scholarly journals Elusive quality: the challenges and ethical dilemmas faced by international non-governmental organisations in sourcing quality assured medical products

2021 ◽  
Vol 6 (Suppl 3) ◽  
pp. e004339
Author(s):  
Katherine Enright
Keyword(s):  
Decision Making ◽  
Low Income ◽  
Ethical Dilemmas ◽  
Medical Product ◽  
Moral Decision Making ◽  
Middle Income ◽  
Medical Products ◽  
Course Of Action ◽  
Falsified Medicines ◽  
New Perspective

Although medical products that are of sound quality are fundamental to the delivery of healthcare, so too is their availability, affordability, accessibility and acceptability. However, achieving all of these aims consistently and simultaneously may be unfeasible due to a host of barriers—no matter the country. If uncertainty, constraints and conflicting priorities also threaten their delivery, not only does the situation becomes yet more challenging, the morally just course of action becomes yet more opaque. While global health organisations, supply chains and projects are heterogenous, international non-governmental organisations (iNGOs) responding to humanitarian crises or delivering development assistance in low-income and middle-income countries are undoubtedly prone to this issue. In a novel framing of the problem of substandard and falsified medicines, this article explores some ethical dilemmas that, directly or indirectly, could result in the quality of medical products in iNGO health projects to be compromised. Drawing on a broad literature base and years of experience as a senior humanitarian pharmacist, the author reflects on the barriers, culture and system that contributes to the existence and persistence of substandard and falsified medical products in global assistance projects. The paper offers an in-depth examination of pressures that may arise in four key areas (capacity, supply chain, bureaucracy and quality assurance) and postulates on the myriad ways in which this may alter the attitudes, behaviours and decision-making of iNGOs in a manner that disincentivises the prioritisation of medical product quality. This paper does not seek to excoriate the aid sector, but rather to lend a new perspective: that such predicaments are overlooked, real-world ethical dilemmas in urgent need of greater openness, research, debate and guidance, for the benefit of moral decision-making and patient care.

Moral decision making: searching for the highest expected moral value

2008 ◽  
Vol 11 (1) ◽  
pp. 1-11
Author(s):  
Kenneth E. Aupperle
Keyword(s):  
Decision Making ◽  
Multiple Solutions ◽  
Social Issues ◽  
Ethical Dilemmas ◽  
Moral Decision ◽  
Moral Decision Making ◽  
Moral Value ◽  
Black And White ◽  
Course Of Action ◽  
Moral Intent

This article offers a new way to conceptualize decision making in regard to ethical dilemmas and complex social issues. The framework provided here identifies steps essential to achieving the highest expected moral value. This process is complex but practical. The purpose is to help academics, students and practitioners in escaping from a simple black and white logic. The framework proposed here attempts to help analysts objectively assess the positives and the negatives associated with a given course of action in order to achieve the best possible outcome. All dilemmas have multiple solutions but too often we reach simple conclusions without addressing consequences. Clearly good moral intent can produce serious harm. Sometimes one may have to choose between the two; good moral intent versus good moral consequences

Modern Military Operations

2021 ◽  
pp. 522-535
Author(s):  
Christine Boshuijzen-van Burken
Keyword(s):  
Decision Making ◽  
Information And Communication Technologies ◽  
Communication Technologies ◽  
Moral Decision ◽  
Military Operations ◽  
Moral Decision Making ◽  
Friendly Fire ◽  
Course Of Action ◽  
Use Of Technology ◽  
Information And Communication

Modern military operations are characterized by ubiquitous use of technology, in particular the use of information and communication technologies for real-time information sharing. The use of technology on the battlefield is assumed to improve decision making in military practice. By making use of a friendly fire incident in Afghanistan, namely the Sangin incident in 2011, the author highlights why moral decision making could be hampered by technology. This is partly due to the fact that information and communication technologies subtly connect sub-practices that exist within the broader military practice, thus potentially blurring normative structures. Blurring of normative structures can cause problems for moral decision making on the battlefield, because it is suddenly not clear who is responsible for the course of action.

Motivating managers to develop their moral curiosity

2014 ◽  
Vol 33 (7) ◽  
pp. 709-722 ◽  
Author(s):  
Leslie E. Sekerka ◽  
Lindsey N. Godwin ◽  
Richard Charnigo
Keyword(s):  
Decision Making ◽  
Business Ethics ◽  
Field Study ◽  
Meaning Making ◽  
Ethical Dilemmas ◽  
Moral Decision ◽  
Moral Decision Making ◽  
Content Type ◽  
Organizational Settings ◽  
Safe Spaces

Purpose – The purpose of this paper is to focus on an inward drive and commitment toward ethical discovery, which the authors refer to as the competency of moral curiosity. When directed toward moral decision making, the authors believe this ability can help managers effectively respond to their ethical challenges and contribute to an organizational environment that supports ethical performance. Design/methodology/approach – After presenting insights from the literature on curiosity and establishing its relevance, the authors describe a specific experiential learning tool designed to cultivate moral curiosity in organizational settings. The authors conduct a field study using this process to explore how moral curiosity can be strengthened through experiential practice. Findings – Results from the field study suggest that engagement in balanced experiential inquiry, a process that asks managers to reflect on their salient ethical dilemmas and then engage in both individual and collective meaning making, positively influenced participants’ curiosity toward moral decision making. Research limitations/implications – Limitations include challenges inherent to the field-study design, including lack of a control group and limited ability to predict long-term impacts of the intervention. Despite these concerns, the study has useful implications for managerial training and development. In particular, providing safe spaces where managers can discuss their ethical dilemmas is an important element of supporting their development into morally curious leaders who are interested in pursuing business ethics. Practical implications – Findings suggest that providing safe spaces where managers can discuss their ethical dilemmas is an important element of supporting their development into morally curious leaders who are interested in pursuing business ethics. Originality/value – The paper contributes to the research literature on ethics training and education for managers. The authors introduce the construct of moral curiosity as a competency that can be developed through experiential practice in organizational settings.

scholarly journals When technology precedes regulation: the challenges and opportunities of e-pharmacy in low-income and middle-income countries

2021 ◽  
Vol 6 (5) ◽  
pp. e005405
Author(s):  
Rosalind Miller ◽  
Francis Wafula ◽  
Chima A Onoka ◽  
Prasanna Saligram ◽  
Anita Musiega ◽  
...  
Keyword(s):  
Low Income ◽  
Data Privacy ◽  
Access To Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Medicine Regulation ◽  
Challenges And Opportunities ◽  
Falsified Medicines ◽  
Health Related ◽  
Dynamic Landscape

The recent growth of medicine sales online represents a major disruption to pharmacy markets, with COVID-19 encouraging this trend further. While e-pharmacy businesses were initially the preserve of high-income countries, in the past decade they have been growing rapidly in low-income and middle-income countries (LMICs). Public health concerns associated with e-pharmacy include the sale of prescription-only medicines without a prescription and the sale of substandard and falsified medicines. There are also non-health-related risks such as consumer fraud and lack of data privacy. However, e-pharmacy may also have the potential to improve access to medicines. Drawing on existing literature and a set of key informant interviews in Kenya, Nigeria and India, we examine the e-pharmacy regulatory systems in LMICs. None of the study countries had yet enacted a regulatory framework specific to e-pharmacy. Key regulatory challenges included the lack of consensus on regulatory models, lack of regulatory capacity, regulating sales across borders and risks of over-regulation. However, e-pharmacy also presents opportunities to enhance medicine regulation—through consolidation in the sector, and the traceability and transparency that online records offer. The regulatory process needs to be adapted to keep pace with this dynamic landscape and exploit these possibilities. This will require exploration of a range of innovative regulatory options, collaboration with larger, more compliant businesses, and engagement with global regulatory bodies. A key first step must be ensuring that national regulators are equipped with the necessary awareness and technical expertise to actively oversee this e-pharmacy activity.

scholarly journals Implementing pharmaceutical track-and-trace systems: a realist review

2021 ◽  
Vol 6 (Suppl 3) ◽  
pp. e003755
Author(s):  
Joeke Kootstra ◽  
Tineke Kleinhout-Vliek
Keyword(s):  
Supply Chain ◽  
Implementation Process ◽  
Realist Review ◽  
Medical Product ◽  
Pharmaceutical Supply Chain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Point Of Entry ◽  
Falsified Medicines ◽  
The Government

IntroductionOne way to prevent falsified medical products from entering the regulated pharmaceutical supply chain is to implement a pharmaceutical track-and-trace system (PTTS). Such systems in the most extensive versions generally mandate a scan at every point of contact with the medical product: from the point of entry to dispensation. There have been several attempts to implement such systems; for example, a ‘full’ PTTS in Turkey and the more pared-down version offered by the European Union’s Falsified Medicines Directive and Delegated Act. This study aims to identify facilitators and barriers to implementing (elements of) a PTTS, with the Turkish system used as a benchmark.MethodsWe conducted a ‘realist’ review, which synthesises literature and aims to establish how a specific technology works, for whom, under which circumstances. We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar databases, yielding 2,790 scholarly articles. We selected 21 for review.ResultsImplementation of PTTS elements has been attempted in different compositions in several primarily high-income and middle-income countries. Factors that affected implementation included stakeholders like the government and supply chain actors, the coordination between them, and their awareness, knowledge, and skills, as well as regulation and legislation, monetary investments, and technical and digital requirements.ConclusionThe interplay between contextual factors is crucial for successful PTTS implementation. Specifically, the findings indicate that aligning the incentives for all actors and allowing for adjustments in a continuous implementation process will likely facilitate implementation.

scholarly journals Applying Deontology to Determine What Ought to be Done

2020 ◽  
Vol 5 (1) ◽  
pp. 1-6
Author(s):  
Thalia Raymond
Keyword(s):  
Decision Making ◽  
Categorical Imperative ◽  
Moral Decision ◽  
Moral Decision Making ◽  
Teaching Career ◽  
Ethical Decisions ◽  
Specific Focus ◽  
Course Of Action

This paper will broadly outline the theory of deontology with a specific focus on how the categorical imperative can be applied in moral decision making. The theory will then be applied to an issue to determine what course of action is consistent with the theory. Two strengths and two weaknesses that can be found in the literature will be considered and how the theory of deontology can be applied in a future teaching career to make ethical decisions will be discussed.

scholarly journals A Study on Income as a Determinant of Buying Decision-making Styles

2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Adyasha Suvadarshini ◽  
Bidhu Bhusan Mishra
Keyword(s):  
Decision Making ◽  
Factor Analysis ◽  
Low Income ◽  
Family Income ◽  
Capital City ◽  
Eastern India ◽  
Middle Income ◽  
Income Groups ◽  
Decision Making Styles ◽  
Low Income Groups

The following paper attempts to understand if income determines the buying decision-making styles of consumers in Bhubaneswar, the capital city of Odisha, a state located on eastern India. A total of 103 respondents of Bhubaneswar were chosen by using the Mall intercept method. The samples were classified into three groups based on their average annual family income such as High Income, Middle Income and Low Income groups. Exploratory Factor Analysis was carried to identify the decisionmaking styles. ANOVA was employed to compare the shopping styles of these three income sub-groups. Results indicate that differences in consumer shopping styles exist among the income sub-groups. Findings of the study can be used by marketers for segmentation, targeting and positioning of retail shoppers which may facilitate them to compete efficiently. It is recommended that different income sub-groups should be viewed as distinct consumer segments and strategies should be formulated to cater each segment effectively.

Horizontal Immobility

2017 ◽  
Vol 82 (2) ◽  
pp. 270-296 ◽  
Author(s):  
Eva Rosen
Keyword(s):  
Decision Making ◽  
Low Income ◽  
Residential Choice ◽  
Residential Instability ◽  
Course Of Action ◽  
Poor Families ◽  
High Crime ◽  
Violent Events

While poor families experience high residential instability, they also stay put for extended periods of time before moving. When they do move, they are likely to move laterally to a similarly disadvantaged place. These two processes—staying in place and churning—amount to “horizontal immobility.” Why do people get stuck in disadvantaged environments? Prevailing understandings focus on constraints to residential choice, but even under limitations, families make active residential decisions. Drawing on fieldwork with 50 renters in a low-income, high-crime Baltimore neighborhood, this article proposes that neighborhoods themselves shape narratives governing residential decision-making. In high-crime neighborhoods, renters stay put as long as they can craft a story that justifies remaining. But when the narrative is ruptured by violent events, residents are pushed to action, often a move. The logic behind these moves is motivated by a desire to restore a sense of safety. The concept of “narrative rupture” sheds light on when a family decides to move, representing a mechanism for how residential decisions are shaped by neighborhood forces to reproduce poverty. This concept also contributes to theories of how culture shapes action: we are most likely to act when the narratives supporting our current course of action break down.

scholarly journals Local ownership of health policy and systems research in low-income and middle-income countries: a missing element in the uptake debate

2019 ◽  
Vol 4 (4) ◽  
pp. e001523 ◽  
Author(s):  
Kudakwashe Paul Vanyoro ◽  
Kate Hawkins ◽  
Matthew Greenall ◽  
Helen Parry ◽  
Lynda Keeru
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Health Systems ◽  
Low Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Level ◽  
Systems Research ◽  
Research Findings ◽  
Health Policy And Systems

Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, the factors that facilitate the research to decision-making process and the real-world challenges faced when translating research findings into practice in different contexts. Drawing on an analysis of HPSR from LMICs presented at the Fifth Global Symposium on Health Systems Research (HSR 2018), we argue that while there is a recognition in policy studies more broadly about the role of co-production, collective ownership and the value of localised HPSR in the evidence-to-policy discussion, ‘ownership’ of research at country level is a research uptake catalyst that needs to be further emphasised, particularly in the HPSR context. We consider embedded research, participatory or community-initiated research and emergent/responsive research processes, all of which are ‘owned’ by policymakers, healthcare practitioners/managers or community members. We embrace the view that ownership of HPSR by people directly affected by health problems connects research and decision-making in a tangible way, creating pathways to impact.

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