Promising waste: biobanking, embryo research, and infrastructures of ethical efficiency.

Biobanks are custodial institutions that enhance the utility and value of biological materials by collecting and curating them. Their custodial functions tend to include ethical oversight and governance. This paper explores how biobanks increase the value of biological materials by standardizing routines of governance in order to engender "ethical efficiency." Focusing in particular upon banking of human embryos for research, the article offers an historical account of how human embryos came to be "waste" available for use by researchers in the US. It offers a case study of a human embryo biobank and the practices of ethical governance that the biobank employs to capture this waste and convert it into a valuable resource for research use. The article draws attention to the ways biobanks' emphasis on efficiency and resolving problems of ethical governance up front codifies otherwise contested normative relationships and authorizes uses of human biological materials that some see as ethically problematic, even as it eliminates institutionalized mechanisms of reflection in which such problems would otherwise be acknowledged and confronted.

Biobanking human embryonic stem cell lines: policy, ethics and efficiency.

Stem cell banks curating and distributing human embryonic stem cells have been established in a number of countries and by a number of private institutions. This paper identifies and critically discusses a number of arguments that are used to justify the importance of such banks in policy discussions relating to their establishment or maintenance. It is argued (1) that 'ethical arguments' are often more important in the establishment phase and 'efficiency arguments' more important in the maintenance phase, and (2) that arguments relating to the interests of embryo and gamete donors are curiously absent from the particular stem cell banking policy discourse. This to some extent artificially isolates this discourse from the broader discussions about the flows of reproductive materials and tissues in modern society, and such isolation may lead to the interests of important actors being ignored in the policy making process.

How can bedside rationing be justified despite coexisting inefficiency? The need for 'benchmarks of efficiency'.

Imperfect efficiency in healthcare delivery is sometimes given as a justification for refusing to ration or even discuss how to pursue fair rationing. This paper aims to clarify the relationship between inefficiency and rationing, and the conditions under which bedside rationing can be justified despite coexisting inefficiency. This paper first clarifies several assumptions that underlie the classification of a clinical practice as being inefficient. We then suggest that rationing is difficult to justify in circumstances where the rationing agent is or should be aware of and contributes to clinical inefficiency. We further explain the different ethical implications of this suggestion for rationing decisions made by clinicians. We argue that rationing is more legitimate when sufficient efforts are undertaken to decrease inefficiency in parallel with efforts to pursue unavoidable but fair rationing. While the qualifier 'sufficient' is crucial here, we explain why 'sufficient efforts' should be translated into 'benchmarks of efficiency' that address specific healthcare activities where clinical inefficiency can be decreased. Referring to recent consensus papers, we consider some examples of specific clinical situations where improving clinical inefficiency has been recommended and consider how benchmarks for efficiency might apply. These benchmarks should state explicitly how much inefficiency shall be reduced in a reasonable time range and why these efforts are 'sufficient'. Possible strategies for adherence to benchmarks are offered to address the possibility of non-compliance.

Measuring best value from 'refurb' projects.

Research at Aberdeen's Robert Gordon University has identified the requirement for the development of a 'Decision Support Model' to 'facilitate and measure the selection of main elements and sub-elements within refurbishment and maintenance projects'. One of the major drivers, explains Grant Wilson, a completing PhD researcher with the University's Institute for Innovation, Design and Sustainability (IDEAS), was to provide a mechanism via which NHS estates managers, design teams, and contractors, could 'evidence and demonstrate' that best value-for-money had been pursued, 'specific to the facility in question, and in the context of its unique business case requirements'.

Economic efficiency of countries' clinical review processes and competitiveness on the market of human experimentation.

Clinical research is a specific phase of pharmaceutical industry's production process in which companies test candidate drugs on patients to collect clinical evidence about safety and effectiveness. Information is essential to obtain manufacturing authorization from the national drug agency and, in this way, make profits on the market. Considering this activity, however, the public stakeholder has to face a conflict of interests. On the one side, there is society's necessity to make advances in medicine and, of course, to promote pharmaceutical companies' investments in this specific phase (new generation). On the other side, there is the duty to protect patients involved in these experimental treatments (old generation). To abide by this moral duty, a protection system was developed through the years, based on two legal institutions: informed consent and institutional review board. How should an efficient protection system that would take human experimentation into account be shaped? Would it be possible for the national protection system of patients' rights to affect the choice of whether to develop a clinical trial in a given country or not? Looking at Europe and considering a protection system that is shaped around institutional review boards, this article is an empirical work that tries to give answers to these open questions. It shows how a protection system that can minimize the time necessary to start a trial can positively affect pharmaceutical clinical research, that is, the choice of pharmaceutical companies to start innovative medical treatments in a given country.

Autoeficacia para el Liderazgo Emprendedor. Adaptación y Validación de la Escala CESE en España / Entrepreneurial leadership self-efficacy. Adaptation and Validation of CESE Scale in Spain

Este estudio tiene como objetivo adaptar a nuestro idioma y validar la escala de autoeficacia para el liderazgo emprendedor (Corporate Entrepreneurial Self-Efficacy Scale, CESE) en una muestra de más de doscientos directivos y mandos intermedios españoles. Esta escala fue desarrollada originalmente por Ehrlich, De Noble y Singh (2005) para medir las habilidades necesarias en el liderazgo y gestión de equipos, así como en la comunicación con los accionistas y grupos internos de interés para obtener apoyo y recursos de la organización para desarrollar nuevos proyectos innovadores. Los resultados obtenidos, a través de la técnica PLS (Partial Least Square), permiten confirman la validez y fiabilidad de la versión española de la escala CESE para evaluar las principales habilidades y actividades necesarias para liderar iniciativas emprendedoras dentro de la organización (AU)

This study aims to adapt and validate a Spanish-language version of the Corporate Entrepreneurial Self-Efficacy (CESE) scale in a sample of more than two hundred Spanish managers and middle managers. This scale was originally developed by Ehrlich, De Noble and Singh (2005) in order to measure the skills needed for leading and managing teams and communicating with internal stakeholders to obtain support and corporate resources to develop new innovative projects. The results obtained, using Partial Least Square (PLS) technique, allow confirming that the Spanish version of CESE scale has a high reliability and validity to measure the main skills and activities necessaries to lead entrepreneurial initiatives inside the organization (AU)

Influencia de los estilos de liderazgo y las prácticas de gestión de RRHH sobre el clima organizacional de innovación / Influence of leadership styles and human resources management practices on innovation climate in organizations

Frente a propuestas de valor asociadas a un bajo coste productivo, numerosas naciones y organizaciones buscan convertir a la innovación en la palanca de un nuevo modelo de crecimiento económico. Por su marcado carácter social, este estudio analiza la relación entre el clima organizacional de innovación, los estilos de liderazgo y las prácticas de gestión de RRHH características en la organización. Los modelos de regresión obtenidos explican una varianza cercana al 60% del clima organizacional innovador y señalan a las prácticas dirigidas a estimular la participación de los miembros y el estilo de liderazgo inspiracional como sus principales predictores(AU)

An increasing number of organizations and countries are focusing in innovations as the lever for a new model of economic development, front proposals based in decreasing costs. Due to their marked social character, the present study analyses the relationship between organizational climate of innovation and the leadership styles and practices of human resources management addressed by organizations to their members. Regression analyses carried out explained near of 60% of the variance in innovation climate, outstanding HRM practices addressed to stimulate workers participation and inspirational leadership as main predictors(AU)

An ethical justification and policy for making commitments during computerized residency application processes: The US matching program as a laboratory for needed reform.

The US National Residency Matching Program (NRMP) is a computerized, national system for matching residency applicants to programs. Similar systems exist in Canada, Australia, and New Zealand, and the need for such a program will probably make itself felt in the European Union soon. NRMP is an important laboratory for the ethical challenges that computerized matching programs create, especially its current prohibition of making commitments by both applicants and residency programs. Nonetheless, it would be denial to suppose that commitments are not being made and that there is no dishonesty when commitments are made. We analyze the current NRMP no-commitment policy by reference to Plato's retelling of the myth of the Ring of Gyges, which makes its wearer physically invisible and therefore ethically unaccountable. Because applicants and programs complete their preference-lists in secret, the matching process inadvertently slips a Ring of Gyges on the fingers of both parties. As a result, making false commitments promotes the rational self-interest of both parties. To strengthen the professional integrity of the matching process, we argue that NRMP should abandon its no-commitment policy and adopt a new paradigm: sanctioning honest, non-contingent, accountable, one-party, and documented commitments. Computerized residency matching systems in other countries should consider the NRMP a laboratory and develop policies about making commitments that promote professionalism in the residency application process.

[Ethical insolvency?]. / Ethische Insolvenz?

The current DRG system has not only changed the economic structure of clinical medicine but also has profound effects on its original mission. In the present paper we discuss the fundamental limits of the DRG system and make a case for placing more emphasis on time and communication in health care.

Fair shares: a preliminary framework and case analyzing the ethics of offshoring.

Much has been written about the offshoring phenomenon from an economic efficiency perspective. Most authors have attempted to measure the net economic effects of the strategy and many purport to show that "in the long run" that benefits will outweigh the costs. There is also a relatively large literature on implementation which describes the best way to manage the offshoring process. But what is the morality of offshoring? What is its "rightness" or "wrongness?" Little analysis of the ethics of offshoring has been completed thus far. This paper develops a preliminary framework for analyzing the ethics of offshoring and then applies this framework to basic case study of offshoring in the U.S. The paper following discusses the definition of offshoring; shifts to the basic philosophical grounding of the ethical concepts; develops a template for conducting an ethics analysis of offshoring; applies this template using basic data for offshoring in the United States; and conducts a preliminary ethical analysis of the phenomenon in that country, using a form of utilitarianism as an analytical baseline. The paper concludes with suggestions for further research.

The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices?

Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency. Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy.

[Economic efficiency and fairness: two ethical criteria? A basic reflection]. / Wirtschaftlichkeit und Gerechtigkeit: zwei ethische Gebote? Eine Grundlagenreflexion.

Many statements on the allocation of health care resources show an appreciation of the two criteria "efficiency" and "fairness" as two values which are to be weighed against each other in case of conflict. This article provides a critique of this model, which is conceived to rest on a hybrid (partly utilitarian, partly counter-utilitarian) basis. The most important fairness-related argument, or so it is argued, is of a sort which is incompatible with the reasons utilitarianism (or, indeed, consequentialism) provides as a basis for the efficiency criterion. If the argument is right, we have to provide another basis, at least as far as moral inhibitions are strong about taking efficiency into account. The present article does not go into detail about such an alternative. It relates to the on-going discussion on John Taurek's (1977) article about "numbers", especially on the so-called aggregation argument against Taurek's "no-worse-claim", and argues against the majority of commentators, consequentialist and deontological alike, that Taurek was right.

Ética de la Calidad Asistencial / No disponible

No disponible

Ética y empresa / No disponible

Afirman algunos malintencionados que el libro más breve de la historia sería uno que llevase por título Ética y negocios. Discrepo de esa opinión, y los hago tanto con argumentos teóricos como por la vía práctica. Quizá sucede que demasiados se atreven a descalificar aquello que ignoran, poniendo más en el candelero su ignorancia. Tanto la gestión empresarial como la ética son ciencias (con importante componente "artístico") que hay que estudiar en profundidad si se quieren realizar aportaciones de una cierta consistencia