“Just Throw It Behind You and Just Keep Going”: Emotional Labor when Ethnic Minority Healthcare Staff Encounter Racism in Healthcare

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The first is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the benefit of staff and patients.

Normalized lifespan inequality: disentangling the longevity–lifespan variability nexus

Previous studies have documented a historically strong and negative association between countries’ life expectancy (i.e., average longevity) and length-of-life inequality (i.e., variability in ages at death). The relationship between both variables might be partially explained by life expectancy increasing at a faster pace than maximal length of life, a phenomenon that mechanically compresses the age-at-death distribution and has not been taken into consideration in previous studies. In this paper, we propose a new approach to lifespan inequality measurement that accounts for the (uncertainly) bounded nature of length-of-life. Applying the new approach to the countries of the Human Mortality Database, we observe that the decline in overall lifespan variability typically associated with increases in longevity seems to stop and even reverse at higher levels of life expectancy. This suggests the emergence of worrying ethical dilemmas, whereby higher achievements in longevity would only be possible at the expense of higher lifespan variability.

Happy New Year from the Editor

Dear readers, advisors, authors, editors, and peer reviewers, As we welcome the new year, we look forward to the opportunity to publish new arguments and pose challenging questions about ethical dilemmas in the realm of medicine, science, and technology. Reflecting on the peer review process at this juncture seems especially important considering the bioethics climate and the challenges in doing justice to ethical dilemmas. Unlike scientific peer review, replicability, reliability, and evaluation of methods are largely irrelevant to much of the bioethics literature, except for empirical research. Much like papers published in law, the humanities, and social sciences, peer reviewing contextual arguments in bioethics requires us to evaluate argument validity and ensure that arguments are based on facts or appropriate hypotheticals. The risk that voices are quieted merely because the editorial staff or peer reviewers would choose the other side of an argument is high and requires mitigation steeped in serious processes built into the peer review system. It is especially important to hear diverse views that represent many points along a continuum during polarized times. The papers that offer conceptual arguments that we tend to publish at Voices in Bioethics call for an examination of logic and argument foremost, with a special emphasis on which conclusions are drawn from the premises supplied. At Voices in Bioethics, the peer review process aims to be inclusive, so we balance our instincts to criticize with our goal to accept as many papers that meet our guidelines as possible. We welcome new arguments, especially ones that highlight overlooked viewpoints, considerations, or stakeholders. We acknowledge how many great ideas result from people who speak English as a second or third language, or who do not use English at all. All of those affected by or who observe an ethical dilemma are welcome to submit their ethics arguments surrounding health care, technology, the environment, and the broader sciences. We are happy to read papers by those outside of bioethics and those with any level of education. We use the peer review questions about mechanics only to inform editors of what the process might entail. We do not accept or reject based on mechanics or style alone. The nature of many bioethics journals is to publish papers that may reflect the bioethics status quo or apply common bioethical frameworks to new problems. In addition to that, we try to showcase new ways of thinking and additional considerations. After all, publishing is not about publishing papers that mimic older well-cited articles or that apply only those frameworks learned in the classroom. It is about giving voice and contributing to an open access ecosystem where new and old ideas coexist, their worth measured not in hits or likes, but in their contribution to ethical analysis. Wishing a happy new year to our advisors, editors, peer reviewers, authors, and readers.

Teaching the History of Sexuality with Images

This article outlines how an in-depth engagement with visual archives has transformed the author’s pedagogical practice. It argues that working with visual sources like photographs and illustrations offers students important opportunities to develop key academic skills, and to think critically about archives and sources. It details how working with such rich materials makes space for personal reflection and discovery, especially for students engaging with histories of sex and sexuality for the first time. Outlining the strengths of this approach, it explores some of the tensions and obstacles inherent in doing this kind of work—discussing, for example, the ethical dilemmas faced when reproducing and disseminating sexualized images in the classroom, the complexities of handling student reactions, and the activities students and the instructor have created to negotiate these issues.

Ethical Considerations in Prosthetics and Orthotics

This chapter introduces the field of advanced technology within the orthotics and prosthetics profession, a healthcare profession that combines technology and engineering science with medical and health science to produce medical devices (orthoses and prostheses) to treat medical conditions that cause physical dysfunction. The chapter sets the background to the ethical dilemmas that are encountered within the field, which technologically advanced devices cause such dilemmas and why, and then discusses the ethical dilemmas as encountered by the three stakeholders within the profession, namely the manufacturers/innovators, the prosthetic and orthotic practitioners, and the users of the devices themselves, the patients. In conclusion, the chapter looks at some solutions and recommendations to overcome or at least reduce these dilemmas.

Dealing With Ethical Dilemma

The unique role of salespeople as “revenue generators” for any organization is pivotal for its growth and success. An interfacing role of salesperson between organization and customers facilitates customer belief and builds long-term relationships. Due to affiliative separation, salespersons face ethical dilemmas more often than their counterparts. The chapter delineates the unique characteristics of sales behavior and major influencers that affect a salesperson's ethical/unethical decision making. The authors recommend designing of effective ethical plan and its implementation to inculcate a robust ethical environment/culture within an organization.

Dangerous Liaisons?

Entrepreneurship is an essential engine for economic growth and innovation. During the last two decades, there has been a lot of academic interest in this kind of activity but only recently has research attention been devoted to the ethical problems encountered by entrepreneurs and intrapreneurs. In this chapter, the authors highlight the ethical issues inherent to family firms. Intrapreneurs in a family business face uniquely moral problems related to fundamental fairness, succession process, copyright and brand use, and other challenges. For example, younger generations in family firms face a tricky balancing act between their loyalty to their families and finding new ventures or spin-offs based on the current business. This theoretical work aims to present some contemporary research in entrepreneurial ethics, examines the kinds of ethical dilemmas entrepreneurs and intrapreneurs face, identifies significant research topics and methodological approaches, and discusses possible directions for future research.

Fintech and Blockchain

The rapidly growing field of Blockchain and Decentralised Finance (DeFi) has the potential to transform many aspects of the financial world. It offers an abundance of opportunities to reduce costs, increase transparency and reduce the need for middlemen in financial services. While this promise of automation and decentralization is attractive, it is important to consider the potential for inadvertent or deliberate automation of unethical conduct at scale. Ethical questions involve the consideration of conflicting moral choices and dilemmas. Blockchain creates ethical dilemmas for developers, investors, consumers, and regulators at the technology, application, and societal levels. This chapter provides a perspective on the emerging field of DeFi and Blockchain in financial services, a reflection on the ethical questions that arise, how they are being addressed, the key issues, and further research needed in this growing field of Blockchain ethics. The objective of the chapter is for students, developers, CEO's and governments to appreciate the moral and ethical issues being uncovered in the course of the development and deployment of Blockchain technology. Blockchain, as with all technology, is a tool and is as beneficial and useful as the care that is taken to make it. There remains a need to ensure that Blockchains are built and deployed with due concern for ethics.