Ethics and incentives: an evaluation and development of stakeholder theory in the health care industry

This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory's focus on ethics, without recognition of the effects of incentives, severely limits the theory's ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering.     

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.     

Organizational ethics in Catholic health care: honoring stewardship and the work environment.

Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.     

A Positive and Proactive Approach to the Ethics of the First Interview

Some may view the initial interview as a mechanistic procedure complete with a list of tasks to accomplish. The primary purpose of this article is to deconstruct this perspective and encourage psychotherapists to explore the initial interview through an ethical acculturation lens. Using a case scenario, we demonstrate the need for purposeful reflection to better understand important judgments and choices psychotherapists make while conducting initial interviews. Employing a proactive approach to ethics using a “wide-angle” lens, we organize the discussion around personal, professional, and global themes. We offer practical tips to facilitate ethical excellence as psychotherapists engage in their first client contacts.     

Infinite Responsibility in the Bedpan: Response Ethics,Care Ethics,and the Phenomenology of Dependency Work

Because Levinas understands ethical response as a response to the radical alterity of the other, he contrasts it with justice, for which alterity becomes a question of equality. Drawing upon the practice of dependency work and the insights of feminist care ethics, I argue that the opposition between responding to another's singularity and leveling it via parity‐based principles is belied in the experience of care. Through a hermeneutic phenomenology of caring for my post‐stroke grandfather, I develop an account of dependency work as a material dialectic of embodied response involving moments of leveling, attention, and interruption. Contra much of response ethics’ and care ethics’ respective literatures, this dialectic suggests that they complement each other in ways that productively illuminate themes of each. I conclude by suggesting that when response and care ethics are thought together through the experience of dependency work, such labors produce finite responsibility with infinite hope.     

Challenges and opportunities in moving toward a public health approach in school mental health

These three outstanding papers are important for the discipline of school psychology, the field of school-based mental health, and more generally for systems of education and mental health for children and adolescents. As the authors emphasize, there is an unprecedented focus on improving programs that remove barriers to learning and enhance development, health, and mental health in youth, in the most universal natural setting—the schools. The authors also correctly highlight that school psychology is uniquely positioned to play a leading role in this reform and change effort. Two interconnected themes of the public health approach—applying the evidence base and moving toward preventive and population-focused interventions—are emphasized in these papers, and while they focus on school psychology, the issues discussed are generalizable to the many disciplines that operate within educational and mental health systems. In the following discussion, I react to the papers' two major themes, discuss realities that should be addressed for progress to be made, and comment on their implications for school psychology.     

A Pilot Evaluation of Portfolios for Quality Attestation of Clinical Ethics Consultants

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step on the pathway to an eventual certification process for clinical ethics consultants.     

A statement of principles for health care journalists

Many journalism organizations have published codes of ethics in recent years. The Association of Newspaper Editors, for example, lists 47 different codes on its website. But an organization of health care journalists felt that none of those codes addressed the unique challenges of covering complex health care topics. The Association of Health Care Journalists (AHCJ) is an independent, non-profit organization dedicated to advancing public understanding of health care issues. Its mission is to improve the quality, accuracy and visibility of health care reporting, writing and editing. AHCJ has written a statement of principles for its 750 members. In it, AHCJ states some of the unique challenges faced by journalists covering health care, and offers suggestions on how to face those challenges. Bioethicists are invited to comment on the statement, and to help generate continued discussion of the issues addressed therein.     

A Statement of Principles for Health Care Journalists

Many journalism organizations have published codes of ethics in recent years. The Association of Newspaper Editors, for example, lists 47 different codes on its website. But an organization of health care journalists felt that none of those codes addressed the unique challenges of covering complex health care topics. The Association of Health Care Journalists (AHCJ) is an independent, non-profit organization dedicated to advancing public understanding of health care issues. Its mission is to improve the quality, accuracy and visibility of health care reporting, writing and editing. AHCJ has written a statement of principles for its 750 members. In it, AHCJ states some of the unique challenges faced by journalists covering health care, and offers suggestions on how to face those challenges. Bioethicists are invited to comment on the statement, and to help generate continued discussion of the issues addressed therein.     

Spirituality in health-care reform

Much of the discussion about health-care reform has focused on questions of political and economic policies. By contrast, this article contends that this dispute involves deeper questions of meaning regarding the kinds of values, including spiritual values, that we wish to be present in health care. Communities of religious believers have a civic duty of responsibility and a theological duty of stewardship for health-care institutions. Such communities bring to the health-care debate spiritual meaning embedded in themes of humility, justice, and mercy. These virtues provide a moral test of the soundness of reform proposals.     

The Religious and Social Principles of Patients’ Rights in Holy Books (Avesta, Torah, Bible, and Quran) and in Traditional Medicine

Health protection and promotion in healthy people and restoring patients’ health have been the most important themes in medicine and health throughout our history. Therefore, discussion of different aspects of patients’ rights includes implementation of these objectives by the medical community, including physicians, nurses, pharmacists, etc., and the people in charge of health affairs. The principal objective of our research is the study of medical ideology and the approaches of our ancestors in relation to different aspects of patients’ rights. To study the different ideologies of traditional medicine in relation to patients’ rights, appropriate data were extracted from the original resources of traditional medicine and from religious books. By means of library research we studied these resources in addition to electronic versions of the Alhavi book (by Rhazes), the Kamel-al-Sanaah (by Ahvazi), the Canon of Medicine (by Avicenna), the Zakhireye Khawrazmshahi (by Jorjani), the Avesta, the Torah, the Bible, the Quran, and many other resources, and, finally, after searching, gathering, and encoding the findings, analyzed them qualitatively for thematic content. The holy Avesta book clearly insists on the competence of physicians and setting the appointment fee in accordance with peoples’ income. The Old Testament (holy Torah) warned government officials who did not observe patients’ rights. In the four gospels (holy Bible) the importance of treatment and taking care of the patient is stressed. After the emergence of Islam, medical students, before beginning the principal courses, had to study Islamic jurisprudence, ethics, logic sciences, natural sciences, geometry, astrology, calculus, and similar courses so that after purifying their soul they could enter the saintly profession of physicians. The holy Quran refers to saving the life of a human irrespective of social class, race, and religion, and insists on exemption of patients from physical activity, including the physical aspects of prayer. In these resources, some warnings are offered in relation to fake drugs, the lack of awareness of some physicians, the need for complete preparedness of medical society, and the need to manufacture appropriate drugs and offer a suitable medical service. This information is to familiarize medical and health authorities and persons receiving health services. According to the evidence available about traditional medicine, there was no specific difference between public and professional ethics, public and professional rights, or rights and ethics—ethics were no different from rights nor rights from ethics. So ethics are similar to the soul in the body of rights, and rights are similar to the litter of ethics, and they have developed in parallel with each other. Traditional medicine is community-based and preservation of the health of healthy people is given priority over the treatment of patients; there is insistence that “health rights” has wider scope than “patients’ rights”. It can be stated that health rights in Iran both before and after the emergence of Islam have been based on guidance from divine religions, observation of humanist ethics, passing suitable courses in the basic sciences, and an introduction to the practical piety of our ancestors, in addition to the syllabus of medical and health education.     

The Ethics of Mandatory Personal Psychotherapy for Trainee Psychotherapists

Although the psychotherapist's personal psychotherapy has received considerable research attention in recent years, little systematic investigation of the ethical issues involved has been published. This article provides a rigorous interrogation of mandatory personal psychotherapy (MPP) as a training requirement for mental health professionals, a topic that remains ethically contentious. The article begins with a discussion of why MPP is an explicitly ethical issue, before debating the ethics of MPP under six questions, each worded to capture a salient ethical issue relevant to the appropriateness of making personal treatment a mandatory training requirement. Using principle, virtue, and care ethics perspectives, the arguments for and against MPP are critically investigated. The article concludes with an ethical position statement.     

An Introduction to Core Competencies for the Use of Mobile Apps in Cognitive and Behavioral Practice

Mobile technologies have become increasingly pervasive and integral in our daily lives. A growing number of mobile applications are focused on health applications with many specifically focused on helping the prevention, treatment, and management of mental health issues. These apps are slowly being introduced into clinical settings, either being brought in by clients who themselves are using these tools or by health systems or providers. Unfortunately, most practicing providers obtained their clinical training before the advent of mobile health tools and methods. Thus, a critical need exists to develop and disseminate resources to develop the essential skills needed to adopt mobile health techniques. We discuss the five core competencies in mobile health care: evidence, integration, security and privacy, ethics, and cultural considerations. Although this paper will not fully prepare a provider to use mobile apps in their practice, it provides an introduction that will helpfully guide a provider to additional resources and additional ways to develop these competencies. Finally, we discuss the future directions of the field, including a growing differentiation of the impact of mobile apps on clinical care and the need for training models and experiences to match this differentiation.     

Prevention of Mental Disorders: Promises, Limitations, and Barriers

In the past few years, the field of psychology has seen a dramatic increase in interest in the prevention of mental disorder and emotional difficulties. This special series provides some excellent examples of the promises held by a- variety of prevention programs. At the same time, the papers in this volume highlight several important issues to consider and barriers to the implementation of prevention programs. This discussion paper explores the themes and issues raised by these papers and considers some of the lessons to be extracted for research into and implementation of prevention programs across mental health.     

Ethics of caring and the institutional ethics committee

Institutional ethics committees (lECs) in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed lECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel Noddings, is an unacknowledged basis for /EC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for lECs.     

Health Care Chaplains and their Role on Institutional Ethics Committees: An Australia Study

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.     

Responsibility,Complexity Science and Education: Dilemmas and Uncertain Responses

While complexity science is gaining interest among educational theorists, its constructs do not speak to educational responsibility or related core issues in education of power and ethics. Yet certain themes of complexity, as taken up in educational theory, can help unsettle the more controlling and problematic discourses of educational responsibility such as the potential to limit learning and subjectivity or to prescribe social justice. The purpose of this article is to critically examine complexity science against notions of responsibility in terms of implications for education. First, themes of complexity science prominent in contemporary educational writing are explained. Then dilemmas of responsibility in complexity are explored, such as what forms and meanings responsibility can have in a ‘complexified’ perspective of education, how care for others is mobilised, and how desire can be understood. Analyses of ethical action grounded in complexity science are then examined, as well as theories of the ethical subject and participatory responsibility that are congruent with certain tenets of a complexity ontology. Finally, the possibility of an educational vision of responsibility animated by complexity theories is considered, drawing from related writings of Bai, Biesta, Derrida, Levinas and Varela.     

Towards and Beyond Edinburgh 2010: A Historical Survey of Ecumenical Missiological Developments since 1910

This article provides a brief history of mission theology of the global church since Edinburgh 1910, highlighting the seismological shifts and major developments in missiological thinking and praxis over the years and through various world mission conferences, specifically from the perspective of the Commission on World Mission and Evangelism (CWME). It argues that, as we prepare ourselves to celebrate the centenary mission conference in Edinburgh in June 2010, mission theology has moved from its early stage of colonial, Eurocentric expressions to post‐colonial and polyphonic articulations of missiology. For the CWME, though, the missiological journey continues even beyond 2010. This article argues that, amongst many important missiological themes that CWME needs to address within the overarching theme of “Ecumenism in Mission”, the themes CWME has identified as its major focus for the coming years – viz. ecclesiology and mission, mission as healing, and mission as contestation – are of crucial pertinence. In the changing global Christian landscape where the centre of gravity of Christianity has moved to the global South, and in a context where new forms of being ecclesial communities are tried out, “The Nature and Mission of the Church” needs to take a “from below” approach, going beyond the traditional frameworks of mainline churches. Mission as healing would provide a comprehensive and more integral perspective to the salvific purpose of God for this world, especially as “healing” is a common strand within many religious, ecclesial and spiritual traditions, offering a dialogical perspective. Mission as contestation is equally significant in today's world where the gospel imperative of confronting satanic forces that express themselves in the form of globalization, neo‐imperialism, patriarchy, racism, casteism and eco‐violence is of cardinal importance.