In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of (...) care. What this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter. (shrink)

Background Nursing is regulated by a set of professional standards. Whilst many forms of ethics apply to nursing, the biomedical ethical framework is common, involving autonomy, beneficence, non-maleficence and justice. In healthcare, nurses often encounter ethical dilemmas that require them to navigate conflicting ethical principles. However, how nurses adhere to these principles in such situations is unclear. Research Aim To explore how registered nurses adhere to ethical principles when dealing with ethical dilemmas at work. Research Design A qualitative descriptive study (...) design. Participants and Research Context Between August and December 2023, 21 registered nurses were recruited from a teaching hospital through purposive sampling. Data were collected through semi-structured in-person interviews or online video conferencing. Braun and Clarke’s thematic analysis approach was employed to analyse the data. Ethical Considerations Interview participation was voluntary. Written consent was obtained before participation. Participants’ real identities were replaced with pseudonyms. This study was approved by the SingHealth Centralised Institutional Review Board. Findings The data analysis developed four major themes and 15 subthemes. The four major themes are “Addressing the dilemma,” “Contemplating the principles and consequences,” “Coordinating for well-informed, ethical decision,” and “Self-reflecting and finding consolation.” Conclusion This study explains how nurses navigate and uphold ethical principles when caring for patients to the best of their ability. Fully adhering to ethical principles can be challenging for caring for actively dying patients. Further research can expound on nurses’ experiences and adherence to ethical principles in complex clinical cases. (shrink)

Background: Ethical codes are guidelines that orient nurses and ensure that their decisions are in accordance with the values of the professional system. These codes show that there is a connection among values, patients’ rights, and nurses’ duties. Objectives: This study aimed to compare the viewpoints of patients, nurses, and nurse managers regarding the extent to which clinical ethical codes are observed. Research design: In this descriptive–comparative study, data were collected using three questionnaires based on Iranian nurses’ ethical codes with (...) a focus on clinical care. The reliability of the questionnaire was verified by test–retest method (r = 0.9). The patients were interviewed by the researcher, but nurses and managers completed the questionnaires themselves. After all, the data were analyzed using the SPSS statistical software (v 15). Participants and research context: In all, 100 patients, 100 nurses, and 30 managers from internal and surgical wards of two major hospitals in Shiraz, Iran, participated in 2014. Ethical considerations: This research was approved by the Ethics Committee of Shiraz University of Medical Sciences. All the participants signed written informed consents. Findings: According to the results, 70% of the patients, 86% of the nurses, and 53.3% of the nurse managers rated nurses’ adherence to ethical codes as satisfactory. The mean scores (standard deviation) of the level of adherence to ethical codes were 38.44 (6.91) in the patients, 41.08 (4.82) in the nurses, and 37.83 (6.98) in the nurse managers. The results of analysis of variance revealed a significant difference between the attitudes of the nurses and the other two groups (p = 0.001). Discussion: Nurses’ adherence to ethical codes was satisfactory in all three groups. Accordingly, our findings agree with the results of some national and international studies, although there are still controversies in this regard. Conclusion: Although the nurses rated their performance in certain fields more satisfactory compared to the patients and managers, all the three groups agreed that clinical ethical codes were properly observed in the internal and surgical wards. Nurses can improve the quality of care by considering the viewpoints of patients and managers about their ethical performance. (shrink)

According to Information-Motivation-Behavioural Skills model (IMB), accurate Information, strong Motivation and adequate Behavioural skills are prerequisites of treatment adherence. This model has been verified among chronically ills patients, usually suffering from one particular disorder. No studies report how the model fits data from a more diverse group. The aim of the study was to analyze adherence and its barriers in a group of three hundred patients suffering from various, common chronic disorders. They filled out IMB and Adherence (...) Questionnaire. Information and Motivation correlated moderately (.35). Behavioural Skills was the strongest predictor of adherence (.24). An additional relationship was found: Information and Motivation interacted and the role of either of these dimensions vanished if the indices of the other were high enough. The relationships between IMB dimensions and adherence were confirmed in a varied clinical sample. Behavioural skills must be considered when working with non-adherent patients, as they are the strongest predictor of adherence. Other interventions may be limited to either Information or Motivation only if there is a chance of raising one of them to extreme levels. This may be useful with special cases, when increasing both is problematic. (shrink)

The possibility of employing human enhancement interventions to aid in future space missions has been gaining attention lately. These possibilities have included one of the more controversial kinds of enhancements: biomedical moral enhancement. However, the discussion has thus far remained on a rather abstract level. In this paper we further this conversation by looking more closely at what type of interventions with what sort of effects we should expect when we are talking about biomedical moral enhancements. We suggest that a (...) more grounded way to picture moral enhancement, at least in the near term, is to envision a form of cognitive enhancement that also provides some moral benefits by heightening the enhanced person's capability for acting according to their own subjective moral code. While this concept of moral adherence enhancement also has relevance for the moral enhancement discussion more widely, in this paper we apply it specifically in the context of space missions. We argue that there are weighty reasons to consider making biomedical enhancements of the proposed kind a mandatory feature of early-phase long-distance space travel because these missions are high-stakes in nature and take place in an environment where the enhancement could be seen as conferring important advantages while negating many of the traditional arguments weighed against it. (shrink)

Rationale, aims and objectives Existing literature suggests that doctors' poor adherence with guidelines is one of the major contributing factors to suboptimal control of hypertension. This study aims to evaluate doctors' adherence with Malaysian clinical practice guideline (CPG 2008) in a tertiary care hospital, and factors associated with guideline adherence and hypertension control.Methods This was a cross-sectional study conducted at Hospital Pulau Pinang, Penang, Malaysia. Prescriptions written by 26 enrolled doctors to 650 established hypertensive outpatients (25 prescriptions (...) per enrolled doctor) were noted on visit 1 along with patients' demographic and clinical data. The noted prescriptions were classified either as compliant or non-compliant to CPG (2008). Five hundred twenty (80%) of the enrolled patients (20 patients per enrolled doctor) were followed for one more visit. Blood pressure (BP) noted on visit 2 was related to the prescription written on visit 1. SPSS 16 (SPSS Inc., Chicago, IL, USA) was used for data analysis.Results Three hundred forty-nine (67.1%) patients received guidelines compliant pharmacotherapy. In multivariate analysis, hypertension clinic had significant negative association with guidelines adherence. Two hundred sixty-five patients (51%) were at goal BP on visit 2. In multivariate analysis, angiotensin-converting enzyme inhibitors and guidelines adherence had significant positive, while renal disease, diabetes mellitus and diabetic clinic had significant negative association with hypertension control.Conclusions An overall fair level of adherence with guidelines and better control of hypertension was observed. Guidelines compliant practices resulted in better control of hypertension. The gaps between what guidelines recommend and clinical practice were especially seen in the pharmacotherapy of uncomplicated hypertension and hypertension with diabetes mellitus and renal disease. (shrink)

The role of artificial intelligence (AI) in organizations has fundamentally changed from performing routine tasks to supervising human employees. While prior studies focused on normative perceptions of such AI supervisors, employees’ behavioral reactions towards them remained largely unexplored. We draw from theories on AI aversion and appreciation to tackle the ambiguity within this field and investigate if and why employees might adhere to unethical instructions either from a human or an AI supervisor. In addition, we identify employee characteristics affecting this (...) relationship. To inform this debate, we conducted four experiments (total N = 1701) and used two state-of-the-art machine learning algorithms (causal forest and transformers). We consistently find that employees adhere less to unethical instructions from an AI than a human supervisor. Further, individual characteristics such as the tendency to comply without dissent or age constitute important boundary conditions. In addition, Study 1 identified that the perceived mind of the supervisors serves as an explanatory mechanism. We generate further insights on this mediator via experimental manipulations in two pre-registered studies by manipulating mind between two AI (Study 2) and two human supervisors (Study 3). In (pre-registered) Study 4, we replicate the resistance to unethical instructions from AI supervisors in an incentivized experimental setting. Our research generates insights into the ‘black box’ of human behavior toward AI supervisors, particularly in the moral domain, and showcases how organizational researchers can use machine learning methods as powerful tools to complement experimental research for the generation of more fine-grained insights. (shrink)

Background: The nature of children’s cancer comes with lots of ethical issues. Nurses are encouraged to adhere to ethical codes in their practice. Objectives: This study aimed to compare the perspectives of nurses and mothers of children with cancer regarding the adherence of nurses to ethical codes. Research design: In this descriptive-comparative study, a researcher-made questionnaire was used to assess the amount of adherence to Iranian nurses’ code of ethics in perspectives of pediatric oncology nurses and mothers. As (...) a convention, the total scores were categorized as optimal, average, and low adherence. Participants and context: A total of 200 mothers and 60 nurses in pediatric oncology wards of five major hospitals in Tehran, Iran, participated in 2016. Ethical considerations: Organizational approval by the university and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process. Findings: Results showed the mean score of the adherence to ethical codes by nurses, as per the nurses is 86.71 (12.57) and as per the mothers is 78.67 (16.09). The highest frequency for “Low adherence” and “Optimal adherence” to code of ethics by nurses were “Respect for individual autonomy and decision-making” (mothers, 72% and nurses, 70%) and “Commitment to confidentiality” (mothers, 64% and nurses, 74%), respectively. This revealed a significant difference between the responses of the nurses and the mothers (p = 0.001). Discussion: The results support the other studies in Iran about the difference between the perspectives of patients and nurses about adherence of nurses to ethical codes. Conclusion: Integration of family-centered and conventional care in addition to more attention to the education of professional ethical principles could be helpful to improve the ethical performance of nurses in oncology pediatric wards. (shrink)

Medical ethics is an applied branch of ethics that addresses the moral issues and challenges encountered in clinical practice. Medical ethics should be adhered to during clinical practice. Non-adherence to medical ethics may cause unnecessary burdens and consequences on patients, deterioration of health status, exposure to other health problems or diseases, unnecessary surgery, additional medical expenditure, psychological distress, bodily injury and death. Globally, adherence to medical ethics is not uniform, while in Ethiopia, there is limited information on (...) class='Hi'>adherence to medical ethics and its determinants. Therefore, this study aimed to assess the level of adherence to medical ethics and its determinants among medical doctors in Ethiopia. An institution-based cross-sectional study was conducted among 1,012 medical doctors from 01 August 2024 to 31 October 2024 in Ethiopia. A multistage sampling technique was applied to select the respondents. A structured self-administered questionnaire was used for data collection. Relevant descriptive statistics was done for all variables. Multivariable binary logistic regression analysis was used to identify factors significantly associated with adherence to medical ethics. The study revealed that only 588 (58.1%) medical doctors had good adherence to medical ethics. Year of medical ethics course (AOR: 1.77; 95% CI: 1.27, 2.46), integration of medical ethics course with clinical practice (AOR: 1.34; 95% CI: 1.08, 1.72), pre-service orientation on medical ethics (AOR: 1.60; 95% CI: 1.15, 2.23), in-service training on medical ethics (AOR: 1.44; 95% CI: 1.11, 1.89), institutional ethics committee (AOR: 1.54; 95% CI: 1.11, 2.13), clinical communication skills (AOR: 1.68; 95% CI: 1.08, 2.61), clinical leadership skills (AOR: 1.74; 95% CI: 1.07, 2.86), knowledge of medical ethics (AOR: 2.56; 95% CI: 1.72, 3.83), and attitude towards medical ethics (AOR: 10.38; 95% CI: 7.02, 15.33) were significantly associated with adherence to medical ethics. Adherence to medical ethics among medical doctors was low. Year of medical ethics course, integration of medical ethics course with clinical practice, pre-service orientation on medical ethics, in-service training on medical ethics, institutional ethics committee, clinical communication skills, clinical leadership skills, knowledge of medical ethics, and attitude towards medical ethics were significantly associated with adherence to medical ethics. Therefore, the implementation of various strategies and interventions is very important to improve adherence to medical ethics among medical doctors in Ethiopia. (shrink)

The relationship of Aristotle’s _Rhetoric_ with the new rhetorics of the 20th century remains an issue among contemporary theorists of argumentation. In the _New Rhetoric_, Chaim Perelman and Olbrechts-Tyteca seem to be discontent with the approaches some contemporary rhetoricians take to the purpose of rhetoric, advocating instead for what they term “adherence,” which awaits to be clarified or even reconceptualized in many ways. We will revisit this foundational term to the NRP from the perspectives of “persuasion,” “identification,” “judgment,” and (...) “modification.” These terms are taken to be most representative of the rhetorical theories in development, signifying the shift from a focus on the speaker’s intention to one on the audience’s reception. But we do not take these theories to be reducible to one term or another. By drawing upon Kenneth Burke’s concept of identification, we contend that wherever there is meaning, there is rhetoric, and wherever there is rhetoric, there is modification. Rhetoric modifies the changes of meaning in the audience’s cognitive environment. (shrink)

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect (...) of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable. (shrink)

Patients with psychosis often have poor insight into their illness. Poor insight into illness is, at least among patients with psychosis, a good predictor of treatment non-adherence. This is no mystery, for as Xavier Amador asks, "Who would want to take medicine for an illness they did not believe they had?" What is curious is that some patients with psychosis do adhere to treatment despite a lack of insight. Why do these patients adhere to treatment, given that they do (...) not believe they are ill to begin with? In this paper, I attempt to answer this question. I do so by first considering cases of non-psychotic patients who adhere to treatment despite a lack of insight. I point out that these sorts of cases are commonplace, and attempt to explain why they arise. The explanation is given in terms of anticipated treatment benefits. However, these benefits are not conceptualized by the patient in terms of pathology. The patient does not, in other words, think of such benefits in terms of illness, symptoms, treatment, and so forth. I then argue that the proposed explanation can be extended to account for why psychotic patients without insight sometimes adhere to treatment. I conclude by drawing out some of the practical implications of the proposed view. I first argue, on practical as well as ethical grounds, that improving insight for purposes of treatment adherence is misguided. I then suggest that such adherence might be increased simply by explaining treatment benefits in language that does not presuppose that the patient is, in any sense, "ill," "diseased," "sick," "unwell," and so on. (shrink)

This chapter asks whether the members of Group O (see chapter 11) have individual reasons to contribute to the group’s efforts by adhering in at least some suboptimal-result cases. It is argued that if enough of them are actually contributing, then they all have moral reasons to contribute in order to avoid riding free on one another. If too few of them are contributing, however, then the case for contributing becomes more difficult to make. Three possible moral principles are suggested, (...) any one of which would support contributing under conditions of general defection. If one of them is true, then it can be argued that judges have reasons to adhere in at least some suboptimal-result cases, even when most other judges are deviating too frequently. This discussion culminates in the defense of individual policy, which specifies permissible deviation rates for judges based in part on how often other judges deviate. The chapter concludes that we must choose between (1) denying that judges must obey restrictive rule, because we have found no sound argument for that conclusion, and (2) accepting as a foundational principle, requiring no argument, that judges must obey restrictive rule. (shrink)

This chapter poses five questions. First, are adherence rules serious rules or pseudorules? Second, what reasons do various adherence rules provide to judges? Third, what reasons do various adherence rules exclude from consideration? Fourth, which adherence rules, if any, do lawmakers have reasons to promulgate and why? Fifth, how should judges take adherence rules into account in their decisions? The function of adherence rules is analyzed in light of discussions by Joseph Raz and Frederick (...) Schauer. The chapter distinguishes between permissive, moderate, and restrictive adherence rules. Various arguments for promulgating adherence rules are discussed, including arguments from formal legality, settlement, predictability, stability, error, efficiency, coordination, reliance, legitimacy, autonomy, respect, and fairness. The chapter concludes that there are good reasons to promulgate a restrictive rule. (shrink)

It is well known in the usûl al-fiqh (fundamental principles of Islamic law) that the Mukallaf (accountable person) is either a Mujtahid or a Muqallid. Mujtahid is a title given to the Islamic jurist who has the ability to arrive at rulings; thus, he is required to practice Ijtihad. While Muqallid is the person who has no ability to conduct such activities; thus, he is required to follow the Mujtahids. Taqlid (conformity of one person to the ijtihad of another) of (...) the four Imams has been common among Muslims since the fourth century of the hijri, their madhhabs including its origins and branches have been well established, and many scholars and laypersons have followed them since that era till the time being. The second considers that restricting imitation (Taqlid) to these schools of thought has caused the stagnation of Islamic jurisprudence and its inability to keep pace with the times. The research dealt with these two points of view and followed the method of comparison and analysis. The two points of view on the issue were presented and discussed, and then the implications in contemporary reality were explained. The research used books written in the science of jurisprudence in general and in the section of Juristic Interpretation and Imitation in particular, in addition to books written in the history of jurisprudence. The research reached several results, most notably are as follow: 1) the need to adhere to the four schools of thought (Madhhabs) in all actions and fatwas and not to depart from them except for necessity and need, 2) these Madhhabs represent the jurisprudential identity of the Sunnis group, it should not be underestimated, and that it is sufficient to meet most of the needs of the age. It is not correct to describe the commitment to it as inertia. The call for liberation from the jurisdiction of the four schools of thought resulted in corruption, the most important of which is the lack of discipline in fatwas and providing fatwas with abnormal sayings. (shrink)

Introduction: The actions taken by the government to deal with the consequences of the coronavirus diseases 2019 pandemic caused different levels of restriction on the mobility of the population. The need to continue offering physical exercise to individuals after stroke became an emergency. However, these individuals may have barriers to adhere to the programs delivered remotely. There is a lack of evidence related to adherence, attendance, safety, and satisfaction of remote exercise programs for this population.Objective: The aim was to (...) evaluate adherence and barriers to attend a remote physical exercise program for individuals after stroke. We aimed to identify adherence and attendance rate of the remote physical exercise program ; to identify the safety of a remote physical exercise program ; and to identify the overall experience to participate in a remote program.Materials and methods: This is a longitudinal study, including 36 stroke survivors who already attended a face-to-face physical exercise program prior to the COVID-19 pandemic. The remote physical exercise program included sessions for 2 days/week for a duration of 22 weeks, with a total of 44 sessions, which were delivered asynchrony via recorded video sessions. As outcome measures, we performed two questionnaires to identify attendance, barriers, safety, and overall experience related to the program.Results: The adherence rate was 86. The attendance rate was 19, with a total of 8 sessions. The main barriers for lower attendance rate were as follows: lack of motor skills and physical fitness to workout in 80 reports, followed by no exercise companion in 44 reports. The remote physical program has been shown to be safe, and the overall experience was positive from the perspectives of the participants and the family members.Conclusion: Although the adherence rate was high, the attendance rate was low on the remote physical exercise program. The main barriers to attending the program remotely reflect the need of tailoring individually an asynchrony mode of delivering the sessions to individuals after stroke. Our results also indicate how the COVID-19 impacted the health conditions of stroke survivors. The program was safe, and the overall experience indicated a change in the mental, physical, and social health of individuals after stroke and their family members. (shrink)

Background: A large number of nurse researchers do not adhere to ethical standards while performing the research. Moreover, there is far less data on knowledge of existing national ethical guidelines. This study was, therefore, done to assess awareness and adherence to current national ethical guidelines among nursing students and faculty members. Methods: A cross-sectional descriptive study was done among nursing faculty members and theses carried out by postgraduate nursing students between 2012 and 2017. Using the convenience sampling technique, seven (...) states of North India were selected. In each of the selected seven states, one government and one private nursing college was selected. Thus, a sample of 14 nursing colleges was selected. Then, using simple random sampling, a total of 140 nursing faculty members and 280 postgraduate nursing theses were selected from all the chosen institutes to be part of the study. Data analysis was done using descriptive statistics. Ethical considerations: The study has been approved by the institutional ethical committee (ECR/737/Inst/UK/2018/RR-18). In addition, written permission from the head of each nursing institute was obtained before conducting the study. After participants read the Participation Information Sheet, they were asked for written informed consent before data collection. Confidentiality of the information and anonymity of the participants were maintained throughout the study. Results: The majority (81.8%) of the participants were females. It was found that compared to private nurses, government college nurses were more adhered to the research guidelines on research project approval (68.6% vs 22.1%), informed consent guidelines (74.3% vs 25%), providing patient information sheets (55.7% vs 10%), maintaining information confidentiality (82.9% vs 72.1%), maintaining anonymity (76.4% vs 22.9%) and obtaining custodian permission (97.8 vs 89.3%). It was also shown that nurses were more aware of the informed consent process domain (4.3 ± 0.3) followed by the general ethical principles domain (3.8 ± 0.8). Conclusion: Government college nurses adhered more to the research guidelines as compared to those employed in private settings. Most of the faculty members were not part of any clinical trials and had no research ethics training at all. Therefore, it is needed to provide an instructional programme to raise awareness of the research ethical standards. (shrink)

The question addressed in this chapter is whether judges have reasons to obey adherence rules. Contrasts are drawn between conduct rules promulgated by rule makers, guidance rules followed by rule subjects, appraisal rules used for evaluating the conduct of rule subjects, and decision rules used by adjudicators. After concluding that judges have excellent _pro tanto_ moral reasons to obey at least permissive rule, the chapter asks whether they have moral reasons to obey restrictive rule. It is concluded that the (...) arguments for promulgating restrictive rule do not support obeying it in suboptimal-result cases. Neither do consequentialist arguments, contractualist arguments, or arguments from separation of powers. In fact, these arguments fail to support a moral duty to obey anything stronger than permissive rule. (shrink)

Taking the medicines as prescribed and continuing the prescription regimen as advised is defined as “medication adherence”. Nonadherence is a significant hurdle to improve patient health outcomes and also has negative repercussions on the healthcare systems, clinicians and other stakeholders involved in healthcare. Estimating the magnitude of medication nonadherence is a crucial step to improve adherence. Though there are many measures, none of them can completely capture nonadherence in its entirety because of inherent drawbacks of each measure. While (...) ‘subjective’ measures help to understand the barriers to adherence, ‘objective’ measures can provide a precise measure of patient’s medication-taking behaviour. Hence, a multi-measure approach is currently recommended to provide a better measure of nonadherence. (shrink)

Poor adherence to medication is a persistent problem in the practice of medicine, which gives rise to problems for individual patients, for the healthcare system as a whole, and in some cases, for third parties and for public health. There has been some progress in understanding the causes and solutions but much more work needs to be done. To develop the ethical responses to adherence, the problems need to be analysed more precisely. It is argued that, given that (...) one pressing concern is whether poorly adherent patients are being unfairly blamed or stigmatised, it is necessary to pay attention not just to the content of claims about adherence, but to the rhetoric of how these are presented. A necessity-concerns framework does much to advance understanding and ethics but may have certain pitfalls, and an approach based on micro-economic modelling may help to refine understandings of the position of the patient. It is also argued that a more sophisticated understanding of the ethical issues will be gained by recognising two problems: first, poor adherence to medications per se; second, poor knowledge about adherence to medications. These are related, but give rise to distinct ethical concerns. (shrink)

To be considered a candidate for transplant, patients with advanced kidney disease must demonstrate their ability to adhere to medical recommendations. An adherence criterion is intended to ensure effective use of deceased donor kidneys by selecting candidates who are able to engage in complicated post-transplant clinical care. However, evidence that pre-transplant assessment of adherence predicts meaningful post-transplant outcomes is equivocal. Further, this criterion risks exacerbating existing inequities in access to transplant and rigid definitions of what constitutes adherent behavior (...) may impede opportunities to tailor treatment plans to individual preferences and circumstances. It is also unclear that an adherence criterion supports ethical standards for a fair process of resource allocation including transparency, relevance to affected groups, regulation, and opportunity for revision. We offer several strategies to revise the current approach to evaluating transplant candidates for adherence to better align with ethical principles guiding allocation of a scarce societal resource. (shrink)

BackgroundPatients with COVID-19 may feel under pressure to participate in research during the pandemic. Safeguards to protect research participants include ethical guidelines [e.g. Declaration of Helsinki and good clinical practice (GCP)], legislation to protect participants’ privacy, research ethics committees (RECs) and informed consent. The International Committee of Medical Journal Editors (ICMJE) advises researchers to document compliance with these safeguards. Adherence to publication guidelines has been suboptimal in other specialty fields. The aim of this rapid review was to determine whether (...) COVID-19 human research publications report compliance with these ethical safeguards.MethodsA rapid systematic literature review was conducted in MEDLINE using the search term ‘COVID-19’. The search was performed in April 2020 with no start date and repeated to include articles published in November 2020. Filters were ‘Full free text available’ and ‘English Language’. Two reviewers assessed article title, abstracts and full texts. Non-COVID-19 articles and non-clinical studies were excluded. Independent reviewers conducted a second assessment of a random 20% of articles. The outcomes included reporting of compliance with the Declaration of Helsinki and GCP, REC approval, informed consent and participant privacy.ResultsThe searches yielded 1275 and 1942 articles of which 247 and 717 were deemed eligible, from the April search and November respectively. The majority of journals had editorial policies which purported to comply with ICMJE ethical standards. Reporting of compliance with ethical guidelines was low across all study types but was higher in the November search for case series and observational studies. Reporting of informed consent for case studies and observational studies was higher in the November search, but similar for case series. Overall, participant confidentiality was maintained but some case studies included a combination of details which would have enabled participant identification. Reporting of REC approval was higher in the November search for observational studies.ConclusionsWhile the majority of journal’s editorial policies purported to support the ethical safeguards, many COVID-19 clinical research publications identified in this rapid review lacked documentation of these important safeguards for research participants. In order to promote public trust, ethical declarations should be included consistently. (shrink)

Sartre's recollection, in Les Mots , of his first visit to the cinema is a multi-layered and ambivalent text through which Sartre proposes a number of interlocking arguments: concerning the contrast between the 'sacred' space of the theatre and the non-ceremonial space of the cinema, between the theatre as associated with paternal authority, and the cinema as associated with a clandestine bond with the mother. But the text also sets up a quasi-sociological account of the public Sartre encounters in the (...) cinema itself as revealing to him the truth of the social bond, a truth he expresses with the term 'adherence', and which he says he only rediscovered in his experience of being a prisoner in the Stalag in 1940. Rather than the basis of a sociological account of the social bond, which would seem at odds with Sartre's social philosophy, I read this as the expression of a desire for physical proximity. The space of the cinema thus develops a fantasy, and this is in continuity with the role of the cinema in the evolution traced in Les Mots , in which it is described as instigating a withdrawal into imaginary life and an indulgence in daydreaming. Through reference to Christian Metz and to Roland Barthes, whose essay 'En sortant du cinéma' is proposed as a parallel and a response to Sartre, I suggest that the 'true bond' of adherence which Sartre encounters is an unconscious rather than an epistemological truth. (shrink)

This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had “ever experienced a blow to the head that caused a concussion,” and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample (...) had a concussion history, and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 ]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population. (shrink)

The mitigation of pandemics like that caused by the current COVID-19 virus is largely dependent on voluntary public adherence to government rules and regulations. Recent research has identified various individual covariates that account for some of the variance in compliance with COVID-19 behavioral guidelines. However, despite considerable research, our understanding of how and why these factors are related to adherence behavior is limited. Additionally, it is less clear whether disease-transmitting behaviors during a pandemic can be understood in terms (...) of more general behavioral tendencies. The current research has examined the utility of a behavioral-failure lens in predicting adherence to COVID-19 guidelines and in illuminating mechanisms underlying the previously established relationship between Conscientiousness and adherence. In the two studies reported here, individual variations in the predisposition to behavioral failures predicted adherence to COVID-19 measures, and mediated the relationships between Conscientiousness and adherence. The Failure Proneness questionnaire predicted compliance with COVID-19 guidelines, while the Cognitive Failure Questionnaire did not. The results of hierarchical regressions showed that COVID-19 behavior was predicted only through the intentional factors. Hence, our data lend support to the notion that noncompliance with official COVID-19 prevention guidelines is driven mainly by intentional factors related to violation of norms and rules. The theoretical and practical implications of this finding are discussed. (shrink)

The low rates of regular exercise and overall physical activity (PA) in the general population represent a significant public health challenge. Previous research suggests that, for many people, exercise leads to a negative affective response and, in turn, reduced likelihood of future exercise. The purpose of this paper is to examine this exercise–affect–adherence relationship from an evolutionary perspective. Specifically, we argue that low rates of physical exercise in the general population are a function of the evolved human tendency to (...) avoid unnecessary physical exertion. This innate tendency evolved because it allowed our evolutionary ancestors to conserve energy for physical activities that had immediate adaptive utility such as pursuing prey, escaping predators, and engaging in social and reproductive behaviors. The commonly observed negative affective response to exercise is an evolved proximate psychological mechanism through which humans avoid unnecessary energy expenditure. The fact that the human tendencies toward negative affective response to and avoidance of unnecessary physical activities are innate does not mean that they are unchangeable. Indeed, it is only because of human-engineered changes in our environmental conditions (i.e., it is no longer necessary for us to work for our food) that our predisposition to avoid unnecessary physical exertion has become a liability. Thus, it is well within our capabilities to reengineer our environments to once again make PA necessary or, at least, to serve an immediate functional purpose. We propose a two-pronged approach to PA promotion based on this evolutionary functional perspective: first, to promote exercise and other physical activities that are perceived to have an immediate purpose, and second, to instill greater perceived purpose for a wider range of physical activities. We posit that these strategies are more likely to result in more positive (or less negative) affective responses to exercise, better adherence to exercise programs, and higher rates of overall PA. (shrink)

Failure to follow prescribed treatment has devastating consequences for those who are seriously and persistently mentally ill. Nurses, therefore, try to get clients to take psychotropic medication on a long-term basis. The goal is either compliance or adherence. Although current nursing literature has abandoned the term compliance because of its implications of coercion, in psychiatric nursing practice with patients suffering from serious long-term mental illness compliance and adherence are in fact different goals. The ideal goal is adherence, (...) which requires the patient to be an active participant in the team. This goal is consistent with nurses’ ethical values, but for such patients this is frequently unrealistic. If the person is severely psychotic, treatment may be involuntary and the goal compliance. Psychiatric nurses participate in involuntary treatment and thus should acknowledge the ethical implications of compliance as a goal and not obscure the issue by calling compliance adherence. (shrink)

Much literature surrounding medical technology and adherence posits that technology is a mechanism for social control. This assumes that the medical establishment can take away patients' agency. Although power relationships and social control can play a key role, medical technology can also serve as an agentive tool to be utilized. We (1) offer the alternative framework of Actor Network Theory to view medical technology, (2) discuss the literature on medication adherence and technology, (3) delve into the ramifications of (...) looking at adherence as a network and (4) use Digital Pills as a case study of dispersed agency. (shrink)

The Medication Event Monitoring System (MEMS) is a relatively new device designed to overcome some of the disadvantages of traditional adherence-measuring techniques. MEMS has also been found useful in tracking adherence behaviour without the need to visit patients frequently. In this study each patient was given a pre-filled, labelled MEMS bottle and cap. Patients were monitored for 24 weeks. For patients specifically studied, there were periods when drug levels may have been low and some exhibited erratic medication-taking behaviour. (...) It is concluded that MEMS can measure adherence behaviour objectively, and so might be used to improve prescribing decisions, identify drug wastage and improve carer support. Further research is needed before the routine use of electronic medication monitoring can be recommended. (shrink)

Background Professional ethics is the regulation and discipline of nurses’ daily nursing work. Nurses often encounter various ethical challenges and problems in their clinical work, but there are few studies on nurses' adherence to professional ethics. Research Aim An analysis of nursing adherence to nursing ethics from the perspective of clinical nurses in the Chinese public health system. Research Design This study adopts the grounded theory approach proposed by Strauss and Corbin. Participants and research context Between July 2021 (...) and January 2022, Clinical nurses were recruited for online video interviews using purposive and theoretical sampling methods in seven hospitals in Beijing, Tianjin, Shanxi, Henan, Guangdong, and Fujian, China. Data analysis was conducted using Strauss and Corbin’s coding approach. Ethical considerations This study was approved by the Ethics Committee of Sanming First Hospital (MingYiLun 71/2021) Findings A total of 27 participants were included. A theoretical model of nursing staff adherence to professional ethics was constructed. The main core was adherence to professional ethics and the other cores were (1) causal conditions: professional ethics code, individual conscience; (2) intervening conditions: personal growth, social support system, matching career compensation, prediction of adverse consequences; (3) action strategies: sticking to professional values, self-regulation, flexible response, post-event improvement; and (4) outcomes: self-harmony, reduced medical disputes. Conclusions This study provides an interpretive understanding of why clinical nurses adhere to professional ethics in China and describes the challenges and issues posed by nurses’ use of strategies to cope with ethical adversity. The findings can be used to develop future complex studies. (shrink)

When Keats identified truth and beauty, he surely intended mere extensionality. I myself have never had much trouble with either half of the equivalence. Others have considerable difficulty. A case in point is the Watson-Allaire-Cummins interpretation of Berkeley's idealism, which I shall refer to henceforth as the inherence account. That account is put forward to answer an extremely perplexing question in the history of philosophy: Why did Berkeley embrace idealism, i.e., why did he hold that esse est percipi, that to (...) be is to be perceived, indeed that what is perceived must be perceived in order to exist? In essence, the IA answers these questions very simply and elegantly: perceived qualities are, for Berkeley, qualities of the mind in the same sense that, in the tradition of substance metaphysics, blue is a quality of a blue flower; just as the blue of the flower is inseparable from it, so the perceived blue is inseparable from the mind that perceives it. (shrink)

Many studies have used ideas from phenomenological philosophy to explore health and health care, yet topics related to public health have often been overlooked. We argue that at least one crucial issue in public health—the question of adherence (or lack thereof) to preventive health measures—can benefit from a phenomenological perspective. While numerous studies have examined the factors influencing adherence, none have addressed the role that embodiment plays in shaping adherence. Building on existing phenomenological research on adherence, (...) we demonstrate that phenomenology can offer a novel, embodied perspective on this issue. This article draws on data from our phenomenologically grounded empirical study on COVID-19 vaccine hesitancy, which involved 16 in-depth interviews with individuals reluctant to receive the COVID-19 vaccine. However, the aim of this article is not to present the specific findings about vaccine hesitancy. Instead, referring to both theoretical research within phenomenological tradition and interview data, we seek to generate new insights into the motivational orientation toward preventive health measures more broadly. We demonstrate that adherence to a preventive measure depends on the type of bodily objectification involved—whether it is good or bad objectification. Good objectification involves a focus on one’s body that is compatible with one’s subjectivity, whereas bad objectification involves a focus on one’s body that disrupts subjectivity. We conclude that from an embodied perspective, nonadherence is grounded in a person’s wish to avoid the disruption of her subjectivity. By recognizing the role that our embodied being in-the-world plays in our willingness or unwillingness to comply with preventive measures, this study offers a deeper understanding of the embodied motivation behind adherence and provides insights for both developing strategies to enhance adherence to preventive health measures and new directions for future phenomenological research in relation to public health. (shrink)

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative and narrative) and argues that determining the specific aspect of autonomy affected is the first step towards protecting or promoting (and respecting) patient autonomy. These different manifestations of (...) autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people’s capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence (where adherence is defined as being the extent to which a patient’s behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive and narrative capacities and taking appropriate action based on the results may help increase adherence rates. (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support (...) the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

We develop a theory of compliance with corporate governance codes by combining insights from agency, network and reputation theories. Subsequently, we test this theory using a unique dataset with fine-grained compliance information for the book year 2004 as to 130 Dutch stock-listed corporations. We find partial support for our theory.

Probably nothing is more complicated, misunderstood, and thus damaged, in a way of speaking, than the viewpoint of "one divides into two" when criticism is being made of the various fallacies spread by Lin Biao and the "gang of four." Some people hold that Lin and the gang's activities to split the Party and their philosophy of making others suffer were related to this viewpoint and thus conclude that this viewpoint is one-sided. Others are of the opinion that this viewpoint (...) constitutes the philosophical base for the ultra-Left line. Such ideas circulate even among a part of the philosophy researchers. It is necessary to repudiate the gang's distorted and subjective explanation and application of the viewpoint "one divides into two"; so is the exposure of a certain simplistic tendency in our previous propaganda work. However, it is inappropriate to view the distortion and simplification as something inherent in the proposition that "one divides into two." After all, is such a proposition scientific or not? Should it be seen as a "mistake" or a "heresy" that ought to be taken out from Marxism-Leninism and Mao Zedong Thought? This, of course, is an issue of theoretical principle and must be clarified through discussion. (shrink)