Evolutionary ethics: can values change

Understanding Associations of Personal Values With Support for Tobacco and Alcohol Control Policies

INTRODUCTION

This cross-sectional analysis of the 2020 Health Information National Trends Survey (N=3,604) examines the associations of personal values with tobacco and alcohol control policy support, which may inform policy-related communication efforts.

METHODS

Respondents selected which of 7 value options they considered most important in their daily life and rated their support for 8 proposed tobacco and alcohol control policies (1=strongly oppose, 5=strongly support). Weighted proportions for each value were described across sociodemographic characteristics, smoking status, and alcohol use. Weighted bivariate and multivariable regressions tested the associations of values with mean policy support (alpha=0.89). Analyses occurred from 2021 to 2022.

RESULTS

The most frequently selected values were assuring my family is safe and secure (30.2%), being happy (21.1%), and making my own decisions (13.6%). Selected values varied across sociodemographic and behavioral characteristics. For example, people with lower education and incomes were overrepresented among those selecting making my own decisions and keeping myself in good health. After adjusting for sociodemographics, smoking, and alcohol use, people selecting family safety (β=0.20, 95% CI=0.06, 0.33) or religious connection (β=0.34, 95% CI=0.14, 0.54) as most important reported higher policy support than those selecting making their own decisions, the value associated with the lowest mean policy support. Mean policy support did not significantly differ across any other value comparisons.

CONCLUSIONS

Personal values are associated with support for alcohol and tobacco control policies, with making my own decisions associated with the lowest policy support. Future research and communication efforts may consider aligning tobacco and alcohol control policies with the idea of supporting autonomy.

Ratings of the reasons for and against the disclosure of an Alzheimer's disease diagnosis: has anything changed in the past 20 years?

OBJECTIVES

The disclosure of an Alzheimer's disease diagnosis poses challenges for health care professionals, patients, and their families. Past research has shown that people favour disclosure, but it is uncertain if this situation has changed.

METHOD

We used a cross-sectional online survey to explore disclosure preferences in a sample of young adults (n = 229; 66.7% aged 18 - 25 years, 79.5% Australian born). Factors contributing to preferences were also examined (knowledge, experience, close experience, age, relationship to diagnosis recipient). Established measures were used to assess knowledge (the Alzheimer's Disease Knowledge Test) and preferences (the Reasons for Wanting to Know Questionnaire).

RESULTS

Most (95%) but not all participants favoured disclosure, whilst recognising as important at least one reason against it. Only age was a significant determinant of preferences (older people were more likely to prefer disclosure). Those against disclosure cited the fear of suicide as a key reason.

CONCLUSION

The right to know remains a primary reason for preferring disclosure. Health care professionals should use pre-diagnostic interviewing to discuss overall preference and the underpinning reasons both for and against disclosure. Focus should be on developing a person-centred approach that responds to concerns, with further research to evaluate this approach.

Understanding Technology-Induced Value Change: a Pragmatist Proposal

We propose a pragmatist account of value change that helps to understand how and why values sometimes change due to technological developments. Inspired by John Dewey’s writings on value, we propose to understand values as evaluative devices that carry over from earlier experiences and that are to some extent shared in society. We discuss the various functions that values fulfil in moral inquiry and propose a conceptual framework that helps to understand value change as the interaction between three manifestations of value distinguished by Dewey, i.e., “immediate value,” “values as the result of inquiry” and “generalized values.” We show how this framework helps to distinguish three types of value change: value dynamism, value adaptation, and value emergence, and we illustrate these with examples from the domain of technology. We argue that our account helps to better understand how technology may induce value change, namely through the creation of what Dewey calls indeterminate situations, and we show how our account can integrate several insights on (techno)moral change offered by other authors.

Organisational values of National Health Service trusts in England: semantic analysis and relation to performance indicators

Background

Organisational values are widely assumed to have positive effects on performance and staff. National Health Service (NHS) trusts in England have accordingly chosen their own organisational values. However, there has been no survey of the values adopted, and there is little evidence that the choice of values per se has consequences for outcomes. We comprehensively described trusts’ organisational values, using natural language processing to identify common themes. We tested whether the choice of themes was associated with outcomes for patients and staff.

Methods

We collected data on trusts’ values (from their websites), performance (Summary Hospital-level Mortality Indicator (SHMI) statistics, Care Quality Commission (CQC) ratings), sickness absence rates (SAR) and staff opinions (NHS Staff Survey responses). We first characterised values based on lexical properties then progressed to semantic analysis, using Google’s Universal Sentence Encoder, to transform values to high-dimensional embeddings, and k-means clustering of embeddings to semantically cluster values into 12 common themes. We tested for associations between trusts’ use of these themes and outcomes.

Results

Organisational values were obtained for 221 of 228 NHS trusts, with 985 values in total (480 unique). Semantic clustering identified themes including ‘care’, ‘value respect’ and ‘togetherness’. There was no significant association between themes and SHMI or CQC ratings. However, themes predicted trusts’ SAR (p=0.001, R2=0.159), with use of ‘care’, ‘value respect’, ‘aspirational’ and ‘people’ all significant predictors of increased sickness absence; themes also predicted staff opinions on ‘Equality, diversity and inclusion’ (p=0.011, R2=0.116), but with ‘supportive’ and ‘openness’ predicting more negative responses.

Conclusion

A trust’s adoption of individualised organisational values does not seem to make a positive difference to its patients or staff. These findings should give NHS managers pause for thought, challenging them to reconsider their reliance on value-defining initiatives, and to seek evidence that a focus on values has measurable benefits on outcomes.

Ethical care during COVID-19 for care home residents with dementia

The COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a set of salient ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood - of residents and staff - are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued.

Professional Values: Results of a Scoping Review and Preliminary Canadian Survey

Purpose : Physiotherapists in Canada do not have an agreed-on list of core professional values. The purpose of this study was to identify physiotherapy values using a scoping review and to preliminarily identify the core professional values important to Canadian physiotherapists. Method: We undertook (1) a comprehensive scoping review of the primary and grey literature and (2) a cross-sectional survey of Canadian physiotherapists attending the 2016 Canadian Physiotherapy Association Congress. We conducted Ovid MEDLINE, Ovid EMBASE, and CINAHL database and Internet searches to identify peer-reviewed and grey literature. Survey participants were asked to list two professional values that guided their practice. Thematic and content analyses were used to analyze the results of both activities. We combined the results of the scoping review and the survey. Results : A total of 23 Web sites and 11 primary articles were retained from the search; 88 physiotherapists participated in the survey. A final list of 10 professional values (accountability, advocacy, altruism, compassion and caring, equity, excellence, integrity, patient and client centred, respect, and social responsibility) was drawn up after analyzing the scoping review and survey. Conclusions: This study describes the first steps in the process of identifying a set of core professional values for Canadian physiotherapists. Although many of values identified in this survey aligned with values published in the literature, some were unique, and further investigation is required.

Ethical issues in deriving stem cells from embryos and eggs

Human embryonic stem cell (ESC) research has attracted wide media coverage. It has been headline news for the past several months, revealing the complex case of Professor Hwang Woo-Suk and the scientific fraud where he purported to have created the first human patient-specific stem cell lines generated by cell nucleus replacement (CNR). To ethically obtain the raw materials (eggs, sperm and embryos) for human ESC research is an enormous challenge, yet essential if this research is to proceed in its quest to try to deliver some of the expectations placed upon it: developing treatments and possible cures for a range of serious diseases. This article examines some of the ethical issues surrounding human ESC research using the four principles frequently applied to healthcare and medical research; autonomy, beneficence, non-maleficence and justice. The author strives to ask questions throughout which will encourage debate and discussion.