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• 30 Apr 2024

When Managers Set Unrealistic Expectations, Employees Cut Ethical Corners

Corporate misconduct has grown in the past 30 years, with losses often totaling billions of dollars. What businesses may not realize is that misconduct often results from managers who set unrealistic expectations, leading decent people to take unethical shortcuts, says Lynn S. Paine.

• 23 Apr 2024
• Cold Call Podcast

Amazon in Seattle: The Role of Business in Causing and Solving a Housing Crisis

In 2020, Amazon partnered with a nonprofit called Mary’s Place and used some of its own resources to build a shelter for women and families experiencing homelessness on its campus in Seattle. Yet critics argued that Amazon’s apparent charity was misplaced and that the company was actually making the problem worse. Paul Healy and Debora Spar explore the role business plays in addressing unhoused communities in the case “Hitting Home: Amazon and Mary’s Place.”

• 15 Apr 2024

Struggling With a Big Management Decision? Start by Asking What Really Matters

Leaders must face hard choices, from cutting a budget to adopting a strategy to grow. To make the right call, they should start by following their own “true moral compass,” says Joseph Badaracco.

• 26 Mar 2024

How Do Great Leaders Overcome Adversity?

In the spring of 2021, Raymond Jefferson (MBA 2000) applied for a job in President Joseph Biden’s administration. Ten years earlier, false allegations were used to force him to resign from his prior US government position as assistant secretary of labor for veterans’ employment and training in the Department of Labor. Two employees had accused him of ethical violations in hiring and procurement decisions, including pressuring subordinates into extending contracts to his alleged personal associates. The Deputy Secretary of Labor gave Jefferson four hours to resign or be terminated. Jefferson filed a federal lawsuit against the US government to clear his name, which he pursued for eight years at the expense of his entire life savings. Why, after such a traumatic and debilitating experience, would Jefferson want to pursue a career in government again? Harvard Business School Senior Lecturer Anthony Mayo explores Jefferson’s personal and professional journey from upstate New York to West Point to the Obama administration, how he faced adversity at several junctures in his life, and how resilience and vulnerability shaped his leadership style in the case, "Raymond Jefferson: Trial by Fire."

• 02 Jan 2024

Should Businesses Take a Stand on Societal Issues?

Should businesses take a stand for or against particular societal issues? And how should leaders determine when and how to engage on these sensitive matters? Harvard Business School Senior Lecturer Hubert Joly, who led the electronics retailer Best Buy for almost a decade, discusses examples of corporate leaders who had to determine whether and how to engage with humanitarian crises, geopolitical conflict, racial justice, climate change, and more in the case, “Deciding When to Engage on Societal Issues.”

• 12 Dec 2023

Can Sustainability Drive Innovation at Ferrari?

When Ferrari, the Italian luxury sports car manufacturer, committed to achieving carbon neutrality and to electrifying a large part of its car fleet, investors and employees applauded the new strategy. But among the company’s suppliers, the reaction was mixed. Many were nervous about how this shift would affect their bottom lines. Professor Raffaella Sadun and Ferrari CEO Benedetto Vigna discuss how Ferrari collaborated with suppliers to work toward achieving the company’s goal. They also explore how sustainability can be a catalyst for innovation in the case, “Ferrari: Shifting to Carbon Neutrality.” This episode was recorded live December 4, 2023 in front of a remote studio audience in the Live Online Classroom at Harvard Business School.

• 11 Dec 2023
• Research & Ideas

Doing Well by Doing Good? One Industry’s Struggle to Balance Values and Profits

Few companies wrestle with their moral mission and financial goals like those in journalism. Research by Lakshmi Ramarajan explores how a disrupted industry upholds its values even as the bottom line is at stake.

• 27 Nov 2023

Voting Democrat or Republican? The Critical Childhood Influence That's Tough to Shake

Candidates might fixate on red, blue, or swing states, but the neighborhoods where voters spend their teen years play a key role in shaping their political outlook, says research by Vincent Pons. What do the findings mean for the upcoming US elections?

• 21 Nov 2023

The Beauty Industry: Products for a Healthy Glow or a Compact for Harm?

Many cosmetics and skincare companies present an image of social consciousness and transformative potential, while profiting from insecurity and excluding broad swaths of people. Geoffrey Jones examines the unsightly reality of the beauty industry.

• 09 Nov 2023

What Will It Take to Confront the Invisible Mental Health Crisis in Business?

The pressure to do more, to be more, is fueling its own silent epidemic. Lauren Cohen discusses the common misperceptions that get in the way of supporting employees' well-being, drawing on case studies about people who have been deeply affected by mental illness.

• 07 Nov 2023

How Should Meta Be Governed for the Good of Society?

Julie Owono is executive director of Internet Sans Frontières and a member of the Oversight Board, an outside entity with the authority to make binding decisions on tricky moderation questions for Meta’s companies, including Facebook and Instagram. Harvard Business School visiting professor Jesse Shapiro and Owono break down how the Board governs Meta’s social and political power to ensure that it’s used responsibly, and discuss the Board’s impact, as an alternative to government regulation, in the case, “Independent Governance of Meta’s Social Spaces: The Oversight Board.”

• 24 Oct 2023

From P.T. Barnum to Mary Kay: Lessons From 5 Leaders Who Changed the World

What do Steve Jobs and Sarah Breedlove have in common? Through a series of case studies, Robert Simons explores the unique qualities of visionary leaders and what today's managers can learn from their journeys.

• 03 Oct 2023
• Research Event

Build the Life You Want: Arthur Brooks and Oprah Winfrey Share Happiness Tips

"Happiness is not a destination. It's a direction." In this video, Arthur C. Brooks and Oprah Winfrey reflect on mistakes, emotions, and contentment, sharing lessons from their new book.

• 12 Sep 2023

Successful, But Still Feel Empty? A Happiness Scholar and Oprah Have Advice for You

So many executives spend decades reaching the pinnacles of their careers only to find themselves unfulfilled at the top. In the book Build the Life You Want, Arthur Brooks and Oprah Winfrey offer high achievers a guide to becoming better leaders—of their lives.

• 10 Jul 2023
• In Practice

The Harvard Business School Faculty Summer Reader 2023

Need a book recommendation for your summer vacation? HBS faculty members share their reading lists, which include titles that explore spirituality, design, suspense, and more.

• 01 Jun 2023

A Nike Executive Hid His Criminal Past to Turn His Life Around. What If He Didn't Have To?

Larry Miller committed murder as a teenager, but earned a college degree while serving time and set out to start a new life. Still, he had to conceal his record to get a job that would ultimately take him to the heights of sports marketing. A case study by Francesca Gino, Hise Gibson, and Frances Frei shows the barriers that formerly incarcerated Black men are up against and the potential talent they could bring to business.

• 04 Apr 2023

Two Centuries of Business Leaders Who Took a Stand on Social Issues

Executives going back to George Cadbury and J. N. Tata have been trying to improve life for their workers and communities, according to the book Deeply Responsible Business: A Global History of Values-Driven Leadership by Geoffrey Jones. He highlights three practices that deeply responsible companies share.

• 14 Mar 2023

Can AI and Machine Learning Help Park Rangers Prevent Poaching?

Globally there are too few park rangers to prevent the illegal trade of wildlife across borders, or poaching. In response, Spatial Monitoring and Reporting Tool (SMART) was created by a coalition of conservation organizations to take historical data and create geospatial mapping tools that enable more efficient deployment of rangers. SMART had demonstrated significant improvements in patrol coverage, with some observed reductions in poaching. Then a new predictive analytic tool, the Protection Assistant for Wildlife Security (PAWS), was created to use artificial intelligence (AI) and machine learning (ML) to try to predict where poachers would be likely to strike. Jonathan Palmer, Executive Director of Conservation Technology for the Wildlife Conservation Society, already had a good data analytics tool to help park rangers manage their patrols. Would adding an AI- and ML-based tool improve outcomes or introduce new problems? Harvard Business School senior lecturer Brian Trelstad discusses the importance of focusing on the use case when determining the value of adding a complex technology solution in his case, “SMART: AI and Machine Learning for Wildlife Conservation.”

• 14 Feb 2023

Does It Pay to Be a Whistleblower?

In 2013, soon after the US Securities and Exchange Commission (SEC) had started a massive whistleblowing program with the potential for large monetary rewards, two employees of a US bank’s asset management business debated whether to blow the whistle on their employer after completing an internal review that revealed undisclosed conflicts of interest. The bank’s asset management business disproportionately invested clients’ money in its own mutual funds over funds managed by other banks, letting it collect additional fees—and the bank had not disclosed this conflict of interest to clients. Both employees agreed that failing to disclose the conflict was a problem, but beyond that, they saw the situation very differently. One employee, Neel, perceived the internal review as a good-faith effort by senior management to identify and address the problem. The other, Akash, thought that the entire business model was problematic, even with a disclosure, and believed that the bank may have even broken the law. Should they escalate the issue internally or report their findings to the US Securities and Exchange Commission? Harvard Business School associate professor Jonas Heese discusses the potential risks and rewards of whistleblowing in his case, “Conflicts of Interest at Uptown Bank.”

• 17 Jan 2023

Good Companies Commit Crimes, But Great Leaders Can Prevent Them

It's time for leaders to go beyond "check the box" compliance programs. Through corporate cases involving Walmart, Wells Fargo, and others, Eugene Soltes explores the thorny legal issues executives today must navigate in his book Corporate Criminal Investigations and Prosecutions.

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Videos Concepts Unwrapped View All 36 short illustrated videos explain behavioral ethics concepts and basic ethics principles. Concepts Unwrapped: Sports Edition View All 10 short videos introduce athletes to behavioral ethics concepts. Ethics Defined (Glossary) View All 58 animated videos - 1 to 2 minutes each - define key ethics terms and concepts. Ethics in Focus View All One-of-a-kind videos highlight the ethical aspects of current and historical subjects. Giving Voice To Values View All Eight short videos present the 7 principles of values-driven leadership from Gentile's Giving Voice to Values. In It To Win View All A documentary and six short videos reveal the behavioral ethics biases in super-lobbyist Jack Abramoff's story. Scandals Illustrated View All 30 videos - one minute each - introduce newsworthy scandals with ethical insights and case studies. Video Series

Case Studies UT Star Icon

Case Studies

More than 70 cases pair ethics concepts with real world situations. From journalism, performing arts, and scientific research to sports, law, and business, these case studies explore current and historic ethical dilemmas, their motivating biases, and their consequences. Each case includes discussion questions, related videos, and a bibliography.

A Million Little Pieces

James Frey’s popular memoir stirred controversy and media attention after it was revealed to contain numerous exaggerations and fabrications.

Abramoff: Lobbying Congress

Super-lobbyist Abramoff was caught in a scheme to lobby against his own clients. Was a corrupt individual or a corrupt system – or both – to blame?

Apple Suppliers & Labor Practices

Is tech company Apple, Inc. ethically obligated to oversee the questionable working conditions of other companies further down their supply chain?

Approaching the Presidency: Roosevelt & Taft

Some presidents view their responsibilities in strictly legal terms, others according to duty. Roosevelt and Taft took two extreme approaches.

Appropriating “Hope”

Fairey’s portrait of Barack Obama raised debate over the extent to which an artist can use and modify another’s artistic work, yet still call it one’s own.

Arctic Offshore Drilling

Competing groups frame the debate over oil drilling off Alaska’s coast in varying ways depending on their environmental and economic interests.

Banning Burkas: Freedom or Discrimination?

The French law banning women from wearing burkas in public sparked debate about discrimination and freedom of religion.

Birthing Vaccine Skepticism

Wakefield published an article riddled with inaccuracies and conflicts of interest that created significant vaccine hesitancy regarding the MMR vaccine.

Blurred Lines of Copyright

Marvin Gaye’s Estate won a lawsuit against Robin Thicke and Pharrell Williams for the hit song “Blurred Lines,” which had a similar feel to one of his songs.

Bullfighting: Art or Not?

Bullfighting has been a prominent cultural and artistic event for centuries, but in recent decades it has faced increasing criticism for animal rights’ abuse.

Buying Green: Consumer Behavior

Do purchasing green products, such as organic foods and electric cars, give consumers the moral license to indulge in unethical behavior?

Cadavers in Car Safety Research

Engineers at Heidelberg University insist that the use of human cadavers in car safety research is ethical because their research can save lives.

Cardinals’ Computer Hacking

St. Louis Cardinals scouting director Chris Correa hacked into the Houston Astros’ webmail system, leading to legal repercussions and a lifetime ban from MLB.

Cheating: Atlanta’s School Scandal

Teachers and administrators at Parks Middle School adjust struggling students’ test scores in an effort to save their school from closure.

Cheating: Sign-Stealing in MLB

The Houston Astros’ sign-stealing scheme rocked the baseball world, leading to a game-changing MLB investigation and fallout.

Cheating: UNC’s Academic Fraud

UNC’s academic fraud scandal uncovered an 18-year scheme of unchecked coursework and fraudulent classes that enabled student-athletes to play sports.

Cheney v. U.S. District Court

A controversial case focuses on Justice Scalia’s personal friendship with Vice President Cheney and the possible conflict of interest it poses to the case.

Christina Fallin: “Appropriate Culturation?”

After Fallin posted a picture of herself wearing a Plain’s headdress on social media, uproar emerged over cultural appropriation and Fallin’s intentions.

Climate Change & the Paris Deal

While climate change poses many abstract problems, the actions (or inactions) of today’s populations will have tangible effects on future generations.

Cover-Up on Campus

While the Baylor University football team was winning on the field, university officials failed to take action when allegations of sexual assault by student athletes emerged.

Covering Female Athletes

Sports Illustrated stirs controversy when their cover photo of an Olympic skier seems to focus more on her physical appearance than her athletic abilities.

Covering Yourself? Journalists and the Bowl Championship

Can news outlets covering the Bowl Championship Series fairly report sports news if their own polls were used to create the news?

Cyber Harassment

After a student defames a middle school teacher on social media, the teacher confronts the student in class and posts a video of the confrontation online.

Defending Freedom of Tweets?

Running back Rashard Mendenhall receives backlash from fans after criticizing the celebration of the assassination of Osama Bin Laden in a tweet.

Dennis Kozlowski: Living Large

Dennis Kozlowski was an effective leader for Tyco in his first few years as CEO, but eventually faced criminal charges over his use of company assets.

Digital Downloads

File-sharing program Napster sparked debate over the legal and ethical dimensions of downloading unauthorized copies of copyrighted music.

Dr. V’s Magical Putter

Journalist Caleb Hannan outed Dr. V as a trans woman, sparking debate over the ethics of Hannan’s reporting, as well its role in Dr. V’s suicide.

East Germany’s Doping Machine

From 1968 to the late 1980s, East Germany (GDR) doped some 9,000 athletes to gain success in international athletic competitions despite being aware of the unfortunate side effects.

Ebola & American Intervention

Did the dispatch of U.S. military units to Liberia to aid in humanitarian relief during the Ebola epidemic help or hinder the process?

Edward Snowden: Traitor or Hero?

Was Edward Snowden’s release of confidential government documents ethically justifiable?

Ethical Pitfalls in Action

Why do good people do bad things? Behavioral ethics is the science of moral decision-making, which explores why and how people make the ethical (and unethical) decisions that they do.

Ethical Use of Home DNA Testing

The rising popularity of at-home DNA testing kits raises questions about privacy and consumer rights.

Flying the Confederate Flag

A heated debate ensues over whether or not the Confederate flag should be removed from the South Carolina State House grounds.

Freedom of Speech on Campus

In the wake of racially motivated offenses, student protests sparked debate over the roles of free speech, deliberation, and tolerance on campus.

Freedom vs. Duty in Clinical Social Work

What should social workers do when their personal values come in conflict with the clients they are meant to serve?

Full Disclosure: Manipulating Donors

When an intern witnesses a donor making a large gift to a non-profit organization under misleading circumstances, she struggles with what to do.

Gaming the System: The VA Scandal

The Veterans Administration’s incentives were meant to spur more efficient and productive healthcare, but not all administrators complied as intended.

German Police Battalion 101

During the Holocaust, ordinary Germans became willing killers even though they could have opted out from murdering their Jewish neighbors.

Head Injuries & American Football

Many studies have linked traumatic brain injuries and related conditions to American football, creating controversy around the safety of the sport.

Head Injuries & the NFL

American football is a rough and dangerous game and its impact on the players’ brain health has sparked a hotly contested debate.

Healthcare Obligations: Personal vs. Institutional

A medical doctor must make a difficult decision when informing patients of the effectiveness of flu shots while upholding institutional recommendations.

High Stakes Testing

In the wake of the No Child Left Behind Act, parents, teachers, and school administrators take different positions on how to assess student achievement.

In-FUR-mercials: Advertising & Adoption

When the Lied Animal Shelter faces a spike in animal intake, an advertising agency uses its moral imagination to increase pet adoptions.

Krogh & the Watergate Scandal

Egil Krogh was a young lawyer working for the Nixon Administration whose ethics faded from view when asked to play a part in the Watergate break-in.

Limbaugh on Drug Addiction

Radio talk show host Rush Limbaugh argued that drug abuse was a choice, not a disease. He later became addicted to painkillers.

U.S. Olympic swimmer Ryan Lochte’s “over-exaggeration” of an incident at the 2016 Rio Olympics led to very real consequences.

Meet Me at Starbucks

Two black men were arrested after an employee called the police on them, prompting Starbucks to implement “racial-bias” training across all its stores.

Myanmar Amber

Buying amber could potentially fund an ethnic civil war, but refraining allows collectors to acquire important specimens that could be used for research.

Negotiating Bankruptcy

Bankruptcy lawyer Gellene successfully represented a mining company during a major reorganization, but failed to disclose potential conflicts of interest.

Pao & Gender Bias

Ellen Pao stirred debate in the venture capital and tech industries when she filed a lawsuit against her employer on grounds of gender discrimination.

Pardoning Nixon

One month after Richard Nixon resigned from the presidency, Gerald Ford made the controversial decision to issue Nixon a full pardon.

Patient Autonomy & Informed Consent

Nursing staff and family members struggle with informed consent when taking care of a patient who has been deemed legally incompetent.

Prenatal Diagnosis & Parental Choice

Debate has emerged over the ethics of prenatal diagnosis and reproductive freedom in instances where testing has revealed genetic abnormalities.

Reporting on Robin Williams

After Robin Williams took his own life, news media covered the story in great detail, leading many to argue that such reporting violated the family’s privacy.

Responding to Child Migration

An influx of children migrants posed logistical and ethical dilemmas for U.S. authorities while intensifying ongoing debate about immigration.

Retracting Research: The Case of Chandok v. Klessig

A researcher makes the difficult decision to retract a published, peer-reviewed article after the original research results cannot be reproduced.

Sacking Social Media in College Sports

In the wake of questionable social media use by college athletes, the head coach at University of South Carolina bans his players from using Twitter.

Selling Enron

Following the deregulation of electricity markets in California, private energy company Enron profited greatly, but at a dire cost.

Snyder v. Phelps

Freedom of speech was put on trial in a case involving the Westboro Baptist Church and their protesting at the funeral of U.S. Marine Matthew Snyder.

Something Fishy at the Paralympics

Rampant cheating has plagued the Paralympics over the years, compromising the credibility and sportsmanship of Paralympian athletes.

Sports Blogs: The Wild West of Sports Journalism?

Deadspin pays an anonymous source for information related to NFL star Brett Favre, sparking debate over the ethics of “checkbook journalism.”

Stangl & the Holocaust

Franz Stangl was the most effective Nazi administrator in Poland, killing nearly one million Jews at Treblinka, but he claimed he was simply following orders.

Teaching Blackface: A Lesson on Stereotypes

A teacher was put on leave for showing a blackface video during a lesson on racial segregation, sparking discussion over how to teach about stereotypes.

The Astros’ Sign-Stealing Scandal

The Houston Astros rode a wave of success, culminating in a World Series win, but it all came crashing down when their sign-stealing scheme was revealed.

The Central Park Five

Despite the indisputable and overwhelming evidence of the innocence of the Central Park Five, some involved in the case refuse to believe it.

The CIA Leak

Legal and political fallout follows from the leak of classified information that led to the identification of CIA agent Valerie Plame.

The Collapse of Barings Bank

When faced with growing losses, investment banker Nick Leeson took big risks in an attempt to get out from under the losses. He lost.

The Costco Model

How can companies promote positive treatment of employees and benefit from leading with the best practices? Costco offers a model.

The FBI & Apple Security vs. Privacy

How can tech companies and government organizations strike a balance between maintaining national security and protecting user privacy?

The Miss Saigon Controversy

When a white actor was cast for the half-French, half-Vietnamese character in the Broadway production of Miss Saigon , debate ensued.

The Sandusky Scandal

Following the conviction of assistant coach Jerry Sandusky for sexual abuse, debate continues on how much university officials and head coach Joe Paterno knew of the crimes.

The Varsity Blues Scandal

A college admissions prep advisor told wealthy parents that while there were front doors into universities and back doors, he had created a side door that was worth exploring.

Providing radiation therapy to cancer patients, Therac-25 had malfunctions that resulted in 6 deaths. Who is accountable when technology causes harm?

Welfare Reform

The Welfare Reform Act changed how welfare operated, intensifying debate over the government’s role in supporting the poor through direct aid.

Wells Fargo and Moral Emotions

In a settlement with regulators, Wells Fargo Bank admitted that it had created as many as two million accounts for customers without their permission.

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Fostering ethical thinking in computing

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Traditional computer scientists and engineers are trained to develop solutions for specific needs, but aren’t always trained to consider their broader implications. Each new technology generation, and particularly the rise of artificial intelligence, leads to new kinds of systems, new ways of creating tools, and new forms of data, for which norms, rules, and laws frequently have yet to catch up. The kinds of impact that such innovations have in the world has often not been apparent until many years later.

As part of the efforts in Social and Ethical Responsibilities of Computing (SERC) within the MIT Stephen A. Schwarzman College of Computing, a new case studies series examines social, ethical, and policy challenges of present-day efforts in computing with the aim of facilitating the development of responsible “habits of mind and action” for those who create and deploy computing technologies.

“Advances in computing have undeniably changed much of how we live and work. Understanding and incorporating broader social context is becoming ever more critical,” says Daniel Huttenlocher, dean of the MIT Schwarzman College of Computing. “This case study series is designed to be a basis for discussions in the classroom and beyond, regarding social, ethical, economic, and other implications so that students and researchers can pursue the development of technology across domains in a holistic manner that addresses these important issues.”

A modular system

By design, the case studies are brief and modular to allow users to mix and match the content to fit a variety of pedagogical needs. Series editors David Kaiser and Julie Shah, who are the associate deans for SERC, structured the cases primarily to be appropriate for undergraduate instruction across a range of classes and fields of study.

“Our goal was to provide a seamless way for instructors to integrate cases into an existing course or cluster several cases together to support a broader module within a course. They might also use the cases as a starting point to design new courses that focus squarely on themes of social and ethical responsibilities of computing,” says Kaiser, the Germeshausen Professor of the History of Science and professor of physics.

Shah, an associate professor of aeronautics and astronautics and a roboticist who designs systems in which humans and machines operate side by side, expects that the cases will also be of interest to those outside of academia, including computing professionals, policy specialists, and general readers. In curating the series, Shah says that “we interpret ‘social and ethical responsibilities of computing’ broadly to focus on perspectives of people who are affected by various technologies, as well as focus on perspectives of designers and engineers.”

The cases are not limited to a particular format and can take shape in various forms — from a magazine-like feature article or Socratic dialogues to choose-your-own-adventure stories or role-playing games grounded in empirical research. Each case study is brief, but includes accompanying notes and references to facilitate more in-depth exploration of a given topic. Multimedia projects will also be considered. “The main goal is to present important material — based on original research — in engaging ways to broad audiences of non-specialists,” says Kaiser.

The SERC case studies are specially commissioned and written by scholars who conduct research centrally on the subject of the piece. Kaiser and Shah approached researchers from within MIT as well as from other academic institutions to bring in a mix of diverse voices on a spectrum of topics. Some cases focus on a particular technology or on trends across platforms, while others assess social, historical, philosophical, legal, and cultural facets that are relevant for thinking critically about current efforts in computing and data sciences.

The cases published in the inaugural issue place readers in various settings that challenge them to consider the social and ethical implications of computing technologies, such as how social media services and surveillance tools are built; the racial disparities that can arise from deploying facial recognition technology in unregulated, real-world settings; the biases of risk prediction algorithms in the criminal justice system; and the politicization of data collection.

"Most of us agree that we want computing to work for social good, but which good? Whose good? Whose needs and values and worldviews are prioritized and whose are overlooked?” says Catherine D’Ignazio, an assistant professor of urban science and planning and director of the Data + Feminism Lab at MIT.

D’Ignazio’s case for the series, co-authored with Lauren Klein, an associate professor in the English and Quantitative Theory and Methods departments at Emory University, introduces readers to the idea that while data are useful, they are not always neutral. “These case studies help us understand the unequal histories that shape our technological systems as well as study their disparate outcomes and effects. They are an exciting step towards holistic, sociotechnical thinking and making."

Rigorously reviewed

Kaiser and Shah formed an editorial board composed of 55 faculty members and senior researchers associated with 19 departments, labs, and centers at MIT, and instituted a rigorous peer-review policy model commonly adopted by specialized journals. Members of the editorial board will also help commission topics for new cases and help identify authors for a given topic.

For each submission, the series editors collect four to six peer reviews, with reviewers mostly drawn from the editorial board. For each case, half the reviewers come from fields in computing and data sciences and half from fields in the humanities, arts, and social sciences, to ensure balance of topics and presentation within a given case study and across the series.

“Over the past two decades I’ve become a bit jaded when it comes to the academic review process, and so I was particularly heartened to see such care and thought put into all of the reviews," says Hany Farid, a professor at the University of California at Berkeley with a joint appointment in the Department of Electrical Engineering and Computer Sciences and the School of Information. “The constructive review process made our case study significantly stronger.”

Farid’s case, “The Dangers of Risk Prediction in the Criminal Justice System,” which he penned with Julia Dressel, recently a student of computer science at Dartmouth College, is one of the four commissioned pieces featured in the inaugural issue.

Cases are additionally reviewed by undergraduate volunteers, who help the series editors gauge each submission for balance, accessibility for students in multiple fields of study, and possibilities for adoption in specific courses. The students also work with them to create original homework problems and active learning projects to accompany each case study, to further facilitate adoption of the original materials across a range of existing undergraduate subjects.

“I volunteered to work with this group because I believe that it's incredibly important for those working in computer science to include thinking about ethics not as an afterthought, but integrated into every step and decision that is made, says Annie Snyder, a mathematical economics sophomore and a member of the MIT Schwarzman College of Computing’s Undergraduate Advisory Group. “While this is a massive issue to take on, this project is an amazing opportunity to start building an ethical culture amongst the incredibly talented students at MIT who will hopefully carry it forward into their own projects and workplace.”

New sets of case studies, produced with support from the MIT Press’ Open Publishing Services program, will be published twice a year via the Knowledge Futures Group’s  PubPub platform . The SERC case studies are made available for free on an open-access basis, under Creative Commons licensing terms. Authors retain copyright, enabling them to reuse and republish their work in more specialized scholarly publications.

“It was important to us to approach this project in an inclusive way and lower the barrier for people to be able to access this content. These are complex issues that we need to deal with, and we hope that by making the cases widely available, more people will engage in social and ethical considerations as they’re studying and developing computing technologies,” says Shah.

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Research and Practice of AI Ethics: A Case Study Approach Juxtaposing Academic Discourse with Organisational Reality

• Original Research/Scholarship
• Open access
• Published: 08 March 2021
• Volume 27 , article number  16 , ( 2021 )

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• Mark Ryan   ORCID: orcid.org/0000-0003-4850-0111 1 ,
• Josephina Antoniou 2 ,
• Laurence Brooks 3 ,
• Tilimbe Jiya 4 ,
• Kevin Macnish 5 &
• Bernd Stahl 3  

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This study investigates the ethical use of Big Data and Artificial Intelligence (AI) technologies (BD + AI)—using an empirical approach. The paper categorises the current literature and presents a multi-case study of 'on-the-ground' ethical issues that uses qualitative tools to analyse findings from ten targeted case-studies from a range of domains. The analysis coalesces identified singular ethical issues, (from the literature), into clusters to offer a comparison with the proposed classification in the literature. The results show that despite the variety of different social domains, fields, and applications of AI, there is overlap and correlation between the organisations’ ethical concerns. This more detailed understanding of ethics in AI + BD is required to ensure that the multitude of suggested ways of addressing them can be targeted and succeed in mitigating the pertinent ethical issues that are often discussed in the literature.

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Introduction

Big Data and Artificial Intelligence (BD + AI) are emerging technologies that offer great potential for business, healthcare, the public sector, and development agencies alike. The increasing impact of these two technologies and their combined potential in these sectors can be highlighted for diverse organisational aspects such as for customisation of organisational processes and for automated decision making. The combination of Big Data and AI, often in the form of machine learning applications, can better exploit the granularity of data and analyse it to offer better insights into behaviours, incidents, and risk, eventually aiming at positive organisational transformation.

Big Data offers fresh and interesting insights into structural patterns, anomalies, and decision-making in a broad range of different applications (Cuquet & Fensel, 2018 ), while AI provides predictive foresight, intelligent recommendations, and sophisticated modelling. The integration and combination of AI + BD offer phenomenal potential for correlating, predicting and prescribing recommendations in insurance, human resources (HR), agriculture, and energy, as well as many other sectors. While BD + AI provides a wide range of benefits, they also pose risks to users, including but not limited to privacy infringements, threats of unemployment, discrimination, security concerns, and increasing inequalities (O’Neil, 2016 ). Footnote 1 Adequate and timely policy needs to be implemented to prevent many of these risks occurring.

One of the main limitations preventing key decision-making for ethical BD + AI use is that there are few rigorous empirical studies carried out on the ethical implications of these technologies across multiple application domains. This renders it difficult for policymakers and developers to identify when ethical issues resulting from BD + AI use are only relevant for isolated domains and applications, or whether there are repeated/universal concerns which can be seen across different sectors. While the field lacks literature evaluating ethical issues Footnote 2 ‘on the ground’, there are even fewer multi-case evaluations.

This paper provides a cohesive multi-case study analysis across ten different application domains, including domains such as government, agriculture, insurance, and the media. It reviews ethical concerns found within these case studies to establish cross-cutting thematic issues arising from the implementation and use of BD + AI. The paper collects relevant literature and proposes a simple classification of ethical issues (short term, medium term, long term), which is then juxtaposed with the ethical concerns highlighted from the multiple-case study analysis. This multiple-case study analysis of BD + AI offers an understanding of current organisational practices.

The work described in this paper makes an important contribution to the literature, based on its empirical findings. By presenting the ethical issues across an array of application areas, the paper provides much-needed rigorous empirical insight into the social and organisational reality of ethics of AI + BD. Our empirical research brings together a collection of domains that gives a broad oversight about issues that underpin the implementation of AI. Through its empirical insights the paper provides a basis for a broader discussion of how these issues can and should be addressed.

This paper is structured in six main sections: this introduction is followed by a literature review, which allows for an integrated review of ethical issues, contrasting them with those found in the cases. This provides the basis for a categorisation or classification of ethical issues in BD + AI. The third section contains a description of the interpretivist qualitative case study methodology used in this paper. The subsequent section provides an overview of the organisations participating in the cases to contrast similarities and divisions, while also comparing the diversity of their use of BD + AI. Footnote 3 The fifth section provides a detailed analysis of the ethical issues derived from using BD + AI, as identified in the cases. The concluding section analyses the differences between theoretical and empirical work and spells out implications and further work.

Literature Review

An initial challenge that any researcher faces when investigating ethical issues of AI + BD is that, due to the popularity of the topic, there is a vast and rapidly growing literature to be considered. Ethical issues of AI + BD are covered by a number of academic venues, including some specific ones such as the AAAI/ACM Conference on AI, Ethics, and Society ( https://dl.acm.org/doi/proceedings/10.1145/3306618 ), policy initiative and many publicly and privately financed research reports (Whittlestone, Nyrup, Alexandrova, Dihal, & Cave, 2019 ). Initial attempts to provide overviews of the area have been published (Jobin, 2019 ; Mittelstadt, Allo, Taddeo, Wachter, & Floridi, 2016 ), but there is no settled view on what counts as an ethical issue and why. In this paper we aim to provide a broad overview of issues found through the case studies. This paper puts forward what are commonly perceived to be ethical issues within the literature or concerns that have ethical impacts and repercussions. We explicitly do not apply a particular philosophical framework of ethics but accept as ethical issues those issues that we encounter in the literature. This review is based on an understanding of the current state of the literature by the paper's authors. It is not a structured review and does not claim comprehensive coverage but does share some interesting insights.

To be able to undertake the analysis of ethical issues in our case studies, we sought to categorise the ethical issues found in the literature. There are potentially numerous ways of doing so and our suggestion does not claim to be authoritative. Our suggestion is to order ethical issues in terms of their temporal horizon, i.e., the amount of time it is likely to take to be able to address them. Time is a continuous variable, but we suggest that it is possible to sort the issues into three clusters: short term, medium term, and long term (see Fig.  1 ).

Temporal horizon for addressing ethical issues

As suggested by Baum ( 2017 ), it is best to acknowledge that there will be ethical issues and related mitigating activities that cannot exclusively fit in as short, medium or long term.

ather than seeing it as an authoritative classification, we see this as a heuristic that reflects aspects of the current discussion. One reason why this categorisation is useful is that the temporal horizon of ethical issues is a potentially useful variable, with companies often being accused of favouring short-term gains over long-term benefits. Similarly, short-term issues must be able to be addressed on the local level for short-term fixes to work.

Short-term issues

These are issues for which there is a reasonable assumption that they are capable of being addressed in the short term. We do not wish to quantify what exactly counts as short term, as any definition put forward will be contentious when analysing the boundaries and transition periods. A better definition of short term might therefore be that such issues can be expected to be successfully addressed in technical systems that are currently in operation or development. Many of the issues we discuss under the heading of short-term issues are directly linked to some of the key technologies driving the current AI debate, notably machine learning and some of its enabling techniques and approaches such as neural networks and reinforcement learning.

Many of the advantages promised by BD + AI involve the use of personal data, data which can be used to identify individuals. This includes health data; customer data; ANPR data (Automated Number Plate Recognition); bank data; and even includes data about farmers’ land, livestock, and harvests. Issues surrounding privacy and control of data are widely discussed and recognized as major ethical concerns that need to be addressed (Boyd & Crawford, 2012 ; Tene & Polonetsky, 2012 , 2013 ; Mittelstadt, Allo, Taddeo, Wachter, & Floridi, 2016 ; Jain, Gyanchandani, & Khare, 2016 ; Mai, 2016 ; Macnish, 2018 ). The concern surrounding privacy can be put down to a combination of a general level of awareness of privacy issues and the recently-introduced General Data Protection Regulation (GDPR). Closely aligned with privacy issues are those relating to transparency of processes dealing with data, which can often be classified as internal, external, and deliberate opaqueness (Burrell, 2016 ; Lepri, Staiano, Sangokoya, Letouzé, & Oliver, 2017 ; Mittelstadt, Allo, Taddeo, Wachter, & Floridi, 2016 ).

The Guidelines for Trustworthy AI Footnote 4 were released in 2018 by the High-Level Expert Group on Artificial Intelligence (AI HLEG Footnote 5 ), and address the need for technical robustness and safety, including accuracy, reproducibility, and reliability. Reliability is further linked to the requirements of diversity, fairness, and social impact because it addresses freedom from bias from a technical point of view. The concept of reliability, when it comes to BD + AI, refers to the capability to verify the stability or consistency of a set of results (Bush, 2012 ; Ferraggine, Doorn, & Rivera, 2009 ; Meeker and Hong, 2014 ).

If a technology is unreliable, error-prone, and unfit-for-purpose, adverse ethical issues may result from decisions made by the technology. The accuracy of recommendations made by BD + AI is a direct consequence of the degree of reliability of the technology (Barolli, Takizawa, Xhafa, & Enokido, 2019 ). Bias and discrimination in algorithms may be introduced consciously or unconsciously by those employing the BD + AI or because of algorithms reflecting pre-existing biases (Baroccas and Selbst, 2016 ). Examples of bias have been documented often reflecting “an imbalance in socio-economic or other ‘class’ categories—ie, a certain group or groups are not sampled as much as others or at all” (Panch et al., 2019 ). have the potential to affect levels of inequality and discrimination, and if biases are not corrected these systems can reproduce existing patterns of discrimination and inherit the prejudices of prior decision makers (Barocas & Selbst, 2016 , p. 674). An example of inherited prejudices is documented in the United States, where African-American citizens, more often than not, have been given longer prison sentences than Caucasians for the same crime.

Medium-term issues

Medium-term issues are not clearly linked to a particular technology but typically arise from the integration of AI techniques including machine learning into larger socio-technical systems and contexts. They are thus related to the way life in modern societies is affected by new technologies. These can be based on the specific issues listed above but have their main impact on the societal level. The use of BD + AI may allow individuals’ behaviour to be put under scrutiny and surveillance , leading to infringements on privacy, freedom, autonomy, and self-determination (Wolf, 2015 ). There is also the possibility that the increased use of algorithmic methods for societal decision-making may create a type of technocratic governance (Couldry & Powell, 2014 ; Janssen & Kuk, 2016 ), which could infringe on people’s decision-making processes (Kuriakose & Iyer, 2018 ). For example, because of the high levels of public data retrieval, BD + AI may harm people’s freedom of expression, association, and movement, through fear of surveillance and chilling effects (Latonero, 2018 ).

Corporations have a responsibility to the end-user to ensure compliance, accountability, and transparency of their BD + AI (Mittelstadt, Allo, Taddeo, Wachter, & Floridi, 2016 ). However, when the source of a problem is difficult to trace, owing to issues of opacity, it becomes challenging to identify who is responsible for the decisions made by the BD + AI. It is worth noting that a large-scale survey in Australia in 2020 indicated that 57.9% of end-users are not at all confident that most companies take adequate steps to protect user data. The significance of understanding and employing responsibility is an issue targeted in many studies (Chatfield et al., 2017 ; Fothergill et al., 2019 ; Jirotka et al., 2017 ; Pellé & Reber, 2015 ). Trust and control over BD + AI as an issue is reiterated by a recent ICO report demonstrating that most UK citizens do not trust organisations with their data (ICO, 2017 ).

Justice is a central concern in BD + AI (Johnson, 2014 , 2018 ). As a starting point, justice consists in giving each person his or her due or treating people equitably (De George, p. 101). A key concern is that benefits will be reaped by powerful individuals and organisations, while the burden falls predominantly on poorer members of society (Taylor, 2017 ). BD + AI can also reflect human intentionality, deploying patterns of power and authority (Portmess & Tower, 2015 , p. 1). The knowledge offered by BD + AI is often in the hands of a few powerful corporations (Wheeler, 2016 ). Power imbalances are heightened because companies and governments can deploy BD + AI for surveillance, privacy invasions and manipulation, through personalised marketing efforts and social control strategies (Lepri, Staiano, Sangokoya, Letouzé, & Oliver, 2017 , p. 11). They play a role in the ascent of datafication, especially when specific groups (such as corporate, academic, and state institutions) have greater unrestrained access to big datasets (van Dijck, 2014 , p. 203).

Discrimination , in BD + AI use, can occur when individuals are profiled based on their online choices and behaviour, but also their gender, ethnicity and belonging to specific groups (Calders, Kamiran, & Pechenizkiy, 2009 ; Cohen et al., 2014 ; and Danna & Gandy, 2002 ). Data-driven algorithmic decision-making may lead to discrimination that is then adopted by decision-makers and those in power (Lepri, Staiano, Sangokoya, Letouzé, & Oliver, 2017 , p. 4). Biases and discrimination can contribute to inequality . Some groups that are already disadvantaged may face worse inequalities, especially if those belonging to historically marginalised groups have less access and representation (Barocas & Selbst, 2016 , p. 685; Schradie, 2017 ). Inequality-enhancing biases can be reproduced in BD + AI, such as the use of predictive policing to target neighbourhoods of largely ethnic minorities or historically marginalised groups (O’Neil, 2016 ).

BD + AI offers great potential for increasing profit, reducing physical burdens on staff, and employing innovative sustainability practices (Badri, Boudreau-Trudel, & Souissi, 2018 ). They offer the potential to bring about improvements in innovation, science, and knowledge; allowing organisations to progress, expand, and economically benefit from their development and application (Crawford et al., 2014 ). BD + AI are being heralded as monumental for the economic growth and development of a wide diversity of industries around the world (Einav & Levin, 2014 ). The economic benefits accrued from BD + AI may be the strongest driver for their use, but BD + AI also holds the potential to cause economic harm to citizens and businesses or create other adverse ethical issues (Newman, 2013 ).

However, some in the literature view the co-development of employment and automation as somewhat naïve outlook (Zuboff, 2015 ). BD + AI companies may benefit from a ‘post-labour’ automation economy, which may have a negative impact on the labour market (Bossman, 2016 ), replacing up to 47% of all US jobs within the next 20 years (Frey & Osborne, 2017 ). The professions most at risk of affecting employment correlated with three of our case studies: farming, administration support and the insurance sector (Frey & Osborne, 2017 ).

Long-term issues

Long-term issues are those pertaining to fundamental aspects of nature of reality, society, or humanity. For example, that AI will develop capabilities far exceeding human beings (Kurzweil, 2006 ). At this point, sometimes called the ‘ singularity ’ machines achieve human intelligence, are expected to be able to improve on themselves and thereby surpass human intelligence and become superintelligent (Bostrom, 2016 ). If this were to happen, then it might have dystopian consequences for humanity as often depicted in science fiction. Also, it stands to reason that the superintelligent, or even just the normally intelligent machines may acquire a moral status.

It should be clear that these expectations are not universally shared. They refer to what is often called ‘ artificial general intelligence’ (AGI), a set of technologies that emulate human reasoning capacities more broadly. Footnote 6

Furthermore, if we may acquire new capabilities, e.g. by using technical implants to enhance human nature. The resulting being might be called a transhuman , the next step of human evolution or development. Again, it is important to underline that this is a contested idea (Livingstone, 2015 ) but one that has increasing traction in public discourse and popular science accounts (Harari, 2017 ).

We chose this distinction of three groups of issues for understanding how mitigation strategies within organisations can be contextualised. We concede that this is one reading of the literature and that many others are possible. In this account of the literature we tried to make sense of the current discourse to allow us to understand our empirical findings which are introduced in the following sections.

Case Study Methodology

Despite the impressive amount of research undertaken on ethical issues of AI + BD (e.g. Mittelstadt, Allo, Taddeo, Wachter, & Floridi, 2016 ; Zwitter, 2014 ), there are few case studies exploring such issues. This paper builds upon this research and employs an interpretivist methodology to do so, focusing on how, what, and why questions relevant to the ethical use of BD + AI (Walsham, 1995a , b ). The primary research questions for the case studies were: How do organisations perceive ethical concerns related to BD + AI and in what ways do they deal with them?

We sought to elicit insights from interviews, rather than attempting to reach an objective truth about the ethical impacts of BD + AI. The interpretivist case study approach (Stake 2003) allowed the researchers ‘to understand ‘reality’ as the blending of the various (and sometimes conflicting) perspectives which coexist in social contexts, the common threads that connect the different perspectives and the value systems that give rise to the seeming contradictions and disagreements around the topics discussed. Whether one sees this reality as static (social constructivism) or dynamic (social constructionism) was also a point of consideration, as they both belong in the same “family” approach where methodological flexibility is as important a value as rigour’ (XXX).

Through extensive brainstorming within the research team, and evaluations of relevant literature, 16 social application domains were established as topics for case study analysis. Footnote 7 The project focused on ten out of these application domains in accordance with the partners’ competencies. The case studies have covered ten domains, and each had their own unique focus, specifications, and niches, which added to the richness of the evaluations (Table 1 ).

The qualitative analysis approach adopted in this study focused on these ten standalone operational case studies that were directly related to the application domains presented in Table 1 . These individual case studies provide valuable insights (Yin, 2014 , 2015 ); however, a multiple-case study approach offers a more comprehensive analysis of ethical issues related to BD + AI use (Herriott & Firestone, 1983 ). Thus, this paper adopts a multiple-case study methodology to identify what insights can be obtained from the ten cases, identifies whether any generalisable understandings can be retrieved, and evaluates how different organisations deal with issues pertaining to BD + AI development and use. The paper does not attempt to derive universal findings from this analysis, in line with the principles of interpretive research, but further attempts to gain an in-depth understanding of the implications of selected BD + AI applications.

The data collection was guided by specific research questions identified through each case, including five desk research questions (see appendix 1); 24 interview questions (see appendix 2); and a checklist of 17 potential ethical issues, developed by the project leader Footnote 8 (see appendix 3). A thematic analysis framework was used to ‘highlight, expose, explore, and record patterns within the collected data. The themes were patterns across data sets that were important to describe several ethical issues which arise through the use of BD  +  AI across different types of organisations and application domains’ (XXX).

A workshop was then held after the interviews were carried out. The workshop brought together the experts in the case study team to discuss their findings. This culminated in 26 ethical issues Footnote 9 that were inductively derived from the data collected throughout the interviews (see Fig.  2 and Table 3). Footnote 10 In order to ensure consistency and rigour in the multiple-case study approach, researchers followed a standardised case study protocol (Yin, 2014 ). Footnote 11

The Prevalence of Ethical Issues in the Case Studies

Thirteen different organisations were interviewed for 10 case studies, consisting of 22 interviews in total. Footnote 12 These ranged from 30 min to 1 ½ hours in-person or Skype interviews. The participants that were selected for interviews represented a very broad range of application domains and organisations that use BD + AI. The case study organisations were selected according to their relevance to the overall case study domains and considering their fit with the domains and likelihood of providing interesting insights. The interviewees were then selected according to their ability to explain their BD + AI and its role in their organisation. In addition to interviews, a document review provided supporting information about the organisation. Thus, websites and published material were used to provide background to the research.

Findings: Ten Case Studies

This section gives a brief overview of the cases, before analysing their similarities and differences. It also highlights the different types of BD + AI being used, and the types of data used by the BD + AI in the case study organisations, before conducting an ethical analysis of the cases. Table 2 presents an overview of the 10 cases to show the roles of the interviewees, the focus of the technologies being used, and the data retrieved by each organisation’s BD + AI. All interviews were conducted in English.

The types of organisations that were used in the case studies varied extensively. They included start-ups (CS10), niche software companies (CS1), national health insurers (Organisation X in CS6), national energy providers (CS7), chemical/agricultural multinational (CS3), and national (CS9) and international (CS8) telecommunications providers. The case studies also included public (CS2, Organisation 1 and 4 in CS4) and semi-public (Organisation 2 in CS4) organisations, as well as a large scientific research project (CS5).

The types of individuals interviewed also varied extensively. For example, CS6 and CS7 did not have anyone with a specific technical background, which limited the possibility of analysing issues related to the technology itself. Some case studies only had technology experts (such as CS1, CS8, and CS9), who mostly concentrated on technical issues, with much less of a focus on ethical concerns. Other case studies had a combination of both technical and policy-focused experts (i.e. CS3, CS4, and CS5). Footnote 13

Therefore, it must be made fundamentally clear that we are not proposing that all of the interviewees were authorities in the field, or that even collectively they represent a unified authority on the matter, but instead, that we are hoping to show what are the insights and perceived ethical issues of those currently working with AI on the ground view as ethical concerns. While the paper is presenting the ethical concerns found within an array of domains, we do not claim that any individual case study is representative of their entire industry, but instead, our intent was to capture a wide diversity of viewpoints, domains, and applications of AI, to encompass a broad amalgamation of concerns. We should also state that this is not a shortcoming of the study but that it is the normal approach that social science often takes.

The diversity of organisations and their application focus areas also varied. Some organisations focused more so on the Big Data component of their AI, while others more strictly on the AI programming and analytics. Even when organisations concentrated on a specific type of BD + AI, such as Big Data, its use varied immensely, including retrieval (CS1), analysis (CS2), predictive analytics (CS10), and transactional value (Organisation 2 in CS4). Some domains adopted BD + AI earlier and more emphatically than others (such as communications, healthcare, and insurance). Also, the size, investment, and type of organisation played a part in the level of BD + AI innovation (for example, the two large multinationals in CS3 and CS8 had well-developed BD + AI).

The maturity level of BD + AI was also determined by how it was integrated, and its importance, within an organisation. For instance, in organisations where BD + AI were fundamental for the success of the business (e.g. CS1 and CS10), they played a much more important role than in companies where there was less of a reliance (e.g. CS7). In some organisations, even when BD + AI was not central to success, the level of development was still quite advanced because of economic investment capabilities (e.g. CS3 and CS8).

These differences provided important questions to ask throughout this multi-case study analysis, such as: Do certain organisations respond to ethical issues relating to BD + AI in a certain way? Does the type of interviewee affect the ethical issues discussed—e.g. case studies without technical experts, those that only had technical experts, and those that had both? Does the type of BD + AI used impact the types of ethical issues discussed? What significance does the type of data retrieved have on ethical issues identified by the organisations? These inductive ethical questions provided a template for the qualitative analysis in the following section.

Ethical Issues in the Case Studies

Based on the interview data, the ethical issues identified in the case studies were grouped into six specific thematic sections to provide a more conducive, concise, and pragmatic methodology. Those six sections are: control of data, reliability of data, justice, economic issues, role of organisations, and individual freedoms. From the 26 ethical issues, privacy was the only ethical issue addressed in all 10 case studies, which was not surprising because it has received a great deal of attention recently because of the GDPR. Also, security, transparency, and algorithmic bias are regularly discussed in the literature, so we expected them to be significant issues across many of the cases. However, there were many issues that received less attention in the literature—such as access to BD + AI, trust, and power asymmetries—which were discussed frequently in the interviews. In contrast to this, there were ethical issues that were heavily discussed in the literature which received far less attention in the interviews, such as employment, autonomy, and criminal or malicious use of BD + AI (Fig.  2 ).

The ethical analysis was conducted using a combination of literature reviews and interviews carried out with stakeholders. The purpose of the interviews was to ensure that there were no obvious ethical issues faced by stakeholders in their day-to-day activities which had been missed in the academic literature. As such, the starting point was not an overarching normative theory, which might have meant that we looked for issues which fit well with the theory but ignored anything that fell outside of that theory. Instead the combined approach led to the identification of the 26 ethical issues, each labelled based on particular words or phrases used in the literature or by the interviewees. For example, the term "privacy" was used frequently and so became the label for references to and instances of privacy-relevant concerns. In this section we have clustered issues together based on similar problems faced (e.g. accuracy of data and accuracy of algorithms within the category of ‘reliability of data’).

In an attempt to highlight similar ethical issues and improve the overall analysis to better capture similar perspectives, the research team decided to use the method of clustering, a technique often used in data mining to efficiently group similar elements together. Through discussion in the research team, and bearing in mind that the purpose of the clustering process was to form clusters that would enhance understanding of the impact of these ethical issues, we arrived at the following six clusters: the control of data (covering privacy, security, and informed consent); the reliability of data (accuracy of data and accuracy of algorithms); justice (power asymmetries, justice, discrimination, and bias); economic issues (economic concerns, sustainability, and employment); the role of organisations (trust and responsibility); and human freedoms (autonomy, freedom, and human rights). Both the titles and the precise composition of each cluster of issues are the outcome of a reasoned agreement of the research team. However, it should be clear that we could have used different titles and different clustering. The point is not that each cluster forms a distinct group of ethical issues, independent from any other. Rather the ethical issues faced overlap and play into one another, but to present them in a manageable format we have opted to use this bottom-up clustering approach.

Human Freedoms

An interviewee from CS10 stated that they were concerned about human rights because they were an integral part of the company’s ethics framework. This was beneficial to their business because they were required to incorporate human rights to receive public funding by the Austrian government. The company ensured that they would not grant ‘full exclusivity on generated social unrest event data to any single party, unless the data is used to minimise the risk of suppression of unrest events, or to protect the violation of human rights’ (XXX). The company demonstrates that while BD + AI has been criticised for infringing upon human rights in the literature, they also offer the opportunity to identify and prevent human rights abuses. The company’s moral framework definitively stemmed from regulatory and funding requirements, which lends itself to the benefit of effective ethical top-down approaches, which is a divisive topic in the literature, with diverging views about whether top-down or bottom-up approaches are better options for improved AI ethics.

Trust & Responsibility

Responsibility was a concern in 5 of the case studies, confirming the importance it is given in the literature (see Sect.  3 ). Trust appeared in seven of the case studies. The cases focused on concerns found in the literature, such as BD + AI use in policy development, public distrust about automated decision-making and the integrity of corporations utilising datafication methods (van Dijck 2014 ).

Trust and control over BD + AI were an issue throughout the case studies. The organisation from the predictive intelligence case study (CS10) identified that their use of social media data raised trust issues. They converged with perspectives found in the literature that when people feel disempowered to use or be part of the BD + AI development process, they tend to lose trust in the BD + AI (Accenture, 2016 , 2017 ). In CS6, stakeholders (health insurers) trusted the decisions made by BD + AI when they were engaged and empowered to give feedback on how their data was used. Trust is enhanced when users can refuse the use of their data (CS7), which correlates with the literature. Companies discussed the benefits of establishing trustworthy relationships. For example, in CS9, they have “ been trying really hard to avoid the existence of fake [mobile phone] base stations, because [these raise] an issue with the trust that people put in their networks” (XXX).

Corporations need to determine the objective of the data analysis (CS3), what data is required for the BD + AI to work (CS2), and accountability for when it does not work as intended or causes undesirable outcomes (CS4). The issue here is whether the organisation takes direct responsibility for these outcomes, or, if informed consent has been given, can responsibility be shared with the granter of consent (CS3). The cases also raised the question of ‘responsible to whom’, the person whose data is being used or the proxy organisation who has provided data (CS6). For example, in the insurance case study, the company stated that they only had a responsibility towards the proxy organisation and not the sources of the data. All these issues are covered extensively in the literature in most application domains.

Control of Data

Concerns surrounding the control of data for privacy reasons can be put down to a general awareness of privacy issues in the press, reinforced by the recently-introduced GDPR. This was supported in the cases, where interviewees expressed the opinion that the GDPR had raised general awareness of privacy issues (CS1, CS9) or that it had lent weight to arguments concerning the importance of privacy (CS8).

The discussion of privacy ranged from stressing that it was not an issue for some interviewees, because there was no personal information in the data they used (CS4), to its being an issue for others, but one which was being dealt with (CS2 and CS8). One interviewee (CS5) expressed apprehension that privacy concerns conflicted with scientific innovation, introducing hitherto unforeseen costs. This view is not uncommon in scientific and medical innovation, where harms arising from the use of anonymised medical data are often seen as minimal and the potential benefits significant (Manson & O’Neill, 2007 ). In other cases (CS1), there was a confusion between anonymisation (data which cannot be traced back to the originating source) and pseudonymisation (where data can be traced back, albeit with difficulty) of users’ data. A common response from the cases was that providing informed consent for the use of personal data waived some of the rights to privacy of the user.

Consent may come in the form of a company contract Footnote 14 or an individual agreement. Footnote 15 In the former, the company often has the advantage of legal support prior to entering a contract and so should be fully aware of the information provided. In individual agreements, though, the individual is less likely to be legally supported, and so may be at risk of exploitation through not reading the information sufficiently (CS3), or of responding without adequate understanding (CS9). In one case (CS5), referring to anonymised data, consent was implied rather than given: the interviewee suggested that those involved in the project may have contributed data without giving clear informed consent. The interviewee also noted that some data may have been shared without the permission, or indeed knowledge, of those contributing individuals. This was acknowledged by the interviewee as a potential issue.

In one case (CS6), data was used without informed consent for fraud detection purposes. The interviewees noted that their organisation was working within the parameters of national and EU legislation, which allows for non-consensual use of data for these ends. One interviewee in this case stated that informed consent was sought for every novel use of the data they held. However, this was sought from the perceived owner of the data (an insurance company) rather than from the originating individuals. This case demonstrates how people may expect their data to be used without having a full understanding of the legal framework under which the data are collected. For example, data relating to individuals may legally be accessed for fraud detection without notifying the individual and without relying on the individual’s consent.

This use of personal data for fraud detection in CS6 also led to concerns regarding opacity. In both CS6 and CS10 there was transparency within the organisations (a shared understanding among staff as to the various uses of the data) but that did not extend to the public outside those organisations. In some cases (CS5) the internal transparency/external opacity meant that those responsible for developing BD + AI were often hard to meet. Of those who were interviewed in CS5, many did not know the providence of the data or the algorithms they were using. Equally, some organisations saw external opacity as integral to the business environment in which they were operating (CS9, CS10) for reasons of commercial advantage. The interviewee in CS9 cautioned that this approach, coupled with a lack of public education and the speed of transformation within the industry, would challenge any meaningful level of public accountability. This would render processes effectively opaque to the public, despite their being transparent to experts.

Reliability of Data

There can be multiple sources of unreliability in BD + AI. Unreliability originating from faults in the technology can lead to algorithmic bias, which can cause ethical issues such as unfairness, discrimination, and general negative social impact (CS3 and CS6). Considering algorithmic bias as a key input to data reliability, there exist two types of issues that may need to be addressed. Primarily, bias may stem from the input data, referred to as training data, if such data excludes adequate representation of the world, e.g. gender-biased datasets (CS6). Secondly, an inadequate representation of the world may be the result of lack of data, e.g. a correctly designed algorithm to learn from and predict a rare disease, may not have sufficient representative data to achieve correct predictions (CS5). In either case the input data are biased and may result in inaccurate decision-making and recommendations.

The issues of reliability of data stemming from data accuracy and/or algorithmic bias, may escalate depending on their use, as for example in predictive or risk-assessment algorithms (CS10). Consider the risks of unreliable data in employee monitoring situations (CS1), detecting pests and diseases in agriculture (CS3), in human brain research (CS5) or cybersecurity applications (CS8). Such issues are not singular in nature but closely linked to other ethical issues such as information asymmetries, trust, and discrimination. Consequently, the umbrella issue of reliability of data must be approached from different perspectives to ensure the validity of the decision-making processes of the BD + AI.

Data may over-represent some people or social groups who are likely to be already privileged or under-represent disadvantaged and vulnerable groups (CS3). Furthermore, people who are better positioned to gain access to data and have the expertise to interpret them may have an unfair advantage over people devoid of such competencies. In addition, BD + AI can work as a tool of disciplinary power, used to evaluate people’s conformity to norms representing the standards of disciplinary systems (CS5). We focus on the following aspects of justice in our case study analysis: power asymmetries, discrimination, inequality, and access.

The fact that issues of power can arise in public as well as private organisations was discussed in our case studies. The smart city case (CS4) showed that the public organisations were aware of potential problems arising from companies using public data and were trying to put legal safeguards in place to avoid such misuse. As a result of misuse, there is the potential that cities, or the companies with which they contract, may use data in harmful or discriminatory ways. Our case study on the use of BD + AI in scientific research showed that the interviewees were acutely aware of the potential of discrimination (CS10). They stated that biases in the data may not be easy to identify, and may lead to misclassification or misinterpretation of findings, which may in turn skew results. Discrimination refers to the recognition of difference, but it may also refer to unjust treatment of different categories of people based on their gender, sex, religion, race, class, or disability. BD + AI are often employed to distinguish between different cases, e.g. between normal and abnormal behaviour in cybersecurity. Determining whether such classification entails discrimination in the latter sense can be difficult, due to the nature of the data and algorithms involved.

Examples of potential inequality based on BD + AI could be seen in several case studies. The agricultural case (CS3) highlighted the power differential between farmers and companies with potential implications for inequality, but also the global inequality between farmers, linked to farming practices in different countries (CS3). Subsistence farmers in developing countries, for example, might find it more difficult to benefit from these technologies than large agro-businesses. The diverging levels of access to BD + AI entail different levels of ability to benefit from them and counteract possible disadvantages (CS3). Some companies restrict access to their data entirely, and others sell access at a fee, while others offer small datasets to university-based researchers (Boyd & Crawford, 2012 , p. 674).

Economic Issues

One economic impact of BD + AI outlined in the agriculture case study (CS3) focused on whether this technology, and their ethical implementation, were economically affordable. If BD + AI could not improve economic efficiency, they would be rejected by the end-user, whether they were more productive, sustainable, and ethical options. This is striking, as it raises a serious challenge for the AI ethics literature and industry. It establishes that no matter how well intentioned and principled AI ethics guidelines and charters are, unless their implementation can be done in an economically viable way, their implementation will be challenged and resisted by those footing the bill.

The telecommunications case study (CS9) focused on how GDPR legislation may economically impact businesses using BD + AI by creating disparities in competitiveness between EU and non-EU companies developing BD + AI. Owing to the larger data pools of the latter, their BD + AI may prove to be more effective than European-manufactured alternatives, which cannot bypass the ethical boundaries of European law in the same way (CS8). This is something that is also being addressed in the literature and is a very serious concern for the future profitability and development of AI in Europe (Wallace & Castro, 2018 ). The literature notes additional issues in this area that were not covered in the cases. There is the potential that the GDPR will increase costs of European AI companies by having to manually review algorithmic decision-making; the right to explanation could reduce AI accuracy; and the right to erasure could damage AI systems (Wallace & Castro, 2018 , p. 2).

One interviewee stated that public–private BD + AI projects should be conducted in a collaborative manner, rather than a sale-of-service (CS4). However, this harmonious partnership is often not possible. Another interviewee discussed the tension between public and private interests on their project—while the municipality tried to focus on citizen value, the ICT company focused on the project’s economic success. The interviewee stated that the project would have terminated earlier if it were the company’s decision, because it was unprofitable (CS4). This is a huge concern in the literature, whereby private interests will cloud, influence, and damage public decision-making within the city because of their sometimes-incompatible goals (citizen value vs. economic growth) (Sadowski & Pasquale, 2015 ). One interviewee said that the municipality officials were aware of the problems of corporate influence and thus are attempting to implement the approach of ‘data sovereignty’ (CS2).

During our interviews, some viewed BD + AI as complementary to human employment (CS3), collaborative with such employment (CS4), or as a replacement to employment (CS6). The interviewees from the agriculture case study (CS3) stated that their BD + AI were not sufficiently advanced to replace humans and were meant to complement the agronomist, rather than replace them. However, they did not indicate what would happen when the technology is advanced enough, and it becomes profitable to replace the agronomist. The insurance company interviewee (CS6) stated that they use BD + AI to reduce flaws in personal judgment. The literature also supports this viewpoint, where BD + AI is seen to offer the potential to evaluate cases impartially, which is beneficial to the insurance industry (Belliveau, Gray, & Wilson, 2019 ). Footnote 16 The interviewee reiterated this and also stated that BD + AI would reduce the number of people required to work on fraud cases. The interviewee stated that BD + AI are designed to replace these individuals, but did not indicate whether their jobs were secure or whether they would be retrained for different positions, highlighting a concern found in the literature about the replacement and unemployment of workers by AI (Bossman, 2016 ). In contrast to this, a municipality interviewee from CS4 stated that their chat-bots are used in a collaborative way to assist customer service agents, allowing them to concentrate on higher-level tasks, and that there are clear policies set in place to protect their jobs.

Sustainability was only explicitly discussed in two interviews (CS3 and CS4). The agriculture interviewees stated that they wanted to be the ‘first’ to incorporate sustainability metrics into agricultural BD + AI, indicating a competitive and innovative rationale for their company (CS3). Whereas the interviewee from the sustainable development case study (CS4) stated that their goal of using BD + AI was to reduce Co2 emissions and improve energy and air quality. He stated that there are often tensions between ecological and economic goals and that this tension tends to slow down the efforts of BD + AI public–private projects—an observation also supported by the literature (Keeso, 2014 ). This tension between public and private interests in BD + AI projects was a recurring issue throughout the cases, which will be the focus of the next section on the role of organisations.

Discussion and Conclusion

The motivation behind this paper is to come to a better understanding of ethical issues related to BD + AI based on a rich empirical basis across different application domains. The exploratory and interpretive approach chosen for this study means that we cannot generalise from our research to all possible examples of BD + AI, but it does allow us to generalise to theory and rich insights (Walsham, 1995a , b , 2006 ). These theoretical insights can then provide the basis for further empirical research, possibly using other methods to allow an even wider set of inputs to move beyond some of the limitations of the current study.

Organisational Practice and the Literature

The first point worth stating is that there is a high level of consistency both among the case studies and between cases and literature. Many of the ethical issues identified cut across the cases and are interpreted in similar ways by different stakeholders. The frequency distribution of ethical issues indicates that very few, if any, issues are relevant to all cases but many, such as privacy, have a high level of prevalence. Despite appearing in all case studies, privacy was not seen as overly problematic and could be dealt with in the context of current regulatory principles (GDPR). Most of the issues that we found in the literature (see Sect.  2 ) were also present in the case studies. In addition to privacy and data protection, this included accuracy, reliability, economic and power imbalances, justice, employment, discrimination and bias, autonomy and human rights and freedoms.

Beyond the general confirmation of the relevance of topics discussed in the literature, though, the case studies provide some further interesting insights. From the perspective of an individual case some societal factors are taken for granted and outside of the control of individual actors. For example, intellectual property regimes have significant and well-recognised consequences for justice, as demonstrated in the literature. However, there is often little that individuals or organisations can do about them. Even in cases where individuals may be able to make a difference and the problem is clear, it is not always obvious how to do this. Some well-publicised discrimination cases may be easy to recognise, for example where an HR system discriminates against women or where a facial recognition system discriminates against black people. But in many cases, it may be exceedingly difficult to recognise discrimination where it is not clear how a person is discriminated against. If, for example, an image-based medical diagnostic system leads to disadvantages for people with genetic profiles, this may not be easy to identify.

With regards to the classification of the literature suggested in Sect.  2 along the temporal dimension, we can see that the attention of the case study respondents seems to be correlated to the temporal horizon of the issues. The issues we see as short-term figures most prominently, whereas the medium-term issues, while still relevant and recognisable, appear to be less pronounced. The long-term questions are least visible in the cases. This is not very surprising, as the short-term issues are those that are at least potentially capable of being addressed relatively quickly and thus must be accessible on the local level. Organisations deploying or using AI therefore are likely to have a responsibility to address these issues and our case studies have shown that they are aware of this and putting measures in place. This is clearly true for data protection or security issues. The medium-term issues that are less likely to find local resolutions still figure prominently, even though an individual organisation has less influence on how they can be addressed. Examples of this would be questions of unemployment, justice, or fairness. There was little reference to what we call long-term issues, which can partly be explained by the fact that the type of AI user organisations we investigated have very limited influence on how they are perceived and how they may be addressed.

Interpretative Differences on Ethical Issues

Despite general agreement on the terminology used to describe ethical issues, there are often important differences in interpretation and understanding. In the first ethics theme, control of data, the perceptions of privacy ranged from ‘not an issue’ to an issue that was being dealt with. Some of this arose from the question of informed consent and the GDPR. However, a reliance on legislation, such as GDPR, without full knowledge of the intricacies of its details (i.e. that informed consent is only one of several legal bases of lawful data processing), may give rise to a false sense of security over people’s perceived privacy. This was also linked to the issue of transparency (of processes dealing with data), which may be external to the organisation (do people outside understand how an organisation holds and processes their data), or internal (how well does the organisation understand the algorithms developed internally) and sometimes involve deliberate opacity (used in specific contexts where it is perceived as necessary, such as in monitoring political unrest and its possible consequences). Therefore, a clearer and more nuanced understanding of privacy and other ethical terms raised here might well be useful, albeit tricky to derive in a public setting (for an example of complications in defining privacy, see Macnish, 2018 ).

Some issues from the literature were not mentioned in the cases, such as warfare. This can easily be explained by our choice of case studies, none of which drew on work done in this area. It indicates that even a set of 10 case studies falls short of covering all issues.

A further empirical insight is in the category we called ‘role of organisations’, which covers trust and responsibility. Trust is a key term in the discussion of the ethics of AI, prominently highlighted by the focus on trustworthy AI by the EU’s High-Level Expert Group, among others. We put this into the ‘role of organisations’ category because our interaction with the case study respondents suggested that they felt it was part of the role of their organisations to foster trust and establish responsibilities. But we are open to the suggestion that these are concepts on a slightly different level that may provide the link between specific issues in applications and broader societal debate.

Next Steps: Addressing the Ethics of AI and Big Data

This paper is predominantly descriptive, and it aims to provide a theoretically sound and empirically rich account of ethical concerns in AI + BD. While we hope that it proves to be insightful it is only a first step in the broader journey towards addressing and resolving these issues. The categorisation suggested here gives an initial indication of which type of actor may be called upon to address which type of issue. The distinction between micro-, meso- and macro perspectives suggested by Haenlein and Kaplan ( 2019 ) resonates to some degree with our categorisation of issues.

This points to the question what can be done to address these ethical issues and by whom should it be done? We have not touched on this question in the theoretical or empirical part of the paper, but the question of mitigation is the motivating force behind much of the AI + BD ethics research. The purpose of understanding these ethical questions is to find ways of addressing them.

This calls for a more detailed investigation of the ethical nature of the issues described here. As indicated earlier, we did not begin with a specific ethical theoretical framework imposed onto the case studies, but did have some derived ethics concepts which we explored within the context of the cases and allowed others to emerge over the course of the interviews. One issue is the philosophical question whether the different ethical issues discussed here are of a similar or comparable nature and what characterises them as ethical issues. This is not only a philosophical question but also a practical one for policymakers and decision makers. We have alluded to the idea that privacy and data protection are ethical issues, but they also have strong legal implications and can also be human rights issues. It would therefore be beneficial to undertake a further analysis to investigate which of these ethical issues are already regulated and to what degree current regulation covers BD + AI, and how this varies across the various EU nations and beyond.

Another step could be to expand an investigation like the one presented here to cover the ethics of AI + BD debate with a focus on suggested resolutions and policies. This could be achieved by adopting the categorisation and structure presented here and extending it to the currently discussed option for addressing the ethical issues. These include individual and collective activities ranging from technical measures to measure bias in data or individual professional guidance to standardisation, legislation, the creation of a specific regulator and many more. It will be important to understand how these measures are conceptualised as well as which ones are already used to which effect. Any such future work, however, will need to be based on a sound understanding of the issues themselves, which this paper contributes to. The key contribution of the paper, namely the presentation of empirical findings from 10 case studies show in more detail how ethical issues play out in practice. While this work can and should be expanded by including an even broader variety of cases and could be supplemented by other empirical research methods, it marks an important step in the development of our understanding of these ethical issues. This should form a part of the broader societal debate about what these new technologies can and should be used for and how we can ensure that their consequences are beneficial for individuals and society.

Throughout the paper, XXX will be used to anonymise relevant text that may identify the authors, either through the project and/or publications resulting from the individual case studies. All case studies have been published individually. Several the XXX references in the findings refer to these individual publications which provide more detail on the cases than can be provided in this cross-case analysis.

The ethical issues that we discussed throughout the case studies refers to issues broadly construed as ethical issues, or issues that have ethical significance. While some issues may not be directly obvious how they are ethical issues, they may give rise to significant harm relevant to ethics. For example, accuracy of data may not explicitly be an ethical issue, if inaccurate data is used in algorithms, it may lead to discrimination, unfair bias, or harms to individuals.

Such as chat-bots, natural language processing AI, IoT data retrieval, predictive risk analysis, cybersecurity machine-learning, and large dataset exchanges.

https://ec.europa.eu/futurium/en/ai-alliance-consultation/guidelines/1 .

https://ec.europa.eu/digital-single-market/en/high-level-expert-group-artificial-intelligence .

The type of AI currently in vogue, as outlined earlier, is based on machine learning, typically employing artificial neural networks for big data analysis. This is typically seen as ‘narrow AI’ and it is not clear whether there is a way from narrow to general AI, even if one were to accept that achieving general AI is fundamentally possible.

The 16 social domains were: Banking and securities; Healthcare; Insurance; Retail and wholesale trade; Science; Education; Energy and utilities; Manufacturing and natural resources; Agriculture; Communications, media and entertainment; Transportation; Employee monitoring and administration; Government; Law enforcement and justice; Sustainable development; and Defence and national security.

This increased to 26 ethical issues following a group brainstorming session at the case study workshop.

The nine additional ethical issues from the initial 17 drafted by the project leader were: human rights, transparency, responsibility, ownership of data, algorithmic bias, integrity, human rights, human contact, and accuracy of data.

The additional ethical issues were access to BD + AI, accuracy of data, accuracy of recommendations, algorithmic bias, economic, human contact, human rights, integrity, ownership of data, responsibility, and transparency. Two of the initial ethical concerns were removed (inclusion of stakeholders and environmental impact). The issues raised concerning inclusion of stakeholders were deemed to be sufficiently included in access to BD + AI, and those relating to environmental impact were felt to be sufficiently covered by sustainability.

The three appendices attached in this paper comprise much of this case study protocol.

CS4 evaluated four organisations, but one of these organisations was also part of CS2 – Organisation 1. CS6 analysed two insurance organisations.

Starting out, we aimed to have both policy/ethics-focused experts within the organisation and individuals that could also speak with us about the technical aspects of the organisation’s BD + AI. However, this was often not possible, due to availability, organisations’ inability to free up resources (e.g. employee’s time) for interviews, or lack of designated experts in those areas.

For example, in CS1, CS6, and CS8.

For example, in CS2, CS3, CS4, CS5, CS6, and CS9.

As is discussed elsewhere in this paper, algorithms also hold the possibility of reinforcing our prejudices and biases or creating new ones entirely.

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Acknowledgements

This SHERPA Project has received funding from the European Union’s Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 786641. The author(s) acknowledge the contribution of the consortium to the development and design of the case study approach.

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Appendix 1: Desk Research Questions

Number Research Question.

In which sector is the organisation located (e.g. industry, government, NGO, etc.)?

What is the name of the organisation?

What is the geographic scope of the organisation?

What is the name of the interviewee?

What is the interviewee’s role within the organisation?

Appendix 2: Interview Research Questions

No Research Question.

What involvement has the interviewee had with BD + AI within the organisation?

What type of BD + AI is the organisation using? (e.g. IBM Watson, Google Deepmind)

What is the field of application of the BD + AI (e.g. administration, healthcare, retail)

Does the BD + AI work as intended or are there problems with its operation?

What are the innovative elements introduced by the BD + AI (e.g. what has the technology enabled within the organisation?)

What is the level of maturity of the BD + AI ? (i.e. has the technology been used for long at the organisation? Is it a recent development or an established approach?)

How does the BD + AI interact with other technologies within the organisation?

What are the parameters/inputs used to inform the BD + AI ? (e.g. which sorts of data are input, how is the data understood within the algorithm?). Does the BD + AI collect and/or use data which identifies or can be used to identify a living person (personal data)?. Does the BD + AI collect personal data without the consent of the person to whom those data relate?

What are the principles informing the algorithm used in the BD + AI (e.g. does the algorithm assume that people walk in similar ways, does it assume that loitering involves not moving outside a particular radius in a particular time frame?). Does the BD + AI classify people into groups? If so, how are these groups determined? Does the BD + AI identify abnormal behaviour? If so, what is abnormal behaviour to the BD + AI ?

Are there policies in place governing the use of the BD + AI ?

How transparent is the technology to administrators within the organisation, to users within the organisation?

Who are the stakeholders in the organisation?

What has been the impact of the BD + AI on stakeholders?

How transparent is the technology to people outside the organisation?

Are those stakeholders engaged with the BD + AI ? (e.g. are those affected aware of the BD + AI, do they have any say in its operation?). If so, what is the nature of this engagement? (focus groups, feedback, etc.)

In what way are stakeholders impacted by the BD + AI ? (e.g. what is the societal impact: are there issues of inequality, fairness, safety, filter bubbles, etc.?)

What are the costs of using the BD + AI to stakeholders? (e.g. potential loss of privacy, loss of potential to sell information, potential loss of reputation)

What is the expected longevity of this impact? (e.g. is this expected to be temporary or long-term?)

Are those stakeholders engaged with the BD + AI ? (e.g. are those affected aware of the BD + AI, do they have any say in its operation?)

If so, what is the nature of this engagement? (focus groups, feedback, etc.)

Appendix 3: Checklist of Ethical Issues

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Ryan, M., Antoniou, J., Brooks, L. et al. Research and Practice of AI Ethics: A Case Study Approach Juxtaposing Academic Discourse with Organisational Reality. Sci Eng Ethics 27 , 16 (2021). https://doi.org/10.1007/s11948-021-00293-x

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Case Study Application of an Ethical Decision-Making Process for a Fragility Hip Fracture Patient

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. The majority of patients are good candidates for surgical repair; however, for some patients, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice. Patients and families face a difficult and hurried decision, often with no time to voice their concerns, or with little-to-no information on which to guide their choice. Similarly, health-care providers may experience moral distress or hesitancy to articulate other options, such as palliative care. Is every fragility fracture a candidate for surgery, no matter what the outcome? When is it right to discuss other options with the patient? This article examines a case study via an application of a framework for ethical decision-making.

INTRODUCTION

Every year, over 30,000 Canadian older adults experience a fragility hip fracture. The Ministry of Health and Long Term Care of Ontario has promoted best practice recommendations which advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. ( 1 , 2 ) The majority of patients are good candidates for surgical repair; however, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice for all. The patients at higher risk of poor outcomes perioperatively deserve the opportunity to explore options and articulate their values. Unfortunately, as a short pre-operative interval predicts the best outcomes, patients and families face a difficult and hurried decision, potentially with limited time to voice their concerns, and little to no information on which to guide their decision.

From a systems perspective, quality of care and health outcomes have not always incorporated the patient-centred perspective. ( 3 ) Patient-centred care is “a moral concept and philosophy, considering it to be the right thing to do when designing and delivering respectful, humane, and ethical care”. ( 4 , 5 ) Patients and families have reported in the past that they feel left out of crucial conversations and decisions surrounding care, ( 6 ) and that relevant information is not always provided. ( 7 )

To better understand the underlying ethical complexities which arise from critical decisions in the acute care setting, this paper will examine a case study to demonstrate application of the Corey et al . ( 8 ) 8-step framework (see Appendix A ) for ethical decision-making.

Ms. Jones is 93 years old and lives in a Long Term Care residence. She was admitted to hospital with a fragility hip fracture after being found on the floor in the middle of the night. Ms. Jones has dementia and is unable to make her own decisions. She has limited mobility, previously used a walker. Her two daughters are at her bedside. They state her health has been declining over the last few weeks, with increasing confusion and she now rarely leaves her room.

On admission, the team discovered a pleural effusion, taking up much of her right lung. Her pre-operative assessment also revealed a heart murmur; the resulting echocardiogram demonstrated a heart in very poor condition, with significant valve issues. Between her cardiac and pulmonary function, the surgery poses an increased risk of perioperative complications—she may never survive the surgery, or come off of the ventilator once she is intubated.

Interprofessional teams (surgery, anesthesia, nursing) are of differing opinions. The issue at hand is very difficult. The family is informed that the risk of not having surgery will likely result in death, yet in this patient’s case, proceeding with surgery carries its own risk. The family is left with an hour to think things over. Should they pursue the palliative care route or proceed with surgery?

Step 1. Identify the Problem or Dilemma

In our case study, 93 year old Ms. Jones is admitted to hospital with a fragility hip fracture. As a first step, we must recognize that there is actually an ethical dilemma; in this case, the dilemma is whether the patient should proceed with surgery or not, given her underlying medical conditions and potential for perioperative complications. We also need to acknowledge that there is an underlying assumption from all involved (staff, Ms. Jones’ family) that surgery will occur, and that health-care providers (HCPs) may not clearly articulate the option of ‘no surgical intervention’. The stakeholders who are required to proceed through the decision-making process include the patient and family, the surgical team, anesthesia, nursing staff, social work, and potentially the palliative care team and bioethics team.

Step 2. Identify the Potential Issues Involved

There are several assumptions made when a patient presents to the hospital with a fragility hip fracture: a) the fracture will be repaired; b) the patient will recover; and c) the patient will eventually go home or to rehabilitation. With a critically ill, frail, and/or previously compromised patient, this standard trajectory should be questioned. Barry and Edgman-Levitan ( 9 ) promote an ideology of patient-centredness, with the argument that an intervention should only be considered standard if there is ‘virtual unanimity amongst patients about the overall desirability… of the outcomes’.

The first potential issue is the ‘standard’ intervention of surgical repair—the assumption to proceed with the surgery, as directed by best practice recommendations. Is this standard intervention appropriate in all patients with a fragility hip fracture? A second potential issue arises with the patient and their family—the presumption that the acute medical issue will be resolved and the patient will eventually return home. Given her underlying health, this concept is in jeopardy. To add to the complexity, Ms. Jones is likely not able to articulate her wishes and values, as she has dementia. Finally, there is the potential issue of moral distress experienced by health-care providers (HCPs) who feel uncomfortable with the expectant surgical trajectory of this patient, and may feel they are not empowered to advocate for the wishes of the patient.

As health-care professionals, we are guided by moral principles in our decision-making process, namely, autonomy, non-malfeasance, beneficence, justice, fidelity, and veracity. ( 10 ) A focused examination and application of the principles to the case study will help to support potential resolutions for the identified issues.

The spirit of ‘patient-centred care’ endorses that patients should be involved at their level of choice to make an autonomous decision. ( 11 ) However, it is important to recognize that no decision is made in isolation. ( 12 ) The decision at hand is not a simple or straightforward one; literature demonstrates that patients and families have a difficult time with making decisions at time of a critical illness, identifying fear, worthlessness, and a lack of autonomy within the hospital system. ( 7 ) Differing levels of patient and family participation requires an individualized approach to convey meaningful, accurate, and timely information. ( 8 ) Older adult patients tend to take a ‘non-participative’ stance in their care. They often have limited participation in the process for decision-making for a variety of reasons, thereby increasing the risk of their inability to understand or find value within the end decision. ( 6 , 7 , 13 )

Non-malfeasance

Hospitalization can cause the patient to experience “needless mental and physical suffering” ( 14 ) in any number of ways (i.e., pain, waiting for surgery, uncertainty of outcomes, patient/family relationship stress). Evidence indicates that the number of different HCPs involved causes immense anxiety to the family, especially when they do not hear the same message from all members of the team. ( 13 , 15 ) HCPs must ensure that they are not withholding information, or are untruthful as to the options in order to expedite a decision. A study by Ekdahl, Andersson, and Friedrichsen ( 13 ) found that physicians perceive they are ‘too short’ of time for patients to participate in the decision making process, that decisions were ‘too complex’ and ‘time consuming’ to fit into the schedule. Ekdahl et al. ( 13 ) also found that physicians feel frustration with the ‘health-care production machine’, especially in those older adult patients with multiple co-morbidities.

Beneficence

Beneficence promotes wellbeing; or is an action that is carried out to benefit another. ( 8 ) The hospitalization ‘process’ promotes assessment of a patient, treatment of the illness, followed by a physical approach to recovery (allowing recovery to be measured against specific milestones), and discharge in a timely manner. ( 15 , 16 ) This ‘process’ may promote beneficence in an overarching global perspective of the system; however, on an individual level, it often falls short. On an individual level, key actions that have been found to be beneficial and meaningful are open communication and sharing of information. ( 6 , 7 , 14 , 17 )

“Practitioners have a responsibility to provide appropriate services to all clients”. ( 8 ) Older adult patients may not receive information about options available, especially if the HCPs feel that it would take too much time to thoroughly explain, or if HCPs assume that patients are too ill to participate in the decision-making process, ( 13 ) or if the assumption is made that all patients want to proceed with surgery. Focusing on each older adult’s individual health goals is time-consuming—in this case, the patient has dementia, and a family meeting would be required. The concept of patient-centred care revolves around patient and HCP partnerships, yet older adult patients face unique problems with hospitalization—a slower communication process, a decreased level of functioning, and a degree of family involvement. ( 14 ) Can we provide this type of relationship and communication effort equally for every patient? Or only for those patients who may be at higher risk of negative outcomes?

Fidelity and Veracity

Fidelity involves fulfilling ones’ professional roles, creating a trusting relationship, and veracity ensures that we are truthful and honest to the patients. How do we ensure that as a HCP we are providing an unbiased opinion? Do we take the same amount of time to present patients with the option of conservative, non-surgical treatment, including palliative care, as we take to advocate for surgery? The HCP team assumes that patients will commit to surgery; however, a patient often displays a suboptimal understanding of the risks and benefits of surgery. ( 18 ) Similarly, there is the very real risk of bias towards an argument of palliative care in those frail patients or those with dementia. HCPs must return to the voice of the patient through their family, to understand that patients’ identity, their meaning of life, and desired goals which emphasize the patients’ dignity. ( 12 )

It is important to acknowledge assumptions that the patient and family may have made upon admission to hospital—that surgery will occur and the patient will recover. Have we presented the patient and their family with as much information as they need to make a decision in a clear format (without medical jargon)? In addition to understanding risks of surgery, it is paramount that the family understands the non-surgical option may result in death or decreased function (if any functional ability returns). It is in an acute situation such as this that families require truthful and open communication with physicians, nurses, and other members of the health-care team. ( 11 )

Self Care (HCPs)

Can we consistently provide care that prioritizes a patient’s values? HCPs are not always able to preserve all of the values and interests at stake. ( 19 ) We know that the most common cause of moral distress in nursing is prolonged, aggressive treatment which we do not believe will be likely to have a positive outcome. ( 20 ) As a HCP, we must look to root causes operating within the larger system, to prevent and/or respond to feelings of moral distress. ( 19 )

From a systems perspective, does the hospital provide an avenue for exploration of patient values within a timely fashion? Is there a framework in place to enhance the HCP’s understanding of moral distress and provide strategies for coping with situations such as these (i.e., an opportunity for a team debriefing with the entire team, or opportunities for learning how to deal with situations that may cause moral distress)?

Step 3. Review the Relevant Ethics Codes

The philosophy of patient-centred care within the hospital encourages active listening, respect, and an attempt to understand individuals. The Canadian Medical Association (CMA) supports “practicing the profession of medicine in a manner that treats the patient with dignity and as a person worthy of respect”. ( 21 ) The College of Nurses of Ontario (CNO) supports the view that nurses “must use the client’s views as a starting point”. ( 22 ) Across all HCPs is the similarity of the need to listen, understand, support, and advocate for a respect of patients’ values with the expected course of treatment.

The importance of collaboration with the patient and respecting a patient’s values are highlighted within similar statements: ”…it is the patient who ultimately must make informed choices about the care he or she will receive”. ( 21 )

Step 4. Know the Applicable Laws and Regulations

In Ontario, legislation and common law require that the wishes of patients or substitute decision-makers be respected. ( 22 ) However, in many systems, health care is not truly patient-centred; rather, patients are required to adapt to the system. ( 11 ) A number of initiatives have been undertaken in the last few years in an attempt to improve the focus of patient-centredness, with the principle assertion that patients should be involved at the level of their choice. ( 11 )

Step 5. Obtain Consultation

It is important to realize that we bring our own biases to the decision-making process, making it difficult to view the current patient/family’s situation objectively. As an individual HCP, our previous experiences will have an impact on the messaging that we provide. From a systems perspective, we are likely to pose a ‘knowledge’ bias towards meeting treatment based outcomes—for example, surgery within 48 hours, immediate post-operative mobility, and the expected length of stay for this type of patient.

Inter-disciplinary consultations with patients and their families ensure review of unbiased information about the risks and benefits of proceeding with surgery, allowing for a fully informed decision. In addition to discussing the operative plan with the surgical team, there is an opportunity to provide Ms. Jones’ family with other options that may be available to her. Consultation with extended family members, clergy, social workers, or an ethics team may help the family to reflect on the patient values; what this illness means to them as a family unit, and how best to proceed. A discussion with palliative care may help the family to better understand what symptom management consists of for their mother. Social work may also be able help explore community services available to the family in this situation—for example, is the patient able to return to home with the future of wheelchair dependence? Are there any other options which may be available to this patient and her family that were not originally considered? How do we, as HCPs, ensure that the family is afforded the opportunity to obtain all the necessary information from differing disciplines to make an informed choice?

Step 6. Consider Possible and Probable Courses of Action

In order to fully understand the options, it is helpful to outline all the possible and probable courses of action that are open to Ms. Jones and her family.

• Surgical team offers a ‘purposeful pause’ to discover Ms. Jones’ core values; to discuss the consequences of a) delaying surgery, b) proceeding with surgery, and c) the non-surgical intervention. From an ethical and legal perspective, this may meet the concept of patient-centred care, but does not likely provide the patient and her family with all the information they need to make an informed choice. They may have more questions that the surgical team may not be able to answer, or they may request more time to consider. Additionally, the patient and her family would still be expected to adapt to the system in place in order to make a decision within the proposed wait time frame (admission to surgery less than 48 hours).
• Advocate for a family meeting with the primary nurse, social work, palliative care team, clergy, internal medicine, in addition to the surgical (surgeon, anesthesia) team, to fully explore both options, and to explore what the ‘non-surgical’ option would mean. From a legal and ethical perspective this embodies the concept of patient-centred care, with as many members of the health-care team at the table to help Ms. Jones’ family fully explore their options.
• Apply the current standard of care recommendations to Ms. Jones’ situation, without consideration of the patient’s needs, values, or preferences. From an ethical and legal perspective, this approach does not represent patient-centred care.

Step 7. Enumerate the Consequences of Various Decisions

With the first option, the surgical team takes a ‘purposeful pause’ to discover the patient’s core values and discusses pros and cons of a surgical intervention. Often, this may be most ‘efficient’ way to deal with the situation at hand. It may also be the preference of the patient; some patients have reported that they value this limited level of involvement—“I get a description of what is going to happen”. ( 13 ) As a consequence, there will be a number of patients who will want to have a greater sense of involvement other than a simple description of planned events. The first option does recognize the principle of autonomy, but does not follow the principle of justice; practitioners have the responsibility to provide information about other options which may be available. The principles of beneficence and non-maleficence are not completely met, as the team approaches the solution primarily to benefit the system (i.e., efficiency). The principles of fidelity and veracity are also partially met, as the surgical team provides an honest perspective, although it may be biased towards proceeding with surgery.

The second option, offering the patient and her family a meeting with all stakeholders, strongly aligns with the fidelity and veracity principles. The information offered is truthful and complete, and is in Ms. Jones’ best interest, as it attempts to discover her values that will affect the family’s final decision. Principles of beneficence and autonomy would be met with patient empowerment through information sharing, and secondly, by allowing the patient and family to arrive at their own decision with that information. As a consequence, taking the time to arrange for a family meeting with all stakeholders may not be possible for all patients, and the principles of justice and non-maleficence are brought to the forefront for future patients. A potential consequence could be harm to the patient, as the time it takes to arrange a meeting could push the time to surgery beyond the recommended 48 hours post-admission, placing the patient at greater risk of negative post-operative outcomes.

The third option is one of passive action, with a lack of communication and recognition of patient-centred care values. Ms. Jones would be placed on the operating room list, and the surgical repair will occur. Consent must legally be obtained for the surgery; however, the family may not think of key questions to ask that may be relevant in this situation. The onus remains on the HCP to provide a full explanation of all options to the family. The only benefit would be to the system, as the procedure will be carried out in a timely manner. Ms. Jones may benefit from the surgery; we cannot assume that surgery is a negative option. As a consequence of this option, HCPs do not explore patient values, and this option is against almost all of the ethical principles. Additionally, this option is likely to cause the highest moral distress amongst staff, as they are unable to meet the unique needs of Ms. Jones and her family.

Step 8. Choose what Appears to be the Best Course of Action

Virtue ethics asks us if we are doing the best action for our patients, and compels us to be conscious of our behaviours. ( 8 ) We need to take the necessary time to discover the patient’s values within the unique situation they are now experiencing. Simply stated, we need to remember that they are a person, with feelings, emotions, past experiences, future hopes/plans, and usually an element of fear and anxiety. The goal is to work with Ms. Jones and her family to decide together on the current care plan and the best plan for action (or inaction), a plan that truly aligns with the patient’s values.

From an ethical perspective, the best course of action is to hold a family meeting with all stakeholders to discover Ms. Jones’ values about a meaningful life and a meaningful death, and come to a consensus as to what the right decision is for this patient. ( 12 ) The team must ensure that the patient and the family have all the necessary tools in which to make this decision. Have we provided them with all the information required? Do they understand the information? Do they understand the consequences of their decision? From a systems perspective, we need to continue to strive towards engaging patients and family members more fully and consistently in care and decision-making processes. ( 6 ) Dissemination of lessons learned from assisting patients and families through difficult decision-making may be helpful to other health-care teams experiencing similar moral conflicts.

As a next step, the HCP team may consider development of an educational reference for future patients to assist with similar decisions, including promotion of an advanced care plan to help communicate goals and concerns to HCPs. ( 12 , 18 ) Additionally, decision aids, such as videos and brochures, can help deliver information to patients and their families. ( 9 ) The use of readily available technology, such as iPads and cellphones, means that families are better able to access these materials at any time of day. A recent Cochrane Review demonstrated that, in comparison to usual care, decision aids can increase knowledge, resulting in a higher proportion of patients choosing the option which most aligns with their values. ( 23 ) Providing patients with information that outlines potential options with risks and benefits clearly explained can also meet many of the ethical principles that are to be considered with ethical decision-making.

The in-depth review of the case study has helped us to examine the underlying issues that come into play when helping this patient and her family to make a critical decision. Although each patient is an individual, literature tells us that many perceive the concept of patient-centredness to represent an ‘involvement in their care’. The level of involvement may vary from person to person, but all patients want the care they receive to reflect their values and preferences, and to make them feel that they have been treated as a whole person. ( 24 )

Clinicians also like to believe that they deliver patient-centred care, yet the characterization of the concept will vary with the health-care provider, their relationship with the patient, and the circumstances surrounding the admission to hospital. Recognizing that there is potential for an ethical dilemma when patients present with a critical illness is important to ensure that we continue to act upon the key concept of understanding a patients’ values and proceeding to align provision of care with those values.

ACKNOWLEDGEMENTS

The author wishes to acknowledge Dr. Tracy Trothen (Queen’s University) for her time and expertise as a ‘practical ethicist’.

Appendix AFramework for Ethical Decision-Making (Corey et al ., 2014)

• Identify the problem or dilemma
• Identify the potential issues involved
• Review the relevant ethics codes
• Know the applicable laws and regulations
• Obtain consultation
• Consider possible and probable courses of action
• Enumerate the consequences of various decisions
• Choose what appears to be the best course of action

CONFLICT OF INTEREST DISCLOSURES

The author declares that no conflicts of interest exist.

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The SPJ Code of Ethics is voluntarily embraced by thousands of journalists, regardless of place or platform, and is widely used in newsrooms and classrooms as a guide for ethical behavior. The code is intended not as a set of "rules" but as a resource for ethical decision-making. It is not — nor can it be under the First Amendment — legally enforceable. For an expanded explanation, please follow this link .

For journalism instructors and others interested in presenting ethical dilemmas for debate and discussion, SPJ has a useful resource. We've been collecting a number of case studies for use in workshops. The Ethics AdviceLine operated by the Chicago Headline Club and Loyola University also has provided a number of examples. There seems to be no shortage of ethical issues in journalism these days. Please feel free to use these examples in your classes, speeches, columns, workshops or other modes of communication.

Kobe Bryant’s Past: A Tweet Too Soon? On January 26, 2020, Kobe Bryant died at the age of 41 in a helicopter crash in the Los Angeles area. While the majority of social media praised Bryant after his death, within a few hours after the story broke, Felicia Sonmez, a reporter for The Washington Post , tweeted a link to an article from 2003 about the allegations of sexual assault against Bryant. The question: Is there a limit to truth-telling? How long (if at all) should a journalist wait after a person’s death before resurfacing sensitive information about their past?

A controversial apology After photographs of a speech and protests at Northwestern University appeared on the university's newspaper's website, some of the participants contacted the newspaper to complain. It became a “firestorm,” — first from students who felt victimized, and then, after the newspaper apologized, from journalists and others who accused the newspaper of apologizing for simply doing its job. The question: Is an apology the appropriate response? Is there something else the student journalists should have done?

Using the ‘Holocaust’ Metaphor People for the Ethical Treatment of Animals, or PETA, is a nonprofit animal rights organization known for its controversial approach to communications and public relations. In 2003, PETA launched a new campaign, named “Holocaust on Your Plate,” that compares the slaughter of animals for human use to the murder of 6 million Jews in WWII. The question: Is “Holocaust on Your Plate” ethically wrong or a truthful comparison?

Aaargh! Pirates! (and the Press) As collections of songs, studio recordings from an upcoming album or merely unreleased demos, are leaked online, these outlets cover the leak with a breaking story or a blog post. But they don’t stop there. Rolling Stone and Billboard often also will include a link within the story to listen to the songs that were leaked. The question: If Billboard and Rolling Stone are essentially pointing readers in the right direction, to the leaked music, are they not aiding in helping the Internet community find the material and consume it?

Reigning on the Parade Frank Whelan, a features writer who also wrote a history column for the Allentown, Pennsylvania, Morning Call , took part in a gay rights parade in June 2006 and stirred up a classic ethical dilemma. The situation raises any number of questions about what is and isn’t a conflict of interest. The question: What should the “consequences” be for Frank Whelan?

Controversy over a Concert Three former members of the Eagles rock band came to Denver during the 2004 election campaign to raise money for a U.S. Senate candidate, Democrat Ken Salazar. John Temple, editor and publisher of the Rocky Mountain News, advised his reporters not to go to the fundraising concerts. The question: Is it fair to ask newspaper staffers — or employees at other news media, for that matter — not to attend events that may have a political purpose? Are the rules different for different jobs at the news outlet?

Deep Throat, and His Motive The Watergate story is considered perhaps American journalism’s defining accomplishment. Two intrepid young reporters for The Washington Post , carefully verifying and expanding upon information given to them by sources they went to great lengths to protect, revealed brutally damaging information about one of the most powerful figures on Earth, the American president. The question: Is protecting a source more important than revealing all the relevant information about a news story?

When Sources Won’t Talk The SPJ Code of Ethics offers guidance on at least three aspects of this dilemma. “Test the accuracy of information from all sources and exercise care to avoid inadvertent error.” One source was not sufficient in revealing this information. The question: How could the editors maintain credibility and remain fair to both sides yet find solid sources for a news tip with inflammatory allegations?

A Suspect “Confession” John Mark Karr, 41, was arrested in mid-August in Bangkok, Thailand, at the request of Colorado and U.S. officials. During questioning, he confessed to the murder of JonBenet Ramsey. Karr was arrested after Michael Tracey, a journalism professor at the University of Colorado, alerted authorities to information he had drawn from e-mails Karr had sent him over the past four years. The question: Do you break a confidence with your source if you think it can solve a murder — or protect children half a world away?

Who’s the “Predator”? “To Catch a Predator,” the ratings-grabbing series on NBC’s Dateline, appeared to catch on with the public. But it also raised serious ethical questions for journalists. The question: If your newspaper or television station were approached by Perverted Justice to participate in a “sting” designed to identify real and potential perverts, should you go along, or say, “No thanks”? Was NBC reporting the news or creating it?

The Media’s Foul Ball The Chicago Cubs in 2003 were five outs from advancing to the World Series for the first time since 1945 when a 26-year-old fan tried to grab a foul ball, preventing outfielder Moises Alou from catching it. The hapless fan's identity was unknown. But he became recognizable through televised replays as the young baby-faced man in glasses, a Cubs baseball cap and earphones who bobbled the ball and was blamed for costing the Cubs a trip to the World Series. The question: Given the potential danger to the man, should he be identified by the media?

Publishing Drunk Drivers’ Photos When readers of The Anderson News picked up the Dec. 31, 1997, issue of the newspaper, stripped across the top of the front page was a New Year’s greeting and a warning. “HAVE A HAPPY NEW YEAR,” the banner read. “But please don’t drink and drive and risk having your picture published.” Readers were referred to the editorial page where White explained that starting in January 1998 the newspaper would publish photographs of all persons convicted of drunken driving in Anderson County. The question: Is this an appropriate policy for a newspaper?

Naming Victims of Sex Crimes On January 8, 2007, 13-year-old Ben Ownby disappeared while walking home from school in Beaufort, Missouri. A tip from a school friend led police on a frantic four-day search that ended unusually happily: the police discovered not only Ben, but another boy as well—15-year-old Shawn Hornbeck, who, four years earlier, had disappeared while riding his bike at the age of 11. Media scrutiny on Shawn’s years of captivity became intense. The question: Question: Should children who are thought to be the victims of sexual abuse ever be named in the media? What should be done about the continued use of names of kidnap victims who are later found to be sexual assault victims? Should use of their names be discontinued at that point?

A Self-Serving Leak San Francisco Chronicle reporters Mark Fainaru-Wada and Lance Williams were widely praised for their stories about sports figures involved with steroids. They turned their investigation into a very successful book, Game of Shadows . And they won the admiration of fellow journalists because they were willing to go to prison to protect the source who had leaked testimony to them from the grand jury investigating the BALCO sports-and-steroids. Their source, however, was not quite so noble. The question: Should the two reporters have continued to protect this key source even after he admitted to lying? Should they have promised confidentiality in the first place?

The Times and Jayson Blair Jayson Blair advanced quickly during his tenure at The New York Times , where he was hired as a full-time staff writer after his internship there and others at The Boston Globe and The Washington Post . Even accusations of inaccuracy and a series of corrections to his reports on Washington, D.C.-area sniper attacks did not stop Blair from moving on to national coverage of the war in Iraq. But when suspicions arose over his reports on military families, an internal review found that he was fabricating material and communicating with editors from his Brooklyn apartment — or within the Times building — rather than from outside New York. The question: How does the Times investigate problems and correct policies that allowed the Blair scandal to happen?

Cooperating with the Government It began on Jan. 18, 2005, and ended two weeks later after the longest prison standoff in recent U.S. history. The question: Should your media outlet go along with the state’s request not to release the information?

Offensive Images Caricatures of the Prophet Muhammad didn’t cause much of a stir when they were first published in September 2005. But when they were republished in early 2006, after Muslim leaders called attention to the 12 images, it set off rioting throughout the Islamic world. Embassies were burned; people were killed. After the rioting and killing started, it was difficult to ignore the cartoons. Question: Do we publish the cartoons or not?

The Sting Perverted-Justice.com is a Web site that can be very convenient for a reporter looking for a good story. But the tactic raises some ethical questions. The Web site scans Internet chat rooms looking for men who can be lured into sexually explicit conversations with invented underage correspondents. Perverted-Justice posts the men’s pictures on its Web site. Is it ethically defensible to employ such a sting tactic? Should you buy into the agenda of an advocacy group — even if it’s an agenda as worthy as this one?

A Media-Savvy Killer Since his first murder in 1974, the “BTK” killer — his own acronym, for “bind, torture, kill” — has sent the Wichita Eagle four letters and one poem. How should a newspaper, or other media outlet, handle communications from someone who says he’s guilty of multiple sensational crimes? And how much should it cooperate with law enforcement authorities?

A Congressman’s Past The (Portland) Oregonian learned that a Democratic member of the U.S. Congress, up for re-election to his fourth term, had been accused by an ex-girlfriend of a sexual assault some 28 years previously. But criminal charges never were filed, and neither the congressman, David Wu, nor his accuser wanted to discuss the case now, only weeks before the 2004 election. Question: Should The Oregonian publish this story?

Using this Process to Craft a Policy It used to be that a reporter would absolutely NEVER let a source check out a story before it appeared. But there has been growing acceptance of the idea that it’s more important to be accurate than to be independent. Do we let sources see what we’re planning to write? And if we do, when?

SPJ News –  SPJ urges swift action by Senate panel on federal shield law to protect journalists –  SPJ calls for action by journalists against gag rules after key legal win –  SPJ Foundation awards over $45,000 in grants to seven initiatives and journalism programs

Ethics: To Tell or Not to Tell-A Case Study

By: Lee J. Zook

Winter 2001, Vol. 8, No. 1

by Lee J. Zook, Ph.D.

Some years ago, prior to teaching in undergraduate social work, I was working with families and children in an outpatient psychiatric setting, Children' Agency. In the previous year, I had completed my MSW, having practiced social work several years with an undergraduate degree. The Director of Social Services at the Children' Agency was my supervisor. We used a team model in our work, with any particular team consisting of at least a social worker, a psychologist, and a psychiatrist. Sometimes other professionals, such as educational specialists, early childhood development specialists, and social group workers were also on the teams. I had first-rate colleagues in whom I could confide about clinical and ethical issues. Continuous learning was valued, especially as it related to clinical practice.

While I was at Children' Agency, Mary Jones (a fictitious name) applied for a job as a social worker. Four years earlier, I had seen Mary as a client while working for an emergency service at Adult Hospital, a psychiatric facility for adults.

My contact with Mary had been rather brief at Adult Hospital. She came to be admitted to the hospital as her psychiatric condition was deteriorating. Mary told me she was a social worker with an MSW and had been in and out of psychiatric hospitals for many years. I located her chart, noted that she was previously diagnosed with schizophrenia, undifferentiated type, did the basic paperwork that social workers did on admission, consulted with the admitting psychiatrist, and took her to the hospital ward. It was a rather simple, routine admission; there were no police or court documents, and she was a voluntary client. However, the situation was a bit unsettling. My feelings had to do with the fact that I was leaving my position in the near future to pursue an MSW, and here I was, a young, rather inexperienced, “untrained” social worker, admitting an older, more experienced social worker with an MSW to a psychiatric hospital. However, I went on with my business and put the event in perspective. After all, academic degrees do not preclude a person from having a mental illness.

So now, three years later, I had my MSW, and Mary came for a job interview at Children' Agency where I was employed. I had no responsibility for employment decisions. My supervisor, who was the Director of Social Services, and the psychiatrist, who was also the Executive Director, made these decisions. But I was faced with an uncomfortable dilemma-an ethical dilemma for which I did not see any clear answer.

On one hand, I was concerned about whether Mary would function as a competent professional colleague. Was her illness in remission? If so, would it remain in remission? If not, what would the impact be on clients? Would she be able to function adequately to work with clients who came to the agency? If she would not, would harm come to clients?

On the other hand, my knowledge of her illness was unquestionably confidential. Further, what right or responsibility did I have to suggest that a person who had a mental illness should not be hired? What right or responsibility did I have to divulge information about her (past) condition to anyone?

There was also the possibility that I could speak to Mary and verbalize my concerns to her. Would this be appropriate? Would Mary remember who I was? After three years, did the brief encounter we had give me the prerogative to confront her about her past or ask about her present condition?

The following discussion focuses on the NASW Code of Ethics and how it may be useful in this situation. At the time, I was not this thorough and did not think much about the Code of Ethics. I struggled in my own mind about what to do. If this were occurring now, I would first of all confer with the Code of Ethics. The first sentence of the preamble of the Code states:

The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.

In this situation, one could contend that clients coming to Children' Agency were the vulnerable people referred to in the Preamble. On the other hand, one could also make a case that Mary, a person who is living with a persistent and long-term mental illness, is a vulnerable person.

As a social worker, I am particularly concerned about creating opportunity for persons with disability. And in this instance, vulnerability of a specific person could be viewed as more important than vulnerability of a general client population.

In further examination of the Code, Section 1.07 Privacy and Confidentiality, paragraph (c) is instructive.

Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person.

This paragraph seems to suggest intervention in the situation with Mary is not appropriate. Do not break confidentiality. However, it also says that there are situations in which confidentiality is not the primary concern. Disclosure of confidential information may be made when it is crucial to “prevent serious, foreseeable, and imminent harm to a client or other identifiable person.” But could I argue that there was such serious, foreseeable and imminent harm to anyone? Would it be appropriate, with the knowledge that I had, to suggest such harm would occur? If the answer to the last question is affirmative, what does that infer about persons with a mental illness?

Other paragraphs in Section 2.09, Impairment of Colleagues, are also on point.

(a) Social workers who have direct knowledge of a social work colleague' impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

(b) Social workers who believe that a social work colleague' impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

I did have knowledge of Mary' impairment. However, to infer that her impairment would interfere with her work as a professional social worker could be seen as prejudiced toward persons with a mental illness. Did I have enough information about Mary to “consult” with Mary as paragraph (a) suggests?

Further, Section 4.02, Discrimination, states that: “Social workers should not practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, or mental or physical disability.” (Italics added.) This suggests that revealing anything about Mary' condition or even confronting Mary with the situation would be discriminatory.

Finally, since Mary was a professional, didn’t she have the responsibility to make sure her “mental health difficulties” did not interfere with her professional judgment and performance as is stated in Section 4.05, Impairment, paragraph a?

(a) Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility.

Paragraph b. of Section 4.05, Impairment goes on to say, in part, that social workers whose “mental health difficulties interfere with their professional judgment and performance” need to seek help, make adjustments in their work situation, or quit practicing.

Doesn’t this mean that since Mary is a professional, she needs to deal with these issues? If that is the case, what is my role?

Obviously, the Code is not a clear set of rules. Rather, it gives guidance to social workers. While it is instructive, the Code does not specify what course of action is best in all instances. As stated in the Preamble, “Core values, and the principles that flow from them, must be balanced within the context and complexity of the human experience.” Professional judgment also comes into play in making ethical decisions.

In summary, there seemed to be no ideal course of action in this situation. I did not know how to predict what would happen if I talked with Mary. It is conceivable that I would have a colleague who was less than happy with my reminding her of her illness. If I did intervene by reporting to persons responsible for hiring, confidential information would be divulged. I could be identified as practicing discrimination toward persons with a mental illness. If I did not intervene, and she was hired, harm could come to clients.

There seemed to be no ideal answer and no way to avoid the situation. There may have been other options, but none seemed apparent to me at the time.

When I relate this case in class, I ask students to work in groups, make a decision, and explain to the rest of the class how they came to their conclusion. Obviously, the Code of Ethics should be a guide in such decisions. But other questions about how to make these types of decisions are also important. Is it appropriate to discuss such issues with my other colleagues? If yes, under what circumstances should such issues be discussed, formally or informally? Should a professional social worker consult with the National Association of Social Workers about such a decision? In general, should a supervisor be consulted about such decisions? In this instance, this would not have seemed appropriate, as the supervisor was also the person in charge of hiring.

In conclusion, there are times in social work practice when professionals are placed in situations, through no wrongdoing on anybody' part, in which dilemmas occur because of a conflict in values or ethical principles within the situation itself. In those situations, it is not a matter of choosing good versus evil, or choosing right versus wrong. It is a matter of choosing between the better of two goods or, possibly more often, the lesser of two evils. Making those decisions is often not pleasant. In fact, it can be quite anxiety provoking. But it is also impossible to side step the issue when doing nothing will predictably yield a certain outcome.

I would welcome a discussion about this case. What would you do? How would you decide what you would do? What besides the Code of Ethics should aid one in making this decision? These are some of the questions that we could discuss together.

National Association of Social Workers. (1999). NASW Code of Ethics. Available online at http://www.socialworkers.org/Code/ethics.htm .

Lee J. Zook, Ph.D., is Associate Professor of Social Work at Luther College in Decorah, Iowa.

Copyright © 2001 White Hat Communications. All rights reserved. From THE NEW SOCIAL WORKER , Winter 2001, Vol. 8, No. 1. For reprints of this or other articles from THE NEW SOCIAL WORKER (or for permission to reprint), contact Linda Grobman, publisher/editor, at P.O. Box 5390, Harrisburg, PA 17110-0390, or at [email protected] .

All material published on this website Copyright 1994-2023 White Hat Communications. All rights reserved. Please contact the publisher for permission to reproduce or reprint any materials on this site. Opinions expressed on this site are the opinions of the writer and do not necessarily represent the views of the publisher. As an Amazon Associate, we earn from qualifying purchases.

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Gabriela Salinas and Jeeva Somasundaram

Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

In April this year, Hein Schumacher, chief executive of Unilever, announced that the company was entering a “new era for sustainability leadership”, and signalled a shift from the central priority promoted under his predecessor , Alan Jope.

While Jope saw lack of social purpose or environmental sustainability as the way to prune brands from the portfolio, Schumacher has adopted a more balanced approach between purpose and profit. He stresses that Unilever should deliver on both sustainability commitments and financial goals. This approach, which we dub “realistic sustainability”, aims to balance long- and short-term environmental goals, ambition, and delivery.

As a result, Unilever’s refreshed sustainability agenda focuses harder on fewer commitments that the company says remain “very stretching”. In practice, this entails extending deadlines for taking action as well as reducing the scale of its targets for environmental, social and governance measures.

Such backpedalling is becoming widespread — with many companies retracting their commitments to climate targets , for example. According to FactSet, a US financial data and software provider, the number of US companies in the S&P 500 index mentioning “ESG” on their earnings calls has declined sharply : from a peak of 155 in the fourth quarter 2021 to just 29 two years later. This trend towards playing down a company’s ESG efforts, from fear of greater scrutiny or of accusations of empty claims, even has a name: “greenhushing”.

Test yourself

This is the fourth in a series of monthly business school-style teaching case studies devoted to the responsible business dilemmas faced by organisations. Read the piece and FT articles suggested at the end before considering the questions raised.

About the authors: Gabriela Salinas is an adjunct professor of marketing at IE University; Jeeva Somasundaram is an assistant professor of decision sciences in operations and technology at IE University.

The series forms part of a wider collection of FT ‘instant teaching case studies ’, featured across our Business Education publications, that explore management challenges.

The change in approach is not limited to regulatory compliance and corporate reporting; it also affects consumer communications. While Jope believed that brands sold more when “guided by a purpose”, Schumacher argues that “we don’t want to force fit [purpose] on brands unnecessarily”.

His more nuanced view aligns with evidence that consumers’ responses to the sustainability and purpose communication attached to brand names depend on two key variables: the type of industry in which the brand operates; and the specific aspect of sustainability being communicated.

In terms of the sustainability message, research in the Journal of Business Ethics found consumers can be less interested when product functionality is key. Furthermore, a UK survey in 2022 found that about 15 per cent of consumers believed brands should support social causes, but nearly 60 per cent said they would rather see brand owners pay taxes and treat people fairly.

Among investors, too, “anti-purpose” and “anti-ESG” sentiment is growing. One (unnamed) leading bond fund manager even suggested to the FT that “ESG will be dead in five years”.

Media reports on the adverse impact of ESG controversies on investment are certainly now more frequent. For example, while Jope was still at the helm, the FT reported criticism of Unilever by influential fund manager Terry Smith for displaying sustainability credentials at the expense of managing the business.

Yet some executives feel under pressure to take a stand on environmental and social issues — in many cases believing they are morally obliged to do so or through a desire to improve their own reputations. This pressure may lead to a conflict with shareholders if sustainability becomes a promotional tool for managers, or for their personal social responsibility agenda, rather than creating business value .

Such opportunistic behaviours may lead to a perception that corporate sustainability policies are pursued only because of public image concerns.

Alison Taylor, at NYU Stern School of Business, recently described Unilever’s old materiality map — a visual representation of how companies assess which social and environmental factors matter most to them — to Sustainability magazine. She depicted it as an example of “baggy, vague, overambitious goals and self-aggrandising commitments that make little sense and falsely suggest a mayonnaise and soap company can solve intractable societal problems”.

In contrast, the “realism” approach of Schumacher is being promulgated as both more honest and more feasible. Former investment banker Alex Edmans, at London Business School, has coined the term “rational sustainability” to describe an approach that integrates financial principles into decision-making, and avoids using sustainability primarily for enhancing social image and reputation.

Such “rational sustainability” encompasses any business activity that creates long-term value — including product innovation, productivity enhancements, or corporate culture initiatives, regardless of whether they fall under the traditional ESG framework.

Similarly, Schumacher’s approach aims for fewer targets with greater impact, all while keeping financial objectives in sight.

Complex objectives, such as having a positive impact on the world, may be best achieved indirectly, as expounded by economist John Kay in his book, Obliquity . Schumacher’s “realistic sustainability” approach means focusing on long-term value creation, placing customers and investors to the fore. Saving the planet begins with meaningfully helping a company’s consumers and investors. Without their support, broader sustainability efforts risk failure.

Questions for discussion

Read: Unilever has ‘lost the plot’ by fixating on sustainability, says Terry Smith

Companies take step back from making climate target promises

The real impact of the ESG backlash

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Ethical issues in the operating room: A scoping review

Affiliation.

• 1 Yonsei University.
• PMID: 37769689
• DOI: 10.1177/09697330231197704

Background: For the patients receiving care in the operating room, it emphasizes that the ethical behavior and attitude of health professionals should be aligned with patients' basic human rights. Surgical ethics may provide an ethical alternative in a specific operating room context. However, it is unclear how actively research is being conducted in this regard.

Aim: This study determines the direction of future research by identifying ethical issues experienced in the operating room.

Method: This scoping review is based on the methodological framework suggested by Arksey and O'Malley in 2005. PubMed, CINAHL, EMBASE, WOS, Cochrane, KISS, and KMbase databases were searched from January 2012 to May 2022. Two researchers independently screened the searched articles by reviewing the titles, abstracts, and full texts. Consequently, 19 studies were selected.

Findings: Five categories were identified: Professional ethics, Organizational ethics, Patients' rights, Patient safety, and Allocating resources. The derived categories covered all the same content as the International Council of Nurses' (ICN) code of ethics, with the exception of one element, that is, global health.

Conclusions: This study highlights ethical issues in the operating theatre and emphasizes the need for individual and organizational strategies aligned with the ICN code of ethics. Future research should cover a wider range of issues, employ diverse perspectives and methodologies, and enhance ethical practices to improve understanding and ethical practices in the field.

Keywords: Ethics; healthcare providers; operating room; patients’ rights; scoping review; surgical ethics.

Publication types

Case Study Research Method in Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

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Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

Related Articles

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What Is Face Validity In Research? Importance & How To Measure

Criterion Validity: Definition & Examples

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• Published: 30 May 2024

Marfan’s syndrome is associated with a greater risk of Peyronie’s disease: a case-control study of the TriNetX database

• Kaushik P. Kolanukuduru   ORCID: orcid.org/0009-0001-9525-2600 1   na1 ,
• Asher L. Mandel 1   na1 ,
• Rishabh K. Simhal 2 ,
• Tamir N. Sholklapper   ORCID: orcid.org/0000-0002-2059-1966 3 ,
• Kelly Sun 3 ,
• Maria Poluch   ORCID: orcid.org/0000-0002-0947-3395 3 ,
• Kerith R. Wang 3 ,
• Yash B. Shah 3 &
• Paul H. Chung   ORCID: orcid.org/0000-0001-9360-1400 3  

International Journal of Impotence Research ( 2024 ) Cite this article

Metrics details

• Erectile dysfunction
• Risk factors

The association between men’s sexual health diseases (MSHD) and connective tissue disorders (CTD) has not been well studied. A relatively common MSHD is Peyronie’s disease (PD), which is characterized by abnormal curvature of the penis due to fibrosis of the tunica albuginea, and is often associated with pain. The fibrotic disease process of PD is poorly understood, but the dominant theory postulates a cycle of pathophysiological wound healing [ 1 ]. CTD such as Ehlers Danlos Syndrome (EDS) and Marfan’s syndrome (MFS) are associated with mutations in genes responsible for the production of fibrous tissue components such as collagen and fibrillin. Patients with EDS and MFS often present with physical injuries such as fractures or joint dislocations during supposedly normal movements, often at a disproportionate rate when compared to the general population, thus highlighting an abnormal tissue composition and repair mechanism [ 2 ]. We postulate that the abnormality in tissue repair and healing in such patients predisposes them to MSHD such as PD. In this study, we leveraged a large, multinational database (TriNetX) to explore the association between PD and CTD (namely EDS and MFS) and compared the results to disease-free controls.

This study was exempt from institutional review board approval, as the TriNetX database is populated by deidentified data of over 200 million patients ( https://live.trinetx.com ). We queried the database to identify adult males with EDS (ICD-10 Q79.6, Q79.60, Q79.62) and MFS (ICD-10 Q87.4). Disease free patients were categorized as controls. The three groups were then individually queried for the diagnosis of PD (ICD-10 N48.6). Continuous variables were represented as means with standard deviations while categorical variables were represented as percentages. T-test for individual samples and Chi-Square test with Pearson correction were used to compare the diseased and control groups, and odds ratios with 95% confidence intervals (CI) were calculated for a two-tailed significance level of 0.05.

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Data availability

The data used in this study was extracted from the TriNetX database. A request can be made to TriNetX ( https://live.trinetx.com ). No patient information can be obtained from this database.

Ziegelmann MJ, Bajic P, Levine LA. Peyronie’s disease: contemporary evaluation and management. Int J Urol. 2020;27:504–16. https://doi.org/10.1111/iju.14230 .

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Folkestad L, Stochholm K, Groth K, Hove H, Andersen NH, Gravholt CH. Fracture rates and fracture risk in patients with Marfan syndrome: a nationwide register-based cohort study. J Bone Miner Res. 2021;36:901–9. https://doi.org/10.1002/jbmr.4258 .

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Ghosh A, Leong JY, Foss H, Ebbott D, Prebay Z, Li M, et al. Evaluating treatment pathways for Peyronie’s disease utilizing the TriNetX research registry. Int J Impot Res. 2024;36:168–70. https://doi.org/10.1038/s41443-023-00815-0 .

Carrieri MP, Serraino D, Palmiotto F, Nucci G, Sasso F. A case-control study on risk factors for Peyronie’s disease. J Clin Epidemiol. 1998;51:511–5. https://doi.org/10.1016/s0895-4356(98)00015-8 .

Bjekic MD, Vlajinac HD, Sipetic SB, Marinkovic JM. Risk factors for Peyronie’s disease: a case-control study. BJU Int. 2006;97:570–4. https://doi.org/10.1111/j.1464-410X.2006.05969.x .

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These authors contributed equally: Kaushik P. Kolanukuduru, Asher L. Mandel.

Authors and Affiliations

Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Kaushik P. Kolanukuduru & Asher L. Mandel

Department of Urology at Ochsner Medical Center, New Orleans, LA, USA

Rishabh K. Simhal

Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

Tamir N. Sholklapper, Kelly Sun, Maria Poluch, Kerith R. Wang, Yash B. Shah & Paul H. Chung

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KP Kolanukuduru: Writing—original draft, Writing – review and editing; AL Mandel—Conceptualization, Data curation, Formal analysis, Writing—review and editing; R Simhal—Conceptualization, Methodology, Validation, Writing – review and editing; T Sholklapper: Writing—original draft, writing—review and editing; K Sun: Writing—review and editing; M Poluch: Writing—review and editing; YB Shah: Writing—review and editing; P Chung: Supervision, Writing—review and editing.

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Correspondence to Kaushik P. Kolanukuduru .

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Kolanukuduru, K.P., Mandel, A.L., Simhal, R.K. et al. Marfan’s syndrome is associated with a greater risk of Peyronie’s disease: a case-control study of the TriNetX database. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00923-5

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Published : 30 May 2024

DOI : https://doi.org/10.1038/s41443-024-00923-5

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Supreme Court Ethics Controversies: Alito’s Upside-Down Flag Flying Draws Concern

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Supreme Court Justice Samuel Alito flew an upside-down American flag outside his house after the 2020 election, The New York Times reported Thursday—a symbol of the “Stop the Steal” movement challenging the election results—the latest in a string of recent ethics issues the court has faced that have ramped up criticism of the court and sparked cries for a binding code of ethics from lawmakers and legal experts.

The Supreme Court’s lack of an ethics code has become a growing source of controversy in recent ... [+] years

Alito’s Flag Flying: Alito flew an inverted flag after the 2020 election outside his house, according to the Times , which published an image of the flag flying on Jan. 17, 2021—when the court was considering a 2020 election-related case—with the Times reporting the flag “alarmed” neighbors and some of them reported it to the Supreme Court, and ethics experts telling the Times the political symbol violates ethics rules that bar justices and judges from appearing politically biased.

Thomas and Harlan Crow: Lawmakers renewed their calls for ethics reform after ProPublica revealed Justice Clarence Thomas accepted gifts and luxury travel from GOP megadonor Harlan Crow for years without disclosing it as federal law requires, and Crow reportedly purchased Georgia real estate from Thomas in 2014—including the home where the justice’s mother still lives—and paid for Thomas’ grand-nephew’s private school tuition .

Thomas’ Wife: Thomas has also drawn significant controversy over his wife Ginni Thomas’ right-wing activism, particularly as she supported efforts to overturn the 2020 election as Thomas was hearing cases on it, and the justice has been criticized for failing to recuse himself in a case concerning documents being turned over to the House January 6 Committee.

Thomas’ RV Loan: Thomas never repaid a “substantial portion” of a $267,230 loan from wealthy friend Anthony Welters that he used to purchase a luxury RV, a Senate Finance Committee investigation found, which raised questions about whether the loan was properly reported on his taxes, as the committee noted there would be a “significant amount of taxable income” if Thomas never paid the principal on the loan, and that income wasn’t reported on his financial disclosure.

Thomas and the Koch Network Summits: Thomas attended at least two donor summits for the Koch network—the right-wing political organization founded by billionaire brothers Charles and David Koch —and participated in a dinner with high-level donors, without disclosing his appearance at the summits or a private jet trip he took to and from the event in 2018, ProPublica reported in September.

Thomas and the Horatio Alger Society: The New York Times reported in July that Thomas has for years received “benefits ... from a broader cohort of wealthy and powerful friends”—some of whom had business before the court—through his membership in the Horatio Alger Society, including more luxury travel and a Super Bowl ring.

Alito’s Travel: ProPublica reported Alito took a luxury fishing trip with billionaire Paul Singer , whose hedge fund has repeatedly had business before the court, without disclosing it—which Alito defended in a Wall Street Journal op-ed that came out before the ProPublica report, claiming he didn’t know about Singer’s connection to the cases or feel he had to disclose the trip, and he flew on Singer’s private jet in a seat that “would have otherwise been vacant.”

Alito and Burwell v. Hobby Lobby: Alito also drew attention after the New York Times reported in November a conservative activist knew the ruling in 2014’s Burwell v. Hobby Lobby after donors of his had dinner with the justice, which sparked a hearing before the House Judiciary Committee in December.

Sotomayor’s Books: An Associated Press report found Justice Sonia Sotomayor’s staff have “prodded” public institutions where the justice was speaking to buy copies of her books, giving the appearance of an ethical conflict as the liberal-leaning justice appeared to “forcefully [leverage] publicly sponsored travel to boost book sales.”

Gorsuch’s Real Estate: Politico reported Justice Neil Gorsuch sold real estate to the head of a law firm with business before the court, in a 2017 transaction that took place days after Gorsuch was sworn in as a justice.

Roberts’ Wife: Chief Justice John Roberts has come under scrutiny in light of reports his wife earned more than $10 million in commissions as part of her work as a recruiter matching attorneys with law firms, some of which have had cases before the Supreme Court.

Public Institutions: The AP’s reporting on Sotomayor was part of a broader investigation that found Supreme Court justices’ appearances at public colleges and universities routinely are used by schools to generate donations and often result in them mingling with donors who may have business before the court, as well as partisan politicians.

Justices Socializing With The Right: Conservative-leaning justices including Gorsuch and Justice Brett Kavanaugh have raised eyebrows for attending events and socializing with right-wing politicians and figures, with Gorsuch appearing last year at a closed-press event for the Federalist Society alongside GOP politicians and Kavanaugh attending a holiday party hosted by the head of the Conservative Political Action Coalition (CPAC).

Crucial Quote

“I think it would be better for the court if [Alito] weren’t involved in cases arising from the 2020 election ... But I’m pretty certain that he will see that differently,” former federal judge and Berkeley Judicial Institute director Jeremy Fogel told the Times about ethics concerns around Alito’s flag flying, noting “the best practice would be to make sure that nothing like that is in front of your house.” Fogel said the incident would almost certainly spark a review if Alito were a lower federal court judge, who are bound by judicial ethics rules, while Supreme Court justices only have to follow them voluntarily.

What To Watch For

The Supreme Court announced an ethics code in November that lays out a series of guidelines that justices should follow, saying they “should maintain and observe high standards of conduct in order to preserve the integrity and independence of the federal judiciary,” including by avoiding conflicts of interest and recusing themselves from cases if necessary. Legal experts and judicial ethics advocates have criticized the code of ethics for not going far enough—namely by not having a way to enforce the code and impose consequences if justices don’t follow it—meaning it hasn’t stopped the calls for ethics reform on the court. In a statement after the code was released, Senate Judiciary Committee chair Sen. Dick Durbin (D-Ill.), who’s been leading the committee’s investigation into the court’s ethics, said lawmakers would “carefully review” the ethics code “to evaluate whether it complies with our goal that the highest court in the land not languish with the lowest standard of ethics in our federal government.” The ethics code “begins a dialogue which can end with restoring the integrity of the Court,” Durbin said, but did not rule out that lawmakers could still take steps to try and impose a stricter ethics code or enforcement mechanism.

Chief Critic

Alito said in a statement to the Times about the flag flying that he “had no involvement whatsoever in the flying of the flag,” claiming “it was briefly placed by Mrs. Alito in response to a neighbor’s use of objectionable and personally insulting language on yard signs.” The Supreme Court’s justices had previously defended their lack of a binding ethics code by maintaining they voluntarily follow the one for lower federal judges, saying when they announced the code there had been a “misunderstanding that the Justices of this Court, unlike all other jurists in this country, regard themselves as unrestricted by any ethics rules.” They have also denied any ethical improprieties. Thomas and Crow have defended their relationship and the gifts Crow has given Thomas in light of the ProPublica reports, and Crow has said he’s never discussed any cases with the justice. Thomas also updated some of his financial disclosures this year to include his real estate transaction with Crow, claiming he was unaware he was previously supposed to include it. The court told the AP in response to its reporting that justices “exercise caution in attending events that might be described as political in nature,” and said Sotomayor’s book sales were in line with ethics guidelines and “at no time have attendees been required to buy a book in order to attend an event.” A spokesperson for the Koch network said in a statement the idea Thomas’ appearances at summits “could somehow be undue influence just doesn’t hold water,” and Thomas’ attorney Elliot S. Burke disputed the Senate Finance Committee’s investigation on the RV loan to the New York Times , arguing “the loan was never forgiven.” Ginni Thomas has also hit back against accusations that her activism has an impact on her husband’s work, and testified to the House January 6 Committee that she “did not speak with [Clarence Thomas]

Key Background

The Supreme Court’s lack of an ethics code has become a growing source of controversy in recent years, and Justice Elena Kagan testified to Congress in 2019 that the issue was “something that’s being thought very seriously about” at the court. The Washington Post reported in February the court had been actively discussing imposing a code of ethics for at least four years, but still wasn’t able to impose one or decided if they will, and justices including Kagan , Justice Brett Kavanaugh and Justice Amy Coney Barrett had publicly said the court was working on the issue. The 6-3 conservative leaning court has seen its public approval rating plummet in recent years amid ethics controversies and as the public has viewed the court as becoming too political, adding to the scrutiny of the court and ramping up cries for justices to avoid conflicts of interest. Legal scholars and the American Bar Association had called for the court to impose a code of ethics, and Thomas’ controversies involving Crow and his wife’s political activism have also sparked calls for him to be impeached or resign .

Further Reading

Supreme Court Chief Justice Roberts Refuses To Testify To Congress — Here’s How Lawmakers Are Still Trying To Force An Ethics Code (Forbes)

Clarence Thomas: Here Are All The Ethics Scandals Involving The Supreme Court Justice (Forbes)

Supreme Court Justices Reportedly Can’t Figure Out How To Adopt Ethics Code Amid Controversies (Forbes)

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You can’t build an effective investment strategy without first knowing your client., from the wharton school to la28, the games of the xxxiv olympiad: meet hilary ash, w’13.

WGAM’s portfolio manager (your team’s teacher/advisor) recently met with a potential client, Hilary Ash , who needs professional help achieving some specific investment goals (which we’ll get to in a minute). You hope to be the WGAM team that Hilary ultimately chooses to build her wealth from an initial $100,000 investment.

Introducing Hilary Ash

But first, let’s get to know your potential client.

Raised in Los Angeles, CA (U.S.), Hilary, now 32, began her college journey on the pre-med track and the volleyball court at the University of Pennsylvania (Penn) in Philadelphia, PA (U.S.). After taking a few business classes, she discovered her true passion and transferred into Penn’s Wharton School, a world leader in business education, her sophomore year. She gravitated toward entrepreneurship and innovation because she was inspired and challenged by the prospect of solving problems with an entrepreneurial mindset.

“I love thinking about business problems and coming up with new solutions, products and ideas.”

Sports have always been an important part of Hilary’s identity and her family’s livelihood (both her father and brother work in the sports industry). She excelled as a student-athlete in college and now co-chairs Penn’s women’s volleyball board. While attending Wharton, she explored the broad business of sports through internships with the cable sports channel ESPN and the X Games, an international action sports competition. She has also had the opportunity in her career to help create professional talent pipelines in underserved communities and rethink the typical standards, training and requirements required to get jobs in the sports industry.

After graduation, Hilary worked as a consultant for BCG, putting her business problem-solving skills to practice. Through her connections, she found her way to LA28, the Games of the XXXIV Olympiad, where she became the Vice President of Games Delivery and Venue Infrastructure. She and her team manage the venue masterplan strategy for the LA 2028 Olympic and Paralympic games, helping to identify, retrofit, design and build the structures needed to successfully deliver the various Olympic and Paralympic competitions when the global games come to Los Angeles in 2028.

Hilary’s Financial Goals

When she’s not strategizing about sports infrastructure, Hilary pursues her passions, including travel, real estate and her Labradoodle, Riggins. She and her husband Scott, who married only a year ago, enjoy immersing themselves in unique cultures and travel experiences.

Hilary believes that real estate investment is a way to create generational wealth for her (future) family. She owns two investment properties, one in the U.S. and, more recently, South America. She is eager to use the design skills she is developing in her professional role to renovate the modest South American property after the close of the Olympic and Paralympic Games in August 2028. She would like to allocate (and Ideally grow) 25% of her $100,000 investment to kickstart her South American home renovation. She expects WGAM to generate at least a $15,000 return on the initial $25,000 short-term investment by the end of 2028 to cover anticipated costs.

Hilary would like to combine her deep interests in entrepreneurship, inclusivity and global sports for her longer-term financial goal. She hopes to play a direct role in bringing more money into women’s sports and elevating women’s positions and influence in an increasingly international industry. Her longer-term financial goal is to open a women-owned sports consulting firm with a dual mission of helping women athletes and industry executives become more successful, while also providing greater sports access (players and fans) to underrepresented communities. She hopes that WGAM’s investing expertise can help make that business dream possible in the next 15 years.

“I think we’re at such an exciting time right now in women’s sports, where we’re starting to see a real shift in an appreciation of what it means to buy into women’s sports…With the success of the Women’s National Team in U.S. soccer and the fight for pay equity, I would love to be able to actually have a direct role in seeing more money flow into women’s sports and a proper appreciation for what female athletes can bring to brands and properties. And I want to see the growth in access for player development for young girls, because that builds a well-funded ecosystem.”

Your Investment Challenge       

Hilary has heard great things about the creativity and investing knowledge of WGAM’s analyst teams and is considering hiring WGAM to manage an investment portfolio of $100,000, which she hopes will help her achieve two fundamental objectives. She told the portfolio manager that WGAM has 10 weeks to put together a detailed portfolio analysis proposal. Your portfolio manager recognizes that it will not be easy to land Hilary as a client. To make the most convincing case to Hilary, everyone on the team must contribute to ensure that WGAM creates the best proposal.

Over the next 10 weeks, your team will develop and test an investment strategy to meet Hilary’s stated financial goals. Please keep in mind that Hilary already has a solid retirement investment plan in place, so you need not consider this goal in your strategy. Your team will conduct a thorough analysis of industries and companies to select optimal stocks and Exchange-traded Funds (ETFs) related to your strategy, with the goal of ensuring both long-term and shorter-term profitability for your prospective client. That’s right, this year we are introducing a new ETF requirement! Read more about this addition HERE . You will test your investment strategy and get stock market experience using the Wharton Investment Simulator (WInS), where you apply the concepts of investments and portfolio management in a hands-on learning environment, using real-world market data without risking real money.

Remember, your 10 weeks on WInS can only accurately assess the performance of investments that are made for the short-term. So, while you should test your strategy and build your stock portfolio on WInS, most of your strategizing should be longer-term and therefore won’t require excessive buying and selling of stocks and ETFs. However, your strategy might include investing guidelines that could influence your decision to sell, even in the short-term.

Your team will start out with a portfolio of $100,000 in virtual cash and will compete against other student teams from all around the world who are trying to land the same client. At the end of the 10 weeks of active trading, you must submit a proposal detailing your recommended investment strategy.

As you strive to win Hilary’s business, how will your team stand out against competing teams? How will you create a compelling and clever pitch to convince Hilary to choose your strategy? Judges will review your final investment reports and select top teams. Those teams will be invited to present their strategies to a panel of experts.

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• Published: 24 May 2024

Integration of case-based learning and three-dimensional printing for tetralogy of fallot instruction in clinical medical undergraduates: a randomized controlled trial

• Jian Zhao 1   na1 ,
• Xin Gong 1   na1 ,
• Jian Ding 1 ,
• Kepin Xiong 2 ,
• Kangle Zhuang 3 ,
• Rui Huang 1 ,
• Shu Li 4 &
• Huachun Miao 1  

BMC Medical Education volume  24 , Article number:  571 ( 2024 ) Cite this article

209 Accesses

Metrics details

Case-based learning (CBL) methods have gained prominence in medical education, proving especially effective for preclinical training in undergraduate medical education. Tetralogy of Fallot (TOF) is a congenital heart disease characterized by four malformations, presenting a challenge in medical education due to the complexity of its anatomical pathology. Three-dimensional printing (3DP), generating physical replicas from data, offers a valuable tool for illustrating intricate anatomical structures and spatial relationships in the classroom. This study explores the integration of 3DP with CBL teaching for clinical medical undergraduates.

Sixty senior clinical medical undergraduates were randomly assigned to the CBL group and the CBL-3DP group. Computed tomography imaging data from a typical TOF case were exported, processed, and utilized to create four TOF models with a color 3D printer. The CBL group employed CBL teaching methods, while the CBL-3DP group combined CBL with 3D-printed models. Post-class exams and questionnaires assessed the teaching effectiveness of both groups.

The CBL-3DP group exhibited improved performance in post-class examinations, particularly in pathological anatomy and TOF imaging data analysis ( P  < 0.05). Questionnaire responses from the CBL-3DP group indicated enhanced satisfaction with teaching mode, promotion of diagnostic skills, bolstering of self-assurance in managing TOF cases, and cultivation of critical thinking and clinical reasoning abilities ( P  < 0.05). These findings underscore the potential of 3D printed models to augment the effectiveness of CBL, aiding students in mastering instructional content and bolstering their interest and self-confidence in learning.

The fusion of CBL with 3D printing models is feasible and effective in TOF instruction to clinical medical undergraduates, and worthy of popularization and application in medical education, especially for courses involving intricate anatomical components.

Peer Review reports

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease(CHD) [ 1 ]. Characterized by four structural anomalies: ventricular septal defect (VSD), pulmonary stenosis (PS), right ventricular hypertrophy (RVH), and overriding aorta (OA), TOF is a focal point and challenge in medical education. Understanding anatomical spatial structures is pivotal for learning and mastering TOF [ 2 ]. Given the constraints of course duration, medical school educators aim to provide students with a comprehensive and intuitive understanding of the disease within a limited timeframe [ 3 ].

The case-based learning (CBL) teaching model incorporates a case-based instructional approach that emphasizes typical clinical cases as a guide in student-centered and teacher-facilitated group discussions [ 4 ]. The CBL instructional methods have garnered widespread attention in medical education as they are particularly appropriate for preclinical training in undergraduate medical education [ 5 , 6 ]. The collection of case data, including medical records and examination results, is essential for case construction [ 7 ]. The anatomical and hemodynamic consequences of TOF can be determined using ultrasonography, computed tomography (CT), and magnetic resonance imaging techniques. However, understanding the anatomical structures from imaging data is a slow and challenging psychological reconstruction process for undergraduate medical students [ 8 ]. Three-dimensional (3D) visualization is valuable for depicting anatomical structures [ 9 ]. 3D printing (3DP), which creates physical replicas based on data, facilitates the demonstration of complex anatomical structures and spatial relationships in the classroom [ 10 ].

During the classroom session, 3D-printed models offer a convenient means for hands-on demonstration and communication, similar to facing a patient, enhancing the efficiency and specificity of intra-team communication and discussion [ 11 ]. In this study, we printed TOF models based on case imaging data, integrated them into CBL teaching, and assessed the effectiveness of classroom instruction.

Research participants

The study employed a prospective, randomized controlled design which received approval from the institutional ethics committee. Senior undergraduate students majoring in clinical medicine at Wannan Medical College were recruited for participation based on predefined inclusion criteria. The researchers implemented recruitment according to the recruitment criteria by contacting the class leaders of the target classes they had previously taught. Notably, these students were in their third year of medical education, with anticipation of progressing to clinical courses in the fourth year, encompassing Internal Medicine, Surgery, Obstetrics, Gynecology, and Pediatrics. Inclusion criteria for participants encompassed the following: (1) proficient communication and comprehension abilities, (2) consistent attendance without absenteeism or truancy, (3) absence of failing grades in prior examinations, and (4) capability to conscientiously fulfill assigned learning tasks. Exclusion criteria were (1) absence from lectures, (2) failure to complete pre-and post-tests, and (3) inadequate completion of questionnaires. For their participation in the study, Students were provided access to the e-book “Localized Anatomy,” authored by the investigators, as an incentive for their participation. Voluntary and anonymous participation was emphasized, with participants retaining the right to withdraw from the study at any time without providing a reason.

The study was conducted between May 1st, 2023, and June 30, 2023, from recruitment to completion of data collection. Drawing upon insights gained from a previous analogous investigation which yielded an effect size of 0.95 [ 10 ]. Sample size was computed, guided by a statistical consultant, with the aim of 0.85 power value, predicated on an effect size of 0.8 and a margin of error set at 0.05. A minimum of 30 participants per group was calculated using G*Power software (latest ver. 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany), resulting in the recruitment of a total of 60 undergraduate students. Each participant was assigned an identification number, with codes placed in boxes. Codes drawn from the boxes determined allocation to either the CBL group or the CBL-3DP group. Subsequently, participants were randomly assigned to either the CBL group, receiving instruction utilizing the CBL methodology, or the CBL-3DP group, which received instruction integrating both CBL and 3D Printed models.

Printing of TOF models

Figure  1 A shows the printing flowchart of the TOF models. A typical TOF case was collected from the Yijishan Hospital of Wannan Medical College. The CT angiography imaging data of the case was exported. Mimics Research 20.0 software (Mimics Innovation Suite version 20, Materialize, Belgium) was used for data processing. The cardiovascular module of the CT-Heart tool was employed to adjust the threshold range, independently obtain the cardiac chambers and vessels, post-process the chambers and vessels to generate a hollow blood pool, and merge it with the myocardial volume to construct a complete heart model. The file was imported into Magics 24.0 software (version 24.0; Materialize, Belgium) for correction using the Shell tool page. After repairs, the model entered the smoothing page, where tools such as triangular surface simplification, local smoothing, refinement and smoothing, subdivision of components, and mesh painting were utilized to achieve varying degrees of smoothness. Finally, optimized data were obtained and exported as stereolithography (STL) files. An experienced cardiothoracic surgeon validated the anatomical accuracy of the digital model.

The STL files were imported into a 3D printer (J401Pro; Sailner 3D Technology, China) for model printing. This printer can produce full-color medical models using different materials. The models were fabricated using two distinct materials: rigid and flexible. Both materials are suitable for the observational discussion of the teaching objectives outlined in our study. From the perspective of observing pathological changes in the TOF, there is no significant difference between the two materials.

Experimental flow chart of this study. A TOF model printing flow chart. B The instructional framework

Teaching implementation

Figure  1 B illustrates the instructional framework employed in this study. One week preceding the class session, all the students were tasked with a 30-minute self-study session, focusing on the theoretical content related to TOF as outlined in the Pediatrics and Surgery textbooks, along with a review of pertinent academic literature. Both groups received co-supervision from two basic medicine lecturers boasting over a decade of teaching experience, alongside a senior cardiothoracic surgeon. Teaching conditions remained consistent across groups, encompassing uniform assessment criteria and adherence to predefined teaching time frames, all conducted in a Project-Based Learning (PBL) classroom at Wannan Medical College. Additionally, a pre-course examination was administered to gauge students’ preparedness for self-study.

In adherence to the curriculum guidelines, the teaching objectives aimed to empower students to master TOF’s clinical manifestations, diagnostic modalities, and differential diagnoses, while acquainting them with treatment principles and surgical methodologies. Additionally, the objectives sought to cultivate students’ clinical reasoning abilities and problem-solving skills. the duration of instruction for the TOF theory session was standardized to 25 min. The didactic content was integrated with the TOF case study to construct a coherent pedagogical structure.

During the instructional session, both groups underwent teaching utilizing the CBL methodology. Clinical manifestations and case details of TOF cases were presented to stimulate students’ interest and curiosity. Subsequently, the theory of TOF, including its etiology, pathogenesis, pathologic anatomy, clinical manifestations, diagnostic methods, and therapeutic interventions, was briefly elucidated. Emphasis was then placed on the case, wherein selected typical TOF cases were explained, guiding students in analysis and discussion. Students were organized into four teams under the instructors’ supervision, fostering cooperative learning and communication, thereby deepening their understanding of the disease through continuous inquiry and exploration (Fig.  2 L). In the routinely equipped PBL classroom with standard heart models (Fig.  2 J, K), all students had prior exposure to human anatomy and were familiar with these models. Both groups were provided with four standard heart models for reference, while the CBL-3DP group received additional four 3D-printed models depicting TOF anomalies, enriching their learning experience (Fig.  2 D, G). After the lesson, summarization, and feedback sessions were conducted to consolidate group discussions’ outcomes, evaluate teaching effectiveness, and assess learning outcomes.

Heart models utilized in instructional sessions. A External perspective of 3D digital models. B, C Cross-sectional views following trans-septal sagittal dissection of the 3D digital model (PS: Pulmonary Stenosis; OA: Overriding Aorta; VSD: Ventricular Septal Defect; RVH: Right Ventricular Hypertrophy). D External depiction of rigid 3D printed model. E, F Sagittal sections of the rigid 3D printed model. G External portrayal of flexible 3D printed model. H, I Sagittal sections of the flexible 3D printed model. J, K The normal heart model employed in the instruction of the CBL group. L Ongoing classroom session

Teaching effectiveness assessment

Following the instructional session, participants from the two groups underwent a theoretical examination to assess their comprehension of the taught material. This assessment covered domains such as pathological anatomy, clinical manifestations, imaging data interpretation, diagnosis, and treatment relevant to TOF. Additionally, structured questionnaires were administered to evaluate the efficacy of the pedagogical approach employed. The questionnaire consisted of six questions designed to gauge participants’ understanding of the teaching content, enhancement of diagnostic skills, cultivation of critical thinking and clinical reasoning abilities, bolstering of confidence in managing TOF cases, satisfaction with the teaching mode, and satisfaction with the CBL methodology.

The questionnaire employed a 5-point Likert scale to gauge responses, with 5 indicating “strongly satisfied/agree,” 4 for “satisfied/agree,” 3 denoting “neutral,” 2 reflecting “dissatisfied/disagree,” and 1 indicating “strongly dissatisfied/disagree.” It comprised six questions, with the initial two probing participants’ knowledge acquisition, questions 3 and 4 exploring satisfaction regarding enhanced competence, and the final two assessing satisfaction with teaching methods and modes. Additionally, participants were encouraged to provide suggestions at the end of the questionnaire. To ensure the questionnaire’s validity, five esteemed lecturers in basic medical sciences with more than 10 years of experience verified its content and assessed its Content Validity Ratio and Content Validity Index to ensure alignment with the study’s objectives.

Statistical analysis

Statistical analyses were conducted utilizing GraphPad Prism 9.0 software. Aggregate score data for both groups were presented as mean ± standard deviation (x ± s). The gender comparisons were analyzed with the chi-square (χ2) test, while the other variables were compared using the Mann-Whitney U test. The threshold for determining statistical significance was set at P  < 0.05.

Three-dimensional printing models

After configuring the structural colors of each component (Fig.  2 A, B, C), we printed four color TOF models using both rigid and flexible materials, resulting in four life-sized TOF models. Two color TOF models were created using rigid materials (Fig.  2 D, E, F). These models, exhibiting resistance to deformation, and with a firm texture, smooth and glossy surface, and good transparency, allowing visibility of the internal structures, were deemed conducive to teaching and observation. We also fabricated two color TOF models using flexible materials (Fig.  2 G, H, I), characterized by soft texture, opacity, and deformability, allowing for easy manipulation and cutting. It has potential utility beyond observational purposes. It can serve as a valuable tool for simulating surgical interventions and may be employed to create tomographic anatomical specimens. In this study, both material models were suitable for observation in the classroom. The participants were able to discern the four pathological changes characteristic of TOF from surface examination or cross-sectional analysis.

Baseline characteristics of the students

In total, 60 students were included in this study. The CBL group comprised 30 students (14 males and 16 females), with an average age of (21.20 ± 0.76) years. The CBL-3DP group consisted of 30 students (17 males and 13 females) with an average age of 20.96 years. All the students completed the study procedures. There were no significant differences in age, sex ratio, or pre-class exam scores between the two groups ( P  > 0.05), indicating that the baseline scores between the two groups were comparable (Table  1 ).

Theoretical examination results

All students completed the research procedures as planned. The post-class theoretical examination encompassed assessment of pathological anatomy, clinical presentations, imaging data interpretation, diagnosis, and treatment pertinent to TOF. Notably, no statistically significant disparities were observed in the scores on clinical manifestations, diagnosis and treatment components between the cohorts, as delineated in Table  2 . Conversely, discernible distinctions were evident whereby the CBL-3DP group outperformed the CBL group notably in pathological anatomy, imaging data interpretation, and overall aggregate scores ( P  < 0.05).

Results of the questionnaires

All the 60 participants submitted the questionnaire. Comparing the CBL and CBL-3DP groups, the scores from the CBL-3DP group showed significant improvements in many areas. This included satisfaction with the teaching mode, promotion of diagnostic skills, bolstering of self-assurance in managing TOF cases, and cultivation of critical thinking and clinical reasoning abilities (Fig.  3 B, C, D, E). All of which improved significantly ( P  < 0.05 for the first aspects and P  < 0.01 for the rest). However, the two groups were not comparable ( P  > 0.05) in terms of understanding of the teaching content and Satisfaction with the CBL methodology (Fig.  3 A, F).

Upon completion of the questionnaires, participants were invited to proffer recommendations. Notably, in the CBL group, seven students expressed challenges in comprehending TOF and indicated a need for additional time for consolidation to enhance understanding. Conversely, within the CBL-3DP group, twelve students advocated for the augmentation of model repertoire and the expansion of disease-related data collection to bolster pedagogical efficacy across other didactic domains.

Five-point Likert scores of students’ attitudes in CBL ( n  = 30) and CBL-3DP ( n  = 30) groups. A Understanding of teaching content. B Promotion of diagnostic skills. C Cultivation of critical thinking and clinical reasoning abilities. D Bolstering of self-assurance in managing TOF cases. E Satisfaction with the teaching mode. F Satisfaction with the CBL methodology. ns No significant difference, * p  < 0.05, ** p  < 0.01, *** p  < 0.001

TOF presents a significant challenge in clinical practice, necessitating a comprehensive understanding for effective diagnosis and treatment [ 12 ]. Traditional teaching methods in medical schools have relied on conventional resources such as textbooks, 2D illustrations, cadaver dissections, and radiographic materials to impart knowledge about complex conditions like TOF [ 13 ]. However, the limitations of these methods in fully engaging students and bridging the gap between theoretical knowledge and practical application have prompted a need for innovative instructional approaches.

CBL has emerged as a valuable tool in medical education, offering students opportunities to engage with authentic clinical cases through group discussions and inquiry-based learning [ 14 ]. By actively involving students in problem-solving and decision-making processes, CBL facilitates the application of theoretical knowledge to real-world scenarios, thus better-preparing students for future clinical practice [ 15 ]. Our investigation revealed that both groups of students exhibited comparable levels of satisfaction with the CBL methodology, devoid of discernible disparities.

CHD presents a formidable challenge due to the intricate nature of anatomical anomalies, the diverse spectrum of conditions, and individual variations [ 16 ]. Utilizing 3D-printed physical models, derived from patient imaging data, can significantly enhance comprehension of complex anatomical structures [ 17 ]. These models have proven invaluable in guiding surgical planning, providing training for junior or inexperienced pediatric residents, and educating healthcare professionals and parents of patients [ 18 ]. Studies indicate that as much as 50% of pediatric surgical decisions can be influenced by the insights gained from 3D printed models [ 19 ]. By providing tangible, anatomically accurate models, 3D printing offers a unique opportunity for people to visualize complex structures and enhance their understanding of anatomical intricacies. Our study utilized full-color, to-scale 3D printed models to illustrate the structural abnormalities associated with TOF, thereby enriching classroom sessions and facilitating a deeper comprehension of the condition.

Comparative analysis between the CBL-3DP group and the CBL group revealed significant improvements in post-test performance, particularly in pathological anatomy and imaging data interpretation. Additionally, questionnaire responses indicated higher levels of satisfaction and confidence among students in the CBL-3DP group, highlighting the positive impact of incorporating 3D printed models into the learning environment, improving the effectiveness of CBL classroom instruction. Despite the merits, our study has limitations. Primarily, participants were exclusively drawn from the same grade level within a single college, possibly engendering bias owing to shared learning backgrounds. Future research could further strengthen these findings by expanding the sample size and including long-term follow-up to assess the retention of knowledge and skills. Additionally, the influence of the 3D models depicting a normal heart on the learning process and its potential to introduce bias into the results warrants consideration, highlighting a need for scrutiny in subsequent studies.

As medical science continues to advance, the need for effective teaching methods becomes increasingly paramount. Our study underscores the potential of combining active learning approaches like CBL with innovative technologies such as 3D printing to enhance teaching effectiveness, improve knowledge acquisition, and foster students’ confidence and enthusiasm in pursuing clinical careers. Moving forward, further research and integration of such methodologies are essential for meeting the evolving demands of medical education, especially in areas involving complex anatomical understanding.

Conclusions

Integrating 3D-printed models with the CBL method is feasible and effective in TOF instruction. The demonstrated success of this method warrants broad implementation in medical education, particularly for complex anatomical topics.

Data availability

All data supporting the conclusions of this research are available upon reasonable request from the corresponding author.

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Acknowledgements

We extend our sincere appreciation to the instructors and students whose invaluable participated in this study.

This paper received support from the Education Department of Anhui Province, China (Grant Numbers 2022jyxm1693, 2022jyxm1694, 2022xskc103, 2018jyxm1280).

Author information

Jian Zhao and Xin Gong are joint first authors.

Authors and Affiliations

Department of Human Anatomy, Wannan Medical College, No.22 West Wenchang Road, Wuhu, 241002, China

Jian Zhao, Xin Gong, Jian Ding, Rui Huang & Huachun Miao

Department of Cardio-Thoracic Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, China

Kepin Xiong

Zhuhai Sailner 3D Technology Co., Ltd., Zhuhai, China

Kangle Zhuang

School of Basic Medical Sciences, Wannan Medical College, Wuhu, China

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Contributions

Jian Zhao and Huachun Miao designed the research. Jian Zhao, Xin Gong, Jian Ding, Kepin Xiong designed the tests and questionnaires. Kangle Zhuang processed the imaging data and printed the models. Xing Gong and Kepin Xiong implemented the teaching. Jian Zhao and Rui Huang collected the data and performed the statistical analysis. Jian Zhao and Huachun Miao prepared the manuscript. Shu Li and Huachun Miao revised the manuscript. Shu Li provided the Funding acquisition. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Shu Li or Huachun Miao .

Ethics declarations

Ethics approval and consent to participate.

This investigation received ethical approval from the Ethical Committee of School of Basic Medical Sciences, Wannan Medical College (ECBMSWMC2022-1-12). All methodologies adhered strictly to established protocols and guidelines. Written informed consent was obtained from the study participants to take part in the study.

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Written informed consent was obtained from the individuals for the publication of any potentially identifiable images or data included in this article.

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The authors declare no competing interests.

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Zhao, J., Gong, X., Ding, J. et al. Integration of case-based learning and three-dimensional printing for tetralogy of fallot instruction in clinical medical undergraduates: a randomized controlled trial. BMC Med Educ 24 , 571 (2024). https://doi.org/10.1186/s12909-024-05583-z

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Received : 03 March 2024

Accepted : 21 May 2024

Published : 24 May 2024

DOI : https://doi.org/10.1186/s12909-024-05583-z

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• Medical education
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