Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices: A Policy Paper From the American College of Physicians.

The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient-physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.

The Effect of Supervisor Identification on Unethical Pro-Supervisor Behavior: The Moderating Role of Employability Perceptions.

Under some employment circumstances, individuals in some organizations are willing to engage in unethical behaviors that benefit one's own supervisors who have a great power to decide the levels of evaluation and compensation for each individual. In this study, two hypotheses were examined. First, based on social identification theory, we hypothesized that individuals' feeling a sense of oneness with one's own supervisors promote unethical pro-supervisor behaviors (UPSB). Second, based on a person-situation interactionist model, we hypothesized that this positive relationship is strengthened if the individual perceives lower levels of one's own employability. Data were collected from 185 individuals of various types of organizations in South Korea. A time-lagged field study supported our hypotheses. In particular, [supervisor identification was positively related to UPSB. Furthermore, for individuals with a weaker employability perception, supervisor identification was positively related to UPSB.

Antibodies as Currency: COVID-19's Golden Passport.

Due to COVID-19, the fragile economy, travel restrictions, and generalized anxieties, the concept of antibodies as a "declaration of immunity" or "passport" is sweeping the world. Numerous scientific and ethical issues confound the concept of an antibody passport; nonetheless, antibodies can be seen as a potential currency to allow movement of people and resuscitation of global economics. Just as financial currency can be forged, so too is the potential for fraudulent antibody passports. This paper explores matters of science, ethics, and identity theft, as well as the problems of bias and discrimination that could promulgate a world of pandemic "golden passports."

Those who tan and those who don't: A natural experiment on colorism.

Are darker-skinned workers discriminated against in the labor market? Studies using survey data have shown that darker skin tone is associated with increased labor market disadvantages. However, it is hard to refute the possibility that other factors correlated with skin tones might affect employment outcomes. To overcome this inherent limitation, we use a natural experiment: we utilize changes in one's own skin tone, generated by exposure to the sun, to explore the effect of skin tone on the tendency to be employed. We find that those people whose skin tone becomes darker by exposure to the sun (but not others) are less likely to be employed when the UV radiation in the previous three weeks in the area in which they reside is greater. These within-person findings hold even when controlling for the week, the year, the region, demographic characteristics and the occupation and industry one is employed in.

What Should Physicians Consider Prior to Unionizing?

Physicians considering unionization face many practical, emotional, and moral obstacles. Even some who feel that a collective bargaining unit is necessary remain concerned that patient care could suffer if physicians unionize. This article discusses unionized physicians' moral obligations to patient populations and health care systems' share in this responsibility. It argues that unionization can be done ethically as long as union actions are focused on improving patient care.

How Should Commerce and Calling Be Balanced?

Physicians and all health professionals need to find an appropriate balance between the interests of individual patients and their organization's bottom line. Corporatization in health care has complicated such efforts. More and more health professionals function as employees of health care organizations, some of which value leaders' and shareholders' interests over those of patients. When faced with such conflicts, physicians bear a responsibility to put patients first and to advocate for their profession.

Bridging the Breach: Using Positive Affectivity to Overcome Knowledge Hiding after Contract Breaches.

With a basis in conservation of resources theory, this study investigates the relationship between employees' exposure to perceived contract breaches and their job performance, while also considering the mediating role of knowledge hiding and the moderating role of positive affectivity. Multisource, three-wave data from employees and their peers in Pakistani organizations reveal that breaches in the psychological contract hinder job performance, because employees respond with an unwillingness to contribute valuable knowledge to execute their job tasks. This mediating role of knowledge hiding is mitigated if employees can draw from their own positive affectivity trait. This study accordingly identifies a key factor, intentional attempts to conceal knowledge requested by other members, that can backfire and make employees suffer doubly: from unfulfilled organizational promises and from lower performance. It also reveals how this risk might be contained, that is, by encouraging employees' positive affect.

A feminist phenomenology on the emotional labor and morality of live-in migrant care workers caring for older people in the community.

BACKGROUND: Global societal changes, such as increasing longevity and a shortage of family caregivers, have given rise to a popular worldwide trend of employing live-in migrant care workers (MCWs) to provide homecare for older people. However, the emotional labor and morality inherent in their interactions with older people are largely unknown. The aim of the present study is to understand the corporeal experiences of live-in migrant care workers in the delivery of emotional labor as seen in their interactions with older people by: (1) describing the ways by which they manage emotional displays with older people; and (2) exploring their morality as enacted through emotional labor. METHODS: We performed a secondary analysis drawing on feminist phenomenology to thematically analyze data from interviews with 11 female MCWs. Follow-up interviews were conducted with 10 participants. The participants had two to 15 years of experience in caring for older people in their homes in Hong Kong. RESULTS: Performing emotional labor by suppressing and inducing emotions is morally demanding for live-in MCWs, who experience socio-culturally oppressive relationships. However, developing genuine emotions in their relationships with older people prompted the MCWs to protect the interests of older people. Through demonstrating both fake and genuine emotions, emotional labor was a tactic that live-in MCWs demonstrated to interact morally with older people. CONCLUSIONS: Emotional labor allowed live-in MCWs to avoid conflict with older people, and to further protect their own welfare and that of others. This study highlights the significance of empowering live-in MCWs by training them in ways that will help them to adapt to working conditions where they will encounter diverse customs and older people who will develop an increasing dependence on them. Thus, there is a need to develop culturally appropriate interventions to empower live-in MCWs to deliver emotional labor in a moral manner.

Employers' views on disability, employability, and labor market inclusion: a phenomenographic study.

Purpose: This study aims to increase our understanding of employers' views on the employability of people with disabilities. Despite employers' significant role in labor market inclusion for people with disabilities, research is scarce on how employers view employability for this group.Methods: This was a qualitative empirical study with a phenomenographic approach using semi-structured interviews with 27 Swedish employers from a variety of settings and with varied experience of working with people with disabilities.Results: The characteristics of employers' views on the employability of people with disabilities can be described as multifaceted. Different understandings of the interplay between underlying individual-, workplace-, and authority-related aspects form three qualitatively different views of employability, namely as constrained by disability, independent of disability, and conditional. These views are also characterized on a meta-level through their association with the cross-cutting themes: trust, contribution, and support.Conclusions: The study presents a framework for understanding employers' different views of employability for people with disabilities as a complex internal relationship between conceived individual-, workplace-, and authority-related aspects. Knowledge of the variation in conceptions of employability for people with disability may facilitate for rehabilitation professionals to tailor their support for building trustful partnerships with employers, which may enhance the inclusion of people with disabilities on the labor market.Implications for rehabilitationEmployers' views on employing people with disabilities vary with respect to individual-, workplace-, and authority-related aspects in relation to trust, contribution and support.Knowledge of the employers' views on the employability of people with disabilities can support professionals in authorities and in vocational rehabilitation.The findings illustrate the importance of analyzing what type of support employers need as a starting point for building trustful partnerships between authority actors and employers.The findings offer a vocabulary that can be used by professionals in authorities and in vocational rehabilitation in tailoring employer-oriented support to increase labor market inclusion of people with disabilities.

Breaking the cycle of abusive supervision: How disidentification and moral identity help the trickle-down change course.

Studies show that abusive leader behaviors "trickle down" to lower organizational levels, but this research ignores that many abused supervisors do not perpetuate abuse by harming their own subordinates. Drawing on social-cognitive theory and related research, we suggest abused supervisors might defy rather than emulate their managers' abusive behavior. Specifically, we predicted that some abused supervisors-namely, those with strong moral identities-might in effect "change course" by engaging in less abuse or demonstrating ethical leadership with their subordinates to the extent they disidentify with their abusive managers. Across 2 experiments (n = 288 and 462 working adults, respectively) and a field study (n = 500 employees and their supervisors), we show that relations between manager abuse and supervisors' abusive and ethical behaviors were carried by supervisors' disidentification, and that the direct and indirect effects of manager abuse were stronger for supervisors with comparatively higher moral identity levels. We discuss our findings' implications and avenues for future research. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The impact of leader moral humility on follower moral self-efficacy and behavior.

This study utilizes social-cognitive theory, humble leadership theory, and the behavioral ethics literature to theoretically develop the concept of leader moral humility and its effects on followers. Specifically, we propose a theoretical model wherein leader moral humility and follower implicit theories about morality interact to predict follower moral efficacy, which in turn increases follower prosocial behavior and decreases follower unethical behavior. We furthermore suggest that these effects are strongest when followers hold an incremental implicit theory of morality (i.e., believing that one's morality is malleable). We test and find support for our theoretical model using two multiwave studies with Eastern (Study 1) and Western (Study 2) samples. Furthermore, we demonstrate that leader moral humility predicts follower moral efficacy and moral behaviors above and beyond the effects of ethical leadership and leader general humility. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Should Genetic Testing for Variants Associated with Influenza Infection Be Mandatory for Health Care Employees?

Scientists are beginning to understand more about the role of host genetics in individuals' responses to influenza virus exposure. This fictional case addresses a situation in which a health care organization proposes requiring all health care practitioners with direct patient care responsibilities to undergo mandatory genetic testing for genetic variants used to (1) predict individuals' responses to the influenza vaccine, (2) determine individual susceptibility to influenza infection, and (3) identify individuals at increased risk for severe disease. This commentary will discuss ethical and legal issues associated with use of genetic test results to determine employee work assignments during an influenza pandemic.

The value of work: Addressing the future of work through the lens of solidarity.

Designing the future of work is crucial to the health and well-being of people and societies. Experts predict that developments such as the advancement of digital technologies, automation, and the movement of manufacturing jobs to low-wage countries will lead to major transformations in the labour market, and some foresee significant job losses. Due to the close relationship between employment and health, major job losses would have significant negative impacts on the health and well-being of individuals and societies. Job losses would also pose a major challenge to solidaristic support within societies because they would negatively affect the recognition of similarities among people, which is vital for solidaristic practice and institutions. To prevent these negative effects, a fundamental redesign of the relationship between work and income is necessary. And for this project to succeed, we need to reconsider of the value of work. Building on definitions of flourishing people and societies, we argue that the value of work should not be determined by the labour market, but according to its importance for society. Using a solidarity-based framework we argue that such a re-valuation of work will help to ensure social cohesion and increase reciprocity in our societies. It will serve as a foundation upon which we can reconfigure the relationship between work and income without risking the loss of social cohesion and solidarity.

Welfare-to-work interventions and their effects on the mental and physical health of lone parents and their children.

BACKGROUND: Lone parents in high-income countries have high rates of poverty (including in-work poverty) and poor health. Employment requirements for these parents are increasingly common. 'Welfare-to-work' (WtW) interventions involving financial sanctions and incentives, training, childcare subsidies and lifetime limits on benefit receipt have been used to support or mandate employment among lone parents. These and other interventions that affect employment and income may also affect people's health, and it is important to understand the available evidence on these effects in lone parents. OBJECTIVES: To assess the effects of WtW interventions on mental and physical health in lone parents and their children living in high-income countries. The secondary objective is to assess the effects of welfare-to-work interventions on employment and income. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, PsycINFO EBSCO, ERIC EBSCO, SocINDEX EBSCO, CINAHL EBSCO, Econlit EBSCO, Web of Science ISI, Applied Social Sciences Index and Abstracts (ASSIA) via Proquest, International Bibliography of the Social Sciences (IBSS) via ProQuest, Social Services Abstracts via Proquest, Sociological Abstracts via Proquest, Campbell Library, NHS Economic Evaluation Database (NHS EED) (CRD York), Turning Research into Practice (TRIP), OpenGrey and Planex. We also searched bibliographies of included publications and relevant reviews, in addition to many relevant websites. We identified many included publications by handsearching. We performed the searches in 2011, 2013 and April 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) of mandatory or voluntary WtW interventions for lone parents in high-income countries, reporting impacts on parental mental health, parental physical health, child mental health or child physical health. DATA COLLECTION AND ANALYSIS: One review author extracted data using a standardised extraction form, and another checked them. Two authors independently assessed risk of bias and the quality of the evidence. We contacted study authors to obtain measures of variance and conducted meta-analyses where possible. We synthesised data at three time points: 18 to 24 months (T1), 25 to 48 months (T2) and 49 to 72 months (T3). MAIN RESULTS: Twelve studies involving 27,482 participants met the inclusion criteria. Interventions were either mandatory or voluntary and included up to 10 discrete components in varying combinations. All but one study took place in North America. Although we searched for parental health outcomes, the vast majority of the sample in all included studies were female. Therefore, we describe adult health outcomes as 'maternal' throughout the results section. We downgraded the quality of all evidence at least one level because outcome assessors were not blinded. Follow-up ranged from 18 months to six years. The effects of welfare-to-work interventions on health were generally positive but of a magnitude unlikely to have any tangible effects.At T1 there was moderate-quality evidence of a very small negative impact on maternal mental health (standardised mean difference (SMD) 0.07, 95% Confidence Interval (CI) 0.00 to 0.14; N = 3352; studies = 2)); at T2, moderate-quality evidence of no effect (SMD 0.00, 95% CI 0.05 to 0.05; N = 7091; studies = 3); and at T3, low-quality evidence of a very small positive effect (SMD -0.07, 95% CI -0.15 to 0.00; N = 8873; studies = 4). There was evidence of very small positive effects on maternal physical health at T1 (risk ratio (RR) 0.85, 95% CI 0.54 to 1.36; N = 311; 1 study, low quality) and T2 (RR 1.06, 95% CI 0.95 to 1.18; N = 2551; 2 studies, moderate quality), and of a very small negative effect at T3 (RR 0.97, 95% CI 0.91 to 1.04; N = 1854; 1 study, low quality).At T1, there was moderate-quality evidence of a very small negative impact on child mental health (SMD 0.01, 95% CI -0.06 to 0.09; N = 2762; studies = 1); at T2, of a very small positive effect (SMD -0.04, 95% CI -0.08 to 0.01; N = 7560; studies = 5), and at T3, there was low-quality evidence of a very small positive effect (SMD -0.05, 95% CI -0.16 to 0.05; N = 3643; studies = 3). Moderate-quality evidence for effects on child physical health showed a very small negative effect at T1 (SMD -0.05, 95% CI -0.12 to 0.03; N = 2762; studies = 1), a very small positive effect at T2 (SMD 0.07, 95% CI 0.01 to 0.12; N = 7195; studies = 3), and a very small positive effect at T3 (SMD 0.01, 95% CI -0.04 to 0.06; N = 8083; studies = 5). There was some evidence of larger negative effects on health, but this was of low or very low quality.There were small positive effects on employment and income at 18 to 48 months (moderate-quality evidence), but these were largely absent at 49 to 72 months (very low to moderate-quality evidence), often due to control group members moving into work independently. Since the majority of the studies were conducted in North America before the year 2000, generalisabilty may be limited. However, all study sites were similar in that they were high-income countries with developed social welfare systems. AUTHORS' CONCLUSIONS: The effects of WtW on health are largely of a magnitude that is unlikely to have tangible impacts. Since income and employment are hypothesised to mediate effects on health, it is possible that these negligible health impacts result from the small effects on economic outcomes. Even where employment and income were higher for the lone parents in WtW, poverty was still high for the majority of the lone parents in many of the studies. Perhaps because of this, depression also remained very high for lone parents whether they were in WtW or not. There is a lack of robust evidence on the health effects of WtW for lone parents outside North America.

Advocating to Protect Our Nurses: Addressing Unethical Recruitment of Foreign-Educated Nurses.

Advocacy in the nursing sector is often about advocating for patients. However, nurses have begun to put more effort into protecting their rights as workers. Advocacy on behalf of foreign-educated nurses has been a critical component of this advocacy. While foreign-educated nurses can make our nursing workforce stronger, this can only happen if they are well-treated and well-trained. Organizations across diverse missions and perspectives have come together to promote fair treatment of foreign-educated nurses, which ultimately ensures that all nurses are working as effectively as possible and that patients receive proper care. The Alliance for Ethical International Recruitment Practices' Health Care Code for Ethical Recruitment and Employment Practices represents a bottom-up agreement on which market practices constitute ethical recruitment. From a top-down level, the World Health Organization's Code of Global Practice establishes obligations and reporting requirements for member states that commit to ensuring ethical recruitment. This combination of efforts, bolstered by strong advocacy, is gaining traction as nursing migration grows at the global level. The collaboration across diverse stakeholder groups and the combination of legal, voluntary, and global efforts to promote the rights of foreign-educated nurses provides a model to apply for advocacy in different areas.