éthique articles

An Ethical Analysis of Treatment of an Active-Duty Service Member With Limited Follow-up

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Kamat S.,Agarwal A.,Stoff B.,Crotty A.

Database Source: Embase Daily Updates

Journal Title: Cutis

Article Title: An Ethical Analysis of Treatment of an Active-Duty Service Member With Limited Follow-up

Year: 2024

Issue: 2

Volume: 113

Abstract:

How papers with doctored images can affect scientific reviews

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Kulkarni S.

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Journal Title: Nature

Article Title: How papers with doctored images can affect scientific reviews

Year: 2024

Issue: 8007

Volume: 628

Abstract:

Exploring the ethical implications in the telesurgery ERA

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Moschovas M.C.,Saikali S.,Rogers T.,Gamal A.,Perera R.,Reddy S.,Patel V.

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Journal Title: International braz j urol : official journal of the Brazilian Society of Urology

Article Title: Exploring the ethical implications in the telesurgery ERA

Year: 2024

Issue: 3

Volume: 50

Abstract:

Declaration of Helsinki: ethical norm in pursuit of common global goals

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Kurihara C.,Kerpel-Fronius S.,Becker S.,Chan A.,Nagaty Y.,Naseem S.,Schenk J.,Matsuyama K.,Baroutsou V.

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Journal Title: Frontiers in Medicine

Article Title: Declaration of Helsinki: ethical norm in pursuit of common global goals

Year: 2024

Issue:

Volume: 11

Abstract: The World Medical Association's Declaration of Helsinki is in the process of being revised. The following amendments are recommended to be incorporated in pursuit of the common goal of promoting health for all. 1. Data-driven research that facilitates broad informed consent and dynamic consent, assuring participant's rights, and the sharing of individual participant data (IPD) and research results to promote open science and generate social value. 2. Risk minimisation in a placebo-controlled study and post-trial access to the best-proven interventions for all who need them. 3. A future-oriented research framework for co-creation with all the relevant stakeholders. Copyright © 2024 Kurihara, Kerpel-Fronius, Becker, Chan, Nagaty, Naseem, Schenk, Matsuyama and Baroutsou.

A call for community-shared decisions

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Doctor J.N.,Meeker D.,Fox C.R.,Persell S.D.,Wagner Z.,Bouskill K.E.,Zanocco K.A.,Romanelli R.J.,Brummett C.M.,Kirkegaard A.,Watkins K.E.

Database Source: Embase Daily Updates

Journal Title: BMJ Evidence-Based Medicine

Article Title: A call for community-shared decisions

Year: 2024

Issue:

Volume:

Abstract:

Electroconvulsive therapy: what should be done when the needs exceed the treatment capacities?-A medical ethics guidance

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Zilles-Wegner D.,Besse M.,Methfessel I.,Simon A.

Database Source: Embase Daily Updates

Journal Title: Nervenarzt,Nervenarzt

Article Title: Electroconvulsive therapy: what should be done when the needs exceed the treatment capacities?-A medical ethics guidance,Elektrokonvulsionstherapie: Was tun, wenn der Bedarf die Behandlungskapazitaten ubersteigt? - Eine medizinethische Handlungsempfehlung

Year: 2024

Issue:

Volume:

Abstract:

Navigating the ethical implications of immunoglobulin replacement therapy during pregnancy

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Buckey T.M.,Sullivan K.E.

Database Source: Embase Daily Updates

Journal Title: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

Article Title: Navigating the ethical implications of immunoglobulin replacement therapy during pregnancy

Year: 2024

Issue:

Volume:

Abstract:

Social media for palliative and end-of-life care research: a systematic review

Fri, 19 Apr 2024 08:30:14 +0000

Author Names: Wang Y.,Koffman J.,Gao W.,Zhou Y.,Chukwusa E.,Curcin V.

Database Source: Embase Daily Updates

Journal Title: BMJ supportive & palliative care

Article Title: Social media for palliative and end-of-life care research: a systematic review

Year: 2024

Issue:

Volume:

Abstract: BACKGROUND: Social media with real-time content and a wide-reaching user network opens up more possibilities for palliative and end-of-life care (PEoLC) researchers who have begun to embrace it as a complementary research tool. This review aims to identify the uses of social media in PEoLC studies and to examine the ethical considerations and data collection approaches raised by this research approach. METHOD(S): Nine online databases were searched for PEoLC research using social media published before December 2022. Thematic analysis and narrative synthesis approach were used to categorise social media applications. RESULT(S): 21 studies were included. 16 studies used social media to conduct secondary analysis and five studies used social media as a platform for information sharing. Ethical considerations relevant to social media studies varied while 15 studies discussed ethical considerations, only 6 studies obtained ethical approval and 5 studies confirmed participant consent. Among studies that used social media data, most of them manually collected social media data, and other studies relied on Twitter application programming interface or third-party analytical tools. A total of 1 520 329 posts, 325 videos and 33 articles related to PEoLC from 2008 to 2022 were collected and analysed. CONCLUSION(S): Social media has emerged as a promising complementary research tool with demonstrated feasibility in various applications. However, we identified the absence of standardised ethical handling and data collection approaches which pose an ongoing challenge. We provided practical recommendations to bridge these pressing gaps for researchers wishing to use social media in future PEoLC-related studies. Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

The benefits and risks of nostalgia: analysis of a fictional case with special reference to ethical and existential issues

Wed, 19 Apr 2023 00:00:00 +0000

Philos Ethics Humanit Med. 2023 Apr 19;18(1):3. doi: 10.1186/s13010-023-00132-w.

ABSTRACT

BACKGROUND: In a previous paper in Philos Ethics Humanit Med, the 1937 Swedish novel Sömnlös (Swedish for sleepless) by Vilhelm Moberg was used as background for a thought experiment, in which last century's progresses concerning the safety of sleeping pills were projected into the future. This gave rise to a theoretical discussion about broad medico-philosophical questions such as (among other things) the concept of pharmaceuticalisation.

METHODS: In this follow-up paper, the theme of insomnia in Sömnlös is complemented by a discussion of the concept of nostalgia. The core of the paper is a theoretical discussion about the benefits and risks of nostalgia, bringing together some aspects of recent psychological research about the construct of nostalgia with the main story line of the novel.

RESULTS AND CONCLUSION: Nostalgia is portrayed as being, in some sense at least, ultimately beneficial for the protagonist of Sömnlös. This is congruent with recent psychological research. However, the story also shows that nostalgia may lead to problematic behaviours, at least when viewed from a virtue ethics perspective. Hence, nostalgia is both what leads the protagonist into ethically problematic behaviour and that which (paradoxically) ultimately saves him from his initial lack of courage, justice, temperance and practical wisdom. Moreover, the protagonist does not only "grow" ethically but also existentially. Hence, the novel opens up the possibility that insomnia and nostalgia might be viewed as bearers of important existential information (cf. sociologist of religion Peter L. Berger and his concept of "signals of transcendence").

PMID:37072749 | DOI:10.1186/s13010-023-00132-w

Update on bioethical, medical and fertility issues in gender incongruence during transition age

Tue, 18 Apr 2023 00:00:00 +0000

J Endocrinol Invest. 2023 Apr 18. doi: 10.1007/s40618-023-02077-5. Online ahead of print.

ABSTRACT

PURPOSE: Many issues still remain unresolved in the management of pubertal patients with gender incongruence (GI). The aim of this review is to discuss the main aspects of the treatment of these patients to provide a practical approach for clinicians.

METHODS: A comprehensive literature search within PubMed was performed to provide updates of available evidence regarding the impact on bioethical, medical and fertility issues in gender incongruence during transition age.

RESULTS: Gender Affirming Hormone Treatment (GAHT) and Gender Affirming Surgery (GAS) can induce unsatisfaction with change, future regrets, and the risk of infertility. This raises ethical issues especially in the management of pubertal patients that remain unresolved. Therapy with GnRH analogues (GnRHa) is intended to delay puberty, so as to give the adolescent a longer period of time to decide whether to continue with the treatments. At the level of physical changes, this therapy may have an effect on bone mineralization and body composition; however, long-term longitudinal data are not yet available. An important feature related to the use of GnRHa is the risk of fertility. Gamete cryopreservation is the most established method of fertility preservation (FP) and should be counselled to transgender adolescents. However, these patients are not always interested in having biological children.

CONCLUSION: Based on the current evidence, there is a need to conduct further research to clarify certain issues and to standardize clinical practice and improve counselling in transgender adolescent decision making and avoid regrets in the future.

PMID:37071372 | DOI:10.1007/s40618-023-02077-5

Viewing the Law and Ethics of Premortem Interventions Through an Interpretive Lens

Tue, 18 Apr 2023 00:00:00 +0000

Transplantation. 2023 Apr 18. doi: 10.1097/TP.0000000000004592. Online ahead of print.

NO ABSTRACT

PMID:37069658 | DOI:10.1097/TP.0000000000004592

Decision-making About Premortem Interventions for Donation: Navigating Legal and Ethical Complexities

Tue, 18 Apr 2023 00:00:00 +0000

Transplantation. 2023 Apr 18. doi: 10.1097/TP.0000000000004591. Online ahead of print.

ABSTRACT

Premortem interventions (PMIs) for organ donation play a vital role in preserving opportunities for deceased donation or increasing the chances of successful transplantation of donor organs. Although ethical considerations relating to use of particular PMIs have been well explored, the ethical and legal aspects of decision-making about the use of PMIs have received comparatively little attention. In many countries, there is significant uncertainty regarding whether PMIs are lawful or, if they are, who can authorize them. Furthermore, emphasis on consideration of therapeutic goals in substitute decision-making frameworks may discourage consideration of donation goals. In this article, we examine the fundamental questions of who should have the authority to make decisions about the use of PMIs on behalf of a potential donor and how such decisions should be made. We draw on international examples of legal reform that have sought to clarify the legal position in relation to administering PMIs and identify potential elements of an effective regulatory model for PMIs. In doing so, we argue that reforms are needed in many countries to provide legal certainty for clinicians who are responsible for supporting decision-making about PMIs and to ensure that the goals and preferences of potential donors are accorded due consideration in the decision-making process.

PMID:37069655 | DOI:10.1097/TP.0000000000004591

Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations

Tue, 18 Apr 2023 00:00:00 +0000

Crit Care. 2023 Apr 18;27(1):144. doi: 10.1186/s13054-023-04432-7.

ABSTRACT

Use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary resuscitation, termed eCPR, offers the prospect of improving survival with good neurological function after cardiac arrest. After death, ECMO can also be used for enhanced preservation of abdominal and thoracic organs, designated normothermic regional perfusion (NRP), before organ recovery for transplantation. To optimize resuscitation and transplantation outcomes, healthcare networks in Portugal and Italy have developed cardiac arrest protocols that integrate use of eCPR with NRP. Similar dissemination of eCPR and its integration with NRP in the USA raise novel ethical issues due to a non-nationalized health system and an opt-in framework for organ donation, as well as other legal and cultural factors. Nonetheless, eCPR investigations are ongoing, and both eCPR and NRP are selectively employed in clinical practice. This paper delineates the most pressing relevant ethical considerations and proposes recommendations for implementation of protocols that aim to promote public trust and reduce conflicts of interest. Transparent policies should rely on protocols that separate lifesaving from organ preservation considerations; robust, centralized eCPR data to inform equitable and evidence-based allocations; uniform practices concerning clinical decision-making and resource utilization; and partnership with community stakeholders, allowing patients to make decisions about emergency care that align with their values. Proactively addressing these ethical and logistical challenges could enable eCPR dissemination and integration with NRP protocols in the USA, with the potential to maximize lives saved through both improved resuscitation with good neurological outcomes and increased organ donation opportunities when resuscitation is unsuccessful or not in accordance with individuals' wishes.

PMID:37072806 | DOI:10.1186/s13054-023-04432-7

Strengths, gaps, and future directions on the landscape of ethics-related research for spinal cord injury

Tue, 18 Apr 2023 00:00:00 +0000

Spinal Cord. 2023 Apr 18. doi: 10.1038/s41393-023-00897-z. Online ahead of print.

ABSTRACT

Spinal cord injury (SCI) affects between 250,000-500,000 people globally each year. While the medical aspects of SCI have received considerable attention in the academic literature, discourse pertaining to its ethical implications is more limited. The experience of SCI is shaped by intersecting demographic and identity factors such as gender, race, and culture that necessitate an intersectional and value-based approach to ethics-related research that is properly situated in context. Given this background, we conducted a content analysis of academic studies exploring the perspectives and priorities of individuals with SCI published in peer-reviewed journals in the decade between 2012-2021. Terms pertaining to SCI and ethics were combined in a search of two major publication databases. We documented overall publication patterns, recruitment and research methods, reporting of demographic variables, and ethics-related discourse. Seventy (70) papers met inclusion criteria and were categorized by their major foci. Findings reveal a gap in reporting of participant demographics, particularly with respect to race and ethnicity, geographic background, and household income. We discuss these person-centered themes and gaps that must be closed in the reporting and supporting of SCI research.

PMID:37072509 | DOI:10.1038/s41393-023-00897-z

Ethical Concerns Amidst Employment of ChatGPT in Plastic Surgery

Tue, 18 Apr 2023 00:00:00 +0000

Aesthet Surg J. 2023 Apr 18:sjad108. doi: 10.1093/asj/sjad108. Online ahead of print.

NO ABSTRACT

PMID:37071797 | DOI:10.1093/asj/sjad108

Against Authority: The Bioethics of Ivermectin Use for COVID-19 Infection

Mon, 17 Apr 2023 00:00:00 +0000

Am J Ther. 2023 Apr 17. doi: 10.1097/MJT.0000000000001629. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has brought new ethical challenges to both health care professionals and the general public. Among the ethical problems amplified during this period were the making of medical decisions to quickly introduce some drugs into therapeutic practice with unproven or insufficiently proven effects (such as ivermectin), the validity of drug testing, and the allocation of limited resources.

FIELDS OF UNCERTAINTY: The COVID-19 pandemic brought to the attention of the entire scientific world a new problem, which exceeded the guidelines and rules known until then. Out of the desire to quickly solve this medical problem, a series of measures were taken, however not sufficiently validated in scientific terms; the recommendations regarding the use of drugs known for their properties to treat a greater number of conditions, such as ivermectin, was tried.

DATA SOURCES: A narrative review of the specialized literature was carried out using keywords such as COVID-19, ivermectin, ethics, and off-label medication from Scopus and Google Scholar but also of official documents developed at the international level (World Health Organization).

ETHICS AND THERAPEUTIC ADVANCES: The off-label use of ivermectin alone or in combination with other medications during COVID pandemic raised problems related to the demonstration of its effectiveness, but also to ethics, starting from the expectations that both the medical staff and the population had of it. Ivermectin therapy was also evaluated by analyzing the behavior of ivermectin based on ethical principles (nonmaleficence, beneficence, and respect for one's autonomy) or on justice. Even in times of pandemic, exceptionalism must not triumph, and finding an effective treatment must be done through studies that respect ethical standard.

CONCLUSIONS: The failures or rather lack of success in decision making during the pandemic showed that alongside scientific knowledge and the development of health policies, it is necessary to constantly evaluate the measures and decisions from an ethical point of view, and the prevention of slippages and abuses is not only necessary but even mandatory.

PMID:37068020 | DOI:10.1097/MJT.0000000000001629

Life Support System for the Fetonate and the Ethics of Speculation

Mon, 17 Apr 2023 00:00:00 +0000

JAMA Pediatr. 2023 Apr 17. doi: 10.1001/jamapediatrics.2023.0486. Online ahead of print.

NO ABSTRACT

PMID:37067812 | DOI:10.1001/jamapediatrics.2023.0486

The Characteristics and Ethics of Sham Surgeries: A Systematic Review of Randomized Controlled Trials

Mon, 17 Apr 2023 00:00:00 +0000

Ann Surg. 2023 Apr 17. doi: 10.1097/SLA.0000000000005882. Online ahead of print.

ABSTRACT

OBJECTIVE: To better characterize these ethical considerations, we sought to perform a large-scale systematic review across all sham-controlled studies currently present in the literature.

BACKGROUND: Innovative surgical procedures are often introduced to the clinical setting without the robust clinical trials performed for medicinal treatments. Sham surgeries serve as placebos by performing all steps of a surgical intervention aside from those deemed therapeutically necessary. Yet, sham trials are underutilized due ethical controversy.

METHODS: Ovid MEDLINE was queried through April 2022 with combinations of the Medical Subject (MeSH) headings and keywords including, but not limited to, "surgery", "endoscopy", "randomized controlled trial", and "sham procedure". Primary outcomes were surgical indications and characteristics, outcome measurements, and whether the investigational treatment was offered to the sham cohort.

RESULTS: One hundred and seventy-two articles fit our inclusion criteria, with gastrointestinal pathologies being the most common surgical indication. Participants, personnel, and outcome assessment were all blinded in 8.7% of trials (n=15). Study populations included adult subjects (age ≥18) in 170 studies (98.8%), and two involved children. The most common level of dissection and type of anesthesia were deep (n=66, 38.4%) and general (n=49, 28.5%), respectively. An open surgical approach was utilized in 20.9% of studies (n=36). Primary outcomes were objective in 75 studies (43.6%), and subjective in 97 (56.4%), 62 of which employed validated outcome measures (36.0%). Four trials explicitly did not offer the surgery to the sham arm (2.3%), while 106 had no mention of whether the intervention was offered (61.6%).

CONCLUSIONS: Our systematic review of 172 randomized, sham controlled trials highlights the ethical considerations that must be considered in these studies, namely the importance of transparent study design and objective outcome reporting, the difficulty of informed consent, and the inherent risks associated with surgical interventions.

PMID:37066793 | DOI:10.1097/SLA.0000000000005882

Ethical content in artificial intelligence systems: A demand explained in three critical points

Mon, 17 Apr 2023 00:00:00 +0000

Front Psychol. 2023 Mar 30;14:1074787. doi: 10.3389/fpsyg.2023.1074787. eCollection 2023.

ABSTRACT

Artificial intelligence (AI) advancements are changing people's lives in ways never imagined before. We argue that ethics used to be put in perspective by seeing technology as an instrument during the first machine age. However, the second machine age is already a reality, and the changes brought by AI are reshaping how people interact and flourish. That said, ethics must also be analyzed as a requirement in the content. To expose this argument, we bring three critical points - autonomy, right of explanation, and value alignment - to guide the debate of why ethics must be part of the systems, not just in the principles to guide the users. In the end, our discussion leads to a reflection on the redefinition of AI's moral agency. Our distinguishing argument is that ethical questioning must be solved only after giving AI moral agency, even if not at the same human level. For future research, we suggest appreciating new ways of seeing ethics and finding a place for machines, using the inputs of the models we have been using for centuries but adapting to the new reality of the coexistence of artificial intelligence and humans.

PMID:37063544 | PMC:PMC10097940 | DOI:10.3389/fpsyg.2023.1074787

Prognostic humility and ethical dilemmas after severe brain injury: Summary, recommendations, and qualitative analysis of Curing Coma Campaign virtual event proceedings

Mon, 17 Apr 2023 00:00:00 +0000

Front Hum Neurosci. 2023 Mar 31;17:1128656. doi: 10.3389/fnhum.2023.1128656. eCollection 2023.

ABSTRACT

BACKGROUND: Patients with severe acute brain injuries (SABI) are at risk of living with long-term disability, frequent medical complications and high rates of mortality. Determining an individual patient's prognosis and conveying this to family members/caregivers can be challenging. We conducted a webinar with experts in neurosurgery, neurocritical care, neuro-palliative care, neuro-ethics, and rehabilitation as part of the Curing Coma Campaign, which is supported by the Neurocritical Care Society. The webinar discussed topics focused on prognostic uncertainty, communicating prognosis to family members/caregivers, gaps within healthcare systems, and research infrastructure as it relates to patients experiencing SABI. The purpose of this manuscript is to describe the themes that emerged from this virtual discussion.

METHODS: A qualitative analysis of a webinar "Prognostic Humility and Ethical Dilemmas in Acute Brain Injury" was organized as part of the Neurocritical Care Society's Curing Coma Campaign. A multidisciplinary group of experts was invited as speakers and moderators of the webinar. The content of the webinar was transcribed verbatim. Two qualitative researchers (NK and BM) read and re-read the transcription, and familiarized themselves with the text. The two coders developed and agreed on a code book, independently coded the transcript, and discussed any discrepancies. The transcript was analyzed using inductive thematic analysis of codes and themes that emerged within the expert discussion.

RESULTS: We coded 168 qualitative excerpts within the transcript. Two main themes were discussed: (1) the concept of prognostic uncertainty in the acute setting, and (2) lack of access to and evidence for quality rehabilitation and specialized continuum of care efforts specific to coma research. Within these two main themes, we found 5 sub-themes, which were broken down into 23 unique codes. The most frequently described code was the need for clinicians to acknowledge our own uncertainties when we discuss prognosis with families, which was mentioned 13 times during the webinar. Several strategies were described for speaking with surrogates of patients who have had a severe brain injury resulting in SABI. We also identified important gaps in the United States health system and in research to improve the care of patients with severe brain injuries.

CONCLUSION: As a result of this webinar and expert discussion, authors identified and analyzed themes related to prognostic uncertainty with SABI. Recommendations were outlined for clinicians who engage with surrogates of patients with SABI to foster informed decisions for their loved one. Finally, recommendations for changes in healthcare systems and research support are provided in order to continue to propel SABI science forward to improve future prognostic certainty.

PMID:37063099 | PMC:PMC10102639 | DOI:10.3389/fnhum.2023.1128656

High retraction rate of Chinese articles: it is time to do something about academic misconduct

Mon, 17 Apr 2023 00:00:00 +0000

Postgrad Med J. 2022 Sep 1;98(1163):653-654. doi: 10.1136/postgradmedj-2021-140853.

NO ABSTRACT

PMID:37062972 | DOI:10.1136/postgradmedj-2021-140853

The ethical matrix as a method for involving people living with disease and the wider public (PPI) in near-term artificial intelligence research

Sun, 16 Apr 2023 00:00:00 +0000

Radiography (Lond). 2023 Apr 14:S1078-8174(23)00076-7. doi: 10.1016/j.radi.2023.03.009. Online ahead of print.

ABSTRACT

INTRODUCTION: The rapid pace of research in the field of Artificial Intelligence in medicine has associated risks for near-term AI. Ethical considerations of the use of AI in medicine remain a subject of much debate. Concurrently, the Involvement of People living with disease and the Public (PPI) in research is becoming mandatory in the EU and UK. The goal of this research was to elucidate the important values for our relevant stakeholders: People with MS, Radiologists, neurologists, Registered Healthcare Practitioners and Computer Scientists concerning AI in radiology and synthesize these in an ethical matrix.

METHODS: An ethical matrix workshop co-designed with a patient expert. The workshop yielded a survey which was disseminated to the professional societies of the relevant stakeholders. Quantitative data were analysed using the Pingouin 0.53 python package. Qualitative data were examined with word frequency analysis and analysed for themes with grounded theory with a patient expert.

RESULTS: 184 participants were recruited, (54, 60, 17, 12, 41 respectively). There were significant (p < 0.00001) differences in age, gender and ethnicity between groups. Key themes emerging from our results were the importance fast and accurate results, explanations over model performance and the significance of maintaining personal connections and choice. These themes were used to construct the ethical matrix.

CONCLUSION: The ethical matrix is a useful tool for PPI and stakeholder engagement with particular advantages for near-term AI in the pandemic era.

IMPLICATIONS FOR PRACTICE: We have produced an ethical matrix that allows for the inclusion of stakeholder opinion in medical AI research design.

PMID:37062673 | DOI:10.1016/j.radi.2023.03.009

Integrative Antiracism and the Salience of Intersectional Assets for Black and Latinx LGBTQ Youth

Sun, 16 Apr 2023 00:00:00 +0000

J Adolesc Health. 2023 May;72(5):647-648. doi: 10.1016/j.jadohealth.2023.02.003.

NO ABSTRACT

PMID:37062570 | DOI:10.1016/j.jadohealth.2023.02.003

Overcoming the history of Eugenics in demography call for contributions from historians, ethicists, and human rights scholars

Sun, 16 Apr 2023 00:00:00 +0000

Biodemography Soc Biol. 2023 Apr 16:1-2. doi: 10.1080/19485565.2023.2203570. Online ahead of print.

NO ABSTRACT

PMID:37062056 | DOI:10.1080/19485565.2023.2203570

Challenges in medically assisted reproduction - Ethics, law and society: An invited scientific review by the European Board and College of Obstetrics and Gynaecology (EBCOG)

Fri, 14 Apr 2023 00:00:00 +0000

Eur J Obstet Gynecol Reprod Biol. 2023 Apr 6;285:50-55. doi: 10.1016/j.ejogrb.2023.04.003. Online ahead of print.

ABSTRACT

Τhe methods of medically assisted reproduction (MAR) are being widely applied all over the world ever since the birth of Louise Brown, the first child conceived after in vitro fertilization (IVF) of a human oocyte and subsequent transfer into the uterus of the ensuing embryo. The possible risks associated with the application of the different MAR methods have given rise to a debate concerning the necessity of a regulatory framework regarding the application of these methods especially in view of the crucial and ambiguous legal and ethical issues attached.

PMID:37058883 | DOI:10.1016/j.ejogrb.2023.04.003

Physician attitudes about disorders of consciousness: Good facts make for good ethics

Fri, 14 Apr 2023 00:00:00 +0000

Dev Med Child Neurol. 2023 Apr 14. doi: 10.1111/dmcn.15619. Online ahead of print.

NO ABSTRACT

PMID:37058590 | DOI:10.1111/dmcn.15619

Policies for Climate-Resilient Health Care Infrastructure-An Environmental Justice Priority

Fri, 14 Apr 2023 00:00:00 +0000

JAMA Health Forum. 2023 Apr 7;4(4):e230366. doi: 10.1001/jamahealthforum.2023.0366.

NO ABSTRACT

PMID:37058291 | DOI:10.1001/jamahealthforum.2023.0366

ETHICAL EXPERTISE OF BIOMEDICAL RESEARCH AS A WAY OF HUMAN RIGHTS PROTECTION

Fri, 14 Apr 2023 00:00:00 +0000

Wiad Lek. 2023;76(3):656-661. doi: 10.36740/WLek202303132.

ABSTRACT

OBJECTIVE: The aim: To find out the peculiarities of ethical expertise of biomedical research as a way of human rights protection.

PATIENTS AND METHODS: Materials and methods: The dialectical method of cognition, based on the epistemological possibilities of the laws and categories of dialectics, provided a study of the formation and activity of bodies and institutions responsible for the ethical examination of biomedical research. Formal and logical methods of analysis and synthesis made it possible to reveal the meaning of the concepts that make up the subject of the study, to carry out their classification, as well as to formulate intermediate and general conclusions. The systematic method made it possible to investigate the role and significance of biomedical human rights among other human and citizen rights and freedoms. Using the historical method, the main stages of the formation of biomedical research with human participation were determined. The structural-functional method made it possible to clarify the internal structure of the mechanism of constitutional and legal protection of the rights and freedoms of a person and citizen in the process of conducting biomedical research, as well as to determine the functional purpose of each of the elements of this mechanism. The content of legal regulations governing social relations, within which the organization and functioning of the human rights protection mechanism in the process of conducting biomedical research is carried out, was revealed with the help of a special legal method of cognition. The comparativist method made it possible to identify similar features and differences in the constitutional and legal regulation of the mechanism for the protection of human rights in the process of conducting biomedical research.

CONCLUSION: Conclusions: Despite such a large number and variety of bioethics committees, it is worth noting that today it is not possible to state with certainty the existence of a full-fledged system of interconnected ethical committees, since the existing normative documents on their activities are of a temporary nature, and do not always clearly define the assigned their functions and tasks. In addition, there is an opinion that attempts to bureaucratize the existing situation (establish clear departmental subordination, define vertical and horizontal connections between ethics committees) are highly undesirable. Of course, on the one hand, excessive complication and bureaucratization will not contribute to progressive development in the activities of committees, and the system that has chaotically developed today is also not satisfactory.

PMID:37057796 | DOI:10.36740/WLek202303132

Process evaluation of workplace health promotion in a sheltered workplace: a care ethics perspective

Fri, 14 Apr 2023 00:00:00 +0000

Health Promot Int. 2023 Apr 1;38(2):daad031. doi: 10.1093/heapro/daad031.

ABSTRACT

Despite the potential health benefits of workplace health promotion for employees in sheltered workplaces, participation is often limited. The aim of this study was (i) to understand this limited participation, and (ii) to find opportunities for adapting workplace health promotion, such that it better meets the needs of the target population. A responsive process evaluation of an extensive multi-component workplace health promotion program targeting lifestyle behaviors, financial behaviors, literacy and citizenship, was performed in a large, sheltered workplace in the Netherlands (>3500 employees). To understand the limited participation, interviews with employees (n = 8), supervisors (n = 7) and managers (n = 2), and 10 participant observations were performed. To find opportunities for improving workplace health promotion in the sheltered workplace, 7 dialogs with employees were performed (n = 30). The interview data on the barriers for participation were evaluated through the lens of care ethics, as this allowed to understand the role of various stakeholders in the limited participation, as well as the indirect role of the institutional context. Findings showed that participation in workplace health promotion could increase if it is organized in a way that it encourages employees to work on health together, allow to tailor activities to different needs and capabilities of employees, and connects activities to employees' daily lives. A strength of this study is that the responsive process evaluation focused both on barriers for participation, as well as on opportunities to increase participation.

PMID:37057390 | PMC:PMC10102729 | DOI:10.1093/heapro/daad031

Negotiating dignity in public geography: The ethics of public engagement in pandemic times

Fri, 14 Apr 2023 00:00:00 +0000

Area (Oxf). 2023 Mar;55(1):53-61. doi: 10.1111/area.12818. Epub 2022 Jul 20.

ABSTRACT

In this paper, I reflect on some of the ethical dimensions of public engagement with geographic research. The paper draws on my recent experience of a project entitled 'Not working from home', which sought to make visible the everyday experiences of essential workers during the COVID-19 pandemic. The project was intended as a space for essential workers to document their daily lives using text, images and video, enabling them to engage with each other, while also informing the wider public about the everyday challenges of not working from home during the pandemic. The paper discusses some of the ethical implications and challenges of conducting this project, drawing on a critical engagement with dignity as an ethical framework for public engagement. I discuss the implications of calling workers 'essential', the role of collective and professional identities explored by the participants, and the impact of offering rewards. I also ask some broader questions on the role that the concept of dignity might play in the ethics of public engagement with research in human geography.

PMID:37057037 | PMC:PMC10083941 | DOI:10.1111/area.12818

Editorial: MacIntyrean virtue ethics for organizations, work and employment: What more and what else?

Fri, 14 Apr 2023 00:00:00 +0000

Front Sociol. 2023 Mar 28;8:1145849. doi: 10.3389/fsoc.2023.1145849. eCollection 2023.

NO ABSTRACT

PMID:37056459 | PMC:PMC10086404 | DOI:10.3389/fsoc.2023.1145849

Dermatologists' ethical obligation to underserved populations

Thu, 13 Apr 2023 00:00:00 +0000

J Am Acad Dermatol. 2023 Apr 11:S0190-9622(23)00592-3. doi: 10.1016/j.jaad.2023.04.007. Online ahead of print.

NO ABSTRACT

PMID:37054811 | DOI:10.1016/j.jaad.2023.04.007

Recent Changes in International Asthma Guidelines May Be Influenced by Pharmaceutical Industry Conflicts of Interest

Thu, 13 Apr 2023 00:00:00 +0000

Am Fam Physician. 2023 Apr;107(4):342-343.

NO ABSTRACT

PMID:37054405

Assessing the Ethical Concerns of Medical Students in the Gross Anatomy Lab

Thu, 13 Apr 2023 00:00:00 +0000

J Med Educ Curric Dev. 2023 Apr 5;10:23821205231168505. doi: 10.1177/23821205231168505. eCollection 2023 Jan-Dec.

ABSTRACT

OBJECTIVES: Cadaver dissection has become the gold-standard for anatomical education in US medical schools. Ethical issues regarding cadavers may not be as obvious as in living patients, which can lead to their potential neglect in medical school curricula. In this study, we assessed the different ethical concerns (ECs) of medical students regarding cadavers in the gross anatomy lab (GAL), gathered student information, including self-reported academic performance (AP) in the GAL, and determined the best predictors for a student's EC.

METHODS: All second-year medical students at the University of Toledo were invited to complete an anonymous, online-survey. Participants were presented with 10 hypothetical but realistic lab scenarios and asked to rate their EC for each on a 5-point Likert scale. Gender, age, and scores received in the GAL course were also collected. A multiple linear regression model was used to find the best predictors of the total EC score.

RESULTS: A total of 112 (63%) responses to the online-survey were recorded. The highest EC was for Q7: Taking pictures of the cadaver. The lowest EC was for Q10: The dissection of cadavers itself is an EC. Gender was the best predictor of total EC, followed by age. Female total EC was significantly higher than that for males (35.8 ± 5.5 vs 33.1 ± 7.9). Female scores for Q1 and Q2 were significantly higher than those for males. Total EC for students in the age group 25 to 34 was significantly higher than those in the age group 18 to 24 (35.9 ± 6.1 vs 33.9 ± 7.2). No significant difference was found for individual scenarios. AP was not significantly related to the total score or the scores of the individual scenarios.

CONCLUSION: The significant differences in ECs of medical students found in our study indicate that not all students have the same outlook towards the GAL specifically and ECs generally.

PMID:37051224 | PMC:PMC10084544 | DOI:10.1177/23821205231168505

Real-world disparities and ethical considerations with access to CFTR modulator drugs: Mind the gap!

Thu, 13 Apr 2023 00:00:00 +0000

Front Pharmacol. 2023 Mar 27;14:1163391. doi: 10.3389/fphar.2023.1163391. eCollection 2023.

ABSTRACT

The third Sustainable Development Goal (SDG), to ensure healthy lives and promote well-being for all at all ages, has particular relevance and implementation challenges amongst people living with rare diseases such as cystic fibrosis (CF). Although the treatment and projected outcome of CF has significantly improved with the advent of CF transmembrane conductance regulator protein modulator (CFTRm) therapy, there remains significant global inequality with regards to access to these life-saving and life-altering drugs. Elexacaftor, tezacaftor, and ivacaftor (ETI) triple combination therapy, first licensed in the United States in 2019, has rapidly become the standard of care for children aged 6 years and older in most high-income countries for individuals with CFTR variants responsive to ETI. Negotiated agreements for access to ETI are currently in place in North America,Europe, Israel ,Australia and New Zealand. However, less priority has been given to negotiate agreements for access to CFTRm in low-middle income countries(LMIC) with significant CF populations such as Central and South America, India, the Middle East, and Southern Africa. These countries and individuals living with CF are therefore effectively being left behind, in direct conflict with the stated principle of the 2030 SDGs. In this review, we highlight the current global inequity in access to CFTRm drugs and its impact on widening disparities between high-income countries and LMIC in CF outcomes and survival. We further discuss the reasons for this inequity and explore the ethical- and human rights-based principles and dilemmas that clinicians, families, governments, and healthcare funders must consider when prioritizing fair and affordable access to expensive CFTRm drugs. Lastly, we propose possible solutions to overcoming the barriers to accessing affordable CFTRm drugs in LMIC and illustrate with examples how access to drug therapies for other conditions have been successfully negotiated in LMIC through innovative partnerships between governments and pharmaceutical industries.

PMID:37050905 | PMC:PMC10083423 | DOI:10.3389/fphar.2023.1163391

Euthanasia and Pain in Canine Patients with Terminal and Chronic-Degenerative Diseases: Ethical and Legal Aspects

Thu, 13 Apr 2023 00:00:00 +0000

Animals (Basel). 2023 Apr 6;13(7):1265. doi: 10.3390/ani13071265.

ABSTRACT

Euthanasia is commonly performed in veterinary medicine to humanely induce the death of an animal when its quality of life is affected by pain or chronic degenerative diseases. The choice of euthanasia is a bilateral decision that represents a challenge for both the veterinarian and the owner of the animal due to the close emotional human-animal bond. Currently, there is legislation that can orient veterinarians concerning euthanasia and the causes that would justify this resolution. However, it is still controversial, and deciding it as the last available resort requires considering it from a medical, legal, and moral perspective. Therefore, this review aims to explore the ethical and legal implications of euthanasia in canine patients. It will analyze the reason that can justify euthanasia in animals with pain or terminal and chronic degenerative diseases, highlighting the importance of effective communication, ethical knowledge, and consideration of euthanasia as a multimodal resolution.

PMID:37048521 | PMC:PMC10093422 | DOI:10.3390/ani13071265

The 12 Rs Framework as a Comprehensive, Unifying Construct for Principles Guiding Animal Research Ethics

Thu, 13 Apr 2023 00:00:00 +0000

Animals (Basel). 2023 Mar 23;13(7):1128. doi: 10.3390/ani13071128.

ABSTRACT

Animal research ethics and animal welfare in science have become progressively tightly regulated, and ethical integrity and scientific quality, as well as social responsiveness and responsibility have become key requirements for research to be approved, funded, published, and accepted. The multitude of factors to contemplate has in some instances not only become complex, requiring a team approach, but often perceived as confusing and overwhelming. To facilitate a process of simplistic yet comprehensive conceptualization, we developed the 12 Rs Framework to act as a mind map to guide scientists, oversight structures, and other stakeholders through the myriad of ethical considerations. It unfolds into three domains of twelve encompassing ethical principles, values, and other considerations, including the animal welfare, social values, and scientific integrity domains, whilst also recognizing the diversity of local context, legal requirements, values, and cultures around the globe. In the end, it can be seen as a unifying ethical framework to foster and promote animal research ethics.

PMID:37048384 | PMC:PMC10093343 | DOI:10.3390/ani13071128

With great power comes great vulnerability: an ethical analysis of psychedelics' therapeutic mechanisms proposed by the REBUS hypothesis

Wed, 12 Apr 2023 00:00:00 +0000

J Med Ethics. 2023 Apr 12:jme-2022-108816. doi: 10.1136/jme-2022-108816. Online ahead of print.

ABSTRACT

Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing the influence of bottom-up input. Put differently, patients become highly suggestible and sensitive to context during a psychedelic session, amplifying therapeutic influence and effects. Due to that, patients are more vulnerable in psychedelic-assisted therapy than in other therapeutic interventions; they lose control during a psychedelic session and become dependent on the therapeutic setting (including the therapist). This enhanced vulnerability is ethically relevant and has been exploited by some therapists in the past. Therefore, patients in current research settings and starting mainstream medical settings need to be well informed about psychedelics' mechanisms and their implications to give valid informed consent to treatment. Furthermore, other security measures are warranted to protect patients from the vulnerability coming with psychedelic-assisted therapy.

PMID:37045591 | DOI:10.1136/jme-2022-108816

Potato Ethics: What Rural Communities Can Teach Us about Healthcare

Wed, 12 Apr 2023 00:00:00 +0000

J Bioeth Inq. 2023 Apr 12. doi: 10.1007/s11673-023-10242-x. Online ahead of print.

ABSTRACT

In this paper I offer the term "potato ethics" to describe a particular professional rural health sensibility. I contrast this attitude with the sensibility behind urban professional ethics, which often focus on the narrow doctor-patient treatment relationship. The phrase appropriates a Swedish metaphor, the image of the potato as a humble side dish: plain, useful, versatile, and compatible with any main course. Potato ethics involves making oneself useful, being pragmatic, choosing to be like an invisible elf who prevents discontinuity rather than a more visible observer of formal rules and assigned tasks. It also includes actively taking part in everyday disaster-prevention and fully recognizing the rural context as a vulnerable space. This intersectional argument, which emphasizes the ongoing, holistic responsibility of those involved in rural communities, draws on work from the domains of care ethics, relational ethics, pragmatic psychology, feminist ethics of embodiment, social location theory, and reflections on geographical narcissism.

PMID:37043082 | DOI:10.1007/s11673-023-10242-x

Analysis of moral courage and related factors among undergraduate nursing students: a scoping review

Wed, 12 Apr 2023 00:00:00 +0000

Rev Bras Enferm. 2023 Apr 7;76Suppl 3(Suppl 3):e20220225. doi: 10.1590/0034-7167-2022-0225. eCollection 2023.

ABSTRACT

OBJECTIVE: to analyze scientific evidence on moral courage and related factors among nursing undergraduate students.

METHOD: the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist.

RESULTS: a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field.

FINAL CONSIDERATIONS: few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.

PMID:37042930 | PMC:PMC10084776 | DOI:10.1590/0034-7167-2022-0225

The ethics of care and pediatric palliative care: a potential dialogue

Wed, 12 Apr 2023 00:00:00 +0000

Cien Saude Colet. 2023 Apr;28(4):1011-1019. doi: 10.1590/1413-81232023284.12422022. Epub 2022 Oct 16.

ABSTRACT

This article, in an essay format, seeks to establish a dialogue between the ethics of care and pediatric palliative care, taking into consideration the fact that moral perceptions are based on a network of relationships, while care is built on intersubjectivity. Four pillars that are referred to as movements are discussed: the ethics of care, as a feminist ethic, in a dialogue with pediatric palliative care, and communication and autonomy as tools of care based on their relational aspects. The conclusion drawn is that considering these aspects from a palliative standpoint can be a way to implement a moral commitment of care.

PMID:37042884 | DOI:10.1590/1413-81232023284.12422022

University ethics boards are not ready for Indigenous scholars

Tue, 11 Apr 2023 00:00:00 +0000

Nature. 2023 Apr;616(7956):221. doi: 10.1038/d41586-023-00974-6.

NO ABSTRACT

PMID:37041250 | DOI:10.1038/d41586-023-00974-6

Telesurgery's Evolution During the Robotic Surgery Renaissance and a Systematic Review of its Ethical Considerations

Tue, 11 Apr 2023 00:00:00 +0000

Surg Innov. 2023 Apr 11:15533506231169073. doi: 10.1177/15533506231169073. Online ahead of print.

ABSTRACT

While robotic-assisted surgery is in a Renaissance, telesurgery, facilitated by robotic technology, is evolving in the space between innovative and mainstream clinical practice. This article outlines the current utilization of robotic telesurgery and barriers to adoption, and it performs a systematic review of relevant ethical concerns. It illustrates how telesurgery can be developed to provide safe, equitable, and high quality surgical care.

PMID:37040578 | DOI:10.1177/15533506231169073

Supervisors' ethical leadership and graduate students' attitudes toward academic misconduct

Tue, 11 Apr 2023 00:00:00 +0000

PLoS One. 2023 Apr 11;18(4):e0283032. doi: 10.1371/journal.pone.0283032. eCollection 2023.

ABSTRACT

Graduate students' academic misconduct has received increasing attention. Although past literature has emphasized university faculty as an important influencing factor on students' moral behaviors, the mechanisms must be further disclosed. We investigated how supervisors' ethical leadership influenced graduate students' attitudes toward academic misconduct. We explained why and how supervisor gender affects post-graduate students' social learning process by integrating social cognitive theory and role congruity theory. Study 1 used a sample of 301 graduate students in 60 academic teams in four Chinese business schools. Study 2 used experimental vignette methodology to enhance the findings' internal and external validity and provided evidence of causality. Based on the two complementary studies, we found that supervisors' ethical leadership significantly inhibited students' acceptance of academic misconduct through students' moral efficacy and the ethical climate of the academic team. The indirect effect via moral efficacy was more significant s for female supervisors. Implications for ethical leadership, academic misconduct, gender differences in leadership, and moral education were discussed.

PMID:37040353 | PMC:PMC10089344 | DOI:10.1371/journal.pone.0283032

Supporting Antiracism Through the Thoughtful Conduct, Evaluation, and Use of Research

Tue, 11 Apr 2023 00:00:00 +0000

J Midwifery Womens Health. 2023 Mar;68(2):163-164. doi: 10.1111/jmwh.13488.

NO ABSTRACT

PMID:37039551 | DOI:10.1111/jmwh.13488

What Do You Do When You Can Do No More? Limited Resources, Unimaginable Environments, Personal Danger: What Have Previous Disasters Taught Us About Moral and Ethical Challenges?

Tue, 11 Apr 2023 00:00:00 +0000

Disaster Med Public Health Prep. 2023 Apr 11;17:e373. doi: 10.1017/dmp.2022.64.

ABSTRACT

Historically, natural and manmade disasters create many victims and impose pressures on health-care infrastructure and staff; potentially hampering the provision of patient care and overloading clinician capacity. Throughout the course of history, clinicians have performed heroics to work well above their required duty, despite limitations, even putting their own health and safety at risk. In times when clinicians needed to either physically abandon patients or consider abandoning active treatment, we have seen extreme hesitancy to do so, fearing that they may be giving up too soon, that undue harm may come to patients, or even feeling unsure of legal or moral burdens that may ensue. In times when clinicians are placed in this unimaginable position, feeling isolated and overwhelmed, it is essential that they be supported and provided with resources to standardize decision-making.

PMID:37039424 | DOI:10.1017/dmp.2022.64

Anatomists' uses of human skeletons: Ethical issues associated with the India bone trade and anonymized archival collections

Tue, 11 Apr 2023 00:00:00 +0000

Anat Sci Educ. 2023 Apr 11. doi: 10.1002/ase.2280. Online ahead of print.

ABSTRACT

Concerns have recently been expressed about the continuing availability of human bones from India, obtained originally for educational purposes but lacking the requisite informed consent that would be expected today. More generally, a broader claim is being made, namely, that the practice of using any unconsented bones in educational settings is unethical and should cease. These calls, in turn, raise broader issues regarding the availability of anonymous archival collections in anatomy museums. Although this debate centers on undergraduate anatomy teaching, much anthropological research utilizes human remains of past populations for which there can have been no consent. A suggested alternative for undergraduate teaching is the use of 3D images of human bones, rather than the bones themselves. In addressing these issues, the background to the India bone trade is assessed, and the year 1985 is pinpointed as having significant ethical weight. The cultural and ethical interests inherent in studying archival anonymous skeletal material are weighed against indiscriminate reburial. Although any use of unconsented material represents ethical compromise, account should be taken of changing ethical expectations with time. It is concluded that: there is no justification for repatriation or disposal of all bones for which specific informed consent has not been obtained; continued use of anonymous archival human bones in a professional setting is acceptable, even in the absence of informed consent, with the proviso that there are no culturally relevant groups seeking repatriation; the continued existence of bones in long-standing private collections cannot be justified since it amounts to long-term storage with no identified goals; the notion that 3D images are an ethically superior alternative to actual human bones is unsustainable, since there is an intimate connection between the bones and the 3D images.

PMID:37039309 | DOI:10.1002/ase.2280

Reporting Ethics Approval in Articles on Criminality. An Audit of Adherence to Swedish Legislation

Tue, 11 Apr 2023 00:00:00 +0000

J Empir Res Hum Res Ethics. 2023 Apr 10:15562646231168980. doi: 10.1177/15562646231168980. Online ahead of print.

ABSTRACT

According to the Swedish Ethics Review Act, research involving personal data on crimes should undergo independent ethics review. To explore the reporting of ethics approval, we extracted information from articles with Swedish personal data on crimes published in 2013-2021. Of the identified 298 articles, 92 (31%) failed to report ethics approval. Failures were particularly common in articles with a qualitative design, single or few authors and when there was a social science focus. Failures varied markedly between universities. We conclude that failures to report compulsory ethics approval are common in articles involving personal data on crime and that these failures vary markedly with the research setting. Several indicators of poor adherence to the Ethics Review Act have been identified.

PMID:37038650 | DOI:10.1177/15562646231168980

Artificial intelligence in surgical education and training: Opportunities, challenges and ethical considerations: Correspondence

Mon, 10 Apr 2023 00:00:00 +0000

Int J Surg. 2023 Apr 12. doi: 10.1097/JS9.0000000000000387. Online ahead of print.

NO ABSTRACT

PMID:37037597 | DOI:10.1097/JS9.0000000000000387

When narcissists exemplify ethics: Contingent consequences of ethical leadership

Mon, 10 Apr 2023 00:00:00 +0000

J Appl Psychol. 2023 Apr 10. doi: 10.1037/apl0001081. Online ahead of print.

ABSTRACT

Organizations increasingly encourage, recognize, and reward ethical leadership to preempt the economic and reputational risks associated with ethical failures. At the same time, organizational leadership positions are disproportionately occupied by individuals higher in narcissism. We highlight how the combination of these two phenomena carries important organizational implications by examining how ethical leadership behaviors differentially impact leaders based on their level of narcissism. Building upon self-concordance theory, we introduce a model of contingent consequences of ethical leadership. Our model identifies motivational (i.e., self-efficacy of the leader) and social (i.e., admiration of the leader) mechanisms that explain why ethical leadership positively predicts leadership effectiveness for some leaders, but not for others. We test our model using a field study and two experiments. Findings from these three studies point to a problematic leadership paradox: When leaders higher in narcissism behave more ethically, they incur higher motivational costs and reap fewer social benefits compared to their peers who are lower in narcissism. Results reveal risks to leadership effectiveness for narcissistic leaders who attempt to lead more ethically. We discuss implications for ethical leadership research and practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37036688 | DOI:10.1037/apl0001081