ABSTRACT. The Ethics of Physician Non-Compete Clauses

In the medical profession, the use of non-compete agreements in employment contracts is becoming increasingly common. At the same time, the number of physicians choosing to open independent single-physician practices has steadily decreased. Much has been written about non-competition agreements from a legal perspective: generally physicians are warned to wary of entering into such contracts and are encouraged to negotiate limits. Yet, in practice, this advice is hard to follow. As medical organizations grow in size and scope, employment contracts tend to become more universal, leaving little to no room to negotiate the terms of the non-compete agreement. As more medical practices turn to non-compete agreements as a method for ensuring a physician's inability to set up a competing practice, many physicians find that their ability to avoid non-competes is negligible at best.

Although much has been written about physician non-competes from the business and legal perspectives, little has been written from the perspective of ethics. Our paper seeks to change this. Using the WMA Declaration of Geneva as a starting point and the four principles of medical ethics, we explore non-competes and their impact on clinics, communities, patients, and members of the medical profession. As a result of this examination we uncover three key assumptions motivating a medical organization's use of non-compete agreements. But a careful examination of these assumptions exposes their flaws. Once these assumptions are exposed as erroneous, the principles of beneficence, non-maleficence, autonomy, and justice can be used to demonstrate that widespread use of non-compete agreements is not only detrimental to physician and patient autonomy, but also to patient and community health care. Yet these stakeholders have no voice in the use of non-competes and little recourse once they have been implemented. Despite this, few states prohibit physician non-competes. We conclude by urging medical professions to voice substantial opposition to the use of non-compete clauses in their codes of ethics and we further urge all stakeholders including clinics and hospitals to carefully consider the ethical and medical implications of non-compete agreements instead of prioritizing legal and financial considerations.

ABSTRACT. This paper is motivated by the Hippocratic Paradox and associated hard cases that have been heard by the U.S. Supreme Court. The Hippocratic Paradox refers to ethical dilemmas caused by the conflict of some of the four principles in medical ethics: nonmaleficence, beneficence, autonomy, and justice. Studies in medicine, law, sociology, and philosophy have contributed considerable expertise and narrative insights on an ad hoc basis. This paper aims to discover general patterns. It is the first mathematical analysis of the co-evolution of the three domains --- ethics, law, and society --- in the context of medicine. It makes several contributions. First, we establish a set of essential components for each of the three domains to understand issues that occur in each domain driven by underlying principles. Second, we apply a novel mathematical approach developed by Saari (2018) to capture the qualitative features of unquantifiable interactions among the three domains, and to predict unexpected outcomes including the existence, number, and nature of hidden equilibria. Third, we update predictions when outcomes switch from one state to another and identify the root causes --- variations in endogenous and exogenous parameters that change the weighing of underlying principles of each domain. Fourth, we compare updated predictions with observations in history to validate the theory development. Fifth, we discover the existence of equivalence classes in which seemingly different issues have similar features, and hence similar evolutions. Sixth, we conduct policy analyses, find undesired outcomes, and propose desired policies. In sum, we create a general theory to explain what has happened for existing cases in medical ethics and law, and to predict what probably will happen for new cases and what can be done. This research serves as a new tool to provide evidence-based predictions and to assist the ethical and legal aspects of health policy-making.

ABSTRACT. This analysis looks back to Isaac Asimov’s 1942 “Three Laws of Robotics” as its starting point for discussing artificial intelligence in machines. Embedded in Asimov’s laws is an important, but rarely stated, fact about examining the rules for the actions of AI enabled autonomous machines. AI enabled machines are created in a pre-existing moral universe and they are assumed, if not expected, to function according to the rules of that moral universe. If one examines Asimov’s rules, this becomes obvious. Asimov’s rules assume a moral universe in which human beings matter and where AI (a robot) functioning in that universe is obligated to act in a manner consistent with that assumption by not harming human beings.

As a result, the greatest concern, therefore, is not necessarily what are the rules for AI, but really a series of actions within a pre-given set of rules. This presentation emerges out of an ongoing project on developing procedures for the ethical use of drones by a police department and how appropriately to embed AI within those drones. This project is well-suited to this analysis because the use of drones in that environment comes preset with rules and norms. First, there are the laws about drone use, understanding laws as being either legislatively enacted statements of a moral universe’s high value norms designed to further a norm’s realization or forbid an act violating it. Additionally, it encompasses the legal and professional rules of police work. An AI enabled drone in this environment, has the rules, the ethics if you will given to it. The ethical challenges, therefore, are not the rules but decisions regarding the rules and the intersection between the machine’s technical capacity and the rules.

This presentation focuses on the following in light of the specific facts involving the previously mentioned police drone project with the goal of illuminating ways to think about ethical action in AI enabled machines.

Technical limitations preventing ethically optimal action Rule/principle selection Rule/principle application Rule/principle negation Rule/principle absolutism Communication of what and how the AI is learning

ABSTRACT. This analysis will discuss the ethical and social issues with MQ-9 drone program. Of particular interest is the degree to which Artificial Intelligence can be employed to make the MQ-9 autonomous. The analysis will be divided into three sections. The first will be to explain the technical capabilities of the MQ-9 drones researching the barriers that need to be overcome to make them autonomous and will then move on to discuss strategies for how to overcome them. The second section will deal with the ethical and social issues in regards to the drones and the drone program. The third and final section will develop recommendations as to how to go about rectifying the ethical and social issues with the MQ-9 with artificial intelligence. The recommendations developed as a result of the conclusions reached in this analysis involve reviewing what AI conjoined with the MQ-9 must accomplish to make the MQ-9 autonomous. There should an official global and bipartisan set of rules and guidelines put together to clearly define how, when, where, and under what circumstances a drone strike can be executed. In addition, all branches of the military should have policies in place on effective ways to reduce the stress on the drone operators. In order to discuss the military’s drone program, it is helpful to focus on the use of a single drone, the MQ-9 Reaper. The Reaper will serve as an example of the evolution of the drone program’s development. Through the discussion of the MQ-9 progress can be made towards developing an autonomous drone, the technical and ethical issues will be understood, and recommendations can be developed to attempt to alleviate these problems. UAVs (Aerial Robots) have changed the nature of warfare and this case study will inform the audience of ethical issues related to the MQ 9 "Reaper" UAV. This analysis researches the obstacles that must be overcome in the area of AI to make the MQ-9 autonomous.

ABSTRACT. New assistive technologies have the potential to aid human caregivers to assist, monitor, and offer companionship to vulnerable individuals. More specifically, carebots, understood as social robots that assist human caregivers attending to the sick, young, elderly, and vulnerable, are on the horizon of future caring practices. Carebots offer the prospect of massive therapeutic benefit to vulnerable individuals in need of care. They also present an opportunity to relieve the burdens of caregivers so that they may more selectively distribute their own caregiving skills and energies among persons in need of care. This can be envisioned as an opportunity to enhance caring with the assistance of carebots as a good and instrumentally beneficial tool to better equip caregivers to take part in caring activities. Technology may be designed and employed in such a way that caring values are upheld and possibly even improved. However, what if we were to delegate all of our caregiving skills and capacities to carebots? Would carebots support caregivers and sustain human caring practices, or might they replace human caregivers? What would be the ripple effects of either prospect for both care-receivers and care-givers? What does the act of caring look like in 21st century healthcare? Elderly care? Parenting? New technologies are changing how we care for others in a variety of caring contexts in ways that stimulate and worry the moral imagination. What do we gain if we shift our caring practices to carebots, that is, artificial non-human agents? What do we lose? In this presentation, the human-robot interaction is illustrated at the specific nexus of caring activities, where carebots assume the mantle of care-giver. It is through caring practices that we put our capacities for reciprocity and empathy to work. Through the power of image and narrative, this presentation assesses foreseen and potentially unforeseen consequences for delegating our caregiving practices to carebots. These implications are morally relevant, for while carebots can be programmed with various technical capacities, the jury is out as to whether they can make moral decisions.

ABSTRACT. Background: Bribery practices in sales are institutionalized in developing countries causing serious challenges for the smooth operations of multinational companies (MNCs). Therefore, bribery control is the primary concern for MNCs. Sales ethics and bribery in international business research largely focus on intra-organizational perspective. This perspective neglects the broader social context to understand and control bribery.

Objective: To investigate the social and emergent nature of bribery as an unethical practice in sales along with its control in developing country markets. This dissertation achieves its goal via four articles.

Theoretical and methodological framework: Research builds on multiple theoretical perspectives: practice-based view (PBV); neo-institutional theory; and industrial network theory. The study employs a qualitative approach to collect and analyze the data. The empirical data has been collected from the pharmaceutical industry in Pakistan.

Key findings: Article 1 systematically reviews the existing knowledge in sales ethics. It reveals the need to study unethical behavior from a social practice perspective. Consequently, article 1 introduces PBV and its applications in sales ethics. The second article empirically examines the evolution process of bribery in sales. Findings show that bribery practices socially evolve in a sequential and partly overlapping process of four identifiable stages: early development; chain reaction; legitimization; and revision. The third conceptual article introduces a practice-based strategic framework for MNCs to control bribery in developing countries. Finally, the fourth article empirically investigates the nature of the invisible pressure of institutionalized bribery and related practices of MNCs to respond. Findings indicate that MNCs closely monitor bribery practices of market actors to make sense of invisible pressure. Results further discover a range of MNCs practices to respond towards pressure.

Theoratical and practical Implications: Overall this dissertation shifts the focus of extant research from the dominated intra-organizational view to PBV that helps to understand the social and dynamic nature of corrupt practices and their control. Study opens new avenues for institutional work to understand the nature of invisible pressure arising from informal institutions and related organizational responses. The study further offers important implications for organizations and policymakers.

ABSTRACT. Motor impairment of the upper extremity is the most common deficit after stroke. Recovery from impairment relies on the learning of new, and relearning old, motor skills. While extensive rehabilitation efforts are made to recover motor function, the most substantial gains are seen ~3 months post-stroke when the brain has an enhanced capacity to be changed. Currently, the inability to harness this enhanced capacity is a major barrier to maximizing the benefits of stroke rehabilitation. It is known that the efficacy of therapy decreases as time post-stroke increases, yet we are unsure if and how motor learning is impacted. There is a critical need to improve our understanding because motor learning is essential for stroke patients’ motor recovery. My objective is to evaluate how the ability to learn motor skills changes depending on the time since stroke. We are also looking at neurophysiological markers that change temporally as well. To test our hypothesis, we will recruit patients 1 months and >6 months post-stroke and age-matched healthy controls. Each participant will complete a hand motor learning task and will have the excitability and connectivity of their brains measured. We will evaluate the changes in motor learning, excitability and connectivity depending on phase of recovery. By relating these outcomes to one another, we will determine if abnormal physiology caused by stroke is associated with impaired motor learning. Our long-term goal is to improve the effectiveness of rehabilitation by better understanding the time course of motor learning that rehabilitative therapeutic strategies rely on. Additionally, if our hypothesis is correct and the strength of brain excitability and connectivity are associated with improved learning, then this will provide us with a target for intervention. Currently, there are non-invasive neuromodulation tools to prime the output of the brain that could be capitalized on to potentially improve motor learning. It is our hope that improving the motor learning capacity will ultimately help us to build healthier lives potentially free from the motor impairments caused by stroke.

ABSTRACT. This project explores the ethicality of public administrators voluntarily refraining from disclosing additional information that could otherwise lead to a more informed citizenry. Existing literature has not addressed the ethical implications of such self-censorship. Through the use of the mundane FOIA request as a case study, Svara’s ethics triangle is employed to evaluate the act of self-censorship; revealing that, though permissible and possibly the norm, it is incongruent with administrative ethics and Frederickson’s virtuous citizen.

Public administrators are uniquely faced with duties to multiple masters — their political superiors, their profession, and most important, the public interest. As one of the leading voices in conceptualizing this obligation to the public interest, Frederickson notes that if government can be no better than the people it represents, then administration must strive to develop an enhanced notion of citizenship, thus incurring an obligation to nurturing an active and informed citizenry. This duty to foster an informed citizenry is ambiguous. What constitutes being sufficiently informed? Does it mean that administrators must provide countervailing arguments or share facts and data challenging their own assertions?

The current political discourse also poses a significant hurdle to achieving this goal. Richard Box, and others, note that we have entered a “regressive” or “post-truth” era, where belief trumps facts and values-based appeals prevail over empirical arguments. This has fostered a rise in conspiracy belief, fueled by a “bureauphobia” that presumes public servants are less competent than their private sector peers. In such an environment, it is difficult to fulfill Frederickson’s mandate.

Many also confuse transparency with being informed, but as Wendy Warner notes, comprehension asymmetries exist where citizens require great effort to process provided information, which leads to cognitive shortcuts such as motivated reasoning that confirms the pre-existing negative perceptions. Assuming the release of supplemental information is not compelled, self-censorship does not run afoul of law or regulation, and it would be a permissible exercise of the First Amendment right against compelled speech. We celebrate this exercise of speech rights, rightfully citing it as a quintessential civil liberty; however, the ethicality of such exercise is often not considered.

ABSTRACT. A spate of recent texts on administrative law have been highly critical of the growth of regulatory law issued by agencies of federal, state and local governments. The arguments of Philip Hamburger (Is Administrative Law Unlawful?), McGroarty, Robbins and Tuttle (Deconstructing the Administrative State) and Adrian Vermeule (Law’s Abnegation: From Law’s Empire to the Administrative State) provide detailed accounts of the encroachment of administrative regulations on the constitutionally sanctioned procedures of lawmaking by legislative bodies, declaring that these encroachments undermine democratic polity, among other nefarious effects. Provisionally assuming that such critiques are justified, how are the legal agents who create and apply the regulations of federal, state and local regulatory agencies to understand the ethical obligations associated with their professional roles? This paper will briefly examine the structure and function of administrative agencies, the laws and regulatory provisions such agencies promulgate, and the ethical mandates under which they operate. Following Alasdair MacIntyre, the question will be raised as to whether such agencies fit the model of a social practice, with internal goods inherent in the practices of administrative law, goods that accelerate the achievement of a virtuous professional character, a character then manifested by those who perform their duties on behalf of the administrative state.

ABSTRACT. The purpose of this panel is to explore current issues in the ethics of forgiveness. The topic of forgiveness is important for professional and applied ethics because of the pernicious and growing prevalence of anger and hate in our social and political discourse. Each panelist will be limited to fifteen minutes followed by audience questions. Paper 1: “When Refusing to Reconcile Amounts to Failing to Forgive.” Emotion-based views of forgiveness allow for the possibility that a victim forgive a wrongdoer while remaining closed to reconciliation. However, other views of forgiveness resist this possibility. Dr. Strabbing has argued that forgiving a wrongdoer just is being open to reconciling with her. Moreover, debt-cancelling views of forgiveness suggest that to forgive is to open oneself to reconciliation with the wrongdoer. This paper defends the emotion-based view of forgiveness against these competing views and attempts to account for what is attractive about such views, explaining why sometimes refusing to reconcile does amount to failing to forgive. Paper 2: “The Armenian Genocide and Forgiveness.” Armenians typically respond in either of two ways to our genocide narrative: (1) refuse to speak about the atrocities to anyone, because it’s too angering, dehumanizing, and painful to recall; or (2) rage loudly against the Turks and other world powers, because of their refusal to acknowledge the genocide of 1915-1918. But forgiveness and reconciliation comprise a third way. This paper shows how Martha Nussbaum's recent thought-provoking book Anger and Forgiveness (2016) presents a powerful argument that bears on the Armenian genocide narrative. Paper 3: “The Place of Anger in an Ethics of Love.” This chapter argues that anger is an understandable but often inappropriate response to wrongdoing, something better left to God than to his followers. Christian ethics is an ethics of love, and Christians are called to love their enemies. So, if anger is morally permissible in the Christian life, it must be compatible with or a means to loving others. In Anger and Forgiveness, Martha Nussbaum proposes a socially-constructive anger – called Transition Anger – which could help show how anger and love are compatible.

ABSTRACT. Exemplary scientists have a characteristic way of viewing the world and their work: their mindset and methods all aim at discovering truths about nature. In An Instinct for Truth, Robert Pennock explores this scientific mindset and argues that what Charles Darwin called “an instinct for truth, knowledge, and discovery” has a tacit moral structure—that it is important not only for scientific excellence and integrity but also for democracy and human flourishing. In an era of “post-truth,” the scientific drive to discover empirical truths has a special value.

Taking a virtue-theoretic perspective, Pennock explores curiosity, veracity, skepticism, humility to evidence, and other scientific virtues and vices. He explains that curiosity is the most distinctive element of the scientific character, by which other norms are shaped; discusses the passionate nature of scientific attentiveness; and calls for science education not only to teach scientific findings and methods but also to nurture the scientific mindset and its core values.

Drawing on historical sources as well as a sociological study of over a thousand scientists, Pennock’s philosophical account is grounded in values that scientists themselves recognize they should aspire to. Pennock argues that epistemic and ethical values are normatively interconnected, and that for science and society to flourish, we need not just a philosophy of science, but a philosophy of the scientist.

ABSTRACT. Many of us struggle with how to reckon, ethically or politically, with complex situations in which we are complicit. We are confronted with wicked problems such as participating in activities that produce global warming while wanting to stop it, benefiting from racism and colonialism but espousing antiracism, believing that food workers deserve dignity while eating foods produced using forced labour of various sorts, traveling to countries that oppress their citizens, and more. In this talk, I argue that relying on a conception of an individual moral willer, knower, and actor has foreclosed a significant part of our ethical capacities to respond to wicked problems, and offer a conception of relational ethics that will help us confront problems that are not resolvable individually but towards which we have responsibility.