Abstract:Pharmaceutical representatives use detailing, gift giving, and the donation of free samples as a means to gain access to and influence over physicians. In biomedical ethics, there has been an ongoing debate as to whether these practices constitute an unethical conflict of interest (COI) on the part of the physician. Underlying this debate are the following antecedent questions: (1) what counts as a conflict of interest, (2) when are such conflicts unethical, and (3) how should the ethical physician respond to (...) conflicts? This article distinguishes between two perspectives that have been developed on these issues: a reliable performance model (PM) and a trustworthiness model (TM). PM advocates argue that a conflict of interest can only be established by demonstrating that a particular influence is undermining the reliability of the physician’s judgment, and this requires empirical evidence of negative patient outcomes. TM advocates, on the other hand, argue that because of the fiduciary nature of the patient-physician relationship, physicians have an obligation to develop and be worthy of patient trust. A COI, on this view, is a condition that undermines the warrant for patients to judge a physician as trustworthy. Although there is much that is right in the PM, it is argued that the TM does a better job of responsibly addressing the unique vulnerabilities of the patient. The TM is then applied to the practices of detailing, gift giving, and sample donation. It is concluded that these practices constitute an unethical conflict of interest. (shrink)

It is often claimed that managed care organizations involve physicians in conflicts of interest by creating financial incentives for physicians to refrain from ordering treatments or making referrals. Such incentives, the argument goes, force the physician to balance the patient's health interests against the MCO's interests and the physician's own financial interest. I assume, for the sake of argument, that such arrangements at least provide reason to believe that physicians in MCOs are involved in conflicts of interest. Two approaches have (...) evolved for dealing with these conflicts. On one approach, MCOs disclose the financial arrangements under which their physicians work so that patients can consent to the managed care plan and thereby to the plan's limitations. The chief proponent of this approach is Mark Hall, whose recent book Making Medical Spending Decisions applies prior consent to a variety of decisions regarding medical financing and allocation. The other approach is simply to forbid conflicts of interest through regulations. (shrink)

The potential for financial conflicts of interest (COIs) to damage the credibility of scientific research has become a significant social concern, especially in the wake of high-profile incidents involving the pharmaceutical, tobacco, fossil-fuel, and chemical industries. Scientists and policy makers have debated whether the presence of financial COIs should count as a reason for treating research with suspicion or whether research should instead be evaluated solely based on its scientific quality. This paper examines a recent proposal to develop criteria for (...) evaluating the credibility of research without considering its source of funding. It concludes that proposals of this sort are likely to be either ineffective or impractical in many cases. Nevertheless, this does not imply that all research funded by those with an interest in the outcome must be placed under a cloud of suspicion; there are conditions under which research is at much more serious risk of being corrupted than in other cases, and attention to these conditions can guide productive responses to financial COIs. (shrink)

To enlarge the discussion of scientific responsibility for research integrity, this paper offers two historico-philosophical observations. First, in the broad history of ideas, modern ethics replaces social role responsibility with appeals to abstract principles; by contrast, discussions within the scientific community of responsibility for research integrity constitute a rediscovery of the continuing vitality of role responsibility. This is a rediscovery from which philosophy itself may benefit. Second, within the context of scientists’ concerns, the idea of role responsibility has undergone significant (...) evolution from “collective responsibility” to the notion of responsibility resting with a “trans-scientific community.” Further challenges nevertheless remain in order to relate scientific role responsibility for scientific integrity to the relationship between science and society. To promote a notion of integrity not just in science but in the science-society relationship, it may be useful to think in terms of a “co-responsibility” for scientific integrity. (shrink)

Independence is a fundamental concept to the audit. There is a clear relationship between independence and conflict of interest in all professions. This paper examines this relationship in the auditing profession and in the context of three specific practices. The paper analyses these practices by using the Davis model of conflict of interest. The results of this analysis give rise to some interesting questions for the ethical practices of the auditing profession.

Disclosure is a common response to conflicts of interest; it is intended to expose the conflict to scrutiny and enable it to be appropriately managed. For disclosure to be effective the receiver of the disclosure needs to be able to use the information to assess how the conflict may impact on their interests and then implement a suitable response. The act of disclosure also creates an expectation of self-regulation, as the person with the conflicting interests will be mindful of their (...) own potential biases and aware that their decisions may be monitored. This article discusses some of the problems of relying on disclosure as a solution to address conflicts of interest in research, including the added complexities around institutional conflicts of interest. The case of Dan Markingson illustrates these issues and highlights the vulnerable position relying on disclosure as a solution leaves research participants in. (shrink)

Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global protocols for (...) dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways. (shrink)

This paper describes the professional ethical context behind the failure of Arthur Andersen’s audit of Enron. It is argued that the evolution of extreme industrial concentration in the accounting profession, and the subsequent unrestrained diversification of the “Big Five” accounting firms were the sources of multiple conflicts of interest that were unresolved by the time of the Enron debacle. In the post-Enron era, the problems of commercial conflicts of interest and of highly concentrated power in the profession remain important issues.

This paper looks at conflicts of interest in the not-for-profit sector. It examines the nature of conflicts of interest and why they are of ethical concern, and then focuses on the way not-for-profit organisations are especially prone to and vulnerable to conflict-of-interest scandals. Conflicts of interest corrode trust; and stakeholder trust (particularly from donors) is the lifeblood of most charities. We focus on some specific challenges faced by charitable organisations providing funding for scientific (usually medical) research, and examine a case (...) study involving such an organisation. One of the principal problems for charities of this kind is that they often distribute their funds within a relatively small research community (defined by the boundaries of a small region, like an American state or Spanish Autonomous region, or a small country), and it often proves difficult to find high-level researchers within the jurisdiction to adjudicate impartially the research grants. We suggest and recommend options appropriate for our case study and for many other organisations in similar situations. (shrink)

: This essay provides an analysis of conflicts of interest in science. It gives an overview of some current conflict of interest policies and distinguishes between real, apparent, and potential conflicts of interest. The essay argues that scientists should disclose real, apparent, and potential conflicts of interest and that they should avoid conflicts that threaten scientific objectivity or trustworthiness. The essay also uses several hypothetical scenarios to illustrate some of the key points made in the analysis and suggests some strategies (...) for buffering the impact of conflicts of interest in science. (shrink)

The virtue of trust is often spoken of as central to the work of dietitians working in nutrition counseling, especially in the context of disordered eating/eating disorders nutrition therapy. Indeed, dietitians are purported to be the most trusted source of information on nutrition and food by professional associations such as Dietitians of Canada. Here trust is explored through educational, relational, and virtue theory in order to elucidate trusts meaning and relevance to dietitians work and interactions with each other, including the (...) general public. If dietitians are to continue to be trusted during times of skepticism in expert knowledge, reflexivity, active contestation, and moral testing in the context of our socio-political milieu need be employed so that we as a profession may respond to clients in respectful, authentic, meaningful ways; practices worthy of our trust. (shrink)

Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team’s interest in winning may not accord with the welfare of (...) an injured player, particularly when it comes to decisions about returning to play after injury. Australia’s two most popular professional football codes—rugby league and Australian Rules football—have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport’s governing body do not necessarily remove or resolve conflicts of interest in the doctor–patient–team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare. (shrink)

Most incidences of dishonesty in research, financial investments that promote personal financial gain, and kickback scandals begin as conflicts of interest (COI). Research indicates that healthcare professionals who maintain COI relationships make less optimal and more expensive patient care choices. The discovery of COI relationships also negatively impact patient and public trust. Many disciplines are addressing this professional issue, but little work has been done towards understanding and applying this moral category within a nursing context. Do COIs occur in nursing (...) and are they problematic? What are the morally appropriate responses to COI for our discipline and for individual practicing nurses? In this paper I examine the nature of 'conflict of interest' as a general ethical category, its characteristics and its application to our discipline. Conflict of interest is an odd moral category that may actually or potentially result in immoral decisions. The moral justification for COI is grounded prime facie by the moral value of respect for persons and principle of fidelity from which trust is developed and maintained. In review of the historical development, there appears to be consensus on some qualities of COI that are presented. I conclude that making judgements about COI are challenging and often difficult to determine from a nursing perspective. Improving nurses' and professional organizations' awareness of COI and sharpening our ability to respond appropriately when COI arise can reduce potential harm and promote trust in those whom we serve. (shrink)

This article describes the development and teaching of a course on global engineering ethics in Shanghai Jiao Tong University, China. It outlines course objectives, methods, and contents, and instructor experience and plans for future development. This is done with the goal of helping educators to plan standalone courses and/or integrated modules on global engineering and technology ethics, which address challenges arising from the increasingly cross-cultural and international environments of contemporary technology and engineering practice. These efforts are motivated by the global (...) environments of engineering, as well as recent research in empirical moral psychology. Although this course was developed and taught in China, as a course on global engineering ethics taught to students from throughout the world, its approach could be beneficial elsewhere. (shrink)

The sensible response to conflicts of interest is impaired by misconceptions and sloppy usage of terminology. Apparent and potential are widely misused modifiers for conflicts. Excessive legislative focus on financial interests limits understanding of the scope and significance of researchers' conflicts of interest. There is no moral or ethical failing in having a conflict of interest; the problem occurs when conflicts are not disclosed appropriately and when conflicts are allowed to bias research, teaching, or practice. Avoidance and prevention should be (...) applied to bias, not conflicts. (shrink)

abstract This paper is an investigation of the moral psychology of decisions that involve a conflict of interest. It draws on the burgeoning field of affective neuroscience, which is the study of the neurobiology of emotional systems in the brain. I show that a recent neurocomputational model of how the brain integrates cognitive and affective information in decision‐making can help to answer some important descriptive and normative questions about the moral psychology of conflicts of interest. These questions include: Why are (...) decisions that involve conflicts of interest so common? Why are people so often unaware that they are acting immorally as the result of conflicts of interest? What is the relation of conflicts of interest to other kinds of irrationality, especially self‐deception and weakness of will? What psychological, social, and logical steps can be taken to reduce the occurrence of immoral decisions resulting from conflicts of interest? I discuss five strategies for dealing with conflicts of interest: avoidance, optimal reasoning patterns, disclosure, social oversight, and understanding of neuropsychological processes. (shrink)