Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty,Utility, Fairness,and Accountability for Reasonableness

Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning policy choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations.     

Translating the Human Right to Water and Sanitation into Public Policy Reform

The development of a human right to water and sanitation under international law has created an imperative to implement human rights in water and sanitation policy. Through forty-three interviews with informants in international institutions, national governments, and non-governmental organizations, this research examines interpretations of this new human right in global governance, national policy, and local practice. Exploring obstacles to the implementation of rights-based water and sanitation policy, the authors analyze the limitations of translating international human rights into local water and sanitation practice, concluding that system operators, utilities, and management boards remain largely unaffected by the changing public policy landscape for human rights realization. To understand the relevance of human rights standards to water and sanitation practitioners, this article frames a research agenda to ensure that human rights aspirations lead to public policy reforms and public health outcomes.     

The Strength of Ethical Matrixes as a Tool for Normative Analysis Related to Technological Choices: The Case of Geological Disposal for Radioactive Waste

The ethical matrix is a participatory tool designed to structure ethical reflection about the design, the introduction, the development or the use of technologies. Its collective implementation, in the context of participatory decision-making, has shown its potential usefulness. On the contrary, its implementation by a single researcher has not been thoroughly analyzed. The aim of this paper is precisely to assess the strength of ethical matrixes implemented by a single researcher as a tool for conceptual normative analysis related to technological choices. Therefore, the ethical matrix framework is applied to the management of high-level radioactive waste, more specifically to retrievable and non-retrievable geological disposal. The results of this analysis show that the usefulness of ethical matrixes is twofold and that they provide a valuable input for further decision-making. Indeed, by using ethical matrixes, implicit ethically relevant issues were revealed—namely issues of equity associated with health impacts and differences between close and remote future generations regarding ethical impacts. Moreover, the ethical matrix framework was helpful in synthesizing and comparing systematically the ethical impacts of the technologies under scrutiny, and hence in highlighting the potential ethical conflicts.     

LONGITUDINAL STUDY OF PROCRASTINATION, PERFORMANCE, STRESS, AND HEALTH:

Abstract— Procrastination is variously described as harmful, innocuous, or even benefical. Two longitudinal studies examined procrastination among students. Procrastinators reported lower stress and less illness than nonprocrastinators early in the semester, but they reported higher stress and more illness late in the term, and overall they were sicker. Procrastination thus appears to be a self-defeating behavior pattern marked by short-term benefits and long-term costs.     

The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs. We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities. We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied. We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives. We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern.     

Occupational Therapy Services to Promote Occupational Performance,Performance Satisfaction,and Quality of Life in University Freshmen: A Pilot Study

Mental health impacts success for many university students. Occupational therapists can intervene during the transition to university to promote mental health. A 5-week, occupation-based group was provided to a group of freshmen university students to encourage short-term improvements in occupational performance (OP), performance satisfaction (PS), and quality of life (QOL). Statistically significant results were obtained for OP and PS (p < 0.05). However, no significant results were obtained when assessing QOL (p > 0.05). Further research, including long term follow-up, about the impact of occupation-based groups with transitioning freshmen is recommended.     

公共卫生资源配置的伦理目标

公共卫生资源配置是医疗卫生体制的核心,在医疗卫生事业的改革和发展中起着关键的基础性作用。公共卫生资源配置不仅要从技术操作层面解决公平性问题,更为重要的是,在公共卫生资源配置过程中,我们应秉持公平的价值取向和伦理诉求,确立以权利的公平、分配的公平和制度的公平为主要内容的公共卫生资源配置伦理目标。     

An A-B-C-D-E Worksheet for Promoting Beneficence When Considering Ethical Issues

An A-B-C-D-E worksheet has been prepared to promote beneficence when considering ethical issues. The components of the worksheet are derived from ethical principles and ethical decision-making models. The worksheet makes abstract concepts of decision-making models concrete and practical. In addition, it provides a shorthand for remembering key elements necessary to good ethical decision making. It is systematic and useful and can aid students of ethics and mental health professionals to think more critically about ethical dilemmas.     

Ethics in health care and medical technologies

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options.     

Methods for Practising Ethics in Research and Innovation: A Literature Review,Critical Analysis and Recommendations

This paper provides a systematic literature review, analysis and discussion of methods that are proposed to practise ethics in research and innovation (R&I). Ethical considerations concerning the impacts of R&I are increasingly important, due to the quickening pace of technological innovation and the ubiquitous use of the outcomes of R&I processes in society. For this reason, several methods for practising ethics have been developed in different fields of R&I. The paper first of all presents a systematic search of academic sources that present and discuss such methods. Secondly, it provides a categorisation of these methods according to three main kinds: (1) ex ante methods, dealing with emerging technologies, (2) intra methods, dealing with technology design, and (3) ex post methods, dealing with ethical analysis of existing technologies. Thirdly, it discusses the methods by considering problems in the way they deal with the uncertainty of technological change, ethical technology design, the identification, analysis and resolving of ethical impacts of technologies and stakeholder participation. The results and discussion of our literature review are valuable for gaining an overview of the state of the art and serve as an outline of a future research agenda of methods for practising ethics in R&I.     

Should we design our descendants?

Rapid breakthroughs in genetic research spurred by the Human Genome Project, advances in molecular biology, and new reproductive technologies are raising the prospect that we may eventually have the technical capacity to modify genes that are transmitted to future generations not only to treat or eliminate diseases but also to "enhance" normal human characteristics beyond what is necessary to sustain or restore good health. This paper explores the ethical and justice implications of such genetic modifications. It argues against developing these technologies primarily because it will not be possible to counter the deleterious justice impacts. It recommends the need for public education and public discussion, preferably with the religious community taking an active role, to shape decisions about future genetic research and applications, and for better regulation of genetic technologies with the potential for inheritable genetic alterations.     

Moral Imagination, Trading Zones, and the Role of the Ethicist in Nanotechnology

The societal and ethical impacts of emerging technological and business systems cannot entirely be foreseen; therefore, management of these innovations will require at least some ethicists to work closely with researchers. This is particularly critical in the development of new systems because the maximum degrees of freedom for changing technological direction occurs at or just after the point of breakthrough; that is also the point where the long-term implications are hardest to visualize. Recent work on shared expertise in Science & Technology Studies (STS) can help create productive collaborations among scientists, engineers, ethicists and other stakeholders as these new systems are designed and implemented. But collaboration across these disciplines will be successful only if scientists, engineers, and ethicists can communicate meaningfully with each other. The establishment of a trading zone coupled with moral imagination present one method for such collaborative communication.     

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested.     

组织中利他行为的可持续性及其前因机制：基于主动性动机视角

随着社会经济的快速发展,对于组织及其成员来说,要想更好地在当前快速变化的工作环境中适应和发展,员工利他行为的可持续性愈发重要。新近研究发现利他行为具有动态性,但在理论框架和研究方法上存在严重不足,无法获得利他行为动态可持续性特征的全貌,对其前因机制的研究则更为缺失。因此,本研究基于主动性动机视角,聚焦利他行为可持续性的动态性特征,并在此基础上探索利他行为可持续性的前因机制,以期增进对利他行为本质的理解,并为可持续互利团队与组织建设实践提供参考。     

E-Therapy: Ethical Considerations of a Changing Healthcare Communication Environment

This paper outlines the current ethical guidelines for electronic therapy services, and the sufficiency and implications of these guidelines in a culturally diverse population as found in the United States. The paper limits the discussion of ethical deliberations to: what is considered adequate competency to practice mental health therapy electronically; the disclosure and identity verification requirements; confidentiality issues when different social norms exist; the social responsibility of public institutions or individuals; and issues that relate to miscommunication due to different cultural or educational backgrounds. It concludes that since E-Therapy helps to reach underserved populations and significantly reduces costs associated with mental health services, compliance with ethical guidelines must be enforced to benefit from the latest communication technologies. This paper is relevant for various professions related to psychology and psychotherapy, including pastors and pastoral counselors, because various forms of E-therapy are emerging in the 21st century and can serve as resources for “E-pastoral counseling.”     

The substitutability of external control and self-control

Three experiments offered participants the opportunity to undertake an activity that had long-term benefits but either small or large short-term costs. The experiments investigated how self-control efforts to undertake the activity are affected by real or primed externally imposed controls. Two forms of self-control were assessed: bolstering the value of the offered activity and self-imposed penalties for failure to undertake it. The results showed that greater short-term costs elicited more self-control efforts when externally imposed controls were absent and less self-control efforts when externally imposed controls were present. Both externally imposed controls and self-control efforts prevented short-term costs from affecting participants’ intention to undertake the activity. The results were interpreted as suggesting that externally imposed control and self-control are substitutable means for pursuing activities with long-term benefits and short-term costs.     

Mental Health and Personality of Slovak Unemployed Adolescents: The Impact of Belief in a Just World1

In 2 questionnaire studies with 3 groups of Slovak adolescents (students, short-term unemployed, long-term unemployed), the role of belief in a just world (B JW) as a buffer for the unemployed individuals’mental health (life satisfaction, personal worries, positive affect, negative affect, self-esteem) was explored. The personal but not the general BJW showed a positive relationship with life satisfaction, positive affect, and self-esteem, and this was true when controlled for objective (gender, unemployment status) and situational (subjective financial situation) predictors and further personality dimensions (Study 2: social desirability, extraversion, emotional lability). These adaptive relationships were consistently observed for students and short-term unemployed adolescents, while the results for the long-term unemployed participants and the negative mental health dimensions were mixed. It is discussed which coping reactions might mediate the personal BJW's adaptive effects.     

Judging Public Health Research: Epistemology,Public Health and the Law

There are three broad ethical issues related to handling public health emergencies. They are the three R's—rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions.     

Health Care,Capabilities, and AI Assistive Technologies

Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that although these objections cannot stand as good reasons for a general and a priori rejection of AI assistive technologies as such or as replacements of human care, they demand us to clarify what is at stake, to develop more comprehensive criteria for good care, and to rethink existing practices of care. In response to these challenges, I propose a (modified) capabilities approach to care and emphasize the inherent social dimension of care. I also discuss the demand for real care by introducing the ‘Care Experience Machine’ thought experiment. I conclude that if we set the standards of care too high when evaluating the introduction of AI assistive technologies in health care, we have to reject many of our existing, low-tech health care practices.     

An Examination of the Impact of Racial and Ethnic Identity,Impostor Feelings,and Minority Status Stress on the Mental Health of Black College Students

This study examined ethnic identity, racial centrality, minority status stress, and impostor feelings as predictors of mental health in a sample of 218 Black college students. Ethnic identity was found to be a significant positive predictor of mental health, whereas minority status stress and impostor feelings were significant negative predictors. Although ethnic identity was the strongest predictor of mental health, racial centrality represented a nonsignificant, negative predictor. Counseling implications for Black college students are discussed. Este estudio examinó la identidad étnica, la centralidad racial, el estrés por estatus de minoría y los sentimientos de impostor como indicadores de salud mental en una muestra de 218 estudiantes universitarios negros. Se halló que la identidad étnica es un indicador positivo significativo de salud mental, mientras que el estrés por estatus de minoría y los sentimientos de impostor fueron indicadores negativos significativos. Aunque la identidad étnica fue el indicador más fuerte de salud mental, la centralidad racial representó un indicador negativo no significativo. Se discuten las implicaciones para la consejería de estudiantes universitarios negros.