Background: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. Objective: The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled (...) conscience among registered nurses (RNs) working in nursing homes. Research design: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. Ethical considerations: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. Findings: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. Discussion: Troubled conscience meant experiencing continuous and simmering tension between one’s ideals and realities and feeling a drive to preserve accountability and one’s moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. Conclusion: Nurses’ troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state’s intentions can be realised within the given framework are important for individual nurses’ occupational health as well as the quality of care provided to patients. (shrink)

UN TRABAJADOR SOCIAL entorpece la tramitación de una denuncia de violencia intrafamiliar porque es mucho papeleo y cree que, si fuera real, la supuesta víctima habría abandonado a su abusador. Una policía obliga a una persona detenida a firmar una confesión bajo coacción porque tiene que cumplir una cuota. Un profesor no asigna importancia a las preguntas de una alumna porque tiene una discapacidad visible. Estas situaciones tienen en común que son ejemplos de la injusticia epistémica. ¿Cómo se pueden combatir (...) las injusticias epistémicas que perjudican a los ciudadanos en sus interacciones con el estado? [...]. (shrink)

A population at the intersection between criminality and victimhood, sex workers1 have contact with myriad service providers in the fields of mental health, housing, child welfare, and criminal jus...

Context-sensitive expressions appear ill suited to the purpose of sharing content across contexts. Yet we regularly use them to that end (in regulations, textbooks, memos, guidelines, laws, minutes, etc.). This paper describes the utility of the concept of a metacontext for understanding cross-contextual content-sharing with context-sensitive expressions. A metacontext is the context of a group of contexts: an infrastructure that can channel non-linguistic incentives on content ascription so as to homogenize the content ascribed to context-sensitive expressions in each context in (...) the group. Documents composed of context-sensitive expressions can share content across contexts when supported by an appropriate metacontext. The bible has its church, the textbook its education system, the form its bureaucracy, and the manifesto its social movement. Some metacontexts support cross-contextual content-sharing. Some don’t. A promising research programme (one with practical importance) would take metacontexts as its unit of analysis. (shrink)

This paper analyses the interrelations between academic disciplines and society beyond academia by the case of sociology in Norway. For that purpose, this paper introduces the concept of disciplines’ societal territories, which refer to bounded societal spaces that are shaped by the knowledge of a discipline, premised on the linkages between the discipline and its audience. By mapping sociologists’ reported contributions to societal changes beyond academia, the paper firstly shows how societal territories are established by sociologists’ recurring engagement with certain (...) topics and research users. Secondly, it traces the interactions between researchers and their users, and identifies four ideal typical pathways by which the cognitive territory of Norwegian sociology is transformed into societal territories. A key observation is that the establishment of societal territories is co-determined by the structures of research use among its audience. As for the case of sociology in Norway, questions therefore arise over the interdependency between sociologists as knowledge ‘suppliers’ and the ‘demand side’ for research, and the autonomy of the sociological discipline in selecting its focus of attention. (shrink)

The notion of “responsibility gap” with artificial intelligence (AI) was originally introduced in the philosophical debate to indicate the concern that “learning automata” may make more difficult or impossible to attribute moral culpability to persons for untoward events. Building on literature in moral and legal philosophy, and ethics of technology, the paper proposes a broader and more comprehensive analysis of the responsibility gap. The responsibility gap, it is argued, is not one problem but a set of at least four interconnected (...) problems – gaps in culpability, moral and public accountability, active responsibility—caused by different sources, some technical, other organisational, legal, ethical, and societal. Responsibility gaps may also happen with non-learning systems. The paper clarifies which aspect of AI may cause which gap in which form of responsibility, and why each of these gaps matter. It proposes a critical review of partial and non-satisfactory attempts to address the responsibility gap: those which present it as a new and intractable problem (“fatalism”), those which dismiss it as a false problem (“deflationism”), and those which reduce it to only one of its dimensions or sources and/or present it as a problem that can be solved by simply introducing new technical and/or legal tools (“solutionism”). The paper also outlines a more comprehensive approach to address the responsibility gaps with AI in their entirety, based on the idea of designing socio-technical systems for “meaningful human control", that is systems aligned with the relevant human reasons and capacities. (shrink)

The administrative practices of officials who process the admission of immigrants show severe variations in the ways in which migration policy is enforced on the ground. For the author, inequality of treatment lies in the very hierarchy of tasks and services of what he dubs, following Pierre Bourdieu, the immigration "field". According to the author, the governments’ securitizing priorities favour the sort of suspicion towards foreigners that the media then reproduces, thus authorizing so-called street-level bureaucrats to act with great leeway (...) with regard to immigrants. Under pressure, governments implement what the author calls a "trompe-l’oeil policy" that explores the ambivalence between international and domestic law: while the state enforces repressive laws that apparently comply with fundamental human rights, it leaves to low-ranking civil servants enough discretion to make those rights ineffective. This point is the author’s central contention. The arbitrariness of these officials is neither contingent nor accidental: it actually constitutes a purposive "front-line policy" to enlarge the discretionary power of street-level bureaucrats in charge of regulating admissions. Unequal treatment comes in three flavours in this context. First, officials are asked to ensure that each right granted to a foreigner will not threaten the national order, which means the economic, social and political order. They are therefore in a position to judge the suitability of each application in view of their own arbitrary interpretation of what such "threats" consist of. The question of discretionary power is in this way intimately linked to the problem of equality before the law. Second, the scarcity of material and human resources allocated to services in charge of welcoming migrants starkly contrasts with the expenditure incurred to deport foreigners. Inequality also arises from how agents perceive users and the leeway they have to implement the law. Third, inequality is related to foreigners’ abilities and means to challenge discretionary power, especially through the legal tools they use or through legal intermediaries. The author thus concludes that such "front-line policy" has increasingly been used as a weapon against migrants, especially since the early 2000s, when immigration and detention policies were generalized in France. More broadly, in Europe as well as in United States, immigration reforms have made greater use of detention and focused on enforcement rather than on hosting programs and services for asylum seekers. But they have also strengthened the role of legal intermediaries. Hence the need to investigate how discretionary power is challenged as it sheds light on the power relations between states and migrants. Keywords: foreigners, discretion, sociology, participant observation, front-line policy, illegalism, jobs, insecurity, legal intermediaries. (shrink)

Many criminal offenders come from disadvantaged backgrounds, which punishment entrenches. Criminal culpability explains some disadvantageous treatment in state-offender interactions; yet offenders remain people, and ‘some mother’s child’, in Eva Kittay’s terms. Offending behaviour neither erases needs, nor fully excuses our responsibility for offenders’ needs. Caring is demanded in principle, recognising the offender’s personhood. Supporting offenders may amplify welfare resources: equipping offenders to provide self-care; to meet caring responsibilities; and enabling offenders’ contribution to shared social life, by providing support and furthering (...) the choices of others seeking to engage with them. The desistance paradigm (viewing desistance from offending as a process, following from an offender’s active choice in the context of stabilising social structures and personal circumstances), implies that a supportive environment may facilitate reduced recidivism. While decisions about criminal culpability need justice, we may use state resources most effectively by also including care ethics in our thinking about punishment. (shrink)

Regulation and governance of medical research is frequently criticised by researchers. In this paper, we draw on Everett Hughes’ concepts of professional licence and professional mandate, and on contemporary sociological theory on risk regulation, to explain the emergence of research governance and the kinds of criticism it receives. We offer explanations for researcher criticism of the rules and practices of research governance, suggesting that these are perceived as interference in their mandate. We argue that, in spite of their complaints, researchers (...) benefit from the institutions of governance and regulation, in particular by the ways in which regulation secures the social licence for research. While it is difficult to answer questions such as: “Is medical research over-regulated?” and “Does the regulation of medical research successfully protect patients or promote ethical conduct?”, a close analysis of the social functions of research governance and its relationship to risk, trust, and confidence permits us to pose these questions in a more illuminating way. (shrink)

The United Nations Convention on the Rights of the Child (UNCRC) is presented and understood as the primary reference point regarding questions of children’s rights. However, the UNCRC is not a neutral instrument deployed to meet the rights of children: it embodies a specific perception of the child, childhood and citizenship. The interpretation of the UNCRC from the point of view of children’s legal status emphasises the autonomy of children; the focus is on the rights that children possess. Conversely, the (...) social-political interpretation of the UNCRC addresses the question of how the rights of children can be realised. It is suggested that distinguishing between these interpretations is essential with regard to questions of pedagogy and education. (shrink)

Despite the growing body of work exploring the weaknesses of police performance systems and the displacement of their goals, less attention has been given to why police officers resist and circumvent by false reporting. Whether police report honestly on their activities is a matter of considerable significance given the role that police have in a broadly democratic society, and the overall question is whether the false reporting undermines the integrity of the police or if it is a collective coping strategy (...) that safeguards the police ethos? This survey reveals that 25% of respondents (n = 2248) had manipulated the numbers at least once in the previous year. To identify why they did so, the variables selected for analysis are those determining their view of the Management by Objective (MBO) system, how far they have participated in the MBO process and how often they are unable to assist a member of the public. Our results show that men are more likely to manipulate the numbers than women and non-leaders are more likely to do so than leaders. Respondents were more likely to submit false reports if they had not participated in the MBO process, were not motivated by MBO goals, believed the MBO indicators misdirected their focus and frequently felt that they were forced to reject members of the public they would like to help. Our findings further show that public servants can be corrupted, though they do not “bring” vices to work with them, but rather acquire vices through what is required of them. (shrink)

Identification technologies like biometrics have long been associated with securitisation, coercion and surveillance but have also, in recent years, become constitutive of a politics of empowerment, particularly in contexts of international aid. Aid organisations tend to see digital identification technologies as tools of recognition and inclusion rather than oppressive forms of monitoring, tracking and top-down control. In addition, practices that many critical scholars describe as aiding surveillance are often experienced differently by humanitarian subjects. This commentary examines the fraught questions this (...) raises for scholars of international aid, surveillance studies and critical data studies. We put forward a research agenda that tackles head-on how critical theories of data and society can better account for the ambivalent dynamics of ‘power over’ and ‘power to’ that digital aid interventions instantiate. (shrink)

Little is known about how gendered understandings of patients can inform professionals’ discretionary actions and decisions to include or exclude in clinical practice. Using Connell's poststructuralist perspectives on gender as an analytic framework, this article aims to investigate how professionals’ articulations of depression are framed by signs of masculinity and femininity, and how these articulations inform service provision to patients with depression in clinical psychiatry. Building on interview data drawn from an ethnographic study, the article shows how the professionals’ articulations (...) reflected a gender binary that framed how the feminized patients were often connected to psychiatric care while masculinized patients were referred to separate alcohol or substance use treatment outside the psychiatric institution. The article discusses the societal and institutional conditionality of gendered understandings in psychiatry. In spite of several limitations, the article elucidates how professionals’ understandings might have wide‐ranging implications for the accuracy of epidemiological research and policy, and how they reflect a power struggle between patients and professionals about the legitimate right to interpret patients’ conditions and efforts to manage their illness‐related problems. (shrink)

This paper explores the impact of the Human Rights Act 1998 on decision making in adult social care in England and Wales. It focuses on a review of the Act by the government in June 2006 and subsequent new guidance on implementation addressed to policy makers, managers and practitioners. The meaning of ?rights? in contemporary legal and social theory is considered and the potential of human rights law to improve the experiences of service users is evaluated in the light of (...) recent research findings and proposed policy changes. (shrink)

In this article, we provide a philosophical and ethical reflection about quiet quitting as a tool of political resistance for nurses. Quiet quitting is a trend that gained traction on TikTok in July 2022 and emerged as a method of resistance among employees facing increasing demands from their workplaces at the detriment of their personal lives. It is characterised by employees refraining from exceeding the basic requirements outlined in their job descriptions. To understand why quiet quitting can be a tool (...) of resistance useful for nurses, we first draw on Frédéric Gros' concept of ‘surplus obedience’ and Michael Lipsky's notion of ‘routines and simplification strategies’ to highlight the ethical implications associated with nurses engaging in and sustaining harmful systems, such as the neoliberal healthcare system. Leaning again on Gros, we then propose that ‘obedience a minima’, a concept akin to quiet quitting, can serve as a method of ethical nursing resistance. After describing what the concept entails, we provide a discussion emphasising the potential of obedience a minima as a one method, among many, that can be leveraged by nurses to challenge and resist a system that prioritises financial considerations over patient wellbeing. The article concludes by reflecting on the ethical nature of resistance in the context of nursing, that is the act of obeying oneself and refraining from participating in systems that are detrimental to the lives of Others. (shrink)

In the mid-19 th century, increases in global migration and mobility produced a discernable rise in the number of ambiguous absences. This shift, combined with a novel expectation, linked to improved communications technology, that such absences might be resolved engendered the emergence of missing persons as a social category. A demand on the part of families of the missing that the state aid in their location would produce a Bourdieusian classification struggle over how to define and categorize this new mass (...) of absences. At issue would be whether an ambiguously absent individual was merely absent, as a routine component of social life, or whether the individual merited legitimation by the state as a new form of deviant: a "missing" person. Scholars have described the emerging administrative state’s enhanced powers of surveillance and classification and its persistent inclination to render their populations, in James Scott’s phrase, “legible.” Brought to the attention of the state, missing persons represented a body of people who had conspicuously fallen out of official sight. Yet, instead of attempting to fix this omission by gathering additional information on the lost — to, in effect, see the missing — as theories of the state would lead us to expect, the state chose to look away. In the United States, the state, in the form of municipal police departments, resisted classifying absences as cases of missingness and pushed back against families’ requests for aid. Leveraging the inherently ambiguous characteristics of the missing, the state promoted a definition of missing persons that conveniently freed it from the burden of managing an unmanageable population. In this article, drawing from archival data, I challenge prevailing theories of the modern state that emphasize its avidly classificatory nature by offering a case in which legibility was strategically withheld and a population was, in service of state interests, intentionally obscured. Only after the state lost its symbolic monopoly and the category was raced and gendered, becoming, in public discourse, associated with a socially valuable demographic – namely, young, white women – would the state, facing a threat to its legitimacy, deem the missing as worthy of being seen. (shrink)

The legislature and the judiciary have been a constant focus of contemporary political philosophy. However, the executive – ‘the government’ itself – has been comparatively neglected. Today, this is changing with a well-spring of new work that bears upon what we might call the ideal of ‘good governance’, that is, how governments (and/or their agents) should exercise their powers. This review paper begins by clarifying the concepts of ‘governance’ and ‘good’ governance (§1). It then highlights five sets of values, working (...) nominally from the most foundational constraints on the exercise of government power to those that should guide the exercise of discretion: legitimacy and rule of law (§2); respect and trustworthiness (§3); efficiency and rationality (§4); public participation and accountability (§5); and the public interest and fiduciary duties (§6). (shrink)

The commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a (...) fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms ofsolidaritybetweencomrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice. (shrink)

Transparency’s importance as an administrative norm seems self-evident. Prevailing ideals of political theory stipulate that the more visible government is, the more democratic, accountable, and legitimate it appears. The disclosure of state information consistently disappoints, however: there is never enough of it, while it often seems not to produce a truer democracy, a more accountable state, better policies, and a more contented populace. This gap between theory and practice suggests that the theoretical assumptions that provide the basis for transparency are (...) wrong. This article argues that transparency is best understood as a theory of communication that excessively simplifies and thus is blind to the complexities of the contemporary state, government information, and the public. Taking them fully into account, the article argues, should lead us to question the state’s ability to control information, which in turn should make us question not only the improbability of the state making itself visible, but also the improbability of the state keeping itself secret. (shrink)

Unwarranted, by NYU law professor Barry Friedman, offers a diagnosis of some of the contemporary ills of American policing and a prescribed cure. Between 2014 and 2016, incidents of fatal shootings...

Commercialization of medicine is a growing trend that threatens to undermine physicians’ commitments to patient care in favor of personal financial interests. Bemoaned by Arnold Relman as early as 1980, growing for-profit sectors of health care have been reshaping medicine from a profession into a business, forming the foundation of what he terms a “medical-industrial complex” that threatens to undermine professional identity and reshape health care funding. Commercialization poses new ethical challenges for health care providers who have a financial stake (...) in their health care decisions and may undermine their fiduciary duties to patients.Certainly, commercialization has brought about new trends in medicine — one need only to look as far as the rise in for-profit hospitals, diagnostic laboratories, and proprietary nursing homes to see how opportunities for financial gain reposition physicians’ orientations vis-à-vis patients. (shrink)

PurposeThe purpose of this paper is to analyse how standardisation influences home care work practice.Design/methodology/approachThe paper presents a qualitative interview‐based case study from the elderly care sector in a Danish council. The interviews reveal care workers and administrative staffs' interpretation of how the implementation of IT and standards affects their work situation. Findings from the case study are supported by a large‐scale quantitative study regarding organisational transformations in the elderly care sector.FindingsThe paper discusses how standardisation, in the form of implementation (...) of IT‐systems and categorization tools, influences the potential for development of competencies. The findings show that an engaged practice is difficult to maintain when working under circumstances characterized by lack of time and a requirement for standardisation and documentation.Originality/valueThe study provides insight into the divergence between standards and the importance of relying on experience‐based knowledge and value rational skills in relation to care work. The paper stresses the point that standards are necessary to coordinate workflow activities and support decision making. Nevertheless, it is shown that when reification dominates, the degree of standardisation will lend itself to an instrumental practice not supportive of growing competencies within the field of care giving. (shrink)

Admitting hospital patients: a qualitative study of an everyday nursing task In recent years new modes of nursing work have been introduced globally in response to radical changes in healthcare policies, technology and new ideologies of citizenship. These transformations have redefined orthodox nurse–patient relationships and further complicated the division of labour within health‐care. One distinctive feature of the work of registered nurses has been their initial assessment of patients being admitted to hospital, and it is of interest that this area (...) of nursing practice remains central to the registered nurse's role at a time where other areas of practice have been relinquished to other occupational groups. This qualitative study, drawing on conversation analysis and ethnographic techniques, explores this area of everyday nursing work. Initial nursing assessments have attracted considerable interest in the nursing literature, where it is clearly stated that assessments should be patient centred and seen as the important first step on the road to a therapeutic nurse–patient relationship. Results from this study lead to the conclusion that the actual nursing practice of patient assessment on admission to hospital is at odds with the recommendations of the literature and that a more routinised, bureaucratic form of work is devised by nurses as a means of expediting the process of admission. (shrink)

This article has two objectives: (1) to map some of the structural limitations to scientific or rational public planning; and (2) to explore the implications of this for a reconceptualization of the legitimacy of public planning. It is argued that some of the limitations to planning are inherent to the planning process in the sense that they cannot be fully mitigated through the refinement of procedures. They come to represent sources of “basic boundedness” that have to be addressed through a (...) radical reinterpretation of the policy process itself. (shrink)

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference to the (...) interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the ‘right’ to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to ‘their clients’ is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to ‘your’ patients in certain circumstances. (shrink)

This paper focuses on the structure and substance of the Core Content Framework (CCF), a controversial document which stipulates content that providers of teacher education in England must incorporate in their programmes. We identify both a concept of instrumental trainability and a lack of coherence in the CCF which suggests it is unsuitable as a guide to a curriculum for teacher education. Drawing on Bernstein’s work and its application by other sociologists of educational knowledge, we identify how the CCF embeds (...) a ‘generic mode’ in teacher education that has roots outside of disciplinary structures of knowledge production and therefore foregrounds a type of official pedagogy that sees teaching as a technical performance and leaves gaps in the knowledge and understanding a new teacher requires to make sound educational judgements. Employing Muller’s distinction between conceptual and contextual coherence, we argue that the CCF is based upon an imaginary notion of instructional practice that does not fully grasp the context of teachers’ work. We illustrate the argument via an analysis of the language, structure, and three of the eight sections in the CCF. (shrink)

The ethical dimension of care work is less explored in Chinese long-term care (LTC) settings. This paper accentuates care ethics embodied by direct care workers (DCWs) from an ethnographic study of care at Sunlight Nursing Home in central China. I include the notion of xiao (filial piety) to construe care ethics by engaging both feminist and intersectional approaches. Empirical findings highlight the narrative of mei banfa (‘there is nothing you can do about it’) in revealing the complexity of caregiving in (...) a commercialised environment where both physical and emotional care intertwine. Mei banfa compels DCWs to invoke their agency in care practice despite inadequate support from the nursing home and negative social portrayals of care work. It is a cognitive coping strategy of DCWs to harness their energy in upholding care ethics for both the elderly residents and their own family members. Such commitment is unlikely to be sustained if structural barriers continue to impede the recognition of care labour as part of social production. Arguably, an ethically informed approach to both policymaking and care practice gives voice to human interdependency in care work and affords ways to reimagine a caring future. (shrink)

This paper contributes to the Business Ethics literature by unpacking the multimodal construction of moral narratives in popular culture and its portrayals of organizations and organizational roles. Understanding such portrayals and their construction is crucial to Business Ethics scholarship because they shape organizational imaginaries, influencing understandings and expectations of the ethical/moral responsibilities of organizations and the actors within them. In particular, we study the construction of moral narratives within a reality TV show that focuses on immigration and border control at (...) an airport. We find that the immigration officers are depicted as rational and heroic figures whilst the travellers are presented as emotional and potentially dangerous characters. Our analysis highlights how this is achieved via five multimodal editing dimensions—the structure of interactional scenes, the ability to address the camera, the narrator’s comments, the visual and music effects—that are key in constructing clearly defined personae. We show how, through the intersubjective construction of clear-cut characters, the show downplays the moral complexity of its content. Portraying immigration officers as heroic, while presenting travellers as potentially dangerous, allows for a silencing of any ethical questioning of immigration officers’ organizational practices. (shrink)

For Aristotle, virtues are neither transcendent nor universal, but socially interdependent; they need to be understood chronologically and with respect to character and context. This paper uses an Aristotelian lens to analyse an especially interesting context in which to study virtue—the state’s response when social order breaks down. During such periods, questions relating to right action by citizens, the state, and state agents are pronounced. To study this, we analyse data from interviews, observation, and documents gathered during a 3-year study (...) of riot policing in the U.K. In doing so, we contribute by joining a number of other conversations within JBE, suggesting detailed empirical examination of this context is useful in opening up considerations relevant to ‘virtue’ elsewhere. This extreme context helps us raise interesting and empirically informed questions that can encourage future theoretical and empirical contributions to virtue in business ethics. One such question is on the role of habituation in virtue, which is not just the inculcation of a reflex or automaticity, but can also refer to a trained and developed tendency to behave in the right way, for the right reasons, at the right time. Whilst we stop short of a simplistic alignment of habituation and virtue, we show ways in which it can inform understanding of both courage and phronēsis. (shrink)

The main objective of this paper is to describe how quality of care may be improved during an involuntary admission process of patients suffering from Korsakoff's syndrome. It presents an empirically grounded analysis with different perspectives on ‘doing good’ during this process. Family carers', healthcare professionals' and legal professionals' ways of understanding and ordering this problematic situation appear very different. This could prevent patients from getting the proper care they need, with risk of more suffering and quality of life below (...) the minimum acceptable. All this possibly lead to immoral dehumanizing situations. Firstly, the background of our empirical study is sketched. Secondly, the different perspectives on ‘doing good’ are summarized and compared. Thirdly, the tensions arising from the different conceptualizations of autonomy and different types of responsibilities of the actors are clarified. A common ‘doing good’ during involuntary admission necessitates removal of any tensions within the relational network by weighing and balancing the different perspectives on autonomy and the resulting responsibilities. With this in mind, we propose a renewed time/action table for involuntary admission, which tends to address all patients' needs at the right time. The solution presented might help healthcare professionals, who are squeezed in between patients, family carers, legal professionals and overall rules, to create practices in which patients suffering from Korsakoff's syndrome can maintain their dignity and receive the care they need. Earlier interventions, timely and adequate diagnosis, and diminishment of tensions between the different actors by fine‐tuning their paradigmatic frameworks are suggested to be part of a solution. (shrink)

The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the “front line”. Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, (...) a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of “ethical labour” borne by those operating “on the ground”, who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs – a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks. (shrink)

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

This research explores the effect of servant leadership on prosocial rule-breaking (PSRB) and the mediating mechanism of public service motivation (PSM) between the association of servant leadership and PSRB. The said phenomenon is examined in the civil service context of Pakistan during the continuing crises of the COVID-19 pandemic, a situation where the traditional civil service policy and rule system has become highly complicated for passionate employees’ service performance and efficiency, and where servant leadership has received greater attention for inspiring (...) the attitudinal and behavioral outcomes of frontline workers during the pandemic. Data were collected from 546 frontline workers of the corona relief tiger force. The findings of the study revealed that servant leadership has a significant effect on PSRB and PSM, and that PSM significantly promotes PSRB. The results also revealed that servant leadership has a significant impact on PSRBviaengendering PSM. (shrink)

Many studies have highlighted a substantial "bureaucracy domination" in procedures relating to migrants’ access to territory. This form of domination is marked by highly discretionary and arbitrary practices, enacted by the administrative authorities of the state. Only minor attention, however, has been devoted to the arbitrariness of judicial decisions and to the judicial role in general in the numerous proceedings that increasingly affect the path of migrants. This path is the main object of this paper. The study focuses on Italian (...) case law in expulsion and detention proceedings of irregular third country national citizens and asylum seekers and presents qualitative empirical research on decisions issued by the competent national authorities. The results have been analysed using a selection of theoretical tools, all referable to the general concept of the rule of law. The judicial decisions on pre-removal detention proceedings in two case studies are examined: the jurisprudence on detention of irregular migrants, in different offices of the Justice of the Peace in Italy; and the case law on detention of asylum seekers in the Ordinary Tribunal of Rome. The assumption underlying the research is that various conceptions of the rule of law may have different explanatory power when it comes to explaining the empirical results. To verify this hypothesis, the study proposes an overview of the main rule of law doctrines in the Western tradition of political and legal thought and applies the method of historical-conceptual analysis. As a result, the explanatory power of six theoretical models of the rule of law was verified against the data with the view to highlight the virtues and vices of the respective explanatory frameworks. This article reaches a two-fold conclusion. First, as far as the explanatory frameworks are concerned: the results of the two case studies cannot be fully explained by any of the models considered in this study. This fact alone casts doubts on the explanatory power of these theories and calls for further research on judicial decision-making more generally. Secondly, a key finding of the study regarding the notions of discretion and arbitrariness is that the judicial approach which assures the highest protection of rights is also the one that is most easily influenced by arbitrariness. The author argues that this paradox can be easily dissolved by paying attention to the plural dimensions of arbitrariness. If we consider arbitrariness from a legal point of view, i.e. as an illegal decision, it is unsurprising that the authority that most uses its discretionary powers is also the one most at risk of abusing these discretionary powers and hence of exercising arbitrary power. However, if we consider arbitrariness from the point of view of philosophical-political theory, i.e. as a form of domination characterised by the absence of sufficient justification, it is unsurprising that the judicial approach which assures the highest protection of rights is also the one that takes its own role as guarantor of these rights and of the constitutional democratic legal order as such most seriously. This judicial approach thus most often risks exercising its power in criticisable ways, as compared to an authority much more in line with the requirements of law enforcement agencies. Keywords: migration, discretion, justice, arbitrariness, civil rights, Rechtsstaat, expulsion, mixed constitution. (shrink)

In the 1996 overhaul of federal welfare legislation, Congress included provisions to promote employment, marriage, and responsible fatherhood to prevent poverty among low-income families. Little previous research has focused on how marriage promotion policies construct paternal identity. Drawing on data from an 18-month study of a federally funded relationship skills program for low-income, unmarried parents, I analyze how responsible fatherhood policies attempt to shape ideas of successful fatherhood and masculinity in the service of the government’s pro-marriage, antipoverty agenda. The program (...) promoted a class-specific version of what I call marital masculinity, one that seeks to redefine marriageability for low-income men by claiming that marriage comes before financial success and encourages fathers to earn more. It did this by targeting fathers’ masculine identities in two ways: first, by emasculating fathers who only provide financially for their children, and second, by promoting a highly gendered conception of paternal caregiving. By analyzing how this strategy can be understood as both empowering and controlling for low-income men, this research adds to the sociological literature on how welfare policies shape paternal identity and gendered family practices. (shrink)

Street-level bureaucracy literature ascertains that policies get made not only in the offices of legislatures or politicians but through the discretion bureaucrats employ in their day-to-day interactions with citizens in government agencies. The discretion bureaucrats use to grant access to public benefits or impose sanctions adds up to what the public ultimately experience as the government and its policies. This perspective, however, overlooks policy-making that gets done in the back offices of government, where there might not be direct interaction with (...) citizens. Furthermore, it treats discretion as inherently anthropogenic and ignores that it is exercised in relation to sociotechnical arrangements of which bureaucrats are a part. In this paper, based on extensive ethnography at national statistical institutes and international statistical meetings across Europe, I make two arguments. The first is that, statisticians emerge as back-office policy-makers as they are compelled to take multiple methodological decisions when operationalizing abstract statistical guidelines and definitions, thus effectively making rather than merely implementing policies. This is the “discretion” they employ, even when they may not interact with citizens. The second argument is that the exercise of discretion is sociotechnical, that is, it happens in relation to the constraints and affordances of technologies and the decisions of other bureaucrats in their institutions and others. (shrink)

This paper studies the construction of ethics in interactions between professionals in meetings, in relation to the rationing of resources. The research context is a supported housing unit targeted at clients with mental health and substance abuse problems. The service is provided for a municipality, which expects good progress of the clients. The research question is: how do the professionals produce implicit ethical justifications for setting limits to helping, even though the need for professional help is not called into question? (...) Five types of justification appear in the data covering 28 meetings. However, these types of justification do not solve the central ethical difficulty arising in the conversations. Limiting help would easily push people out of reach of all help. Thus, in spite of the talk about ethical justification, workers do not ultimately resort to limiting help in situations with no real alternatives for getting help. The ethical principle of following non-exclusionary practices is highly prioritized. (shrink)

Drawing on 38 in-depth, qualitative interviews, this article explores how people working in the equality sector in England and Wales view and use the current law around sex and gender, and how they imagine law’s future, particularly potential decertification, where the state would withdraw from certifying and regulating a person’s sex/gender. Whilst situated in the bureaucratic strand of the literature, the paper also contributes to wider legal consciousness studies. This literature has generally focused on people’s relationships to law in terms (...) of domination, alienation and game-playing. Drawing on idioms and the language of touch, the paper unpacks the way in which equality actors talked about law not as remote or alienating, but as close and familiar; not as oppressive, but as “precious” and hard-won. Some also regarded law as a place of safety in unsafe times. These proposed ‘attached to law’ and ‘protective of law’ strands of consciousness enrich and extend Ewick and Silbey’s classic ‘before the law’ narrative. The findings are also useful for critical legal and feminist scholarship. Combined with the equality sector’s pragmatic and tactical use of law to problem-solve, this close and protective orientation towards law reproduces its hegemony. The paper concludes by exploring a recurrent refrain that, in relation to decertification, “we’re not there yet” and that gender equality would need to be achieved before decertification would “fly”. (shrink)

The extant pieces of literature on discretion has mainly focused on its effect on policy implementation and public service delivery, but few studies have looked at its influence on street-level bureaucrats' work behavior, such as taking charge behavior, which is of great importance for government reforms, especially in developing and transitional countries. Based on the self-determination theory, this study examines whether and how discretion promotes street-level bureaucrats' TCB. Two studies were conducted among street-level bureaucrats in China. First, a survey experiment (...) suggests that discretion positively predicts street-level bureaucrats' TCB. Then, a survey questionnaire study shows that discretion is positively related to TCB through the mediator of public service motivation. We concluded with implications for theory and practice. (shrink)

After U.S. welfare was reformed in 1996, many states reduced their support of postsecondary education and instead emphasized work-first programs. This study uses in-depth interviews and participant observation to examine how case managers implement work-first policies when dealing with students desiring a college education. Case managers are expected to reconcile the goals of their clients with those of the Temporary Assistance for Needy Families program, while negotiating cultural definitions of “work” that frequently serve to reproduce gender, race, and class inequalities. (...) In this context, overburdened case managers, many of whom support proffering educational solutions, nonetheless find themselves promoting work over education. As a result, many economically poor women are dissuaded from pursuing postsecondary degrees that have the potential of increasing their chances of achieving financial self-sufficiency. (shrink)