Resolving Ethical Dilemmas in Management: Experimental Investigations of Values, Accountability, and Choice

Hypotheses regarding the effects of personal values and accountability on the resolution of ethical dilemmas in management were formulated and tested experimentally with a sample of 135 M.B.A. students. Personal values were found to be related to how subjects chose to resolve an ethical dilemma presented to them; but, as expected, this relationship did not hold when subjects were made to feel accountable to another for their choices. Accountability, unexpectedly, however, did not have a main effect on choices. This lack of an effect tentatively was attributed to the inexplicitness of the accountability manipulations. In a second and third experiment, support for the importance of explicitness in accountability research was obtained. The theoretical and practical implications of the findings from all three experiments were discussed.     

Ethical Dilemmas of Confidentiality With Adolescent Clients: Case Studies From Psychologists

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices (breach/don’t breach) because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” (highest client autonomy) to “disclosure without the client’s knowledge or consent” (lowest client autonomy). Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development.     

Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model

Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians, and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and health care providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation of clinical ethics committees as a mechanism to analyze, discuss, and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method, as well as the approach that was taken to create a clinical ethics committee.     

A Survey of Telephone Answering Services in Suicide Prevention and Crisis Intervention Agencies*

ABSTRACT: The telephone service established by directors of suicide prevention and crisis intervention services is generally given little careful consideration. Many agencies take their telephone systems for granted, assuming that almost any system will function adequately if an operator is available and a crisis worker is on call. There are a number of important issues at stake that should be carefully considered before a program is established that uses any system other than full-time coverage by the trained crisis worker at a permanent location. In order to investigate just what really happens under the various systems in use, a series of 76 calls was placed to 19 different emergency crisis services in the southeastern United States. Times were recorded to show how much time elapsed, through what various systems, to get an actual crisis worker on the line. There were marked differences across the eight different systems identified. The results clearly indicate that crisis services are in danger of unknowingly providing inferior and dangerously low quality service unless they maintain maximum control over their own telephone answering system 24 hours a day.     

The Relationship between Coping Strategies and Perceived Stress in Telephone Intervention Volunteers at a Suicide Prevention Center

This study examines stress perceived by telephone intervention volunteers at a suicide prevention center before their shift, during the most high-urgency call, and after the shift. Eighty of the 82 active volunteers completed questionnaires concerning stress, coping strategies, motivations for volunteer work, and experiences with suicide. Stepwise multiple regression analysis indicated that only one variable, the amount of experience in telephone intervention with suicidal persons, predicted stress level before the shift; volunteers with more experience tended to be less stressed. Stress during the most urgent call was related first to the level of urgency of the call, then to the total length of all calls received, followed by the coping mechanisms of magical thinking, detachment, and feeling personally responsible. Stress after the shift was related first to the total amount of time spent on calls, then to the number of other persons present during the shift. Stress after the shift was also negatively related to amount of education and having realistic expectations about interventions. Magical thinking was positively related to stress, and the mechanism of positive thinking was negatively related. A high proportion of volunteers had attempted suicide, had previous thoughts about suicide, and had known persons who attempted or died by suicide. These findings are discussed as to their implications for the selection and training of volunteers in suicide prevention.     

Youth Suicide Prevention: A Survey and Analysis of Policies and Efforts in the 50 States

State-level initiatives directed at youth suicide prevention since 1980 were analyzed. During 1992 and 1996, each governor was surveyed regarding his or her state's efforts in youth suicide prevention. Questions pertained to legislation, a mandated or recommended school-based suicide prevention curriculum, funding, a special advisory council, a state plan, the development and dissemination of materials, and assessment. Several states sent examples of their prevention activities, which were reviewed to determine the extent to which they represent conceptually and/or empirically grounded preventive intervention strategies. The number of suicides, suicide rates, and percentage change in rate for youth 15–19 years old were reported by state for the periods 1979–1981 and 1992–1994. The results of a repeated measures 2 × 5 ANOVA revealed that while changes in suicide rates over time were statistically significant, there was no relation between these changes and any of the variables studied. Suggestions for future research on state-level initiatives are presented.     

The Relationship Between a Counselor's Ethical Orientation and the Stress Experienced in Ethical Dilemmas

The interaction of a counselor's ethical orientation, the ethical dilemmas within the counseling profession, and the stress experienced in resolving ethical dilemmas is examined in this research. A significant relationship was found between a societal orientation of ethical reasoning and the perception of stress associated with ethical dilemmas. The demographic variables of setting and gender also were significantly related to the stress associated with making ethical choices. Implications of the findings and future research on the relationship between ethical orientation and the stress involved in the ethical dilemmas of counseling are discussed.     

Effects of Different Telephone Intervention Styles with Suicidal Callers at Two Suicide Prevention Centers: An Empirical Investigation

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of Rogerian nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.     

Technological Advances and the Future of Suicide Prevention: Ethical,Legal, and Empirical Challenges

Technological advancements have brought multiple and diverse benefits to our human existence. In suicide prevention, new technologies have spurred great interest in and reports of the applicability to assessing, monitoring, and intervening in various community and clinical populations. We argue in this article that we need to better understand the complexities of implementation of technological advances; especially the accuracy, effectiveness, safety, ethical, and legal issues, even as implementation occurs at individual, clinical, and population levels, in order to achieve that measure of public health impact we all desire (i.e., greater benefit than harm).     

The Effectiveness of Suicide Prevention Centers

The presence of suicide prevention centers in a state in 1970 was negatively associated with changes in the suicide rate from 1970 to 1980 in the USA, indicating a preventive effect from suicide prevention centers. This effect, though weak, was consistently found for most demographic subgroups of the population and when a strong social correlate of suicide rates (divorce rates) was taken into account by means of multiple regression analysis.     

The Role of Decision-Making Models and Reflection in Navigating Ethical Dilemmas

The ACA Code of Ethics (American Counseling Association [ACA], 2014) mandates counselor competency in using ethical decision-making models (EDMs) and mandates that counselors use an EDM when confronted with making ethical decisions. Additionally, researchers have highlighted the importance of counselors continually evaluating and reflecting when faced with ethical dilemmas and working through a decision-making model. Using a phenomenological research design, the authors examined how counselors address ethical dilemmas, including how reflection and EDMs are incorporated into the decision-making process. Emergent themes from data analysis include (a) incomplete following of EDMs, (b) varied dilemmas, (c) power, and (d) ethics training.     

The Effectiveness of Suicide Prevention Centers: A Review

This article reviews 14 studies examining whether suicide prevention centers have a preventive effect on suicide rates. Seven studies were identified that provide some support for a preventive effect, one found an increase in the suicide rates, and six failed to find any significant effects (either preventive or facilitative). The studies' different methodologies are reviewed, and limitations on the authors' conclusions pointed out. The conclusion of this article is that the evidence provides support for a preventive effect from suicide prevention centers, albeit small and inconsistently found.     

Ethical Dilemmas at the End of Life: Islamic Perspective

Many Muslim patients and families are often reluctant to accept fatal diagnoses and prognoses. Not infrequently, aggressive therapy is sought by the patient or his/her family, to prolong the life of the patient at all costs. A series of searches were conducted of Medline databases published in English between January 2000 and January 2015 with the following Keywords: End-of-life, Ethics and Islam. Islamic law permits the withdrawal of futile treatment, including all kinds of life support, from terminally ill patients leaving death to take its natural course. However, such decision should only take place when the physicians are confident that death is inevitable. All interventions ensuring patient’s comfort and dignity should be maintained. This topic is quite challenging for the health care providers of Muslim patients in the Western World.     

The Risks of Revolution: Ethical Dilemmas in 3D Printing from a US Perspective

Additive manufacturing has spread widely over the past decade, especially with the availability of home 3D printers. In the future, many items may be manufactured at home, which raises two ethical issues. First, there are questions of safety. Our current safety regulations depend on centralized manufacturing assumptions; they will be difficult to enforce on this new model of manufacturing. Using current US law as an example, I argue that consumers are not capable of fully assessing all relevant risks and thus continue to require protection; any regulation will likely apply to plans, however, not physical objects. Second, there are intellectual property issues. In combination with a 3D scanner, it is now possible to scan items and print copies; many items are not protected from this by current intellectual property laws. I argue that these laws are ethically sufficient. Patent exists to protect what is innovative; the rest is properly not protected. Intellectual property rests on the notion of creativity, but what counts as creative changes with the rise of new technologies.