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  1. Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda.Mathias Barra, Mari Broqvist, Erik Gustavsson, Martin Henriksson, Niklas Juth, Lars Sandman & Carl Tollef Solberg - 2019 - Health Care Analysis 1:1-20.
    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...)
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  • Currents in Contemporary Ethics.Mary R. Anderlik & Mark A. Rothstein - 2003 - Journal of Law, Medicine and Ethics 31 (3):450-454.
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  • Committing to Priorities: Incompleteness in Macro-Level Health Care Allocation and Its Implications.Anders Herlitz - 2018 - Journal of Medicine and Philosophy 43 (6):724-745.
    This article argues that values that apply to health care allocation entail the possibility of “spectrum arguments,” and that it is plausible that they often fail to determine a best alternative. In order to deal with this problem, a two-step process is suggested. First, we should identify the Strongly Uncovered Set that excludes all alternatives that are worse than some alternatives and not better in any relevant dimension from the set of eligible alternatives. Because the remaining set of alternatives often (...)
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  • Substantial Life Extension and the Fair Distribution of Healthspans.Christopher S. Wareham - 2016 - Journal of Medicine and Philosophy 41 (5):521-539.
    One of the strongest objections to the development and use of substantially life-extending interventions is that they would exacerbate existing unjust disparities of healthy lifespans between rich and poor members of society. In both popular opinion and ethical theory, this consequence is sometimes thought to justify a ban on life-prolonging technologies. However, the practical and ethical drawbacks of banning receive little attention, and the viability of alternative policies is seldom considered. Moreover, where ethicists do propose alternatives, there is scant effort (...)
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  • Uterustransplantation. Ethisch gerechtfertigt?Claudia Bozzaro, Franziska Krause & Melanie Weismann - 2019 - Ethik in der Medizin 31 (2):113-129.
    ZusammenfassungDie Uterustransplantation ermöglicht Frauen mit einer absoluten uterinen Infertilität eine Schwangerschaft mit biologisch eigenem Kind. Das neuartige experimentelle Verfahren wirft eine Reihe von ethischen Fragen auf. Ziel dieses Artikels ist es, relevante ethische Problemkonstellationen im Kontext der Uterustransplantation überblickshaft darzulegen und kritisch zu diskutieren. Als systematischer Rahmen der Darstellung dienen die vier Prinzipien der Medizinethik Autonomie, Nicht-Schaden, Wohltun und Gerechtigkeit nach Beauchamp und Childress. Nach eingehender ethischer Betrachtung plädieren die Autorinnen mit Blick auf die Akkumulation schwerwiegender ethischer Probleme für die (...)
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  • Uterus Transplantation: The Ethics of Using Deceased Versus Living Donors.Bethany Bruno & Kavita Shah Arora - 2018 - American Journal of Bioethics 18 (7):6-15.
    Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...)
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  • Fairness and Transparency in an Expanded Access Program: Allocation of the Only Treatment for SMA1.Alyssa M. Burgart, Julie Collier & Mildred K. Cho - 2017 - American Journal of Bioethics 17 (10):71-73.
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  • Is There a ‘Right to Try’ Experimental Therapies? Ethical Criteria for Selecting Patients With Spinal Muscular Atrophy to Receive Nusinersen in an Expanded Access Program.Nancy S. Jecker - 2017 - American Journal of Bioethics 17 (10):70-71.
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  • Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development.Jeffrey Kirby - 2016 - American Journal of Bioethics 16 (1):38-47.
    Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of (...)
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  • Problems With Prioritization: Exploring Ethical Solutions to Inequalities in HIV Care.Kjell Arne Johansson & Ole Frithjof Norheim - 2011 - American Journal of Bioethics 11 (12):32-40.
    Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is (...)
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  • A Step Toward Pluralist Fairness.Samia A. Hurst - 2011 - American Journal of Bioethics 11 (12):46-47.
    The American Journal of Bioethics, Volume 11, Issue 12, Page 46-47, December 2011.
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  • Creating Moral Conflict Through an Inequality Sensitive Summary Measure.Julie Aultman & Joel S. Beil - 2011 - American Journal of Bioethics 11 (12):44-46.
    The American Journal of Bioethics, Volume 11, Issue 12, Page 44-46, December 2011.
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  • Priority to the Young or to Those with Least Lifetime Health?Ole Frithjof Norheim - 2010 - American Journal of Bioethics 10 (4):60 – 61.
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  • Response to Open Peer Commentaries on “Complete Lives in the Balance”.Samuel J. Kerstein & Greg Bognar - 2010 - American Journal of Bioethics 10 (4):W3 – W5.
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  • Standing by Our Principles: Meaningful Guidance, Moral Foundations, and Multi-Principle Methodology in Medical Scarcity.Govind C. Persad, Alan Wertheimer & Ezekiel J. Emanuel - 2010 - American Journal of Bioethics 10 (4):46 – 48.
    In this short response to Kerstein and Bognar, we clarify three aspects of the complete lives system, which we propose as a system of allocating scarce medical interventions. We argue that the complete lives system provides meaningful guidance even though it does not provide an algorithm. We also defend the investment modification to the complete lives system, which prioritizes adolescents and older children over younger children; argue that sickest-first allocation remains flawed when scarcity is absolute and ongoing; and argue that (...)
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  • Balancing Relevant Criteria in Allocating Scarce Life-Saving Interventions.Erik Nord - 2010 - American Journal of Bioethics 10 (4):56 – 58.
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  • Assessing the Modified Youngest-First Principle and the Idea of Non-Persons at the Bedside: A Clinical Perspective.Sadath A. Sayeed - 2010 - American Journal of Bioethics 10 (4):52 – 54.
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  • Complete Lives, Short Lives, and the Challenge of Legitimacy.Paul T. Menzel - 2010 - American Journal of Bioethics 10 (4):50 – 52.
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  • Dueling Ethical Frameworks for Allocating Health Resources.Dorothy E. Vawter, J. Eline Garrett, Karen G. Gervais, Angela Witt Prehn & Debra A. DeBruin - 2010 - American Journal of Bioethics 10 (4):54 – 56.
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  • Complete Lives, Incomplete Theories.Alexander Friedman - 2010 - American Journal of Bioethics 10 (4):58 – 60.
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  • Balancing Principles, QALYs and the Straw Men of Resource Allocation.John McMillan & Tony Hope - 2010 - American Journal of Bioethics 10 (4):48 – 50.
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  • Complete Lives in the Balance.Samuel J. Kerstein & Greg Bognar - 2010 - American Journal of Bioethics 10 (4):37 – 45.
    The allocation of scarce health care resources such as flu treatment or organs for transplant presents stark problems of distributive justice. Persad, Wertheimer, and Emanuel have recently proposed a novel system for such allocation. Their “complete lives system” incorporates several principles, including ones that prescribe saving the most lives, preserving the most life-years, and giving priority to persons between 15 and 40 years old. This paper argues that the system lacks adequate moral foundations. Persad and colleagues' defense of giving priority (...)
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  • The Badness of Death and Priorities in Health.Carl Tollef Solberg & Espen Gamlund - 2016 - BMC Medical Ethics 17 (1):1-9.
    BackgroundThe state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic (...)
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  • Do Healthcare Professionals Have Different Views About Healthcare Rationing Than College Students? A Mixed Methods Study in Portugal.Micaela Pinho, Ana Pinto Borges & Richard Cookson - 2018 - Public Health Ethics 11 (1):90-102.
    The main aim of this paper is to investigate the views of healthcare professionals in Portugal about healthcare rationing, and compare them with the views of college students. A self-administered questionnaire was used to collect data from a sample of 60 healthcare professionals and 180 college students. Respondents faced a hypothetical rationing dilemma where they had to order four patients and justify their choices. Multinomial logistic regressions were used to test for differences in orderings, and content analysis to categorize the (...)
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  • The Intensive Care Lifeboat: A Survey of Lay Attitudes to Rationing Dilemmas in Neonatal Intensive Care.C. Arora, J. Savulescu, H. Maslen, M. Selgelid & D. Wilkinson - 2016 - BMC Medical Ethics 17 (1):69.
    BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...)
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  • Which Newborn Infants Are Too Expensive to Treat? Camosy and Rationing in Intensive Care.D. Wilkinson - 2013 - Journal of Medical Ethics 39 (8):502-506.
    Are there some newborn infants whose short- and long-term care costs are so great that treatment should not be provided and they should be allowed to die? Public discourse and academic debate about the ethics of newborn intensive care has often shied away from this question. There has been enough ink spilt over whether or when for the infant's sake it might be better not to provide life-saving treatment. The further question of not saving infants because of inadequate resources has (...)
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  • End-of-Life Decisions as Bedside Rationing. An Ethical Analysis of Life Support Restrictions in an Indian Neonatal Unit.I. Miljeteig, K. A. Johansson, S. A. Sayeed & O. F. Norheim - 2010 - Journal of Medical Ethics 36 (8):473-478.
    Introduction Hundreds of thousands of premature neonates born in low-income countries are implicitly denied treatment each year. Studies from India show that treatment is rationed even for neonates born at 32 gestational age weeks (GAW), and multiple external factors influence treatment decisions. Is withholding of life-saving treatment for children born between 28 and 32 GAW acceptable from an ethical perspective? Method A seven-step impartial ethical analysis, including outcome analysis of four accepted priority criteria: severity of disease, treatment effect, cost effectiveness (...)
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  • HIV Priorities and Health Distributions in a Rural Region in Tanzania: A Qualitative Study.Kjell Arne Johansson, Ingrid Miljeteig, Hamisi Kigwangalla & Ole Frithjof Norheim - 2011 - Journal of Medical Ethics 37 (4):221-226.
    Next SectionBackground International and national agencies play a major role in setting HIV care-and-treatment priorities in low-income-countries. Little is known about priority setting at lower health-system levels. The objective of this article is to explore experiences of HIV priority decisions, at what levels these decisions are made and how they might influence the distribution of health benefits in a high-endemic region in Tanzania. Methods This is a qualitative study using observations, key documents and semistructured focus-group and individual interviews (43) with (...)
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  • Priority Setting in the Assessment for Kidney Transplant Candidacy: A Canadian Case Study.Faisal Omar - 2012 - Journal of Clinical Research and Bioethics 3 (S1).
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  • One and Done? Equality of Opportunity and Repeated Access to Scarce, Indivisible Medical Resources.Marco D. Huesch - 2012 - BMC Medical Ethics 13 (1):11.
    Background: Existing ethical guidelines recommend that, all else equal, past receipt of a medical resource (e.g. a scarce organ) should not be considered in current allocation decisions (e.g. a repeat transplantation).DiscussionOne stated reason for this ethical consensus is that formal theories of ethics and justice do not persuasively accept or reject repeated access to the same medical resources. Another is that restricting attention to past receipt of a particular medical resource seems arbitrary: why couldn't one just as well, it is (...)
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  • Competing Principles for Allocating Health Care Resources.Drew Carter, Jason Gordon & Amber M. Watt - 2016 - Journal of Medicine and Philosophy 41 (5):558-583.
    We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and (...)
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  • Sozial-epidemiologische und ethische Ansätze zur Bewertung der gesundheitlichen Ungleichheit.Andreas Mielck - 2010 - Ethik in der Medizin 22 (3):235-248.
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  • Let Us Be Fair to 5-Year-Olds: Priority for the Young in the Allocation of Scarce Health Resources.Kelsey Gipe & Samuel J. Kerstein - forthcoming - Public Health Ethics:phy007.
    Life-saving health resources like organs for transplant and experimental medications are persistently scarce. How ought we, morally speaking, to ration these resources? Many hold that, in any morally acceptable allocation scheme, the young should to some extent be prioritized over the old. Govind Persad, Alan Wertheimer and Ezekiel Emanuel propose a multi-principle allocation scheme called the Complete Lives System, according to which persons roughly between 15 and 40 years old get priority over younger children and older adults, other things being (...)
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  • Pandemic Ventilator Rationing and Appeals Processes.Daniel Patrone & David Resnik - 2011 - Health Care Analysis 19 (2):165-179.
    In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions has been (...)
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  • Public Preference for Allocation of Donated Livers for Transplantation: A Conjoint Analysis.Ahmad Danesh, Fariba Asghari, Hojjat Zeraati, Kamran Yazdani, Saharnaz Nedjat, Mohammad-Ali Mansournia, Ali Jafarian & Akbar Fotouhi - 2016 - Clinical Ethics 11 (4):176-181.
    Despite the fact that the criteria for allocation of donated livers have been laid down for years, these criteria may not help to select a potential recipient from those with the same medical requirements. This study used conjoint analysis method to determine the importance of certain non-medical factors from the public’s point of view. Through a population based study, a sample of 899 randomly selected persons filled a questionnaire where in each question the respondents had to choose one out of (...)
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  • The Seminal Contribution of Rabbi Moshe Feinstein to the Development of Modern Jewish Medical Ethics.Alan Jotkowitz - 2014 - Journal of Religious Ethics 42 (2):285-309.
    The purpose of this essay is to show how, on a wide variety of issues, Rabbi Moshe Feinstein broke new ground with the established Orthodox rabbinic consensus and blazed a new trail in Jewish medical ethics. Rabbi Feinstein took power away from the rabbis and let patients decide their treatment, he opened the door for a Jewish approach to palliative care, he supported the use of new technologies to aid in reproduction, he endorsed altruistic living organ donation and recognized brain (...)
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  • Allocation of Antiretroviral Drugs to HIV-Infected Patients in Togo: Perspectives of People Living with HIV and Healthcare Providers.Lonzozou Kpanake, Paul Clay Sorum & Etienne Mullet - 2017 - Journal of Medical Ethics 43 (12):845-851.
    Aim To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. Method From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for (...)
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  • Conceptions of Care: Altruism, Feminism, and Mature Care.Tove Pettersen - 2012 - Hypatia 27 (2):366-389.
    In “Conceptions of Care,” Tove Pettersen discusses and articulates select ways in which care can be comprehended. Several difficulties related to an altruistic understanding of care are examined before the author presents the case for a more favorable concept: mature care. Mature care is intended to take into account the interests of both parties to the caring relationship. This understanding of care facilitates the expression of the relational and reciprocal aspects of caring while emphasizing the equal worth of all involved. (...)
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  • Experience Adjusted Life Years and Critical Medical Allocations Within the British Context: Which Patient Should Live?Michal Pruski - 2018 - Medicine, Health Care and Philosophy 21 (4):561-568.
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  • When Clinical Trials Compete: Prioritising Study Recruitment.Luke Gelinas, Holly Fernandez Lynch, Barbara E. Bierer & I. Glenn Cohen - 2017 - Journal of Medical Ethics 43 (12):803-809.
    It is not uncommon for multiple clinical trials at the same institution to recruit concurrently from the same patient population. When the relevant pool of patients is limited, as it often is, trials essentially compete for participants. There is evidence that such a competition is a predictor of low study accrual, with increased competition tied to increased recruitment shortfalls. But there is no consensus on what steps, if any, institutions should take to approach this issue. In this article, we argue (...)
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  • Benefit in liver transplantation: a survey among medical staff, patients, medical students and non-medical university staff and students.Christine Englschalk, Daniela Eser, Ralf J. Jox, Alexander Gerbes, Lorenz Frey, Derek A. Dubay, Martin Angele, Manfred Stangl, Bruno Meiser, Jens Werner & Markus Guba - 2018 - BMC Medical Ethics 19 (1):7.
    The allocation of any scarce health care resource, especially a lifesaving resource, can create profound ethical and legal challenges. Liver transplant allocation currently is based upon urgency, a sickest-first approach, and does not utilize capacity to benefit. While urgency can be described reasonably well with the MELD system, benefit encompasses multiple dimensions of patients’ well-being. Currently, the balance between both principles is ill-defined. This survey with 502 participants examines how urgency and benefit are weighted by different stakeholders. Liver transplant patients (...)
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  • Challenges for Principles of Need in Health Care.Niklas Juth - 2015 - Health Care Analysis 23 (1):73-87.
    What challenges must a principle of need for prioritisations in health care meet in order to be plausible and practically useful? Some progress in answering this question has recently been made by Hope, Østerdal and Hasman. This article continue their work by suggesting that the characteristic feature of principles of needs is that they are sufficientarian, saying that we have a right to a minimally acceptable or good life or health, but nothing more. Accordingly, principles of needs must answer two (...)
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  • Fair, Just and Compassionate: A Pilot for Making Allocation Decisions for Patients Requesting Experimental Drugs Outside of Clinical Trials.Arthur L. Caplan, J. Russell Teagarden, Lisa Kearns, Alison S. Bateman-House, Edith Mitchell, Thalia Arawi, Ross Upshur, Ilina Singh, Joanna Rozynska, Valerie Cwik & Sharon L. Gardner - 2018 - Journal of Medical Ethics 44 (11):761-767.
    Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...)
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  • What is so Important About Completing Lives? A Critique of the Modified Youngest First Principle of Scarce Resource Allocation.Espen Gamlund - 2016 - Theoretical Medicine and Bioethics 37 (2):113-128.
    Ruth Tallman has recently offered a defense of the modified youngest first principle of scarce resource allocation [1]. According to Tallman, this principle calls for prioritizing adolescents and young adults between 15–40 years of age. In this article, I argue that Tallman’s defense of the modified youngest first principle is vulnerable to important objections, and that it is thus unsuitable as a basis for allocating resources. Moreover, Tallman makes claims about the badness of death for individuals at different ages, but (...)
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  • Is Risk Stratification Ever the Same as ‘Profiling’?R. Scott Braithwaite, Elizabeth R. Stevens & Arthur Caplan - 2016 - Journal of Medical Ethics 42 (5):325-329.
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  • The Rule of Rescue: An Investigation Into Age-Related Preferences and the Imperative to Save a Life.S. Watters - 2015 - Clinical Ethics 10 (3):70-79.
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  • Currents in Contemporary Ethics.Mark A. Rothstein - 2010 - Journal of Law, Medicine and Ethics 38 (2):412-419.
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  • Public Health Doctors' Ancillary-Care Obligations.H. S. Richardson - 2010 - Public Health Ethics 3 (1):63-67.
    This comment on the case presented in ‘Cholera and Nothing More’ argues that the physicians at this public-health centre did not have an ordinary clinician's obligations to promote the health of the people who came to them for care, as they were instead set up to serve a laudable and urgent public-health goal, namely, controlling a cholera outbreak. It argues that, nonetheless, these physicians did have some limited moral duties to care for other diseases they encountered—some ancillary-care duties—arising from their (...)
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  • Uterus Transplantation: Ethical and Regulatory Challenges.K. S. Arora & V. Blake - 2014 - Journal of Medical Ethics 40 (6):396-400.
    Moving forward rapidly in the clinical research phase, uterus transplantation may be a future treatment option for women with uterine factor infertility, which accounts for three per cent of all infertility in women. This new method of treatment would allow women, who currently rely on gestational surrogacy or adoption, to gestate and birth their own genetic offspring. Since uterus transplantation carries significant risk when compared with surrogacy and adoption as well as when compared with other organ transplants, it requires greater (...)
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