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The authors discuss haunting aspects resulting from a request for ethics consultation to support surrogate decision-maker authorization of long-acting reversible contraception in an individual with disabilities. The authors highlight the ethical tension between procreative freedom and equitable access to contraception, particularly noting ableism underlying each side of the argument. Bringing in prior case law, the authors favor a least-restrictive approach to contraception to best preserve the individual’s reproductive rights.
The narrative of the chapter explores haunting aspects of a patient’s inability to participate in capacity assessment due to communication challenges and generalized weakness. Through relying on prior wishes and historical context provided by the surrogate decision-maker, the ethical analysis presented by the authors demonstrates expressed concern with the surrogate decision-maker’s request for long-acting reversible contraception. As the consultation progresses to the patient’s assent to an informal arrangement of supported decision-making, each author shares their professional reflections on issues including equity, diversity and inclusion with a keen focus on ableism in the care of individuals with disabilities. While it may be legally permissible as well as ethically supportable to permit for surrogate decision-maker authorization of long-acting reversible contraception through supported decision-making, the authors grapple with whether the decision honored the patient’s values.
To understand how the Go Wish Cards Game (GWCG) can support the expression of values, wishes, and preferences at the end of life among women living with advanced breast and/or gynecological cancer.
Methods
This descriptive qualitative study was conducted as part of a larger randomized clinical trial. Participants were recruited from a leading cancer center in Brazil and invited to sort the GWCG cards into three categories: “very important,” “somewhat important,” and “not important.” The 10 cards rated as “very important” were discussed individually to explore their meanings. At the end of the session, participants were asked: “What did it mean for you to play the cards?” Narratives associated with the “very important” cards were analyzed using content analysis based on Bardin’s methodological framework.
Results
Thirty-three women completed the GWCG. Participants described the game as a meaningful opportunity for reflection, communication, and expression of personal values and end-of-life wishes. Discussions of the “very important” cards elicited narratives focused on trust-based relationships, emotional and spiritual support, dignity, and relief from suffering. The most frequently selected cards included wishes such as “to have a doctor I trust and nurses who care about me” and “to have my family and friends with me,” reflecting shared priorities across narratives. Values and wishes were organized into three overarching dimensions: emotional and existential connections; dignity and autonomy; and care and comfort at the end of life. The GWCG was perceived as a valuable tool for facilitating the expression of biopsychosocial and spiritual values.
Significance of results
The findings indicate that the GWCG supports reflection and the articulation of end-of-life values, wishes, and priorities, particularly those related to dignity, autonomy, comfort, and emotional connection. The tool shows potential to promote meaningful conversations and care aligned with what gives purpose and meaning to women living with advanced cancer.
This chapter further develops the framework presented in the previous chapter. It does so by elaborating upon the value pluralism involved in the umbel view and the substantial interior of the framework. The chapter begins by accounting for the pluralism involved in the umbel view and discussing what that implies for political priority-setting. It then argues that the capability approach, developed by Amartya Sen and Martha Nussbaum, provides the best available currency of justice for a multiple threshold sufficientarian theory. The chapter then moves on to provide a suggested index of eight spheres of capabilities relevant for sufficientarian justice. The index includes the following items: Basic Needs, Health, Education, Meaningful Work, Political Equality, Community, Social Status, Reasonable Autonomy. The purpose of the index is to serve as input into the further interdisciplinary and public debate on the identification of the justice-relevant threshold. The chapter ends by emphasizing that public policy should give particular priority to manifest deficiencies, such as cases of deficiency clusters, where the same group of people face insufficiency in several value spheres.
For three decades, politicians have promised that new technologies will solve climate change, but they haven’t emerged at meaningful scale. So, instead we must act with technologies we already have, which will involve some restraint. However, knowing this fact does not of itself motivate change. Instead, we present a new framing of our response to climate change as an expression of our values. The restraint, perhaps lasting for two or three decades, that is required to deal with climate change is not only a sacrifice. Embracing it can also help us to find a different good life, as responsible and joyful custodians of creation. The seven virtues inspire us to lift up our heads, be honest about the options and motivate our action, and encourage us to find a safe climate, in good faith.
The European Union (EU) is considered to be a unique economic and political union that integrates most European countries. This article focuses on the cultural aspect of European integration, which has been increasingly debated over the course of deepening and widening integration and in the context of the legitimation crisis of the EU. Among the main goals of the EU is to promote certain values, which raises the question of whether it has been efficient in (or enabled) reducing cultural value gaps among the participating countries. World polity and institutional isomorphism theories suggest that cultural values may trickle down in a vertical manner from the institutions of the EU to its member states and candidates. Furthermore, hybridisation theory postulates that values diffuse horizontally through intensified interactions enabled by the EU. These two perspectives imply the possibility of cultural convergence among countries associated with the EU. By contrast, the culture clash thesis assumes that differences in cultural identity prevent value convergence across countries; growing awareness of such differences may even increase the pre‐existing cultural value distances. To test these different scenarios, distances in emancipative and secular values are compared across pairs of countries using combined repeated cross‐sectional data from the European Values Study and the World Values Survey gathered between 1992 and 2011. This study finds that the longer a country has been part of the EU, the more closely its values approximate those of the EU founding countries, which in turn are the most homogenous. Initial cultural distance to the founders’ average values appears irrelevant to acquiring membership or candidacy status. However, new member states experienced substantial cultural convergence with old member states after 1992, as did current candidates between 2001 and 2008. Since 1992, nations not participating in the integration process have diverged substantially from EU members, essentially leading to cultural polarisation in Europe. The findings are independent of (changes in) economic disparities and suggest the importance of cultural diffusion as one of the fundamental mechanisms of cultural change. This empirical study contributes to the literature on European integration, political and sociological theories of globalisation, and cross‐cultural theories of societal value change.
This study considers key value differences between leaders of two types of social ventures: for-profit social benefit corporations and nonprofit organizations. The research question asks to what degree the value sets of leaders of benefit corporations are congruent with those of similarly situated individuals in nonprofit organizations. The results show the values of leaders working in benefit corporations and nonprofit organizations are in many ways aligned, but there are notable statistical differences. A sectoral association of values is also present with employees in both types of organization, especially when the previous work experience of employees is considered.
Huntington's third wave of democracy was no such thing. It neither ushered in a democratic era nor was it a wave in any acceptable historical sense. What it did do was to highlight a contrast and competition among norms and values, so that what we automatically regard as undemocratic practice that is norm-free is no such thing. They might perhaps, and with a freight of contingencies, be bad norms—but they are still norms.
Volunteering motivation has been studied from many perspectives during the last few decades. These studies have increased our understanding on the individual, dynamic, and reflexive nature of volunteering. Moreover, research that combines volunteering with the concept of identity or role identity has deepened this understanding. Nevertheless, the ways individual volunteers experience and associate volunteering with their personal identities has been little studied. Values can provide an empirical window into the core of personal identity. Identity, values, and volunteering are combined in the approach used in this study, which introduces the theoretical viewpoints of narrative identity and value identity. The analyses of 24 life course interviews demonstrated volunteering can be used in identity work for expressing the core values of individuals. The results also indicate the variety and range of values, which can be associated with volunteering.
Values are an essential part of the identity of non-government organizations (NGOs), distinguishing them from other sectors and contributing to their legitimacy. Values are neither uncontested nor wholly self-determined, but rather are products of the broader social and political environment. The meaning of values must be negotiated with multiple actors, such as funding agencies, the state, and the general public including their “clients.” This paper looks at the ways that the meaning of a particular NGO value—voluntarism—is negotiated and contested in India. I argue that conceptualizations of voluntarism are neither singular, nor static, and that NGOs draw on these to claim legitimacy, or contest them through counter-narratives. These struggles over the meaning of voluntarism are in themselves productive, shaping organizational identity, and functioning. Values can thereby be a useful analytical tool to understanding NGOs.
The middle class is considered the most relevant group for formal volunteering. However, the middle class is shrinking, raising the question of the consequences for volunteering in general. Based on four samples of the Swiss Volunteering Survey from 2006, 2010, 2014, and 2019 containing over 5′000 individual responses, we test whether the intensity of middle-class volunteering changes over time. Our results show that the middle class is an essential source for formal volunteering compared to other parts of society, especially those with lower income. The relationship between the middle class and volunteering is positive, though non-significant in our samples. We found no significant changes over time in the volunteering development of the middle class.
Much attention has recently been paid to comparative work in the public and private sectors looking at work values, motivations, and the impact of government reform movements in organizations. Several studies have compared the public and private sectors in the dimension of values; but none have questioned the popular assumption that nonprofit and public managers share the same or a similar set of values or the value expectations they have for each other. This paper reports on the results of an empirical survey of public and nonprofit managers that compares their individual democratic, ethical, and professional values. In brief, the results lend strong support to the assumption that nonprofit employees share the same value set as their public sector counterparts; but their value sets do have statistically significant differences in the perceived level of importance of altruism, generosity, and individualism.
In a recently published article in this journal, Ross Campbell argues that adherence to socialist values establishes a hitherto neglected factor when it comes to the explanation of differences in East and West German citizens’ political trust. As the results of his study indicate, adherence to socialist values impacts negatively on citizens’ political trust, this effect is more pronounced and more stable over time for East German as compared to West German citizens and is sufficiently strong to eliminate aggregate‐level differences in political trust between East and West Germany. However, this research note suggests that Campbell's article contains several substantial inconsistencies and obscurities that question the reliability and validity of the empirical findings presented. It provides a re‐analysis of Campbell's main arguments and shows to what extent his initial conclusions can be upheld after the shortcomings have been remedied. The results of this re‐analysis suggest that socialist values indeed exhibit a negative impact on German citizens’ political trust, which is relatively stronger for East as compared to West German citizens. However, contrary to Campbell's initial results, the negative effect of socialist values on political trust is robust over time for both East and West German citizens. What is more, there is no empirical evidence confirming that differences in adherence to socialist values between East and West German citizens are sufficiently strong to account for aggregate‐level differences in political trust. In light of these findings, two of Campbell's three main conclusions are dubious and call for further examination.
The values espoused by third sector service delivery organizations form the basis of normative claims of legitimacy. Such claims are subject to on-going debate with critics arguing that third sector service delivery organizations do not truly represent the views of those they are trying to assist or that they often fail to institutionalize their values in their relationships with service users. Using instrumental case studies of six social welfare programs in three cities in Australia, this article explores questions of legitimacy by examining whether organizational values were the same as those of service users and whether this matters in terms of services having a positive impact on service users. While research findings generally support normative claims of legitimacy, instrumental values were found to be more important than underlying ethical values or outcome values in generating positive outcomes for service users. However it is these instrumental values that are most at risk from overly prescriptive funding mechanisms.
The study employs the person–organization (P–O) fit approach to explaining volunteers’ organizational commitment (OC). It examined three dimensions of P–O fit that contribute to OC (degree of: needs-fulfillment, values-realization, self-identityand its expression) and their relationships with three manifestations of OC (identification, contribution, staying). Based on a questionnaire given to 138 volunteers results showed that values-realization was central in its contribution to OC, and its greatest contribution was to the components expressing identification with the organization and contribution to the organization. However, needs-fulfillment and self-identity expression also contributed to OC. Moreover, the three types of P–O fit were distinct from one another; they contributed differentially to the explanation of OC manifestations, and their respective contributions to the prediction of OC level were additive. Therefore, volunteer organizations which put emphasis not only on realizing their members’ values but also satisfying their needs and allowing for the expression of their self-identity should extract a higher degree of commitment from their members.
The role of voluntary and community sector organizations in the delivery of public services is increasing and these changes bring new responsibilities and benefits to organizations that have the capacity to participate. There are concerns within the sector about the implications for citizenship and participation. The sector is highly dependent on volunteers yet little is known about how organizational change in response to new relationships with the statutory sector impact upon the commitment and well-being of people who volunteer. This paper addresses that gap in knowledge for older volunteers. Drawing upon collaborative research with a voluntary organization in the north of England, the authors explore the meanings and aspirations of volunteering for older people, and explain how and why changes associated with closer engagement with public service delivery and less grant dependency can be disempowering for them.
In recent years, new forms of investment have been created to direct funds towards companies performing well according to predefined environmental, social, and governance (ESG) indicators. This volume addresses moral, political, and legal questions about the legitimacy of ESG as a management and investment strategy. Some chapters argue that ESG strategies should focus on creating real-life impacts on morally significant problems, such as climate change, human rights violations, and corporate corruption. Other chapters instead examine the possibility that the long-term feasibility of ESG limits its moral ambitions, requiring ESG to be regarded as only a set of devices for minimizing risk in a way that protects financial gain. The book contributes a much-needed understanding of ethical interpretations of the ESG movement, which are likely to drive future social, political and legal developments.
The development of continuous distribution (CD) proposals for lungs, kidneys, pancreases, and livers display the interrelationship of values and evidence. CD involves identifying attributes that assess progress toward five goals: (1) prioritize sickest candidates first to reduce waitlist deaths; (2) improve long-term survival after transplant; (3) increase transplant opportunities for patients who are medically harder to match; (4) increase transplant opportunities for candidates with distinct characteristics, such as pediatric and prior living donor status; (5) promote efficient management of organ placement through consideration of geographic proximity between donor hospitals and patient transplant centers. Weights are then assigned to the attributes and goals to obtain a composite priority score. Both values and evidence influenced the choice of attributes and their functional forms. Rather than primarily statements of values, weights became design features in machine learning optimization exercises that allowed for the identification of alternatives that predicted the most favorable combinations of efficiency and equity outcomes.
Taylor Swift has dreamt of two things: fame and success, and a quiet life with someone she loves. She dreams of making it and of escaping it. The problem is that these dreams seem to conflict. Achieving one can feel like giving up on the other. Swift’s new album, The Life of a Showgirl, finds both dreams well represented. She wants immortality and a basketball hoop in the driveway. She also has a new insight for reconciling them. Happiness can be made, she tells us. And if you make it with another person, you might be able to live two dreams that once felt impossible to fit together.
This book examines contemporary progress rhetoric and its history by focusing on medicine, a field that has become the touchstone of the focus on progress. In recent decades, the term progress has been used by a wide range of people, including politicians, scientists, engineers, physicians, and patients, to make sense of medicine’s past developments, current achievements, and desired future. Large, private companies such as Meta and Google, for example, link artificial intelligence research and genomic analysis to progress in medicine and praise their own contributions for that reason. Using a philosophically informed historical approach, this book argues that debates about progress in medicine are always political debates underpinned by different interests, which reflect distinct approaches to persons, health, and society. It draws on academic engagements with the history and philosophy of progress, as well as the insights of physicians, patients, and tech actors, to show how medical progress can hold multiple meanings simultaneously.
This study examines the role of normative values and stakeholder commitment in the evalua-tion and implementation process of social and organizational innovations in highly regulated systems, using the example of the four-day work week in German healthcare. Based on 26 expert interviews across micro, meso, and macro levels, the study reveals how actor-specific values and institutional contexts shape judgment about ecological, economic, social, and or-ganizational performance sustainability. The findings show that commitment to innovation is not determined solely by functional considerations but emerges in a field of tension between normative aspirations. Stakeholders align themselves differently along axes such as employee vs. patient orientation or short- vs. long-term thinking, resulting in competing innovation scenarios. The study proposes a transferable framework enabling organizations to map stakeholder values, locate areas of tension, and assess the depth and direction of commitment.