Ethical Situations Research Articles

Applicants' success in the ethics entrance exam: A cross-sectional study.

Student selection is the first step in recruiting future social and healthcare professionals. Ethically competent professionals are needed in social and healthcare. It is important to select applicants who have the best possible abilities to develop their ethical competence in the future. Values-based recruitment has been used to inform the recruitment and selection of higher education applicants. However, objective and valid tests in student selection are needed. To assess social and healthcare applicants' success and related factors in the ethics section of the universities of applied sciences digital entrance examination (UAS Exam) to undergraduate degree programmes. A cross-sectional design was used. Social and healthcare applicants needed to identify ethical situations in the ethics section of a national digital entrance examination (UAS Exam) in autumn 2019 (between 29 October and 1 November) in 20 Finnish universities of applied sciences. The process for the responsible conduct of research was followed in the study. Ethics committee approval was obtained from the Human Sciences Ethics Committee in the Satakunta region (27 September 2019). Approval to undertake the study was obtained from the participating universities of applied sciences. Participation to the study was voluntary and based on informed consent. The applicants' (n = 8971) mean scores were 7.1/20 (standard deviation 6.5), and 22.7% of the applicants failed the ethics section. Age, previous education, and place of birth (own/parent) explained the applicants' success in the ethics section (total score and failed exam results). Applicants' success in the ethics section varied indicating that future students may have a different basis to develop their ethical competence. This may impact on (new) students' learning, especially in practical studies.

Experiences of intensive care nurses providing care to the victims ofKahramanmaraş earthquakes.

Two earthquakes of magnitude 7.7 and 7.6 occurred in the Turkish province of Kahramanmaraş in 2023. The earthquakes resulted in serious losses of life and property in 11 provinces, and the injured were transferred to other provinces for treatment and care. To date, no studies on the experiences of intensive care nurses providing care to earthquake victims after the Kahramanmaraş earthquake sequence have been identified. The aim of the present study is to explore the experiences of intensive care nurses providing care to earthquake victims who were transferred to other provinces. A qualitative descriptive research design with conventional content analysis was used. Snowball sampling was used in the selection of intensive care nurses. Data saturation was achieved with 20 nurses. In-depth interviews were conducted with the participants through phone between March 8 and March 15, 2023. MAXQDA 20 software was used for data analysis. The COREQ checklist was used to guide the reporting of the study. Twenty nurses were recruited. Four themes emerged from the data: challenges in caregiving processes; psychological challenges; ethical situations; urgent need for training and support. After the Kahramanmaraş earthquake sequence, described by some as the disaster of the century, nurses encountered patients with unique needs that they had never encountered before and tried to cope with the constantly changing health conditions. For this reason, they were affected psychologically and experienced challenges in caregiving processes. Conducting comprehensive training for diseases common among earthquake victims, developing new protocols for providing care to earthquake victims, developing more action plans for nurses, and psychologically supporting intensive care nurses would facilitate the caregiving processes.

‘Being there’ is what matters: Methodological and ethical challenges when undertaking research on the outdoor environment with older people during and beyond the COVID-19 pandemic

This paper reflects on adapting research methods and processes during the COVID-19 pandemic, drawing on our experiences of conducting research on the outdoor environment with older people (aged 50+) living in Scotland. First, we discuss the challenges to the organisation of research experienced in the context of changing government and university guidelines and managing delays to planned research timelines. The shift toward remote methods stimulated by the pandemic transformed traditional notions of the research field. We consider some of the implications of this for outdoor environment research, grounded as it is on exploring the interaction between people and the places they are embedded within. Further, despite a growth of literature highlighting the benefits of remote research, we found uses for digital and online approaches limited when working with older people. Second, we reflect on whether research with older people in the context of a pandemic can be conducted ethically. Drawing on our research we describe how developing an ‘ethics of care’ included negotiating with formal ethics processes but also the relational, situated ethics of qualitative health research that, because of the pandemic, had begun to shift in new ways. We describe the often intangible impacts of COVID-19 such as social isolation and bereavement that we uncovered as researchers entering into the lives of older people. In closing, we outline some of the key lessons learnt from conducting research on outdoor environments with older people to enable future qualitative health research during and beyond the pandemic.

Competence-based assessment and training for ethical situations in practice: a pilot study

ABSTRACT In this pilot study, deliberate practice and competence-based assessment were incorporated into a first-year graduate course on professional issues and ethics. Students responded to challenging simulations of basic ethical situations in therapy before and after the course. Aspects of deliberate practice were incorporated into the course. Student self-report ratings and independent performance ratings blind to timing found improvements in students’ ability to manage basic ethical situations in practice. Pilot evidence suggests competence-based assessment and training have potential use for training students preparing to engage in their first therapy practicum experiences. Additional controlled studies are needed to examine the benefits of competence-based assessment and training.

An Ethical Literary Analysis of Edward’s Ethical Choices in The Cocktail Party

This paper examines Edward's ethical choices in T.S. Eliot's play, "The Cocktail Party," through the lens of ethical literary criticism. Edward, the protagonist, faces an emotional crisis in his relationships with his wife, Lavinia, and his lover, Celia, which sets the stage for his ethical dilemma. The study utilizes a qualitative research design, employing literary analysis and interpretation to delve deeper into Edward's ethical choices and their appropriateness within his particular situations and ethical environment. Drawing from previous scholarly work, particularly from scholars in China who have explored the ethical fables and perspectives within "The Cocktail Party," this paper builds upon the existing research by offering further insights into Edward's ethical journey. The analysis considers the interplay between Edward's marital and romantic ethical identities and his professional identity as a lawyer, which results in contradictions and conflicts, leading to ethical dilemmas. The study also explores the factors influencing Edward's ethical choices, including the disruption of ethical relationships and order within the play. By applying ethical literary criticism, the paper argues that Edward's ethical choices are not arbitrary but appropriate responses to his circumstances. Situational ethics and love norms are examined to understand the motivations and justifications behind Edward's decisions. Ultimately, the analysis provides a comprehensive exploration of the ethical themes within the play, shedding light on the complexities of decision-making processes and the moral dimensions of literary works.

LANGUAGE ECOLOGY OF CONTEMPORARY TRANSLATOR’S DISCOURSE

The paper considers the axiological problems of postmodern translator’s discourse in the aspect of the ecology of language. The object of the study is the contemporary translator’s discourse, its subject is the changes in the axiological linguistic scale of this discourse in the postmodern paradigm, reflected in the language (the “text lifting” strategy). The material under consideration is the contemporary translations of the English literary texts into Russian. The paper aims at the revealing of the contemporary translation discourse axiological constants and their linguistic ecology status in the contemporary translator’s discourse, including the situations of political correctness. The linguistic ecology problems of the postmodern translator’s discourse are connected, firstly, with the contemporary global and democratic tendency to transfer the authenticity of the source text, its style and lexis, and secondly, with a decrease in the standards of translation ethics and aesthetics. Translation ethics in such situations is often subordinated to postmodern anti-aesthetics, which challenges the basic principles of the classical Soviet translation tradition.

Barriers to providing quality care for patients with substance use disorders from the perspective of baccalaureate nursing students: A descriptive qualitative study

BackgroundWith Iran facing an epidemic in substance use disorders, nursing students are increasingly encountering people impacted by substance misuse. Providing care for this group brings with it many barriers and challenges. These serious barriers have not been a priority in Iranian nurse education. ObjectivesTo describe barriers to providing quality care for people with substance use disorders from the perspective of nursing students. DesignA descriptive qualitative study, using content analysis was used to address the study aim. Setting and participantsPurposive sampling was used to recruit participants. Participants were 34 baccalaureate nursing students from different academic semesters studying at two medical sciences universities in Iran. MethodsData were collected using semi-structured interviews from July 2022 to October 2022. Granheim & Lundman's method for qualitative content analysis was used to analyze data. ResultsThe barriers to providing quality care for people with substance use disorders were described through the major theme: “lack of communication skills and difficulty finding language for therapeutic communication with people with substance use disorders”. Based on nursing student perspectives, a lack of communication and language for therapeutic communication was described through the three barriers of: 1. “possessing or witnessing prejudiced attitudes and stereotypes”, 2 “negative role models”, and 3. “Knowledge deficit in self or others”. ConclusionThe result of this study showed that nursing students interact with people with substance use disorders through prejudiced attitudes, negative stereotypes, and knowledge deficits. Academic education should include practical techniques to reduce negative stereotypes and moral distress among nursing students as well as strategies to manage tough ethical situations and decrease prejudiced attitudes. Nurses and clinical educators must be attentive to their power to influence nursing students and should model appropriate unbiased behavior and language.

Moral Distress and Nursing Education: Curricular and Pedagogical Strategies for a Complex Phenomenon.

Moral distress is a common phenomenon among nurses and is related to the complicated work environments and complex nature of ethical situations in day-to-day nursing practice. Moral distress impacts nurses as well as patient care and the health care system. Few strategies have been identified for instructors to effectively engage with learners when communicating about moral distress. We discuss two key curricular and pedagogical strategies that should be utilized when learning about moral distress: difficult knowledge' and 'terror management theory'. Whether it is with new nursing students or experienced nurses, there is necessary learning that needs to occur on moral distress. Difficult knowledge' and 'terror management theory', when implemented, can provide a starting point for both the learner and the instructor to discuss the emotionally difficult and complex topic of moral distress. Knowledge about moral distress has the potential to mitigate its negative effects, therefore it is vital to consider educational strategies to teach nurses about this complex phenomenon.

Practical Ethics: A Medical Student's Ethical Case in Surgery Clerkship.

AbstractOne factor that impedes medical students from speaking up about ethical situations is the lack of sufficient knowledge and skills in conflict resolution. This may also affect students' decision and timing to intervene. This article will provide practical ways to effectively and efficiently address the medical student's ethical case presented in August A. Culbert et al.'s "Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees."

Mapping the Islamic Ethical Discourse on Prenatal Diagnosis and Termination of Pregnancy: A Methodological Analysis

Abstract The development of prenatal diagnosis technologies has created challenging ethical situations and raised complex ethical questions. The hardest among these is the question of whether to continue or terminate pregnancies due to fetal anomalies. This article examines the Islamic methodological approaches that are employed to resolve contemporary issues pertaining to prenatal diagnosis and termination of pregnancy due to fetal anomaly. The objective is, firstly, to understand on which basis the various Islamic views and perspectives have been constructed, and secondly, to assess the rules and principles that Muslim jurists apply to arrive at decisions regarding prenatal diagnosis and termination of pregnancy across the different schools of thought. This helps in identifying the methodological characteristics of contemporary Islamic discourse on prenatal diagnosis and termination of pregnancy, and recognizing existing gaps. This methodological analysis aspires to generate further and richer discussion on how to develop thorough ethical approaches to prenatal diagnosis and termination of pregnancy due to fetal anomaly with the aim of advancing antenatal care for Muslim patients. Key concepts and principles within Islamic theology, law, and ethics are explored.

Unravelling The Auditors’ Dilemma: Ethics Or Money? A Case Of Indonesia Auditors

Purpose: This study aims to examine several influencing factors of auditors’ behavior in ethical dilemma situations and whether auditor behavior in ethical dilemmas is driven by the love of money Methodology/Approach: This study populations are all external auditors in Indonesia period 2019 with 282 auditors as samples. Partial Least Squares analysis (PLS) was used to analyze the data obtained. Findings: This study reveals that in an ethical dilemma situation, experience and level of education do not affect auditor behavior. However, idealism and love of money affect auditor behavior. While an auditor's experience increases the love of money, the more experienced an auditor is, the lower the level of love of money is. In dilemma situations, the love of money mediates the effect of education and experience on ethical behavior. Excessive love for money can arise through the process of socialization that is obtained and maintained in life. Practical implications: These findings prove that love of money mediate the relationship between the influencing factor of auditor’s behavior Originality/value: The novelty of this study lies in love of money as intervening variable on the relationship between the influencing factor of auditor’s behavior in ethical dilemma situations which has never been done in previous research.

Physiotherapists' ethical behavior in professional practice: a qualitative study.

In health professions, ethics is considered a fundamental competence. The increase in clinical autonomy in the field of physiotherapy is associated with an increase in ethical situations in their clinical practice. To explore the ethics of the clinical relationship between physiotherapists and patients, the ethics training received by physiotherapists, and if in the clinical context, physiotherapists identify the necessary attitudes and apply the ethical recommendations of the profession for the ethical situations they experience. A qualitative exploratory and descriptive study was performed with physiotherapists. Data were collected through semi-structured interviews. The data were analyzed using content analysis, as proposed by Krippendorf. The study protocol was approved by the University of Valencia Ethics Committee of Human Research. This study included 15 physiotherapists (66.66% women, average age = 42.2 years), which was sufficient to reach data saturation. We identified four categories: (i) Ethics of the clinical relationship (ethical values, principles, and norms; type of clinical relationship), (ii) Ethics training received (during the physiotherapy studies; current training of students; low importance of ethics in the curriculum), (iii) Necessary attitudes for professional ethical practice (main attitudes were identified: personal attitudes and professional attitudes); (iv) Experiences from professional practice (general; public sector vs. private sector). The ethics of the clinical relationship between physiotherapists and patients is determined by the attitudes of the practitioner, which are the result of his or her values and previous experiences; and are very centered on ethics of indication (founded mainly on the principles of Beneficence and Non-Maleficence). It is necessary to improve the ethical training received by physiotherapists, which is poorly focused on professional attitudes.

Responding to Unethical Demands by One’s Leader: The Role of Public Service Motivation

ABSTRACT Research shows that public service motivation (PSM) may serve as a buffer of unethical decision-making. We expand research by studying whether PSM is also related to ethics in situations where supervisors demand unethical behaviours from their employees. Our results show that PSM as a global concept and the PSM-dimension “Commitment to Public Values” are both negatively associated with the acceptance of unethical guidelines by one’s supervisor. Our study contributes to a better understanding of the ethical outcomes of highly public-service motivated individuals, while also looking at the dimensionality of the concept of PSM. This research is important because we contribute to a better understanding of how public workers might react when being confronted with unethical demands in their workplace, which presents worrisome issue across many countries around the world.

Introduction of a Novel Ethics Curriculum to the Third-Year Psychiatry Clerkship Experience.

The purpose of this study was to determine if a brief ethics curriculum embedded in a third-year required clerkship differentially impacted students' self-rated confidence versus competence (determined by a written examination) regarding ethical principles related to psychiatry. Using a naturalistic design, 270 medical students at the University of Washington were assigned to one of three groups during their third-year psychiatry clerkship: a control group with no additional ethics content, a group with access to a pre-recorded video ethics curriculum, or a group with live didactic sessions in addition to the video curriculum. All students took a pre- and post-test that assessed their confidence and competence in ethical theory and behavioral health ethics. Confidence and competence were not statistically different across the three groups prior to completing the curriculum (p > 0.1). Post-test scores on confidence in behavioral health ethics were not significantly different between the three groups (p > 0.05). Post-test scores on confidence in ethical theory were significantly higher in the video-only and video + discussion group as compared to the control group (3.74 ± 0.55 and 4.00 ± 0.44 vs. 3.19 ± 0.59 respectively; p < 0.0001). Both the video-only and video + discussion group showed greater improvement in competence in ethical theory and application than the control group (0.68 ± 0.30 and 0.76 ± 0.23 vs. 0.31 ± 0.33, respectively; p < 0.0001) and behavioral health ethics (0.79 ± 0.14 and 0.85 ± 0.14 vs. 0.59 ± 0.15, respectively; p < 0.002). With the addition of this ethics curriculum, students showed both increased confidence and competence in their ability to analyze ethical situations as well as increased competence regarding behavioral health ethics.

In search of epistemic justice. Dialogical reflection of researchers on situated ethics in studies with people living with language and/or cognitive impairment

BackgroundAcademics aim to understand the experiences of people living with cognitive and/or language impairment in their search for epistemic justice. Methods that do not rely solely on verbal information (e.g., interviews, focus groups) but also employ an attunement to the non-verbal - such as participant observation and creative methods, are seen as a suitable way to do justice to people's non-verbal interactions. However, in practice, researchers still experience ethical issues in everyday encounters with participants with cognitive and/or language impairment even when trying to address epistemic issues while employing such methods. This article aims to demonstrate 1) the importance of attending to the non-verbal in order to prevent epistemic injustice in research and 2) how a case-study approach and discussing ethical dilemmas with peers may help to unpack some of the ethical tensions that the researchers experience. Aim and methodsThis article focuses on ethical dilemmas the authors encountered during their research projects in the past. Three cases chosen by the authors illustrate these dilemmas. Dilemmas are presented as auto-ethnographical written accounts, which were discussed during ten retrospective dialogical sessions (60–90 min) organized by the research group consisting of six academic researchers. ResultsEthically sound research, in which older people living with cognitive and/or language impairment are engaged, entails much more than following procedures about informed consent, privacy, submitting a proposal to an ethics committee, and using suitable methods and techniques. Ethical issues in these studies relate to everyday situations in which researchers tried to do justice to the knowledge of people who have difficulties expressing themselves verbally, but were challenged by what they have initially experienced as ‘having it wrong,’ ‘not knowing,’ and ‘losing something in translation’ in their practice. Finally, we learned that the interactions the researchers encountered were complex. They had to constantly evaluate the appropriateness of their approach, balance rational and intuitive forms of interaction and interpretation, and consider ways of communicating the research findings. Discussion and conclusionApproximating epistemic justice in research with people with cognitive and/or language impairment requires extra effort in daily research routines. Sharing everyday ethical issues via case stories and reflecting on these issues encourages moral learning and brings new knowledge about the craftsmanship of researchers. Especially the collaborative and dialogical reflection helped the researchers to dig deeper and find words for intangible processes that often remain unaddressed. However, sharing stories about ethical issues requires mutual trust and safety because sharing and reflecting may bring discomfort, messiness, and uncertainty.

Ethical considerations and dilemmas for the researcher and for families in home-based research: A case for situated ethics

When researching with or about families in home-based research, there are numerous unexpected ethical issues that can emerge, particularly in qualitative research. This paper is based on reflective accounts of four homed-based research projects, two in the UK and two Australia, which examined ethical dilemmas identified when engaged in home-based research with young children. Using a synergy of ecocultural theory and Foucauldian ideas of Heterotopia as theoretical conceptualisations, the authors employed reflective lenses to guide their approach, and examine dilemmas and complexities when conducting research in the home. We argue that, to address ethical dilemmas, researchers need to problematise and reflect upon the nature of respectful approaches and the ethical implications of their behaviours. We conclude that, although ethical codes are valuable when researching families at home, researchers should plan for and forefront their methodological approaches in ways that are family-centred, whilst also framed by practices that are ethical, respectful and reflective to the situated contexts of family’s ecologies and heterotopias.

The Ethics of Publicly Available Data Research: A Situated Ethics Framework for Reddit

Using user-generated content from open-access platforms such as Reddit for research raises ethical questions and challenges. Research projects involving publicly available data can qualify for an exemption from human research ethics review. However, when the exemption is granted, some scholars move to the data collection phase without attending further to ethical considerations. This does not always result from negligence but can be driven by the lack of coherent guidelines or limitations of procedural ethics. Despite receiving an exemption from ethics review, researchers can still engage with ethical concerns throughout the project. This article argues that a “situated ethics approach” to researching publicly available online data, which pays attention to flexibility, reflexivity, and complexity of research ethics, should be applied to projects working with data from user-led platforms—Reddit or others. Using a reflexive process and drawing iteratively on learnings, this article describes and analyses a situated ethics framework applied to a case study of doctoral research about youth health discussions on Reddit. Through a focus on three key areas: digital context, users’ views, and project specificity, the framework inspired a set of ethical questions that can assist with applying situated ethics to other studies. This paper advocates that a “situated ethics approach” to researching publicly available online data can usefully advance debates and practice in research on user-led platforms with public data, such as Reddit.

Empowering general practitioners in dementia care: The ANTISTIGMA education intervention in Europe.

There is a well-documented lack or delay of diagnosis of dementia in all countries, including in Europe. Most general practitioners (GPs) have acquired adequate academic and scientific information about dementia but avoid using it in practice because of stigma. To persuade GPs of their role in dementia detection, an Antistigma education intervention was designed, with teaching objectives focusing on "Why" and "How" to diagnosis and manage dementia, based on ethical and practical content, as opposed to classical training centered on teaching "What", with mainly academic content. During the European Joint Action "ACT ON DEMENTIA", the Antistigma education intervention was implemented in four Universities: Lyon and Limoges (France), Sofia (Bulgaria) and Lublin (Poland). General data, including information about training and experience in dementia, was collected. Specific scales measured Dementia Negative Stereotypes DNS and Dementia Clinical Confidence D-CO before and after training. 134 GPs and 58 residents R completed the training. The participants were mainly women (74%), and the mean age was 42.8±13.2. Before training, participants expressed difficulties in defining GPs role and worries about inflicting Stigma, Risks of diagnosis, Lack of benefit and Communication difficulties. Participants' D-CO was significantly higher for Diagnosis process (64%) than for other clinical situations. After training, total NS was reduced from 34.2% to 29.9% (p<0.001), and stereotypes were improved: GPs' role (40.1% reduced to 35.9%; p<0.001), Stigma (38.7% reduced to 35.5%; p<0.001), Risks of diagnosis (39.0% reduced to 33.3%; p<0.001), Lack of Benefit (29.3% reduced to 24.6%; p<0.001) and Communication difficulties (19.9% reduced to 16.9%; p<0.001). After training, D-CO was significantly increased in all the clinical situations (p<0.001), but stayed highest for Diagnosis Process. There was no significant difference between the universities. Participants who benefited best from the Antistigma education intervention were those without training in Geriatrics and those working in nursing homes (who reduced the most D-NS), as well younger participants and those who managed less than five people living with dementia per week (who increased the most D-CO). The Antistigma program is based on the idea that most often GPs and R have acquired adequate academic and scientific information about dementia but avoid using it in practice because of stigma. These results outline the importance of addressing ethical issues and practical management situations in dementia education, to empower GPs in dementia care.

간호대학생의 윤리적 성향, 전문직 자아개념, 심폐소생술 태도가 생명의료윤리의식에 미치는 영향

Purpose : The purpose of this study is a descriptive study to identify the factors that influence nursing students’ ethical disposition, professional self-concept, and cardiopulmonary resuscitation attitude on bio-medical ethics.&#x0D; Method : This study identifies the factors that affect bio-medical ethics by convenience sampling. Data were collected using a questionnaire from 257 students participating in bio-medical ethics education from December 15, 2019 to January 15, 2020.&#x0D; Results : The subjects’ ethical disposition were 42.21±5.18 for idealism and 38.91±5.96 for relativism. The average professional self-concept was 3.72±0.43, and the CPR attitude was 3.83±0.47. The overall average of bio-medical ethics was 3.17±0.44. The relationship between idealism (r＝.54), relativism (r＝.28), professional self-concept (r＝.39), CPR attitude (r＝.26), and bio-medical ethics of nursing students showed a statistically significant positive correlation. The significant predictors of bio-medical ethics were idealism (β＝.04) and professional self-concept (β＝.18).&#x0D; Conclusion : Based on the research results, the development of various types of educational programs that can improve bio-medical ethics capabilities should be developed. First, comprehensive education on ethical principles and concepts should be provided in ethical decision-making situations. Second, educational content that can foster professional self-concept and idealistic ethical disposition should be included to understand ethical beliefs. It is necessary to apply educational programs, such as simulation, discussion, and problem-solving teaching and learning methods, so nursing students can actively participate in and judge bio-medical ethics situations.

Этические риски в практике искусственного интеллекта

The article raises the question of the relationship between the practice of artificial intelligence and universal ethics. The topic is fundamentally important, since a person and society that have lost their ethical foundations are deprived of their humanity. The ethics of scientists, designers, high-level managers play a decisive role in modern processes of development and application of artificial intelligence. In their activities, an ethic of responsibility develops, originating from the Russell-Einstein Manifesto, published in 1955 in the conditions of a nuclear standoff during the Cold War. The article shows the modern indescribably rapid growth and development of artificial intelligence applications in the practical life of people. Attention is drawn to the fact of the presence of uncertainty in situations of practical application of artificial intelligence, the presence of unforeseen consequences in addition to the expected consequences, who is responsible for those consequences (individuals, corporations, governments). The responsibility lies with the one who decides on the action: the actor. The actor is in a situation of ethical risk. It is shown that the risk increases due to a number of circumstances: 1) a variety of applications; 2) uncontrolled rampant growth; 3) difficulties in tracking the empirical situation of application; 4) difficulties in theoretical analysis of the situation of action. The article focuses on the risks of the practice of peaceful use of remotely piloted aircraft, as well as their military use and automated weapons without operator confirmation. The sharp, apparently exponential growth of information technology, the practical implementation of artificial intelligence, puts people in a difficult situation, an ethical situation: what to choose ‘to have or to be’. Or is there a third choice?