of both patients and healthcare professionals by carrying out a study with broad participation by health sector representatives, especially lawyers, in order to overcome this deficiency.

A neo-aristotelian perspective on the need for artificial moral agents (AMAs)

We examine Van Wynsberghe and Robbins (JAMA 25:719-735, 2019) critique of the need for Artificial Moral Agents (AMAs) and its rebuttal by Formosa and Ryan (JAMA 10.1007/s00146-020-01089-6, 2020) set against a neo-Aristotelian ethical background. Neither Van Wynsberghe and Robbins (JAMA 25:719-735, 2019) essay nor Formosa and Ryan’s (JAMA 10.1007/s00146-020-01089-6, 2020) is explicitly framed within the teachings of a specific ethical school. The former appeals to the lack of “both empirical and intuitive support” (Van Wynsberghe and Robbins 2019, p. 721) for AMAs, and the latter opts for “argumentative breadth over depth”, meaning to provide “the essential groundwork for making an all things considered judgment regarding the moral case for building AMAs” (Formosa and Ryan 2019, pp. 1–2). Although this strategy may benefit their acceptability, it may also detract from their ethical rootedness, coherence, and persuasiveness, characteristics often associated with consolidated ethical traditions. Neo-Aristotelian ethics, backed by a distinctive philosophical anthropology and worldview, is summoned to fill this gap as a standard to test these two opposing claims. It provides a substantive account of moral agency through the theory of voluntary action; it explains how voluntary action is tied to intelligent and autonomous human life; and it distinguishes machine operations from voluntary actions through the categories of poiesis and praxis respectively. This standpoint reveals that while Van Wynsberghe and Robbins may be right in rejecting the need for AMAs, there are deeper, more fundamental reasons. In addition, despite disagreeing with Formosa and Ryan’s defense of AMAs, their call for a more nuanced and context-dependent approach, similar to neo-Aristotelian practical wisdom, becomes expedient.

Does Moral Case Deliberation Change Current Views on Restrictions?: Staff Perceptions on Restrictions

AbstractBackgroundIn the care of people with intellectual disability, support staff apply restrictions to people with moderate intellectual disabilities (ID) in several domains of daily life, such as restrictions on bedtimes or on the amount of food intake. Support staff may experience moral dilemmas applying these restrictions. In this respect, moral case deliberation (MCD) is used as an instrument for support staff to jointly reflect on dilemmas in care and is considered a form of ethical support. MCD also seems to broaden the perspective of their participants.Specific AimsThis study examined to what extent MCD led to changes in support staff's perspectives with regard to daily life restrictions placed upon people with moderate ID. Consequently, this study examined to what extent support staff's perspectives on these restrictions were broadened as a result of their participation in the study.MethodPrior to and following a series of three MCD sessions on moral dilemmas commonly encountered in daily life care, interviews were held with 12 support staff across two teams. Participants were asked what they considered to be good care in the given dilemmas. To systematically compare all of the answers given in the interviews prior to and following the MCDs, the same interview‐guide was used in both instances. Interviews were analyzed inductively.FindingsFollowing the MCD sessions, the respondents tended to hold onto their perspective to restrict clients to provide them with structure, clarity and rest, as expressed prior to the MCD. However, some respondents adapted their perspective on restrictions and were willing to provide people with moderate ID more freedom after the MCD.DiscussionThis study contributed to the evidence underlying MCD in healthcare and in providing insights into MCD with regard to daily life restrictions in the care of people with moderate ID. Partly, MCD leads to a broadening of perspective on restrictions applied in the daily life of people with moderate ID.