Applied Ethics in the Fractured State: Volume 20

Cover of Applied Ethics in the Fractured State

Table of contents

(11 chapters)


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There are some notable ethical problems about role obligations, including the three prominent issues of role relativism, role definition, and role identification. The first is the problem to what extent roles may create duties or rights at odds with other moral requirements, the second is where roles are unclear or conflicting in what they prescribe, and the third is about the extent to which people commit themselves to their roles, or dissociate themselves from those roles. The three problems are significant in business ethics. A Confucian approach to roles can assist in dealing with them. Classical texts suggest a nuanced approach to roles, which allows greater flexibility, paying attention to context and detailed circumstances, always relating role prescriptions to respect and concern for other people, and emphasizing the importance of sincerity and authenticity in role performance. Such an account is consistent with virtue ethics approaches to business ethics.


This chapter investigates the central role that intention (cetanā) plays in Buddhist ethics, the unique perspective into the nature of the self and agency from a Theravāda Buddhist stance. Intention is paramount in determining every mental, verbal, and physical action as wholesome, unwholesome, or neutral in the Buddhist ethico-psychology. Buddhist ethics offer an inclusive, compassionate, and non-theistic perspective into the many moral dilemmas we face today as the mind and its processes, the underlying volition of a thought, context, and circumstances all determine the nature of an action. This is of relevance particularly in the digital age where agency is often imperceptible from societal, legal, and materialistic stances. The virtual world is perceived to be distinct from concrete reality and hence unethical actions considered to be less negative and destructive, and the perpetrators often difficult to trace or made to pay the consequences as societies and legal systems struggle to deal with this new reality. Buddhism has little to say about reforming society but on the other hand provides a refined investigative system of categorization of ethical and unethical actions through its theory of kamma (action) originating in a seed of positive or negative intention in the mind, and the consequences are said to be unavoidable although subject to manifold variations. Although the influence of Buddhism is still fragmented in the West with debates on its relevance, what to adopt, adapt, and discard, it can offer a fresh perspective on ethics, intention, agency, and the self.


Much ink has been spilled in recent years over the controversial topic of conscientious objection in health care. In particular, commentators have proposed various ways with which we might distinguish legitimate conscience claims from those that are poorly reasoned or based on prejudice. The aim of this chapter is to argue in favor of the “reasonableness” approach to conscientious objection, viz., the view that we should develop an account of “reasonableness” and “reasonable disagreement” and use this as a way of distinguishing licit and illicit conscience claims. The author discusses Rawls’ account of “reasonableness” and “reasonable disagreement,” and consider how this might guide us in regulating conscientious objection in health care. The author analyzes the “public reason” account offered in Card (2007, 2014), and argue that we should modify Card’s account to include a consensus among regulators about what counts as “basic medical care.” The author suggests that Medical Conscientious Objection Review boards should consider whether conscience-based refusals are based on defensible ethical foundations.


Euthanasia and assisted suicide is about changing the law to enable doctors, under certain circumstances, to intentionally kill patients. For proponents the issues have been determining what are “appropriate circumstances” for such activity and gathering up enough political support to win the day on numbers. The community and medical profession have been exposed to years of misinformation about euthanasia, and advocates have become so vocal that contrary positions are now barely heard. Nevertheless, there are enormous adverse implications for all healthcare professionals. Clinical management in the twenty-first century has moved well past scenarios painted to justify killing the patient. The inclusion of killing in the therapeutic armamentarium will cause an inexorable erosion of what is at present an absolute protection for the patient, the doctor, and other healthcare professionals.


Natural Law philosophy asserts that there are universally binding and universally evident principles that can be determined to guide the actions of persons. Moreover, many of these principles have been enshrined in both statute and common law, thus ensuring their saliency for staff and institutions charged with palliative care. The authors examine the often emotive and politicized matter of (non-voluntary) euthanasia – acts or omissions made with the intent of causing or hastening death – with reference to Natural Law philosophy. This leads us to propose a number of important public policy remedies to ensure dignity in dying for the patient, and their associates.


This study is a considered interpretation of the National Registration and Accreditation Scheme for the health professions, which commenced operations in Australia in 2010. The development of the Scheme and its operational elements (namely the Australian Health Practitioner Regulation Agency and 14 profession-specific national Boards) are positioned within the context of regulatory capitalism. Regulatory capitalism merges the experience of neoliberalism with an attentiveness to risk, particularly by the State. Nationally consistent legislation put in place a new set of arrangements that enabled the continuity of governments’ role in health workforce governance. The new arrangements resulted in an entity which is neither exclusively subservient to nor independent of the State, but rather “quasi-independent.” In exploring this arrangement, specific consideration is given to how the regulatory response matched the existing reality of a global (and national) health workforce market. This study considers this activity by the State as one of consolidation, as opposed to fracturing, against a backdrop of purposeful regulatory reform.


In 2013, the National Mutual Acceptance (NMA) of single ethical review was introduced into the Australian public health sector to address the timeliness of multisite clinical trials. A clinical trial is usually designed to test the effects of an experimental therapeutic product. While all research involving humans must comply with ethical guidelines, clinical trials testing products in Australia are also subject to stringent regulatory controls making the need to meet trial milestones critically import. Commercial clinical trials offer participating research sites substantial financial and clinical advantages. Concerns that bureaucratic processes have impeded commercial investment have influenced countries, including Australia, to introduce single ethical review, where one ethics review is accepted at multiple sites participating in the same research project. Although a central tenet of the NMA is the standardization of the behaviors and procedures of research review, concerns of inconsistency remain. This raises the question of whether the NMA does lead public healthcare agencies to adopt similar research governance practices.

A questionnaire survey was undertaken to explore the current experiences (n = 149) of the NMA in Victorian public health agencies, and 21 semi-structured interviews were conducted to explore expectations of the future of the NMA. The findings indicated that, while there was conformity to many of the process requirements of the NMA, a persistent focus on the needs of each individual healthcare agency rather than on complying with the national system weakened pressure on agencies to adopt standardization.

The NMA has the capacity to be a powerful tool in delivering quality clinical trial outcomes, maximize research resources and create dependable performance metrics if consistent policies and governance are followed.


An increase in community engagement by governments across Australia’s three-tiered federal polity conforms to international trends. It represents a multidimensional institutionalization of participatory democracy designed to involve the public in decision-making. Increasingly, it is a practice which displays the markers of professionalization, including (self-described) professionals, professional associations and a code of ethics. The individuals who design, communicate, and facilitate community engagement are placed in a unique position, whereas most professions claim to serve both their client or employer and a greater public good, community engagement practitioners play these roles while also claiming to serve as “guardians” of democratic processes. Yet the claimed professionalization of community engagement is raising some questions: Is community engagement really a profession – and by what criteria ought this be assessed? What tensions do community engagement practitioners face by “serving multiple masters,” and how do they manage these? More pointedly, how can ethics inform our understanding of community engagement and its professionalization? This chapter examines the case for the practice of community engagement as a profession using Noordegraaf’s (2007) pillars of pure professionalism as a guide. It then explores some practical examples of the tensions practitioners may experience. The chapter concludes by reflecting on the future direction of community engagement given its positioning.


Pages 135-137
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Cover of Applied Ethics in the Fractured State
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Book series
Research in Ethical Issues in Organizations
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Emerald Publishing Limited
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