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Tonight I would like to take your time consider the matters of how one can avoid simply seeing what one knows; and of how, not always but now and then, I have been able to know what I saw, in those very different decades of my life. So here is one story for each my seven decades here, and then a story at the end that speaks to the future in an unexpected way.

Health Impact Assessment, HIA is intended to contribute to public health by allowing those who make decisions on behalf of the public to anticipate how those decisions will affect people's health. It is a combination of procedures, methods and tools to be adapted in different contexts to evaluate projects, plans, and policies. The premise of HIA is thus the possibility to foresee impacts; the same is true for Environmental Impact Assessment, as well as Strategic Environmental Assessment. The difference is the inclusion of humans as subjects: local communities often require HIA where high impacts are present or suspected, because HIA produces numbers relating to people that could impact their lives. Here we find the first ethical implication of HIA. It is a decision support tool, based on the inclusion of communities in HIA design and process development; the inclusion of nonexpert knowledge is foreseen by HIA methods through both quantitative and qualitative data collection and evaluation. The roles of actors have to be considered, and their ethical duties linked to their responsibility. In addition, the power vested of assessors and decision-makers also needs to be considered. The ethical duty of assessors is to provide decision-makers with the information needed in order to make ethical decisions, describing existing inequalities, identifying positive and negative impacts under each option, and describing on whom these will fall. HIA involves multiple competencies, among which environmental epidemiology plays a central role. Ethical issues relate specifically to the hypothesis to be tested, which health impacts have to be considered, the scientific strength of evidence produced, the validity of results obtained, as well as the equity and equality considerations along the health-disease continuum. The ethical duty of decision-makers is linked to the responsibility to act and decide, supported by legislation, where the right of the public to information and participation is recognised, and by the practice of openness and transparency required by democracy.

Characterizes and discusses terrorism and considers when, if ever, terrorism might be morally justified. Focuses on "state terrorism" arguing that it is the main engine for creating and sustaining other forms of terrorism.

Some organisations, and some individual humans, violate moral and ethical rules, whether or not they are written down in laws or codes of conduct. Corporate transgressions, as this behaviour is called, occur because of the actions of those in charge, usually bright and dedicated people. Immoral and unethical conduct can adversely affect the safety of workers, the general public and the environment. A scoping review method for a literature search is used to explore morality and ethics in relation to health and safety management. Our findings show that controlling the risks associated with misconduct and corporate transgression is not usually seen as a responsibility allocated to safety systems but is left to general management and corporate governance. The moral and ethical principles, however, can be applied in safety management systems to prevent misconduct and transgression-related safety risks. Our results show that ethical leadership, ethical behaviour, sustaining an ethical climate and implementation of an ethical decision-making process emerge as key preventive measures. The discussion presents a proposed way to include these measures in safety management systems. Conclusion and recommendations underline that unwanted behaviour and transgression risks can be brought under control, starting from a set of best practices. Not only the managers themselves but also board members, independent external supervisors and government regulators need to embrace these practices.

BACKGROUND: Ethical climate and moral distress have been shown to affect nurses' ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. RESEARCH AIM: To investigate paediatric oncology nurses' perceptions of ethical climate and moral distress. RESEARCH DESIGN: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. RESPONDENTS AND RESEARCH CONTEXT: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. ETHICAL CONSIDERATIONS: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. RESULTS: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. DISCUSSION: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. CONCLUSION: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

Many decision-making situations today affect the safety of individuals and the environment,for instance hazardous waste management. In practice, many of these decisions are madewithout an overall view and with the focus on either the environment or safety. Now and then the areas of regulation are in conflict, i.e. the best alternative according to environmental considerations is not always the safest way and vice versa.A tool for taking an overall view within the areas of safety and environment would simplify matters and provide authorities and industry with a better basis for their work. This thesis forms part of a project which aims to develop a framework tool giving this overall view and supporting decision-making in which the issues (areas) of environment, safety, ethics and costs are all integrated. By developing a framework tool, different areas of interest could be taken into consideration more easily when a decision is to be made and could also help develop legislation and policy locally (at an industry or company), nationally and internationally. The project also aims to provide knowledge about different destruction/decommission methods, their good and bad points and their consequences, in order to provide different actors with a better basis for decision-making. This thesis focuses on development of the framework. The scope of the studies was restricted to environment, ethics and personnel safety due to the extent of the work and time limitations. In the next part of the project, the areas of costs and evaluation will be studied and a first draft of the framework tool will be presented. In order to develop the framework tool, two case studies were carried out here: an environmental analysis involving a life cycle assessment and an ethical analysis. With the help of these analyses, three different methods of destruction of ammunition were compared: Open detonation, modelled both with and without recovery and recycling of metals; incineration in a static kiln with air pollution control combined with ...

Background: Ethical climate and moral distress have been shown to affect nurses' ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses' perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses. ; publishedVersion ; Peer reviewed

The prospect of creating children through somatic cell nuclear transfer has elicited widespread concern, much of it in the form of fears about harms to the children who may be born as a result. There are concerns about possible physical harms from the manipulations of ova, nuclei, and embryos, which are parts of the technology, and about possible psychological harms, such as a diminished sense of individuality and personal autonomy. There are ethical concerns as well about a degradation of the quality of parenting and family life if parents are tempted to seek excessive control over their children's characteristics, to value children according to how well they meet overly detailed parental expectations, and to undermine the acceptance and openness that typify loving families. Virtually all people agree that the current risks of physical harm to children associated with somatic cell nuclear transplantation cloning might justify a prohibition at this time on such experimentation[i]. In addition to physical harms, many worry about psychological harms associated with such cloning. One of the forms of psychological harm most frequently mentioned is the possible loss of a sense of uniqueness. Although the myth of genetic determinism is dispelled, but some doubts about cloning and identity remain that I am going to argue that somatic cell nuclear transfer cloning creates serious issues of identity and individuality especially in the Psychological identity and forces us to reconsider how we define ourselves because Cloned children each will be genetically virtually identical to a human being who has already lived and also the expectations for their lives may be shadowed by constant comparisons to the life of the "original."[ii] Moreover, comment on the importance of genetic uniqueness not only for individuals but also in the eyes of their parents [i] . See :National Bioethics Advisory Commission [NBAC], Cloning Human Beings, Bethesda, MD: Government Printing Office, June 1997.p.62 [ii] . See :President's Council on ...

BACKGROUND: As 'disease detectives' and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive considerable attention in medical and research settings, less is known about ethical challenges faced by field epidemiologists in public health programs. Similarly, little is known about moral distress among field epidemiologists, i.e., situations in which they are constrained from acting on what they know to be morally right. Moral distress is strongly associated with empathy fatigue, burnout, reduced job retention, and disengagement. To better understand ethics training needs for field epidemiologists, in February 2019, members of TEPHIConnect, an online and mobile networking platform for Field Epidemiology Training Program (FETP) alumni, were invited to participate in an anonymous survey about ethical challenges and moral distress. RESULTS: Among 126 respondents from 54 countries, leading causes of ethical dilemmas included inadequate informed consent (61%), inequitable allocation of resources (49%), and conflicts of interest (43%). These occur primarily in settings of disease outbreaks (60%); research (55%); and public health programs at the state, province, or national level (45%) or community level (43%). Work-related moral distress was reported by 91% of respondents, including 26% who experience it "frequently" or "almost always." Field epidemiologists working in low- and low-middle income countries were more likely to report moral distress "frequently" or "almost always" than those in higher-income countries (33.0% vs 9.1%, P = 0.006). The most common perceived contributors to moral distress included excessive stress and work demands (30%) and inadequate support from leaders (25%). CONCLUSIONS: Field epidemiologists face significant work-related ethical challenges, which are endemic to public health and political systems. A substantial proportion of field epidemiologists also experience some degree of moral distress, often in ...

This article seeks to understand how values enter into political discourse via justification and how those values are negotiated over time. The article maps out the terrain of diversity discourses, both as a specific type of discourse and as an example of ethical, moral and pragmatic modes of argumentation. The author examines Swedish "diversity discourses" in the periods of 1968–1975 and 1991–1995 in an effort to tease out the pragmatic, moral and ethical aspects of these discourses. Diversity discourses are defined as discourses regarding how much and what kind of diversity is acceptable or desirable in a society, as well as how such diversity should be handled. I find that values, both contextually-dependent ethical values and universal moral values, rather than being "prior" to politics, arise out of the intersection of pragmatic, ethical and moral discourses. What is moral and ethical, then is colored by the particular nexus of moral, ethical and pragmatic concerns such that what is acceptable at one particular time and location, may be unacceptable in another, even coming from the same actors with the same ideological commitments. Shifts in the ethical/moral modes of justification, then, lead to shifts in who is included in a democratic community.

The Life Esidimeni tragedy highlights several ethical transgressions. Health professionals' ethics are put to the test when their own interests are balanced against competing claims. Core values of compassion, competence and autonomy, together with respect for fundamental human rights, serve as the foundation of ethical practice in healthcare. These values are increasingly being challenged by governments and other third parties. The duties conferred on healthcare practitioners require them to act responsibly and be accountable for their actions. Codes in healthcare serve as a source of moral authority. The Gauteng health authorities exerted tremendous power and created a culture of fear and disempowerment among healthcare practitioners. When health professionals choose to support state interests instead of those of patients, problematic dual-loyalty conflicts arise.

The development of In Vitro Fertilisation (lVF) is a perfect example of how medical science has outpaced morality and ethics. Reproductive technology, while offering enormous benefits to infertile couples, has opened up a veritable Pandora's box of ethical dilemmas. Louise Brown, now 21 years of age, was the first IVF baby born in England. Here in Malta our first IVF baby was born only a few years ago in what could well be described as a legal and ethical vacuum. For while Science and Technology have forged ahead, Law and EthicS have lagged behind. So, in launching this document on Reproductive Technology (or, should it be Assisted Procreation?). the Bioethics Consultative Committee has taken a decisive step towards remedying this deplorable state of affairs. ; N/A

Medical tourism – the travel of patients from one (the "home") country to another (the "destination") country for medical treatment – represents a growing business. A number of authors have raised the concern that medical tourism reduces access to health care for the destination country's poor and suggested that home country governments or international bodies have obligations to curb medical tourism or mitigate its negative effects when they occur. This article is the first to comprehensively examine both the question of whether this negative effect on access to health care occurs for the destination country's poor, and the normative question of the home country and international bodies' obligations if it does occur. I draw on the work of leading theorists from the Statist, Cosmopolitan, and Intermediate camps on Global Justice and apply it to medical tourism. I also show how the application of these theories to medical tourism highlights areas in which these theories are underspecified and suggests diverging paths for filling in lacunae. Finally, I discuss the kinds of home country, destination country, and multilateral forms of regulation this analysis would support and reject. ; Peer reviewed

Diseases change the life of individuals, the social status of groups, the obligations of professionals, and the welfare of nations. Disease classifications function as a demarcation of access to care, rights, and duties. Disease also fosters social stigmatization and discrimination, and is a personal, professional, and political matter. It raises a wide range of ethical issues that are of utmost importance in patient communication and education. Accordingly, the objective of this article is to present and discuss a range of basic ethical aspects of this core concept of medicine and health care. First and foremost, disease evokes compassion for the person suffering and induces a moral impetus to health professionals and health policy makers to avoid, eliminate or ameliorate disease. The concept of disease has many moral functions, especially with respect to attributing rights and obligations. Classifying something as disease also has implications for the status and prestige of the condition as well as for the attitudes and behavior towards people with the condition. Acknowledging such effects is crucial for avoiding discrimination and good communication. Moreover, different perspectives on disease can create conflicts between patients, professionals and policy makers. While expanding the concept of disease makes it possible to treat many more people for more conditions - earlier, it also poses ethical challenges of doing more harm than good, e.g., in overdiagnosis, overtreatment, and medicalization. Understanding these ethical issues can be difficult even for health professionals, and communicating them to patients is challenging, but crucial for making informed consent. Accordingly, acknowledging and addressing the many specific ethical aspects of disease is crucial for patient communication and education.

The suffering that initially prompts ethical reflection is frequently forgotten in the generalised rational response of much contemporary International Relations theory. This thesis draws on Theodor W. Adorno and Gillian Rose to propose an alternative approach to suffering in world politics. Adorno argues suffering and trauma play a key role in the task of enlightening Enlightenment. They emphasise the concrete particularity of human existence in a way that is radically challenging to Enlightenment thought. Understanding suffering helps to drive a negative dialectics that preserves the non-identical (that which cannot be understood, manipulated or controlled by reason), holding it up against the instrumentalism and abstraction that have prevented Enlightenment thought from fulfilling its promise. Part One reviews contemporary approaches to international ethics in a way that draws out their affinity with the Enlightenment thought Adorno criticises. Despite their variety, liberal and Habermasian approaches to international ethics tend to be rational and problem-solving, to assume moral progress, to underestimate the importance of history and culture, and to neglect inner lives. They approach ethics in a way that pays too little attention to the social, historical, and cultural antecedents of suffering and therefore promotes solutions that, whilst in some ways inspiring, are too disconnected from the suffering they seek to address to be effective in practice. Part Two deepens the critique of modern ethics through an exposition of Adorno's work. It then draws on Adorno's conception of promise, Rose's writing on mourning and political risk, and a broader literature on ways of working through trauma to propose an alternative way of being in the world with ethical and political implications. I advocate a neo-Hegelian work of mourning, which deepens understanding of the complexities of violence and informs a difficult, tentative, anxiety-ridden taking of political risk in pursuit of a good enough justice.