While Medical Large Language Models (MedLLMs) have demonstrated remarkable potential in clinical tasks, their ethical safety remains insufficiently explored. This paper introduces $\textbf{MedEthicsQA}$, a comprehensive benchmark comprising $\textbf{5,623}$ multiple-choice questions and $\textbf{5,351}$ open-ended questions for evaluation of medical ethics in LLMs. We systematically establish a hierarchical taxonomy integrating global medical ethical standards. The benchmark encompasses widely used medical datasets, authoritative question banks, and scenarios derived from PubMed literature. Rigorous quality control involving multi-stage filtering and multi-faceted expert validation ensures the reliability of the dataset with a low error rate ($2.72\%$). Evaluation of state-of-the-art MedLLMs exhibit declined performance in answering medical ethics questions compared to their foundation counterparts, elucidating the deficiencies of medical ethics alignment. The dataset, registered under CC BY-NC 4.0 license, is available at https://github.com/JianhuiWei7/MedEthicsQA.
Recognizing how technical systems can embody social values or cause harms, human-computer interaction (HCI) research often approaches addressing values and ethics in design by creating tools to help tech workers integrate social values into the design of products. While useful, these approaches usually do not consider the politics embedded in the broader processes, organizations, social systems, and governance structures that affect the types of actions that tech workers can take to address values and ethics. This paper argues that creating infrastructures to support values and ethics work, rather than tools, is an approach that takes these broader processes into account and opens them up for (re)design. Drawing on prior research conceptualizing infrastructures from science \& technology studies and media studies, this paper outlines conceptual insights from infrastructures studies that open up new tactics for HCI researchers and designers seeking to support values and ethics in design.
Sahibzada Farhan Amin, Sana Athar, Anja Feldmann
et al.
Internet measurement research is essential for understanding, improving, and securing Internet infrastructure. However, its methods often involve large-scale data collection and user observation, raising complex ethical questions. While recent research has identified ethical challenges in Internet measurement research and laid out best practices, little is known about how researchers actually make ethical decisions in their research practice. To understand how these practices take shape day-to-day from the perspective of Internet measurement researchers, we interviewed 16 researchers from an Internet measurement research group in the EU. Through thematic analysis, we find that researchers deal with five main ethical challenges: privacy and consent issues, the possibility of unintended harm, balancing transparency with security and accountability, uncertain ethical boundaries, and hurdles in the ethics review process. Researchers address these by lab testing, rate limiting, setting up clear communication channels, and relying heavily on mentors and colleagues for guidance. Researchers express that ethical requirements vary across institutions, jurisdictions and conferences, and ethics review boards often lack the technical knowledge to evaluate Internet measurement research. We also highlight the invisible labor of Internet measurement researchers and describe their ethics practices as craft knowledge, both of which are crucial in upholding responsible research practices in the Internet measurement community.
Elizabeth Ankrah, Stephanie Nyairo, Mercy Muchai
et al.
Small and medium sized businesses often struggle with data driven decision making do to a lack of advanced analytics tools, especially in African countries where they make up a majority of the workforce. Though many tools exist they are not designed to fit into the ways of working of SMB workers who are mobile first, have limited time to learn new workflows, and for whom social and business are tightly coupled. To address this, the Dukawalla prototype was created. This intelligent assistant bridges the gap between raw business data, and actionable insights by leveraging voice interaction and the power of generative AI. Dukawalla provides an intuitive way for business owners to interact with their data, aiding in informed decision making. This paper examines Dukawalla's deployment across SMBs in Nairobi, focusing on their experiences using this voice based assistant to streamline data collection and provide business insights
This article presents a new theoretical model, the Sentiment Exchange, which explores the ethical, economic, and technological implications of transforming human emotions into digital assets within blockchain-based platforms. The core idea is to define a normative framework for what the author calls the Economy of Emotions, where emotions such as love, fear, happiness, and anger can be recorded, tokenized, and exchanged in a decentralized environment. Unlike traditional economic models that treat emotions as behavioral background noise, this model places emotional capital at the center of value creation and decision-making. The novelty of the proposal lies in its emphasis on ethical governance, emotional equity, and decentralized consent, offering conceptual tools such as the Emotional Equity Index and Subject Quotations to ensure emotional dignity and transparency. The article bridges behavioral economics, ethics of technology, and digital sociology to create a hybrid model with practical implications for future emotional markets. It does not rely on empirical data but offers a normative and theoretical architecture to contribute to a more equitable and human-centered digital future.
This study critically examines the impact of International Non-Government Organizations’ (INGOs) educational funding on human development outcomes in conflict-affected and developing regions, focusing on Syria, Bangladesh, DRC, Sudan, and Ukraine. Employing a mixed-methods approach, the research analyses the relationship between INGO budget allocations for education and the Human Development Index (HDI), utilizing panel data regression models and qualitative thematic analysis. Quantitative findings indicate a positive association between INGO educational expenditures and HDI; however, econometric issues such as autocorrelation, heteroskedasticity, and cross-sectional dependence limit the robustness of results. Qualitative insights reveal that most INGOs operate with limited budgets, prioritize needs assessments, and consider macroeconomic factors like GDP and HDI in planning. Despite resource constraints, a majority intend to increase educational investments, often through partnerships with local governments. The study underscores the importance of context-sensitive strategies and comprehensive analysis for effective development interventions. While findings support the hypothesis that increased INGO funding correlates with improved human development, methodological limitations necessitate cautious interpretation. The research contributes to understanding operational dynamics, strategic planning, and the nuanced role of INGOs in fostering sustainable development in fragile contexts, offering valuable insights for policy and future research directions.
Business ethics, Social responsibility of business
Abdolrasoul Rahmanian Koushkaki, Sohrab Vahdan Asl
The purpose of this study is to investigate the effect of fixed asset investment and financial performance on the relationship between social responsibility and debt financing. The present study is applied and, from the methodological point of view, is a causal-correlational (post-event) study. The statistical population includes all companies listed on the Tehran Stock Exchange, and using the systematic elimination sampling method, 141 firms were selected as the research sample and studied over a 10-year period between 2014 and 2023. The findings of hypothesis testing showed that there is a direct and significant relationship between social responsibility and debt financing. Investment in fixed assets does not affect this relationship between social responsibility and debt financing, but financial performance has an inverse and significant effect on this relationship. By adhering to social responsibilities and respecting the rights of stakeholders and society, company managers can more easily access external financing by creating a better image. In addition, obtaining a higher social rank can strengthen the company's image for investors and provide greater assurance IntroductionCompanies and economic institutions need appropriate and timely financing to invest, repay debts, and increase working capital. Financial managers are always trying to increase the value of the company by creating new financing methods. Companies do not rely on only one type of resource; they try to use multiple resources to implement their plans and address their needs. Various factors can affect access to debt financing. Corporate social responsibility is one of the important issues that can influence the company's financing process. It is described as the process of creating wealth, promoting the company's competitive advantage, and maximizing the value of wealth and benefits created for society. In general, it reflects the commitment and attention of the business to the quality of life of employees, customers, the local community, and society as a whole, with the aim of developing a sustainable economy. Literature ReviewDebt financing is a more desirable solution for financing due to tax savings and its lower rate compared to the expected returns of shareholders, but what is important for creditors is the company’s repayment ability (Ebrahimi et al., 2019). Organizations should always consider themselves a part of society and have a sense of responsibility towards society. In order to improve public welfare, employees, and related stakeholders, companies should also work beyond their direct interests. A company's social responsibility focuses on important issues such as ethics, environment, security, education, and human rights (Kordestani et al., 2018). Companies with higher social responsibility can, in fact, provide a strong guarantee for debt repayment, ensure the proper functioning of the company, reduce managers' behavioral biases, and ensure the provision of accurate information by managers to the capital market. This can increase companies’ access to financing through debt (Oyar et al., 2024). Therefore, the first hypothesis of the present study is as follows:H1: Social responsibility affects access to financing through debt.Financial performance is an objective measure of how effectively an organization has used its assets to generate revenue. It is one of the most important indicators for evaluating its performance and the degree of achievement of predetermined goals (Rahimian et al., 2013). Financial performance reflects the efficiency or inefficiency of the company and can therefore influence the opinions of investors and creditors regarding the company's performance. Accordingly, the second hypothesis of the present study is as follows:H2: Investment in fixed assets affects the relationship between social responsibility and access to financing through debt.One of the fundamental variables affecting the future performance of companies, and consequently the return on their shares, is the level of investment in fixed assets. This can pave the way for achieving the desired return in the future. However, since higher investment involves greater risk, it can weaken the company's financial position, reducing its ability to maintain current returns and achieve growth in future periods. In the long run, this can also decrease the company's efficiency and performance (Oyar et al., 2024). Therefore, the third hypothesis of the present study is as follows:H3: Financial performance affects the relationship between social responsibility and access to financing through debt. MethodologyThe present study is applied and, from a methodological point of view, is causal-correlational (post-event). The statistical population includes all companies listed on the Tehran Stock Exchange, and the study period covers 2014 to 2023. The systematic elimination method was used to determine the sample, and 141 companies were selected as the research sample. Data analysis was carried out using the combined data method and the panel data approach, and Eviews 12 software was applied to test the hypotheses. ResultsThe findings from testing the research hypotheses showed that there is a direct and significant relationship between social responsibility and financing through debt. Investment in fixed assets does not affect the relationship between social responsibility and financing through debt, but financial performance has an inverse and significant effect on this relationship. By adhering to social responsibilities and respecting the rights of stakeholders and society, company managers can more easily access external financing by creating a better image. In addition, obtaining a higher social rank can strengthen the company's image for investors and provide greater assurance. DiscussionThe results showed that corporate social responsibility directly affects financing through debt. In fact, when companies adhere to social principles and responsibilities, those who extend credit to the company operate in a more favorable environment for repayment, which simplifies companies’ access to debt financing. One of the fundamental variables affecting the future performance of companies, and consequently the return on their stocks, is the level of investment in fixed assets. Such investment can pave the way for achieving desirable returns in the future, but because of the added risk it places on the company's financial position, higher investment can reduce the company's ability to maintain its current return and achieve growth in future periods. While investing in fixed assets should theoretically affect debt financing because such assets can serve as collateral, the results showed that this feature has no effect on the relationship between social responsibility and debt financing. Financial performance reflects the overall performance of the company and the profitability derived from expenses and assets. It weakens the relationship between social responsibility and debt financing. In fact, it can be interpreted that financial performance influences the relationship between social responsibility and debt financing. ConclusionThe main limitation of the present study is the lack of a comprehensive and complete index to measure the social responsibility of companies. If the Stock Exchange Organization were to provide a general measure of social responsibility through comprehensive studies, the scope of research in this field would be greatly expanded.
AI systems may have transformative and long-term effects on individuals and society. To manage these impacts responsibly and direct the development of AI systems toward optimal public benefit, considerations of AI ethics and governance must be a first priority. In this workbook, we introduce and describe our PBG Framework, a multi-tiered governance model that enables project teams to integrate ethical values and practical principles into their innovation practices and to have clear mechanisms for demonstrating and documenting this.
The development of an IT strategy and ensuring that it is the best possible one for business is a key problem many organizations face. This problem is that of linking business architecture to IT architecture in general and application architecture specifically. In our earlier work we proposed Category theory as the formal language to unify the business and IT worlds with the ability to represent the concepts and relations between the two in a unified way. We used rCOS as the underlying model for the specification of interfaces, contracts, and components. The concept of pseudo-category was then utilized to represent the business and application architecture specifications and the relationships contained within. The linkages between them now can be established using the matching of the business component contracts with the application component contracts. However the matching was based on manual process and in this paper we extend the work by considering automated component matching process. The ground work for a tool to support the matching process is laid out in this paper.
Fabrizio Fornari, Ivan Compagnucci, Massimo Callisto De Donato
et al.
Modern organizations necessitate continuous business processes improvement to maintain efficiency, adaptability, and competitiveness. In the last few years, the Internet of Things, via the deployment of sensors and actuators, has heavily been adopted in organizational and industrial settings to monitor and automatize physical processes influencing and enhancing how people and organizations work. Such advancements are now pushed forward by the rise of the Digital Twin paradigm applied to organizational processes. Advanced ways of managing and maintaining business processes come within reach as there is a Digital Twin of a business process - a virtual replica with real-time capabilities of a real process occurring in an organization. Combining business process models with real-time data and simulation capabilities promises to provide a new way to guide day-to-day organization activities. However, integrating Digital Twins and business processes is a non-trivial task, presenting numerous challenges and ambiguities. This manifesto paper aims to contribute to the current state of the art by clarifying the relationship between business processes and Digital Twins, identifying ongoing research and open challenges, thereby shedding light on and driving future exploration of this innovative interplay.
Bibliometric analysis is a widely recognized approach for examining extensive scientific data sets. However, its application is relatively new, particularly in greenwashing within the environment. As a comprehensive concept, sustainability encompasses various aspects, and greenwashing has emerged as a specific branch that has garnered increased attention and research in recent years. The study's primary purpose is to deploy the bibliometric method to analyze greenwashing literature from 2003 to 2023 using the Web of Science Core Collection and VOSviewer software to identify and visualize the intellectual landscape of the field. The number of scientific publications related to the topic confirms the importance and popularity of the subject. In this period, a total of 807 publications on the topic of greenwashing were identified, and three different periods were set. Most publications and citations primarily come from the USA, China, and other developed European countries. In terms of journals, prominent publications hold positions in the top 10, such as the Journal of Business Ethics, Journal of Cleaner Production, Business Strategy and The Environment, and Sustainability. The topic mainly concerns social and natural sciences branches, emphasizing corporate social responsibility and environmental concerns. Regarding keywords, four clusters can be distinguished as being in the center of governmental, consumer, corporate, and management issues. The ongoing trends predict a persistent rise in worldwide publications regarding greenwashing.
Loréa Baïada-Hirèche, Lionel Garreau, Jean Pasquero
While business ethics (BE) courses have increasingly formed part of business school curricula, we still do not know much about how these courses can change students’ capacity to deal with ethical issues. Drawing on a sensemaking perspective, we conducted an action research study with 66 business professionals enrolled in an executive training program at a French university. The aim was to investigate the processes underlying ethical judgment (EJ) change through a BE course. Participants were invited to pick a significant ethical issue they had personally experienced at work. They were then asked to make sense of it, in writing, at the beginning and at the end of the course, 3 months later. In comparing pre-course and post-course judgments, we concluded that the structure and contents of the respondents’ initial judgment had indeed been modified. This change could be accounted for as the outcome of four ‘sense-remaking’ mechanisms, which we theorize as complexifying, reprioritizing, conceptualizing and contextualizing. Our study contributes to the literature on BE education by demonstrating the benefits of a sensemaking approach. It also offers an original process-based model of EJ, specifying the mechanisms at play in EJ change. Finally, it contributes to the field of sensemaking studies by introducing the concept of sense-remaking, shedding new light on the evolutive dimension of sensemaking.
Miglena Angelova, Tsvetana Stoyanova, Philip Stoyanov
Today`s business organizations face enormous challenges: an unpredictable, unsecured and complex business environment, strong competitiveness, substitute products, spoiled customers with growing needs and demands, pandemic restrictions and social isola-tion, post-pandemic situation and recovery, economy crisis, military conflicts etc. On this background the rapid development of information and communication technologies offers very logical and convenient way to secure company`s existence and growth. Recent past years proved that the usage of ICT in HR management opens new horizon both for the employees and their manag-ers. On the other hand, the implementation of Artificial Intelligence and digitalization in HR management is not an unambigu-ous process. Still there are many open questions concerning ethics, personal freedom of employees etc. The aim of the present article is to understand the opinion of young people as future employees on the usage of ICT and AI in companies and on this base to propose some workable solutions for improving HR management in innovative business organizations. Our findings indi-cate that young people are not yet ready to accept the decision made only by AI without any interference from the managers. At the same time our responders admit that the most serious advantage of AI is in collection and analysis of large amounts of data, while the most serious limitation is the heavy reliance on the technology, which is the logical result in digital era.
David Ngwoke Mbazor, Clinton Ohis Aigbavboa , Wellington Didibhuku Thwala
Nowadays, there exists a high incidence of competitions between organizations seeking control, relevance, and dominance in the market space due to globalization exacerbated by the continuous advancement in technologies, high customers’ tastes, and expectations. Thishas significantly influenced organizational decisions leading to constant reevaluation of operational procedures, adopting and implementing changes that will influence positive business outcomes. The literature search revealed that past studies on organizational leadership focused mainly on elements of leadership styles, strategies, and ethics. Hence, studies have not identified the factors that influence organizational leadership for adequate housing delivery in Nigeria. The study identified the factors that influence organizational leadership in the delivery of housing in Nigeria using the Broaden and Build theory, and Kurt Lewin’s leadership philosophical concepts as the fundamental basis underpinning the study. Delphi study approach was used to determine the areas of commonality before a consensus was reached. A structured questionnaire was administered to validate and removing outliers from the result. The Delphi study identified 20 distinct factors that influence organizational leadership for AHD in Nigeria. Factors such as organizational sustainability, motivation, etc., are the most significant factors influencing organizational leadership towards AHD. However, results from SEM analysis showed that only 12 variables are significant in measuring organizational leadership and management for AHD. The study concludes that the 12 identified factors are significant in AHD. Nevertheless, the application of these factorsin housing delivery is still low in Nigeria. Hence, it is recommended that real estate developers and other operators in housing should use the result from this study as a template for developing adequate housing.
Elisabeth Sartoretti, Thomas Sartoretti, Dow Mu Koh
et al.
Abstract Background Breast cancer screening is essential in detecting breast tumors, however, the examination is stressful. In this study we analyzed whether humor enhances patient satisfaction. Methods In this prospective randomized study 226 patients undergoing routine breast cancer screening at a single center during October 2020 to July 2021 were included. One hundred thirty-two were eligible for the study. Group 1 (66 patients) received an examination with humorous intervention, group 2 (66 patients) had a standard breast examination. In the humor group, the regular business card was replaced by a self-painted, humorous business card, which was handed to the patient at the beginning of the examination. Afterwards, patients were interviewed with a standardized questionnaire. Scores between the two study groups were compared with the Mann-Whitney U test or Fisher’s exact test. P-values were adjusted with the Holm’s method. Two-sided p-values < 0.05 were considered significant. Results One hundred thirty-two patients, 131 female and 1 male, (mean age 59 ± 10.6 years) remained in the final study cohort. Patients in the humor group remembered the radiologist’s name better (85%/30%, P < .001), appreciated the final discussion with the radiologist more (4.67 ± 0.73–5;[5, 5] vs. 4.24 ± 1.1–5;[4, 5], P = .017), felt the radiologist was more empathetic (4.94 ± 0.24–5;[5, 5] vs.4.59 ± 0.64–5;[4, 5], P < .001), and rated him as a humorous doctor (4.91 ± 0.29–5;[5, 5] vs. 2.26 ± 1.43–1;[1, 4], P < .001). Additionally, patients in the humor group tended to experience less anxiety (p = 0.166) and felt the doctor was more competent (p = 0.094). Conclusion Humor during routine breast examinations may improve patient-radiologist relationship because the radiologist is considered more empathetic and competent, patients recall the radiologist’s name more easily, and value the final discussion more. Trial registration We have a general approval from our ethics committee because it is a retrospective survey, the patient lists for the doctors were anonymized and it is a qualitative study, since the clinical processes are part of the daily routine examinations and are used independently of the study. The patients have given their consent to this study and survey.
Medical physics. Medical radiology. Nuclear medicine, Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Luis Rubalcaba, Kirsty Strokosch, Anne Vorre Hansen
et al.
Citizen participation in the planning, design, and delivery of public services has been of central interest for public administration and management scholars since the 1970s at least (Osborne and Strokosch 2021, 2022) [...]
Political institutions and public administration (General)
Photo by National Cancer Institute on Unsplash
“An expert is someone who knows some of the worst mistakes that can be made in his subject, and how to avoid them.”
― Werner Heisenberg
INTRODUCTION
Bioethicists have long debated the question of expertise in clinical ethics and who gets a say in bedside clinical ethics consults.[1] From Seattle’s famous God Committee that decided on the allocation of kidneys, to clinical ethicists at a suburban hospital in Ohio, clinical ethics ‘experts’ have been central to bioethics and its development.[2] However, it is time to question what expertise in clinical ethics means, and if there can ever be such an expert. Does expertise mean proficiency in clinical care or the ethics part of clinical ethics? Should professionals who are not healthcare practitioners be involved in clinical ethics discussions? In this paper, I argue that clinical ethics consults involving non-clinicians should be done away with for two reasons: first, they lack clinical medical experience to properly analyze the ethical issues, and second, moral expertise should give way to medical expertise.
Although clinical ethics consultants might venture into areas of clinical expertise with a bona fide intention of helping patients or surrogates, their judgment is often based on knowledge of ethical theories.[3] However, bioethicists have cautioned against a casuistic method and signaled for clinical ethicists to have clinical experience and medical education.[4] While it is perfectly possible to familiarize oneself with the law and ethics, I argue that it is not possible to appreciate the complexity of certain medical decisions entirely without medical experience.[5] Bedside ethical conundrums are unique and impact every patient differently. Thus, when an ethics consultant or a healthcare practitioner draws on a single bedside dilemma and applies the knowledge gained from it to a different patient or a different dilemma, they may find themselves creating bad rules and ignoring autonomy. As non-clinicians who sit on ethics committees have no bedside clinical experience, their magnitude of transformative experiences (experiences that give the subject knowledge that would otherwise be otherwise unavailable)[6] is limited. The clinicians develop such experiences over time giving care. The ethics committee members do not have a similar way to gain experience. This also speaks to the importance of a phenomenological reading of clinical ethics decisions. Specifically, clinical ethics consultants without sufficient medical expertise may fail to guide patients in the best way possible in making medical decisions. A confined and parochial, or purely philosophical, approach that non-clinicians often use might not be in the best interests of the particular patient. If they were to venture into clinical situations to comment on the ethical aspect, they could step into matters they know little about which might end up causing harm to the patient.
We, as bioethicists, would be doing a disservice to patients if we let non-clinicians claim the moral high ground in the face of medical advice. As Scofield puts it, “(Clinical) Ethics consultation is and can only be what it purports not to be—a moral, if not an ethics, disaster. It has acted unprofessionally because … of its failure to do what a profession worthy of the name would do.”[7]
l. Medical Expertise May Be More Appropriate than Moral Expertise
An idea that a clinical ethics consult should be conducted by clinicians themselves comports with the makeup of clinical ethics committees. They are usually comprised primarily of medical professionals, but increasingly hospitals are attracting more ethics professionals who are not healthcare practitioners. As Hauschildt and De Vires note, “a closer examination suggests that clinical ethicists are likely to be clinicians themselves and that clinical considerations are often the ultimate authority in defining what is, and is not, determined to be ethical.”[8] In cases that are reported to ethics consults, 63 percent show a disagreement between the patient and the doctor about the course of treatments.[9] Those disagreements speak to ethical issues. For example, if a doctor recommends palliative care and patient wants to pursue an aggressive course of treatment, the ethical dilemma is built into the clinical care decision. While we would like to think that ethicists on hospital ethics committees deliberate on philosophical nuances of treatment (or the lack thereof), I argue that clinical ethics consults focus on resolving clinical ambiguities and reaching consensus, which ultimately relies on clinical judgment. An ethics consultant may not be able to appreciate the medical nuances of the situation. Studies conducted have clearly demonstrated that most ethics consults are called in when there is a lack of communication.[10] What would serve the patients, in this case, is perhaps investing the money that is spent in training and employing non-clinician consultants into teaching doctors and nurses how to communicate better.
ll. Authoritarian Ethics Consults
As with healthcare workers delving into ethics advice, in clinical ethics consults, there is a risk that the consultant might adopt an “authoritarian approach”[11] and impose his or her values, priorities, and/or religious convictions on the patients and their families. It is inevitable that in the work of bioethics, the personal meets the professional. Even if they do not mean to impose their values on the patients, there is strong empirical data to suggest that in most clinical ethics consults, patients end up following recommendations of the ethics committees. For example, in a study conducted of 229 clinical ethics consults, approximately 88 percent of the recommendations were followed. Certain types of consults such as initiating a palliative care treatment or proceeding with life-sustaining intervention had a 100 percent compliance rate with the ethics committee’s advice.[12] Additionally, studies have shown that clinicians frame consults in a way that nudges the patients in making decisions that maximize their welfare and is seen as an acceptable form of paternalism.[13] Yet, patients likely do not appreciate paternalistic nudges. In the studies, most questions were about futility or the withdrawal of life-sustaining treatment. Arguably, these questions require clinical expertise and not ethical expertise. A clinician or a nurse may be better suited to help guide the patient’s family because they would be able to comprehend and explain the complexity of the clinical case to the family better. If the idea of a clinical ethics consult is to further patient autonomy, it is failing.
lll. Addressing Counterarguments
Two arguments may challenge a proposal as radical as kicking all the ethics consultants who are not also medical professionals or healthcare practitioners out of clinical ethics consults or committees: first, the argument that a broader variety of professionals should have a say in bioethics; and second, that ethics committee members may relate to patients more effectively than some physicians and other healthcare workers do. Yet, these claims are not strong rebuttals.
As bioethics developed within philosophy, it may have lost sight of the day-to-day ethical issues that arise in the clinic. Komesaroff argues that the task of handling clinical ethics consults is only one that clinicians can handle, and there is a need to separate bioethics from clinical ethics. He suggests that the time is ripe for clinical ethics to be considered through the lens of micro-ethics and established as an area of research distinct from bioethics.[14] I agree and assert that there is a need to distinguish the broader ethical debate from the work of everyday clinical practice, a work where clinicians are best suited to handle the issues, perhaps a subcategory of bioethics. This will involve the need for redefining the relationship between the macro ethical work of bioethics, and the micro ethical work of everyday medical/clinical ethics which happens at the bedside.[15] What is required in a clinical ethics setting, in my opinion, is for the doctor not to frame the issue in terms of bioethical or large philosophical concepts such as autonomy or deontology, but to talk to the patient and more importantly, listen to the patient. A smooth communication structure, if put in place, would help alleviate fear and establish a common ground on which decisions can be reached in clinical settings. That is, I see clinical ethics as also not necessary to the doctor-patient relationship but argue that better communication would help patients make important decisions. The ethics ultimately would belong to the patient, with the clinician providing necessary data that will help guide patient decision making and do no more.
The second issue is relatability. Clinicians are often constrained by their vocabulary and medical expertise and may not be able to break down the complex pathology of a disease to the patients. Thus, some may argue that non-clinicians, not held back by the jargon, would be able to relate to the patient. As I proposed earlier, the money spent hiring and training clinical ethics consultants could be redirected to teaching doctors how to be more effective communicators. That would perhaps further patient autonomy. Nurses may also make effective interlocutors between patients and doctors in cases where the doctor cannot get through to the patient. Nurses are often involved more in the day-to-day dealing with the patient and thus know the patient and their families closely. Secondly, they possess the requisite medical knowledge to help the patients through decision-making processes. Yet the current shortage of nurses also poses issues in this realm. Some doctors and nurses make a point to get to know the patients, their beliefs, and their goals of care and could thus be better at helping patients arrive at decisions by using open jargon-free communication.
CONCLUSION
Much of this paper stems from my experiences as a Master of Bioethics candidate at Harvard Medical School. As a non-clinician who studied clinical ethics for a semester, under excellent guidance, I often found myself turning to friends who had clinical experience with questions about the medical aspects of case discussions. More often than not, the clinical insight that they gave me helped me better understand the choices that were before me as a purported expert in simulations. I have been plagued with the question-- would I be qualified to consult in clinical ethics, after a Master of Bioethics degree at Harvard Medical School? My answer would be an unequivocal NO. While I expect to be highly qualified to weigh in at the policy level and I have been provided the skillset necessary for in-depth philosophical analysis of complex bioethical issues, I have not become, and I suggest others are not as well, a moral expert (if there is such a thing). The hubris of a bioethicist should not get in the way of patient care. I do not mean to say through this paper, that non-clinicians are to be brushed aside is bioethical discussions. Lawyers, ethicists, chaplains, and the diverse set of people that are attracted to the work of bioethics provide an incredibly diverse set of skills, knowledge, and views that the clinicians often miss. They discuss and bring in perspectives from a variety of vantage points which have been instrumental in furthering the debates in bioethics. But as I have argued, they need not populate clinical ethics committees where they are at risk of exerting moral expertise, especially as their ethics position on a case may not be grounded in a deep enough understanding of the medical issues at hand. Instead, they should be used in broad policy-making decisions, framing issues, debating in print and digital media, and on IRBs. Bioethics is “everyone’s business,”[16] but clinical ethics should not be.
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[1] Jan Crosthwaite, ‘In Defence of Ethicists. A Commentary on Christopher Cowley’s Paper’ (2005) 8 Medicine, Health Care and Philosophy 281 <http://link.springer.com/10.1007/s11019-005-0085-6> accessed 11 December 2021, Jukka Varelius, ‘Is Ethical Expertise Possible?’ (2008) 11 Medicine, Health Care and Philosophy 127 <http://link.springer.com/10.1007/s11019-007-9089-8> accessed 11 December 2021, Christopher Cowley, “A New Rejection of Moral Expertise,” Medicine, Health Care and Philosophy 8, no. 3 (November 2005): 273–79, https://doi.org/10.1007/s11019-005-1588-x.Ana S. Iltis and Lisa M. Rasmussen, “The ‘Ethics’ Expertise in Clinical Ethics Consultation,” Journal of Medicine and Philosophy 41, no. 4 (August 2016): 363–68, https://doi.org/10.1093/jmp/jhw013.
[2] Albert R. Jonsen, “The God Squad and the Origins of Transplantation Ethics and Policy,” Journal of Law, Medicine & Ethics 35, no. 2 (2007): 238–40, https://doi.org/10.1111/j.1748-720X.2007.00131.x.
[3] Albert R. Jonsen, “Casuistry as Methodology in Clinical Ethics,” Theoretical Medicine 12, no. 4 (December 1991): 295–307, https://doi.org/10.1007/BF00489890.
[4] Matthew A. Butkus, “The Necessity of Clinical Experience in Medical Ethics Expertise,” in Moral Expertise: New Essays from Theoretical and Clinical Bioethics, ed. Jamie Carlin Watson and Laura K. Guidry-Grimes (Cham: Springer International Publishing, 2018), 227–44, https://doi.org/10.1007/978-3-319-92759-6_13.
[5] Butkus.
[6] L. A. Paul, “What You Can’t Expect When You’re Expecting,” Res Philosophica 92, no. 2 (2015): 149–70, https://doi.org/10.11612/resphil.2015.92.2.1.
[7] Giles R. Scofield, “What Is Medical Ethics Consultation?” Journal of Law, Medicine & Ethics 36, no. 1 (2008): 95–118, https://doi.org/10.1111/j.1748-720X.2008.00241.x.
[8] Katrina Hauschildt and Raymond De Vries, “Reinforcing Medical Authority: Clinical Ethics Consultation and the Resolution of Conflicts in Treatment Decisions,” Sociology of Health & Illness 42, no. 2 (February 2020): 307–26, https://doi.org/10.1111/1467-9566.13003.
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AbstractThis paper explores the role of the leading universities and best‐ranked business schools in the evolution of the academic field of business ethics. An advanced bibliometric methodology is applied to publications in business ethics from the major universities of the Shanghai ARWU ranking and from the FT‐ranked business schools. The comprehensive bibliometric study encompasses multiple indicators and examines the evolution of business ethics publications over time. Business ethics research is built on two complementary interdisciplinary streams of research, philosophy, and management. The study indicates that it were not the top universities that contributed most to research advancements in the field of business ethics but second and third tier universities. This finding suggests that academic research in new subfields constitutes a niche strategy for universities and business schools to differentiate themselves. The study furthermore highlights the prominent role of the product champion or ‘idea champion’ in management research at universities. The diffusion of business ethics research illustrates the possibilities for lower ranked business schools with lower budget to excel in specialised subfields and interdisciplinary subthemes.