This paper analyzes the ethics of performance-enhancing drugs in professional baseball from the perspective of ethical theories: Kantianism, libertarianism, and utilitarianism. It argues that none of these theories can explain why performance-enhancing drugs should be prohibited. The paper argues that virtue ethics is the best moral framework for understanding the ethical problem of performance-enhancing drugs and why their use should be prohibited.

This article argues that performance enhancing drugs ought to be allowed across all elite sporting competitions for athletes over the age of 16 so long as consuming them does not pose a significant risk to their health. I begin with a brief explanation of the current state of PED use in professional sports before assessing the prospect of allowing PEDs by three widely accepted measures of ethical merit: well-being, autonomy, and justice. I end with a critique (...) of the World Anti-Doping Agency's criteria for banning PEDs, concluding that allowing athletes to use PEDs is a superior alternative to the current prohibitive approach. (shrink)

In an essay on performance-enhancing drugs, author Chuck Klosterman (2007) argues that the category of enhancers extends from hallucinogens used to inspire music to steroids used to strengthen athletes—and he criticizes those who would excuse one means of enhancement while railing against the other as a form of cheating: After the summer of 1964, the Beatles started taking serious drugs, and those drugs altered their musical performance. Though it may not have been their overt (...) intent, the Beatles took performance-enhancing drugs. And . . . absolutely no one holds it against them. No one views “Rubber Soul” and “Revolver” as “less authentic” albums, despite the fact that they would not (and probably could .. (shrink)

The most plausible line of anti-doping argumentation starts with the fact that performance enhancing substances are harmful and put at considerable risk the health and the life of those who indulge in the overwhelming promises these substances hold. From a liberal point of view, however, this is not a strong reason neither to morally reject doping altogether, nor to put a blanket ban on it; on the contrary, allowing adult, competent and informed athletes to have access to (...) class='Hi'>performance enhancement drugs is often showcased as a liberty-related right of noninterference. In this article I will first discuss doping from the liberal point of view, especially in the light of the harm principle as it was introduced by Mill and elaborated by his successors, most notably by Joel Feinberg. Then I will examine whether – and to what degree – one’s decision to receive performance enhancement drugs would mean to use humanity in one’s own person only as a means, which would be self-defeating in the light of Kantian ethics. From this I will move one step backwards to what I consider as the core question concerning the ethics of doping, the one that is logically prior to any other in my view, and concerns the consistency of the thesis that doping may be compatible with sport. I will argue that there is an inherent logical antinomy between doing sport and using performance enhancement drugs, one that presents any argumentation in favor of doping as essentially self-contradictory. (shrink)

A strong moral reason for prohibiting doping in sport is to be found in the bad choices that would be faced by clean athletes in a sporting world that tolerated doping. The case against doping is not, however, to be grounded in the concept of coercion. Instead, it is grounded in a general duty of sport to afford fair opportunity to the goods that are distinctively within sport's sphere of control. The moral reason to prohibit doping need not be balanced (...) against any autonomy claim of athletes who would prefer to dope because, upon closer examination, such claims have no force. The moral reason to prohibit doping does, however, need to be balanced against the enforcement costs imposed on all athletes by effective prohibition. (shrink)

This article investigates the ethical requirements and features that characterize the professional life of successful contemporary classical orchestras, with particular focus on the leadership style of their conductors. As we will show, the traditional authoritarian approach, marked by the conductor’s commanding charisma and strict demand for obedience from orchestra members, has evolved today into a more ethically-based transformational style of leadership. This new approach is rooted in principles of respect, voluntary compliance, and trust. The present paper delves into the (...) interpersonal dynamics within contemporary orchestras, focusing specifically on the character traits required to establish trust and collaboration between the conductor and the orchestra members, as well as among the orchestra members themselves. In particular, drawing from recent research in psychology, we underscore the significance of deference, empathy, and shared commitment toward the common goal of excellence in performance. We conclude that the ethics-centered style of leadership adopted by most contemporary conductors may extend beyond the realm of music, offering insights applicable to leaders in various other fields. By fostering deep connections, shared purpose, and collaboration, this approach has the potential to enhance organizational performance and outcomes in general. (shrink)

New scientific advances have created previously unheard of possibilities for enhancing combatants' performance. Future war fighters may be smarter, stronger, and braver than ever before. If these technologies are safe, is there any reason to reject their use? In this article, I argue that the use of enhancements is constrained by the importance of maintaining the moral responsibility of military personnel. This is crucial for two reasons: the military's ethical commitments require military personnel to be morally responsible agents, (...) and moral responsibility is necessary for integrity and the moral emotions of guilt and remorse, both of which are important for moral growth and psychological well-being. Enhancements that undermined combatants' moral responsibility would therefore undermine the military's moral standing and would harm combatants' well-being. A genuine commitment to maintaining the military's ethical standards and the well-being of combatants therefore requires a careful analysis of performance-enhancing technologies before they are implemented. (shrink)

Drama is a relatively unexplored tool in academic science education. This paper addresses in what way the use of drama may allow science students to deepen their understanding of recent developments in the emerging and controversial field of neuro-enhancement, by means of a case study approach. First, we emphasise the congruency between drama and science, notably the dramatic dimension of experimental research. Subsequently, we draw on educational literature to elaborate the potential of using drama as a teaching modality, specifically focusing (...) on the ethical and moral dimensions of future techno-scientific innovations. Our case study consisted of a drama experiment as a module in a philosophy course on human enhancement. Twenty-two students from various science disciplines performed multiple roles, as authors, actors, audience and reviewers. Qualitative data were collected on the educational process and student performance during the course, i.e. observations and video recordings of class discussions, group work and plays, interviews and questionnaires. Our drama experiment proved to be effective in enabling students to explore and relate to a future life world affected by enhancement technologies. It allowed them to deepen their awareness of social and ethical implications of neuro-technologies and of the different viewpoints people may have on this issue in academic, professional or everyday settings. Moreover, drama allowed them to develop a reflexive position of their own in the neuro-enhancement debate by enacting a moral dilemma in front of an audience. Our results confirm the potential of drama as a tool for exploring techno-scientific futures in science education. (shrink)

There are a number of premises underlying much of the vigorous debate on pharmacological cognitive enhancement. Among these are claims in the enhancement literature that such drugs exist and are effective among the cognitively normal. These drugs are deemed to enhance cognition specifically, as opposed to other non-cognitive facets of our psychology, such as mood and motivation. The focus on these drugs as cognitive enhancers also suggests that they raise particular ethical questions, or perhaps more pressing ones, (...) compared to those raised by other kinds of neuroenhancement. Finally, the use of these drugs is often claimed to be significant and increasing. Taken together, these premises are at the heart of the flurry of debate on pharmacological cognitive enhancement. In this article, it is argued that these are presumptions for which the evidence does not hold up. Respectively, the evidence for the efficacy of these drugs is inconsistent; neurologically it makes little sense to distinguish the cognitive from non-cognitive as separate targets of pharmacological intervention; ethically, the questions raised by cognitive enhancement are in fact no different from those raised by other kinds of neuroenhancement; and finally the prevalence rates of these drugs are far from clear, with the bulk of the claims resting on poor or misrepresented data. Greater conceptual clarity along with a more tempered appreciation of the evidence can serve to deflate some of the hype in the associated literature, leading to a more realistic and sober assessment of these prospective technologies. (shrink)

Torben Kjærsgaard’s argues that the term “cognitive enhancement substances” is an inappropriate term considering that stimulants do not enhance cognition, but rather only enhance motivation. Therefore, he concludes that stimulants are best described as “performance maintenance” and not “performance enhancement.” I challenge his conclusion on the grounds that both life’s ordinary, daily activities and life’s extraordinary activities are types of performances necessary for living the kinds of lives that we want to live, which can be enhanced, not just (...) maintained, with the effects of cognitive enhancing substances. “Cognitive enhancing substances” may be a misleading term, but referring to the effects of cognitive enhancing substances as “performance maintenance,” rather than “performance enhancing,” misguidedly minimizes the role that motivation plays into our self-determined lives. (shrink)

Abstract: To improve the countries’ pharmaceutical situation and to monitor the progress, the World Health Organization (WHO) and member states developed a system of indicators to measure the respective important aspects as a prerequisite step. Level I indicators to assess the country’s pharmaceutical situation include the national drug policy; legislation and regulations; drug accessibility and affordability; essential drug list; quality control; pharmacovigilance; storage and distribution; information and rational use. This study is aimed to document the professional opinion of 20 (...) pharmacy practice professionals on Libya’s current pharmaceutical situation, utilizing WHO indicator-based approach. The core indicators measure the most important information needed to understand the pharmaceutical situation in a country. A closed-end questionnaire was distributed to ten practicing pharmacists and ten pharmacy teaching staff members who practice pharmacy. The questionnaires were handed over personally and collected on the same day. The responses were analyzed using simple statistics. The results were argued in the light of the first author’s observation and view, being expert in this field, with reference to the other experts’ views, relevant publications’ findings and WHO reports’ conclusions on these indicators. Suggestions and recommendations for a proper situation assessment, planning and action taking are presented. Primarily, government’s commitment towards appropriate restructuring, management and monitoring of the pharmaceutical sector is crucial. That is to enhance the country’s pharmaceutical situation, to provide and sustain efficient pharmaceutical services and to improve the overall health care system’s performance. (shrink)

Are universities justified in trying to regulate student use of cognitive enhancing drugs? In this article I argue that they can be, but that the most appropriate kind of regulatory intervention is likely to be voluntary in nature. To be precise, I argue that universities could justifiably adopt a commitment contract system of regulation wherein students are encouraged to voluntarily commit to not using cognitive enhancing drugs. If they are found to breach that commitment, they should (...) be penalized by, for example, forfeiting a number of marks on their assessments. To defend this model of regulation, I adopt a recently-proposed evaluative framework for determining the appropriateness of enhancement in specific domains of activity, and I focus on particular existing types of cognitive enhancement drugs, not hypothetical or potential forms. In this way, my argument is tailored to the specific features of university education, and common patterns of usage among students. It is not concerned with the general ethical propriety of using cognitive enhancing drugs. (shrink)

Healthcare professionals decide wisely about personalized medicine, treatment plans, and resource allocation by utilizing big data analytics and machine learning. To guarantee that algorithmic recommendations are impartial and fair, however, ethical issues relating to prejudice and data privacy must be taken into account. Big data analytics and machine learning have a great potential to disrupt healthcare, and as these technologies continue to evolve, new opportunities to reform healthcare and enhance patient outcomes may arise. In order to investigate the patient’s outcomes (...) with empirical evidence, this research was conducted using an online survey to incorporate healthcare professionals, patient’s reviews, and clinical staff. The data were analyzed using SmartPLS 4.0 to predict the structural model. The findings revealed a direct impact as positive influence of using machine learning on healthcare performance and patient outcomes through big data analytics. Moreover, it is evident that this can lead to personalized treatment plans, early interventions, and improved patient outcomes. Additionally, big data analytics can help healthcare providers optimize resource allocation, improve operational efficiency, and reduce costs. The impact of big data analytics on patient outcome and healthcare performance is expected to continue to grow, making it an important area for investment and research. (shrink)

An interesting aspect of Ernest Sosa’s (2017) recent thinking is that enhanced performances (e.g., the performance of an athlete under the influence of a performance-enhancing drug) fall short of aptness, and this is because such enhanced performances do not issue from genuine competences on the part of the agent. In this paper, I explore in some detail the implications of such thinking in Sosa’s wider virtue epistemology, with a focus on cases of cognitive enhancement. A certain puzzle (...) is then highlighted, and the solution proposed draws from both the recent moral responsibility literature on guidance control (e.g., Fischer and Ravizza 1998; Fischer 2012) as well as from work on cognitive integration in the philosophy of mind and cognitive science (e.g., Clark and Chalmers 1998; Clark 2008; Pritchard 2010; Palermos 2014; Carter 2017). (shrink)

Abstract: The integration of Artificial Intelligence (AI) into Human Resource Management (HRM) is fundamentally transforming how organizations approach recruitment, performance management, and employee engagement. This paper explores the multifaceted impact of AI on HR practices, highlighting its role in enhancing efficiency, reducing bias, and driving strategic decision-making. Through an in-depth analysis of AI-driven recruitment tools, performance management systems, and personalized employee engagement strategies, this study examines both the opportunities and challenges associated with AI in HRM. Ethical considerations, (...) including data privacy, algorithmic bias, and the potential displacement of human jobs, are critically discussed to provide a balanced perspective on the adoption of AI technologies in the HR domain. By presenting case studies of organizations successfully leveraging AI, this paper offers insights into the future trajectory of HRM in an increasingly AI-driven world. Ultimately, the findings underscore the need for HR professionals to adapt and innovate in response to the growing influence of AI, ensuring a harmonious balance between technological advancement and the human element in the workplace. (shrink)

Sports physicians are continuously confronted with new biotechnological innovations. This applies not only to doping in sports, but to all kinds of so-called enhancement methods. One fundamental problem regarding the sports physician's self-image consists in a blurred distinction between therapeutic treatment and non-therapeutic performance enhancement. After a brief inventory of the sports physician's work environment I reject as insufficient the attempts to resolve the conflict of the sports physician by making it a classificatory problem. Followed by a critical assessment (...) of some ideas from the US President's Council on Bioethics, the formulation of ethical codes and attempts regarding a moral topography, it is argued that the sports physician's conflict cannot be resolved by the distinction between therapy and enhancement. Instead, we also have to consider the possibility that the therapy-based paradigm of medicine cannot do justice to the challenges of the continuously increasing technical manipulability of the human body and even our cognitive functions as well. At the same time we should not adhere to transhumanist ideas, because non-therapeutic interventions require clear criteria. Based on assistive technologies an alternative framework can be sketched that allows for the integration of therapeutic and non-therapeutic purposes. After a thorough definition of standards and criteria, the role of the sports physician might be defined as that of an assistant for enhancement. Yet the process of defining such an alternative framework is a societal and political task that cannot be accomplished by the sports physicians themselves. Until these questions are answered sports physicians continue to find themselves in a structural dilemma that they partially can come to terms with through personal integrity. (shrink)

Recent discussions of cognitive enhancement often note that drugs and technologies that improve cognitive performance may do so at the risk of “cheapening” our resulting cognitive achievements Arguing about bioethics, Routledge, London, 2012; Harris in Bioethics 25:102–111, 2011). While there are several possible responses to this worry, we will highlight what we take to be one of the most promising—one which draws on a recent strand of thinking in social and virtue epistemology to construct an integrationist defence of (...) cognitive enhancement.. According to such a line, there is—despite initial appearances to the contrary—no genuine tension between using enhancements to attain our goals and achieving these goals in a valuable way provided the relevant enhancement is appropriately integrated into the agent’s cognitive architecture. In this paper, however, we show that the kind of integration recommended by such views will likely come at a high cost. More specifically, we highlight a dilemma for users of pharmacological cognitive enhancement: they can meet the conditions for cognitive integration at the significant risk of dangerous dependency, or remain free of such dependency while foregoing integration and the valuable achievements that such integration enables. After motivating and clarifying the import of this dilemma, we offer recommendations for how future cognitive enhancement research may offer potential routes for navigating past it. (shrink)

Since before we can remember, humanity aims to overcome its biological limitations; such a goal has certainly played a key role in the advent of technique. However, despite the benefits that technique may bring, the people who make use of it will inevitably be under risk of harm. Even though human technical wisdom consists in attaining the best result without compromising anybody’s safety, misuses are always a possibility in the horizon. Nowadays, technology can be used for more than just improving (...) human capacities, preserving and restoring health or promoting human well-being. It also enables us to overcome human limitations and reach way beyond our "natural design". That being said, what could possibly justify the fear for these new directions of biotechnology? Should medicine and health care change their traditional goals and begin searching for artificial improvements to wellness in human nature? In this paper, I will hereby present and briefly discuss the main topics of the contemporary issue of human enhancement: the therapy-enhancement distinction, the possibility of cognitive enhancements and better physical performances, the fight against senescence, the arguments for and against human eugenics, the search for perfection, the quest of moral enhancement, the problem of public priorities, and some questions on medical ethics. Then, finally, I will want to present some realist perspectives on the subject. (shrink)

Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. (...) We also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the “war on drugs.”. (shrink)

Limitless is a movie (released in 2011) as well as a novel (published in 2001) about a tormented author who (plagued by a writer’s block) becomes an early user of an experimental designer drug. The wonder drug makes him highly productive overnight and even allows him to make a fortune on the stock market. At the height of his career, however, the detrimental side-effects become increasingly noticeable. In this article, Limitless is analysed from two perspectives. First of all, building on (...) the views of the French novelist Emile Zola, the novel is seen as the report of a closely monitored experiment. Subsequently, building on the phenomenology of Ludwig Binswanger, I will show how the cognitive enhancement drug not only boosts the protagonist’s information processing capacities, but also modifies his experience of space and time, his sense of spatiality, his way of being-in-the-world. On the basis of these (complementary) analyses I will indicate how genres of the imagination (such as movies and novels) may play a significant role in assessing the societal implications of emerging technological developments such as neuro-enhancement, especially during the preparatory or anticipatory stage. (shrink)

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

While there is a prolific debate surrounding the issue of conscientious objection of individuals towards performing certain clinical acts, this debate ignores the fact that there are other reasons why clinicians might wish to object providing specific services. This paper briefly discusses the idea that healthcare workers might object to providing specific services because they are against their professional judgement, they want to maintain a specific reputation, or they have pragmatic reasons. Reputation here is not simply understood as being (...) in good standing with a professional body. Rather, reputation is treated in the sense that a craftsman might wish to be known for providing a specific type, quality, and style of service. Professionalism is understood as acting according to the philosophical and scientific principles that are the basis of healthcare (such as acting for the benefit of the patient’s health and following well- evidenced treatment pathways). (shrink)

In the United States, prohibitionist policies are used as the primary approach to combat the negative effect of substance use on society. An extensive academic literature spanning the disciplines of economics, political science, and multiculturalism documents the great social costs of the United States’ “War on Drugs” both nationally and internationally. These costs come with at best marginal effect on substance abuse and other crimes linked to the drug trade. In many cases, there is a reason to believe that (...) these policies exacerbate the problems they aim to address. This article explores psychologists’ ethical commitments to social change concerning such drug policy, given the field of psychology’s expanding commitment to social justice. We examine arguments regarding the boundaries between psychologists’ personal and professional ethics with regard to political participation. Using drug prohibition as an exemplar, we suggest that many psychologists’ political actions and professional ethics may be misaligned. Ultimately, we conclude that the endorsement of prohibitionist drug policies is in direct conflict with the guiding ethical principles put forth by the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. (shrink)

Drugs used to provide improvement of cognitive functioning have been shown to be effective in healthy individuals. It is sometimes assumed that the use of these drugs constitutes cheating in an academic context. We examine whether this assumption is ethically sound. Beyond providing the most up-to-date discussion of modafinil use in an academic context, this contribution includes an overview of the safety of modafinil use in greater depth than previous studies addressing the issue of cheating. Secondly, we emphasize (...) two crucial, but hitherto nearly overlooked, nuances to the issues: the potential for modafinil to decrease inequality and disadvantage in academic settings, and the fact that how modafinil is used dramatically impacts its effects on health, coercion, fairness, authenticity and effort. Finally, we explicitly defend the position that there are no qualitatively morally relevant differences between modafinil use and other enhancement modalities; any such differences are in degree,... (shrink)

In todays educational landscape, adapting teaching methods to the digital age is important. While traditional approaches remain essential, they may not fully engage students in multimedia-rich environments. This study evaluates multimedia tools effectiveness in teaching Filipino subjects to Grade 10 learners at Tikalaan National High School for School Year 2023-2024. It examines the impact of such tools on academic performance and student attitudes by comparing pretest and posttest results between control and experimental groups and its implications in teaching Filipino (...) to Grade 10 learners. The study involves Grade 10 students divided into two groups of thirty-five (35) both the Control Group and the Experimental Group. Data collection involved the Division-Based Quarterly Assessment for both pretest and posttest evaluations to measure academic progress. Additionally, a researcher-created survey is made to assess students attitudes towards multimedia tools. Respondents were selected through purposive sampling, focusing on characteristics relevant to the studys objectives. A quasi-experimental design was used, comparing the pretest and posttest results of both groups to determine multimedia tools effectiveness. Statistical analyses, including T-test, ANOVA, and F-test, were used to evaluate the significance of observed differences. The study reveals significant improvement in academic performance and a positive shift in attitudes towards multimedia tools among the experimental group. These findings suggest that multimedia tools can enhance learners academic performance and foster greater student engagement. It underscores the importance of integrating multimedia tools into educational practices to improve teaching and learning outcomes. Recommendations include incorporating multimedia into the curriculum and providing professional development for educators to maximize these tools effectiveness. (shrink)

Aim: Low professional help-seeking intention (PHSI) hinders effective treatment of mental illness. PHSI among Chinese students is still understudied and under-recognized. This study aimed to evaluate the status of PHSI and its associated risk factors among Chinese medical students. -/- Methods: A cross-sectional survey was conducted in Hainan province, South China, between January 1, 2021, and May 31, 2021. A total of 2182 medical students were recruited and surveyed via an anonymous structured questionnaire. Logistic regression analyses were performed to (...) identify the factors associated with PHSI. -/- Results: Among the 2182 medical students (mean age 21.0 years (SD = 3.70), 61.5% females), those with and without PHSI were 72.0% and 28.0%, and 16.4% with moderate to severe depression. Male students, those with a high level of depression stigma, serious family dysfunction, and heavy dependence on mobile phones were significantly less likely to seek professional mental health help, with odds ratios (ORs) of 1.5, 2.0, 2.1, and 1.7, respectively. -/- Conclusion: A significant proportion of Chinese medical students demonstrate low PHSI, influenced by factors such as gender, depression stigma, family dysfunction, and mobile phone dependence. Future interventions aimed at increasing medical students’ PHSI should prioritize reducing depression stigma, mitigating reliance on mobile phone use, and enhancing family function to address these key barriers to seeking professional mental health support. (shrink)

The ability to solve problems is a prerequisite in preparing mathematics preservice teachers. This study assessed preservice teachers’ problem-solving difficulties and performance, particularly in worded problems on number sense, measurement, geometry, algebra, and probability. Also, academic profile differences in the preservice teacher’s problem-solving performance and common errors were determined. A descriptive-comparative research design was employed with 158 random respondents. Data were gathered face-to-face during the first semester of the school year 2022-2023, and data were analyzed with the aid (...) of jamovi software, ensuring ethical measures. Overall findings revealed that the preservice teachers experienced average difficulty in solving problems. The low performance of the preservice teachers on the given problems was also demonstrated. Further analysis revealed a significant difference between the preservice teachers’ problem-solving performance based on their subject preference and program. Moreover, the error analysis revealed that the preservice teachers incurred comprehension errors in misrepresentation, misinterpretation, and miscalculation. These results will serve as a measure for policymakers and curriculum developers of the teacher education institution concerned to make relevant enhancements to the math courses offered in the elementary and secondary education programs. (shrink)

Given the wide the range of legally available options for end-of-life care in recent decades: from aggressive, even experimental, treatment to active euthanasia, our ethical analysis struggles to keep pace with technology and law. In this essay I show that the principle of double effect (PDE) remains, and will continue to be, a useful tool for ethical analysis of end-of-life care. According to PDE, an agent may ethically perform an act that s/he foresees will have a significant bad effect (e.g., (...) death) in addition to a good effect (e.g., pain relief) only if s/he does not intend the bad effect, the act is not bad for reasons other than its causing the bad effect, and there is a proportionately serious reason to act. Following a brief explanation of PDE and preliminary considerations in favor of counting death as a bad effect, I analyze several end-of-life options in terms of the principle. I begin with those that enjoy significant consensus among proponents of PDE: active euthanasia, “passive euthanasia,” and palliative care. Then I consider the less-straightforward cases of drug provision, refusing food and water, and terminal sedation, arguing that participation in such actions is justifiable via PDE only under very limited conditions. (shrink)

Quality education needs quality teachers to achieve success. Thus, this study determined the factors related to the teachers’ performance in delivering the K to 12 Curriculum in the Narra del Sur district, Palawan, Philippines. A descriptive-correlational research design was employed, with a sample of 132 randomly selected public elementary teachers. The study used frequency counts and percentages, arithmetic mean and standard deviation, and Spearman’s rho to analyze and draw conclusions from the data. The findings revealed a correlation between the (...) respondents’ age and their utilization of teaching materials and ICT. The number of pupils taught was correlated with teachers’ commitment, while number of pupils taught, position, highest educational attainment, and length of service were related to the respondents’ performance. The main problem encountered by the respondents was excessive workloads, paperwork, and reports. To solve the problem teachers encountered in delivering the K to 12 Curriculum, the respondents preferred preparing a work plan and allocating time to daily and weekly tasks to avoid excessive workloads. These results may aid policymakers and curriculum developers in the Department of Education to make relevant enhancements to the factors that affect teachers’ performance in curriculum delivery. (shrink)

In Education Sciences, the notion of ‘competence’ is widely used, both as an aim to be reached with students and as performance in teachers’ education. This article advances a type of competence that is highly relevant for teachers’ work, namely the ‘ethical competence.’ Ethical competence enables teachers to responsibly deal with the daily challenges arising from their professional roles. In this study, I put forward a definition of ethical competence and I propose a conceptual structure, both meant to (...) support the illustration, description, and development of ethical competence for teachers. (shrink)

This paper offers an overview of the prospects and ethics of using AI to achieve human enhancement, and more broadly what we call intellectual augmentation (IA). After explaining the central notions of human enhancement, IA, and AI, we discuss the state of the art in terms of the main technologies for IA, with or without brain-computer interfaces. Given this picture, we discuss potential ethical problems, namely inadequate performance, safety, coercion and manipulation, privacy, cognitive liberty, authenticity, and fairness in more (...) detail. We conclude that while there are very significant technical hurdles to real human enhancement through AI, and significant ethical problems, there are also significant benefits that may realistically be achieved in ways that are consonant with a rights-based ethics as well. We also highlight the specific concerns that apply particularly to applications of AI for "sheer" IA (more realistic in the near term), and to enhancement applications, respectively. (shrink)

How do we prepare engineering students to make ethical and responsible decisions in their professional work? This paper presents an approach that enhances engineering students’ engagement with ethical reasoning by simulating decision-making in a complex scenario. The approach has two principal inspirations. The first is Anthony Weston’s scenario-based teaching. Weston’s concept of a scenario is a situation that changes in response to choices made by participants, according to an inner logic. Scenarios can dynamically explore open-ended complex problems without imposing (...) predetermined results, allowing students to apply their ethical reasoning in a more realistic fashion. The second inspiration is Thi Nguyen’s theory of games. According to Nguyen, games are the “art of agency,” meaning that they provide a structure under which some result is agreed to be valuable, along with prescribed ways of achieving that result, in a relatively low-stakes and temporary social arrangement. By playing many games, Nguyen argues, we can develop a “library of agency,” that is to say, a set of values and means to achieving them that can inform how we make high-stakes decisions in real life. Engaging with carefully designed game scenarios, then, can enable students to practice making ethical decisions within a structured framework, which unfolds in response to their choices, while their decisions are driven by some defined goal. This roleplaying game–based approach thus allows students to build their own ethical libraries of agency, in preparation for professional decision-making. The approach is illustrated using a specific example recently deployed in a seminar on engineered living materials (building materials that incorporate living tissues). The scenario uses techniques from tabletop roleplaying games (e.g. Dungeons & Dragons) for outcome resolution, adventure design, and character creation. Through the game, students practice making difficult decisions in a humanitarian context. (shrink)

Aim: This research aimed to determine the teaching competence towards job satisfaction and teacher performance of secondary school teachers of Cagayan de Oro City and Misamis Oriental for the School Year 2020-2021. Methodology: This study utilized a descriptive-survey method of research, a patterned and modified questionnaire of Javillonar and Boni of 2023. The data collected were analyzed using descriptive statistics such as mean and standard deviation to describe the variables of the study where the three hundred fifty secondary (350) (...) secondary public school teachers from the two divisions of Cagayan de Oro City are the respondents of the study. Results: The study examined with a 0.01 correlation coefficient (two-tailed) on the significance between teacher competence, job satisfaction, and job performance found that teachers demonstrated high competence in critical thinking, teamwork, leadership, professionalism, and career management. The job satisfaction was generally high, but areas like compensation, facilities, and interpersonal relationships showed lower satisfaction. Teachers also demonstrated high performance in content, pedagogy, diversity of learners, curriculum planning, and community linkage. It has found out that there is a significant positive correlation between teacher competence and job satisfaction and performance, suggesting that teachers with strong competence are more likely to experience higher job satisfaction and superior performance. Conclusion: The teacher's proficiency in influencing job satisfaction and performance outcomes demonstrated high competence in essential skills; concerns in areas like compensation and interpersonal relationships impact overall satisfaction levels. The positive correlation between teacher competence, job satisfaction, and performance underscores the need for investing in professional development to enhance skills and engagement. Their skill is crucial in creating job satisfaction, which means an improvement in teaching skills is correlated with higher job satisfaction levels. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for (...) gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

An influential argument in bioethics involves appeal to disgust, calling on us to take it seriously as a moral guide (e.g. Kass, Miller, Kahan). Some argue, for example, that genetic enhancement, especially via human reproductive cloning, is repellant or grotesque. While objectors have argued that repugnance is morally irrelevant (e.g. Nussbaum, Kelly), I argue that the problem is more fundamental: it is psychologically irrelevant. Examining recent empirical data suggests that disgust’s influence on moral judgment may be like fatigue: an exogenous (...) influence, yielding a “performance error” that does not reflect our understanding of moral matters. This conclusion also challenges appeals to repugnance on other topics (such as homosexuality) and generally downplays the importance of disgust in moral discourse. (shrink)

Modern philosophy recognizes two major ethical theories: deontology, which encourages adherence to rules and fulfillment of duties or obligations; and consequentialism, which evaluates morally significant actions strictly on the basis of their actual or anticipated outcomes. Both involve the systematic application of universal abstract principles, reflecting the culturally dominant paradigm of technical rationality. Professional societies promulgate codes of ethics with which engineers are expected to comply, while courts and the public generally assign liability to engineers primarily in accordance with (...) the results of their work, whether intended or unintended. A third option, prominent in ancient philosophy, has reemerged recently: virtue ethics, which recognizes that sensitivity to context and practical judgment are indispensable in particular concrete situations, and therefore rightly focuses on the person who acts, rather than the action itself. Beneficial character traits—i.e., virtues—are identified within a specific social practice in light of the internal goods that are unique to it. This paper proposes a comprehensive framework for implementing virtue ethics within engineering. (shrink)

This essay is an interreligious study of spirituality of work and its implications for business ethics. It considers the normative / doctrinal teachings on human work in Bhagavadgita (BG) and Catholic Social Teaching (CST). In as much as the focus of this study is spirituality of work, it does not present an in-depth and comprehensive comparison of Hindu and Catholic religions. Similarities and differences between the texts under consideration will be examined, but such examination will be limited to the most (...) critical and relevant points. It will begin by exploring a Hindu spirituality of work based on BG. The paper will analyze salient ideas and relevant passages in the text that tackle the religio-spiritual significance of our daily engagement in the world through paid work from a Hindu perspective. A discussion on major themes in CST that resonate with BG’s teachings on work will follow. These themes will serve as analytical elements that will frame an interreligious spirituality of work from the two points of view. The interreligious analysis will demonstrate that as far as BG and CST are concerned, spirituality of work can be a unifying force, a locus for cross-cultural dialogue, and a bridge between different beliefs. Next, the essay will tackle the implications of a Hindu-Catholic spirituality of work for business ethics. It will explain how the two textual traditions deepen our understanding of work by providing answers to the questions why must we work, what is the right attitude to work, and how our work connects us with other beings and with our ultimate end. Finally, the conclusion will demonstrate how the findings of this study relate and enhance the outcomes of current research in spirituality of work. Finding common grounds on how different religions regard work would enable business professionals and managers to truly value diversity and inclusiveness and respond ethically to the expression of religions in an increasingly pluralistic workplace. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/protective highlights counter normative consequences and opposes the use enhancers. The Individual/proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

Physicians try hard to alleviate mental and physical ailments of their patients. Thus, they are heavily burdened by observing ethics and staying well-informed while improving health of their patients. A major ethical concern or dilemma in medication is that some physicians know their behavior is unethical, yet act against their moral compass. This study develops models of theory–practice gap, offering optimal solutions for the gap. These solutions would enhance self-motivation or remove external obstacles to stimulate ethical practices in medicine. The (...) Constructivist Grounded Theory Methodology is applied here where the participants and the main researcher mutually interacted with each other. Data collection was performed through qualitative methods including observation and semi-structured interviews with 21 physicians and medical students. Initial and focused coding was done, from which principal concepts were later extracted. MAXQDA software was used for analyzing data. Analysis of twelve major concepts in the study resulted in two factors and solution groups, from which four general notions influencing the ethical theory and practice gap in medicine were extracted: (1) providing effective education to change attitude and behavior; (2) considering motivational and emotional factors; (3) reconstructing regulations and processes to facilitate ethical practice; (4) conducting comprehensive and systematic studies. The existing medical educational system needs to be reconsidered to add to individual internal motivation, including optimizing persuasion strategies, maximizing participation of students, adhering to virtuous ethical theories, and fostering emotions. Additionally, regulations and processes can be reconstructed to remove practical obstacles and promote ethical practice with insignificant damages to individual self-motivation. (shrink)

Seeking consensuses from the public is difficult, this also applies to the heritage sector, particularly in heritage preservation. ‘What, why and how to preserve?’ are the core of debates in the field and the differ- ences between points of views are basically due to the difference in valuation. In order to know everyone’s needs, views and expectations better and for sustainability, involving the community for preservation be- comes fundamental. Education, an experience which does not only provide opportunities for enlightenments and (...) widening horizons, but also introduce various concepts in terms of moral, ethical and social through systematic instructions. Having such great impact to community, promoting heritage education can be an effective approach awakening public consciousness on heritage preservation, and thus, enhancing people’s responsibility towards heritage, for both tangible and intangible, and developing a sustainable future for heritage through public engagement. However, it is necessary to understand the structure or the level of engagement prior setting the goal for heritage education. A model for classifying the level of engagement from performance is proposed for clarification and appraisal. This model is part of the research project of Community Engagement with Heritage in Macau which has an intention to examine its level of community engagement and give suggestions. This essay will first discuss community engagement, then classify the levels of engagement with models and lastly argue heritage education can elevate the level of community engagement which ultimately achieves the aim of heritage preservation. (shrink)

Today’s organizations are operating in a highly competitive and changing environment ‎that ‎pushes them to adapt their organizational structures to such ‎environments continuously. ‎However, the ethical behavior of employees is considered a bridge to the organization’s success ‎, driven by positive beliefs. This study's purpose of examining the psychological and ethical ‎beliefs' that influence employees' behavior at the workplace through a literature review. This ‎paper uses two terms: "ethical beliefs” and “psychological beliefs.” They both ‎are different but can significantly influence (...) the behavior of employees. Positive psychological and ‎strong ethical beliefs drive ethical behaviors at the workplace, such as honesty, accountability, ‎fairness, responsibility, trust, and integrity, which lead to better performance, a productive team, and ‎positivity in the workplace. It helps to develop a professional relationship with employees, ‎effective communication, accountability, and professionalism at work. While negative ‎psychological and weak ethical beliefs drive unethical behavior, including taking credit for other ‎hard work, abuse, verbal harassment, violence, lack of ambitions and professionalism, theft, ‎corrupt practices, etc. Finally, the arguments demonstrate that some ethical beliefs are perceived ‎to be more objective and appropriate than psychological beliefs. The ethical beliefs of workers ‎considered more formal than psychological beliefs. ‎. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/Protective highlights counter normative consequences and opposes the use enhancers. The Individual/Proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

We argue that the fragility of contemporary marriages—and the corresponding high rates of divorce—can be explained (in large part) by a three-part mismatch: between our relationship values, our evolved psychobiological natures, and our modern social, physical, and technological environment. “Love drugs” could help address this mismatch by boosting our psychobiologies while keeping our values and our environment intact. While individual couples should be free to use pharmacological interventions to sustain and improve their romantic connection, we suggest that they may (...) have an obligation to do so as well, in certain cases. Specifically, we argue that couples with offspring may have a special responsibility to enhance their relationships for the sake of their children. We outline an evolutionarily informed research program for identifying promising biomedical enhancements of love and commitment. (shrink)

There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets by the Department of (...) Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

In today’s rapidly evolving business landscape, organizations must continuously adapt to stay competitive. AI-driven human resource (HR) analytics has emerged as a strategic tool to enhance workforce agility and inform decision-making processes. By leveraging advanced algorithms, machine learning models, and predictive analytics, HR departments can transform vast data sets into actionable insights, driving talent management, employee engagement, and overall organizational efficiency. AI’s ability to analyze patterns, forecast trends, and offer data-driven recommendations empowers HR professionals to make proactive decisions in hiring, (...) skill development, performance management, and retention. (shrink)

Artificial Intelligence (AI) is rapidly transforming Human Resource Management (HRM) by enhancing the efficiency and effectiveness of key functions such as recruitment, performance management, and employee engagement. This paper explores the integration of AI technologies in HRM, focusing on their potential to revolutionize these critical areas. In recruitment, AI-driven tools streamline candidate sourcing, screening, and selection processes, leading to more accurate and unbiased hiring decisions. Performance management is similarly transformed, with AI enabling continuous, data-driven feedback and personalized (...) development plans that align with organizational goals. Furthermore, AI facilitates more engaging and tailored employee experiences by leveraging predictive analytics to anticipate and address employee needs. Despite these advancements, the paper also addresses the ethical considerations and challenges associated with AI in HRM, including data privacy concerns and the risk of over-reliance on automated systems. Through a comprehensive analysis, this paper aims to provide insights into how AI can be strategically leveraged to optimize HRM practices, while highlighting the need for a balanced approach that integrates human judgment with technological innovation. (shrink)

: The idea of enhancing our mental functions through medical means makes many people uncomfortable. People have a vague feeling that altering our brains tinkers with the core of our personalities and the core of ourselves. It changes who we are, and doing so seems wrong, even if the exact reasons for the unease are difficult to define. Many of the standard arguments against neuroenhancements—that they are unsafe, that they violate the distinction between therapy and enhancements, that they undermine (...) equality, and that they will be used coercively—fail to show why the use of any such technologies is wrong in principle. Two other objections—the arguments that such changes undermine our integrity and that they prevent us from living authentic lives—will condemn only a few of the uses that are proposed. The result is that very few uses of these drugs are morally suspect and that most uses are morally permissible. (shrink)

Animal research has long been a source of biomedical aspirations and moral concern. Examples of both hope and concern are abundant today. In recent months, as is common practice, monkeys have served as test subjects in promising preclinical trials for an Ebola vaccine or treatment 1 , 2 , 3 and in controversial maternal deprivation studies. 4 The unresolved tension between the noble aspirations of animal research and the ethical controversies it often generates motivates the present issue of the Cambridge (...) Quarterly of Healthcare Ethics. As editors of this special section, we hope that these original and timely articles will push the professional discussion of animal research ethics in a positive direction that will benefi t research scientists and others interested in moral problems in animal research. We also look forward to a day when animal research will genuinely meet both appropriate scientifi c and appropriate ethical criteria—criteria that themselves can be improved by critical scrutiny. Animal research—that is, the use of live animals as experimental subjects in biomedical and behavioral fi elds of learning—has been deeply entrenched for well over half a century. One signal development was the enactment in the late 1930s of federal product safety legislation in the United States and other nations that required animal testing of food, drugs, and medical devices prior to use by human subjects or consumers. 5 Another development was the publication of codes of research ethics that called for animal research prior to human research. The Nuremberg Code, published by an American military tribunal in 1947–48 after scrutiny of Nazi medical atrocities, stated that experiments involving the use of human subjects should be " based on the results of animal experimentation. " 6 The Declaration of Helsinki, fi rst published in 1964, reaffi rmed this assumption and added, rather imprecisely, that " the welfare of animals used for research must be respected. " 7 Against the background of such statements, the institutionalization and widespread acceptance of animal research in the twentieth century rested on two basic assumptions, one factual and one moral. The factual assumption was that animal research is suffi ciently reliable as a basis for predicting the effects of drugs, products, and other materials on human beings that animal trials can be expected to yield signifi cant scientifi c conclusions and medical benefi ts to humanity. (shrink)

Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. -/- Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. -/- Methods: On the basis of a systematic (...) literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles. -/- Results: We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients. -/- Conclusions: The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access. (shrink)

Until recently, the problem of traumatic brain injury in sports and the problem of performance enhancement via hormone replacement have not been seen as related issues. However, recent evidence suggests that these two problems may actually interact in complex and previously underappreciated ways. A body of recent research has shown that traumatic brain injuries, at all ranges of severity, have a negative effect upon pituitary function, which results in diminished levels of several endogenous hormones, such as growth hormone and (...) gonadotropin. This is a cause for concern for many popular sports that have high rates of concussion, a mild form of TBI. Emerging research suggests that hormone replacement therapy is an effective treatment for TBI-related hormone deficiency. However, many athletic organizations ban or severely limit the use of hormone replacing substances because many athletes seek to use them solely for the purposes of performance enhancement. Nevertheless, in the light of the research linking traumatic brain injury to hypopituitarism, this paper argues that athletic organizations’ policies and attitudes towards hormone replacement therapy should change. We defend two claims. First, because of the connection between TBI and pituitary function, it is likely many more athletes than previously acknowledged suffer from hormone deficiency and thus could benefit from hormone replacement therapy. Second, athletes’ hormone levels should be tested more rigorously and frequently with an emphasis on monitoring TBI and TBI-related issues, rather than simply monitoring policy violations. (shrink)