scholarly journals Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039463
Author(s):  
Ramin Asgary ◽  
Katharine Lawrence
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Moral Distress ◽  
Unintended Consequences ◽  
Aid Effectiveness ◽  
International Agency ◽  
Negative Consequences ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Humanitarian Operations

IntroductionData regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.MethodsWe conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.Results61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.ConclusionsEthical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.

scholarly journals Pensions Auto-Enrolment: Unintended Consequences of Regulation and Private Law Remedies

2017 ◽  
Vol 21 (3) ◽  
pp. 352-375 ◽  
Author(s):  
Amanda Wyper
Keyword(s):  
Decision Making ◽  
Financial Services ◽  
Free Choice ◽  
Unintended Consequences ◽  
Private Law ◽  
Negative Consequences ◽  
Opt Out ◽  
Contract Of Employment ◽  
Minimum Criteria ◽  
Workplace Pensions

The introduction of auto-enrolment (AE) into workplace pensions in 2012 requires employers to enrol workers into a pension. Employers have significant discretion in this process and rely on the financial services industry to ensure compliance with AE minimum standards. Employers may not always have pension expertise and will engage pension providers for advice on establishing compliant pension arrangements or modifying existing schemes to use for AE. Whilst this policy benefits many, there are a number of negative consequences flowing from the introduction of AE. Examples include employers choosing poorly performing schemes, insufficient protection of free choice and poor default positions replacing active decision making, all of which result in poor value for some employees. The parties' interests may not always be aligned. Despite the minimum criteria, there can be significant variations between fund costs and scheme quality as private sector pensions are frequently used for compliance. Whilst the ability of employees to opt-out provides legitimacy for the regime, the form of implementation and use of defaults erodes the exercise of choice and there are no provisions to encourage engagement and active decision-making by individuals. In addition to this, inadequate advice impacts on the effects of AE for many. For some this means that they pay in less overall than they would have if they had voluntarily chosen to contribute to a plan. This article explores whether further statutory change to the AE regime is required or whether existing private law remedies, with a focus on Scots law, afford sufficient remedies for those suffering loss. If fiduciary, agency, contractual or delictual obligations arise from the AE relationship then this may provide adequate remedies. This article will consider whether fiduciary duties are owed to employees, particularly by the employer (as an agent) to the employee, and the extent of duties owed under the contract of employment.

scholarly journals Analytical study of care quality and moral distress in clinical situations and patient care

2019 ◽  
Vol 6 (4) ◽  
pp. 327-334
Author(s):  
Masoumeh Hasanlo ◽  
Arezo Azarm ◽  
Parvaneh Asadi ◽  
Kourosh Amini ◽  
Hossein Ebrahimi ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Analytical Study ◽  
Moral Distress ◽  
Professional Competence ◽  
Care Quality ◽  
Nursing Profession ◽  
Ethical Challenges ◽  
Significant Difference ◽  
Distress Scale

Abstract Objective Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality. Methods In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13. Results Investigating moral distress domains (ignoring patient, decision-making power, and professional competence) and care quality domains (psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain (P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical (bodily), and communication domains of care quality. Conclusions Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decision-making domains, improve the professional competence, and pay attention to patients.

Mitigating ethical conflict and moral distress in the care of patients on ECMO: impact of an automatic ethics consultation protocol

2021 ◽  
pp. medethics-2020-106881
Author(s):  
M Jeanne Wirpsa ◽  
Louanne M Carabini ◽  
Kathy Johnson Neely ◽  
Camille Kroll ◽  
Lucia D Wocial
Keyword(s):  
Decision Making ◽  
Moral Distress ◽  
Ethics Consultation ◽  
Outcome Data ◽  
System Level ◽  
Ethical Challenges ◽  
Ethical Conflict ◽  
Novel Therapy ◽  
Intervention Protocol ◽  
The Impact

AimsThis study evaluates a protocol for early, routine ethics consultation (EC) for patients on extracorporeal membrane oxygenation (ECMO) to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019 (n=68). Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages.

scholarly journals Adopting an ethical approach to migration health policy, practice and research

2021 ◽  
Vol 6 (7) ◽  
pp. e006425
Author(s):  
Kristine Husøy Onarheim ◽  
Kolitha Wickramage ◽  
David Ingleby ◽  
Supriya Subramani ◽  
Ingrid Miljeteig
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Policy Making ◽  
Ethical Issues ◽  
Health Workers ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Ethical Approach ◽  
Trade Offs

Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an ‘all things considered’ approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions – from ‘bedside rationing’ to collection of big data or in policy making – that can ensure that migrants’ interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.

Moral distress in veterinarians

2019 ◽  
Vol 185 (20) ◽  
pp. 631-631 ◽  
Author(s):  
Alejandra I Arbe Montoya ◽  
Susan Hazel ◽  
Susan M Matthew ◽  
Michelle L McArthur
Keyword(s):  
Healthcare Professionals ◽  
Moral Distress ◽  
Mental Health Problems ◽  
Psychological State ◽  
Negative Consequences ◽  
Ethical Challenges ◽  
Limited Data ◽  
Medical Field ◽  
Modifying Factors ◽  
Distress Scale

Moral distress is a psychological state of anguish that has been widely studied in healthcare professionals. Experiencing moral distress can lead to problems including avoidance of patients and increased staff turnover. Moral distress in veterinarians has not yet been explored to the extent seen in the human medical field, and there is limited data regarding moral distress in veterinarians. However, it is expected to be prevalent in these professionals. So far, it has been reported that veterinarians commonly experience moral conflict, ethical challenges and ethical dilemmas during their career. These conflicts in association with other modifying factors such as personality traits can lead to the experience of moral distress. In a profession with known levels of occupational stress and reported mental health problems, exploring the area of moral distress and its effects on the professional wellbeing of veterinarians is important. Further studies such as developing a moral distress scale to measure this issue are needed in order to evaluate the incidence of this problem in veterinary professionals. Furthermore, assessing a possible relationship between moral distress, mental illness and attrition in veterinarians would be useful in developing intervention strategies to minimise the experience of moral distress and its associated negative consequences in veterinarians.

03  What factors affect paramedics’ involvement of people with dementia in decisions affecting their care? A qualitative study

2020 ◽  
Vol 37 (10) ◽  
pp. e3.1-e3
Author(s):  
Esme Choonara
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Best Practice ◽  
Dementia Care ◽  
Research Approach ◽  
Best Interest ◽  
Complex Needs ◽  
Ethical Frameworks ◽  
People With Dementia ◽  
The Impact

BackgroundParamedics are frequently called to people with dementia due to high rates of co-morbidities and complex needs, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible. A small number of qualitative studies have looked at paramedics’ decision-making in relation to dementia, but these studies have not specifically investigated the involvement of people with dementia in decisions. This study aimed to explore how paramedics make decisions when attending people with dementia, with a particular focus on understanding the factors that impact on whether, how, and to what degree paramedics involve people with dementia in decisions about their care.MethodsA generic qualitative research approach was used, informed by social constructivism and by the researcher’s commitment to the concept of ‘personhood’ in dementia care. Data were collected through semi-structured individual interviews with seven paramedics, each lasting between 40 and 80 minutes. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis.ResultsFour themes were identified that all touched on challenges to delivering person-centred care for people with dementia. Themes identified were: 1. Paramedics’ differing approaches to assessing capacity and making best interest decisions. 2. Communication and developing a rapport. 3. Interconnections with others important to the person with dementia. 4. The impact of paramedics’ values and attitudes.ConclusionThe involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics’ values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care.

Pandemic Disease, Public Health, and Ethics

2019 ◽  
pp. 796-811 ◽  
Author(s):  
Maxwell Smith ◽  
Ross Upshur
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Ethical Challenges ◽  
Pandemic Preparedness ◽  
Scarce Resources ◽  
Ethical Frameworks ◽  
Health Measures ◽  
Care Workers ◽  
The Face ◽  
Conducting Research

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.

The Ethics of AI in Biomedical Research, Patient Care, and Public Health

2020 ◽  
pp. 702-718 ◽  
Author(s):  
Alessandro Blasimme ◽  
Effy Vayena
Keyword(s):  
Public Health ◽  
Patient Care ◽  
Biomedical Research ◽  
Disease Surveillance ◽  
Ethical Issues ◽  
Ethical Review ◽  
Ethical Challenges ◽  
Healthcare Provision ◽  
Social Scientists ◽  
Ethical Frameworks

This chapter explores ethical issues raised by the use of artificial intelligence (AI) in the domain of biomedical research, healthcare provision, and public health. The litany of ethical challenges that AI in medicine raises cannot be addressed sufficiently by current regulatory and ethical frameworks. The chapter then advances the systemic oversight approach as a governance blueprint, which is based on six principles offering guidance as to the desirable features of oversight structures and processes in the domain of data-intense biomedicine: adaptivity, flexibility, inclusiveness, reflexivity, responsiveness, and monitoring (AFIRRM). In the research domain, ethical review committees will have to incorporate reflexive assessment of the scientific and social merits of AI-driven research and, as a consequence, will have to open their ranks to new professional figures such as social scientists. In the domain of patient care, clinical validation is a crucial issue. Hospitals could equip themselves with “clinical AI oversight bodies” charged with the task of advising clinical administrators. Meanwhile, in the public health sphere, the new level of granularity enabled by AI in disease surveillance or health promotion will have to be negotiated at the level of targeted communities.

scholarly journals The Biography of an Algorithm: Performing algorithmic technologies in organizations

2021 ◽  
Vol 2 (2) ◽  
pp. 263178772110046
Author(s):  
Vern L. Glaser ◽  
Neil Pollock ◽  
Luciana D’Adderio
Keyword(s):  
Decision Making ◽  
Organizational Capabilities ◽  
Negative Consequences ◽  
Organizational Decision Making ◽  
Computational Tools ◽  
Dynamic Perspective ◽  
Over Time

Algorithms are ubiquitous in modern organizations. Typically, researchers have viewed algorithms as self-contained computational tools that either magnify organizational capabilities or generate unintended negative consequences. To overcome this limited understanding of algorithms as stable entities, we propose two moves. The first entails building on a performative perspective to theorize algorithms as entangled, relational, emergent, and nested assemblages that use theories—and the sociomaterial networks they invoke—to automate decisions, enact roles and expertise, and perform calculations. The second move entails building on our dynamic perspective on algorithms to theorize how algorithms evolve as they move across contexts and over time. To this end, we introduce a biographical perspective on algorithms which traces their evolution by focusing on key “biographical moments.” We conclude by discussing how our performativity-inspired biographical perspective on algorithms can help management and organization scholars better understand organizational decision-making, the spread of technologies and their logics, and the dynamics of practices and routines.

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