The Oswald Clergy Burnout Scale: reliability, factor structure and preliminary application among Australian clergy

This study assesses the Oswald Clergy Burnout Scale (OCBI), the psychometric properties of which have not been previously described. Analysis of responses from a large number (N  = 3,012) of ministers in charge of Australian congregations showed that the scale’s internal reliability was satisfactory, and that the scale could be represented by two factors, identified, respectively, as the personal and social aspects of burnout. This structure was supported by confirmatory factor analysis. Several demographic and job-related variables that might relate to burnout were regressed on the total, personal and social factor scores. Age is the predominant (negative) predictor of burnout as measured by the total scale and the personal factor scores. All variables predict burnout as measured by the social factor. However, in all models, the predictor variables account for no more than 5% of the total variance. These findings suggest that demographic factors and working conditions are poor predictors of burnout among clergy

Federalism and the Right to Travel: Medical Aid in Dying and Abortion

This article explores how rights to movement may limit state efforts to restrict abortions, either directly or indirectly. We use the language of “movement” to encompass short-term visits, longer-term residency changes, and the movement of goods or services across state lines. We prefer “movement” to “travel” or “tourism,” as this language risks trivializing the seriousness of what might be at stake. However, since “travel” is the term used in many U.S. court decisions and other discussions concerning the right,7 we use that term as relevant to these. The centerpiece of our defense is the relationship between freedom of movement and what it is to be fully recognized as a person in a federal society. Our defense is nuanced; some interferences with interstate movement go to the very heart of what it is to be recognized as a person, whereas others may not

The Significance of Injustice for Bioethics

In my judgment, applied ethics is ineluctably non-ideal and partial compliance theory. It’s ethics in the context of unjust institutions and conduct. Theorizing or teaching about concepts such as autonomy in abstraction from this recognition is misleading. Instead, questions such as how to realize autonomy should be framed in the context of incomplete justice. There’s much to be learned from the past nearly 50 years of discussions of justice to help with this enterprise, but they are too little known or discussed in much contemporary bioethics

Is Surrogacy Ethically Problematic?

This chapter takes up less well-trodden questions about whether a surrogacy arrangement in which one person carries a pregnancy for another is ethically problematic in itself—and if so, why. Pregnancy and delivery are quintessential bodily labor. One set of arguments tests whether carrying a pregnancy is the type of bodily labor one person ethically may perform for another, whether or not for pay. These arguments contend that surrogacy cannot be a permissible service, no matter how well intended or structured. Another set of questions probes the value and identity of the child, asking whether surrogacy is inevitably akin to baby selling or, if not, devalues the child in some other way. A final set of related questions attends to whether surrogacy properly respects the relationship between the pregnant woman and the child-to-be. The general strategy of the argument is to show that we cannot reject all surrogacy on any of these grounds without also rejecting other practices that we find acceptable. The conclusion is that although there are serious ethical issues about surrogacy arrangements, they can be allayed by how these arrangements are structured and are far outweighed by the interests of infertile individuals or couples in becoming parents

Illegal Substance Abuse and Protection from Discrimination in Housing and Employment: Reversing the Exclusion of Illegal Substance Abuse as a Disability

When landlords or employers know that someone is using opioids, either legally or illegally, the consequences can be significant. Rental housing or employment are both critical to well-being, yet may be at particularly high risk. As this Article argues below, legal protections in these areas are inadequate. To summarize the argument briefly, a crucial legal problem for people suffering from substance abuse disorders is that current illegal use of controlled substances is excluded from the definition of disability in federal anti-discrimination statutes. A history of substance abuse is a disability protected from discrimination, but recent relapses vitiate this protection. Relatedly, federal law still criminalizes the medical use of marijuana and federal anti-discrimination law reflects the federal prohibition rather than legalization under state law. The legal use of prescription opioids and medication assisted treatment (MAT) is protected under anti-discrimination law, but many employers subject MAT patients to increased scrutiny and others continue to insist on drug free workplace policies that prohibit their employment

Transparency

Transparency is one of the key concepts of privacy protection. Transparency means openness about data collection, use, and retention. Individuals need to know what information about them is being collected, how it is being collected, how it is to be used and shared, how it is protected, what has been learned from data use, how what has been learned might benefit them, and how they can seek correction or redress for security breaches or other unjustified uses or disclosures of data. This chapter begins with a highly salient recent example of transparency in action: the principled commitment to transparency in the precision medicine initiative (PMI) and the limited extent to which it has been developed in the initiative to date. The chapter then provides an overview of justifications for transparency and challenges inherent in providing consumers with understanding that is meaningful to them. The chapter then considers methods for achieving transparency through publication or notice and what is known about the success or failure of these methods. For example, privacy notices have grown bloated and legalistic; patients rarely read them and if they do, they do not understand them. The chapter concludes with a discussion of emerging solutions

Risk Management and Conflicts of Interest

Risk management aims to reduce the costs of adverse events. In entities such as hospitals, risk managers do this in two ways: reducing the likelihood or seriousness of adverse events and reducing the costs of these events when they do happen. Activities aimed at the latter present direct conflicts of interest between protecting the institution and respecting the interests of the clients served by the institution—so-called institutional conflicts of interest. Activities aimed at the former would appear to benefit all parties--those at risk of accidents (because the risk is reduced) and the institution (because reducing risks also reduces the costs of adverse events)--and thus escape problems of conflicts. This appearance may also misleading, however, if efforts to reduce risks to agents of the institution (such as hospital staff) conflict indirectly with efforts to reduce risks to clients (such as patients). Here, too, institutional conflicts of interest may arise for the risk manager. This chapter discusses the role of the risk manager in handling institutional conflicts of interest in health care organizations. When risk managers attempt to reduce the costs of adverse events to the institution, conflicts of interest are likely to arise and to present ethical issues for the risk manager. These conflicts are institutional ones that are built into the risk manager’s role: the risk manager’s goal is to settle potentially expensive claims on terms that are favorable to the institution rather than on the terms that might be most beneficial to the patient. These conflicts must be identified and managed ethically