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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 - 2020 - Health Care Analysis 28 (1):25-44.
    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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  • 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.
    Medical resource allocation is a controversial topic, because in the end it prioritises some peoples’ medical problems over those of others. This is less controversial when there is a clear clinical reason for such a prioritisation, but when such a reason is not available people might perceive it as deeming certain individuals more important than others. This article looks at the role of social utility in medical resource allocation, in a situation where the clinical outcome would be identical if either (...)
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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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  • Prioritising Access to Pandemic Influenza Vaccine: A Review of the Ethics Literature. [REVIEW]Jane H. Williams & Angus Dawson - 2020 - BMC Medical Ethics 21 (1):1-8.
    BackgroundThe world is threatened by future pandemics. Vaccines can play a key role in preventing harm, but there will inevitably be shortages because there is no possibility of advance stockpiling. We therefore need some method of prioritising access.Main textThis paper reports a critical interpretative review of the published literature that discusses ethical arguments used to justify how we could prioritise vaccine during an influenza pandemic. We found that the focus of the literature was often on proposing different groups as priorities. (...)
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  • Should Lack of Social Support Prevent Access to Organ Transplantation?Keren Ladin, Norman Daniels & Kelsey N. Berry - 2019 - American Journal of Bioethics 19 (11):13-24.
    Transplantation programs commonly rely on clinicians’ judgments about patients’ social support when deciding whether to list them for organ transplantation. We examine whether using social support to make listing decisions for adults seeking transplantation is morally legitimate, drawing on recent data about the evidence-base, implementation, and potential impacts of the criterion on underserved and diverse populations. We demonstrate that the rationale for the social support criterion, based in the principle of utility, is undermined by its reliance on tenuous evidence. Moreover, (...)
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  • Against ‘Saving Lives’: Equal Concern and Differential Impact.Richard Yetter Chappell - 2016 - Bioethics 30 (3):159-164.
    Bioethicists often present ‘saving lives’ as a goal distinct from, and competing with, that of extending lives by as much as possible. I argue that this usage of the term is misleading, and provides unwarranted rhetorical support for neglecting the magnitudes of the harms and benefits at stake in medical allocation decisions, often to the detriment of the young. Equal concern for all persons requires weighting equal interests equally, but not all individuals have an equal interest in ‘life-saving’ treatment.
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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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  • 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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  • The Ethics of the Reuse of Disposable Medical Supplies.Anjan Kumar Das, Taketoshi Okita, Aya Enzo & Atsushi Asai - forthcoming - Asian Bioethics Review.
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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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  • Beneficence and Wellbeing: A Critical Appraisal.Laurence B. McCullough - 2020 - American Journal of Bioethics 20 (3):65-68.
    Volume 20, Issue 3, March 2020, Page 65-68.
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  • Goal-Concordant Care Within the Range of the Possible.Wynne Morrison - 2020 - American Journal of Bioethics 20 (3):63-65.
    Volume 20, Issue 3, March 2020, Page 63-65.
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  • Clinical Research Subject Selection During Public Health Disasters: Reconceptualizing Fairness in a Global Ethical Context.Ikeolu O. Afolabi, Stephen O. Sodeke & Michael O. S. Afolabi - 2020 - American Journal of Bioethics 20 (2):38-41.
    Volume 20, Issue 2, February 2020, Page 38-41.
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  • The Challenge of Selecting Participants Fairly in High-Demand Clinical Trials.Annette Rid, Saskia Hendriks & Alexander A. Iyer - 2020 - American Journal of Bioethics 20 (2):35-38.
    Volume 20, Issue 2, February 2020, Page 35-38.
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  • Context is Needed When Assessing Fair Subject Selection.G. Owen Schaefer - 2020 - American Journal of Bioethics 20 (2):20-22.
    Volume 20, Issue 2, February 2020, Page 20-22.
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  • Allocating Scarce Medical Resources: Using Social Usefulness as a Criterion.D. Selvaraj, A. McClelland & A. Furnham - 2019 - Ethics and Behavior 29 (4):274-286.
    This study aimed to determine if people would use social usefulness as a criterion when allocating a kidney to potential recipients. Participants ranked hypothetical patients in order of priority to receive the kidney, using only information on the patients’ volunteering record, intelligence, emotional intelligence, and attractiveness. The results showed that volunteers were prioritized over nonvolunteers, highly intelligent patients over those with average intelligence, patients with high emotional intelligence over those with average emotional intelligence, and good-looking patients over average-looking patients. There (...)
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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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  • 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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  • Complete Lives, Incomplete Theories.Alexander Friedman - 2010 - American Journal of Bioethics 10 (4):58 – 60.
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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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  • 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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  • 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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  • 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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  • 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.
    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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  • 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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  • Sozial-epidemiologische und ethische Ansätze zur Bewertung der gesundheitlichen Ungleichheit.Andreas Mielck - 2010 - Ethik in der Medizin 22 (3):235-248.
    ZusammenfassungEin niedriger sozialer Status ist oft mit erhöhter Morbidität und Mortalität verbunden. In dem Beitrag wird versucht, diese „gesundheitliche Ungleichheit“ aus sozial-epidemiologischer Sicht zu bewerten. Im Mittelpunkt steht dabei die Frage nach der Verantwortung für die erhöhte gesundheitliche Gefährdung der unteren Statusgruppen. Nur ein kleiner Teil der gesundheitlichen Ungleichheit kann durch das Gesundheitsverhalten erklärt werden. Umso wichtiger sind andere Ursachen. Dazu gehören die sozialen Unterschiede bei den Belastungen in der Wohnumgebung, bei den Arbeitsbedingungen und auch beim Zugang zur gesundheitlichen Versorgung. (...)
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  • Uterustransplantation. Ethisch gerechtfertigt?Is the transplant of uterus ethically acceptable?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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  • Vulnerability Identified in Clinical Practice: A Qualitative Analysis.Laura Sossauer, Mélinée Schindler & Samia Hurst - 2019 - BMC Medical Ethics 20 (1):1-10.
    Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The findings revealed the (...)
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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 - 2018 - Public Health Ethics 11 (3):325-335.
    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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  • Social Value Judgements in Healthcare: A Philosophical Critique.Laura R. Biron, Ruth Faden & Benedict Rumbold - 2012 - Journal of Health Organization and Management 26 (3):317-30.
    PURPOSE: The purpose of this paper is to consider some of the philosophical and bioethical issues raised by the creation of the draft social values framework developed to facilitate data collection and country-specific presentations at the inaugural workshop on "Social values and health priority setting" held in February 2011. -/- DESIGN/METHODOLOGY/APPROACH: Conceptual analysis is used to analyse the term "social values", as employed in the framework, and its relationship to related ideas such as moral values. The structure of the framework (...)
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  • From Protection to Entitlement: Selecting Research Subjects for Early Phase Clinical Trials Involving Breakthrough Therapies.Nancy S. Jecker, Aaron G. Wightman, Abby R. Rosenberg & Douglas S. Diekema - 2017 - Journal of Medical Ethics 43 (6):391-400.
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  • The Rule of Rescue: An Investigation Into Age-Related Preferences and the Imperative to Save a Life.Sarah Watters - 2015 - Clinical Ethics 10 (3):70-79.
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  • Practical Allocation System for the Distribution of Specialised Care During Cellular Therapy Access Scarcity.Andrew Hantel, Gregory A. Abel & Mark Siegler - 2019 - Journal of Medical Ethics 45 (8):532-537.
    Novel cellular therapy techniques promise to cure many haematology patients refractory to other treatment modalities. These therapies are intensive and require referral to and care from specialised providers. In the USA, this pool of providers is not expanding at a rate necessary to meet expected demand; therefore, access scarcity appears forthcoming and is likely to be widespread. To maintain fair access to these scarce and curative therapies, we must prospectively create a just and practical system to distribute care. In this (...)
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  • Uterus Transplantation: Ethical and Regulatory Challenges.Kavita Shah Arora & Valarie 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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  • Public Preferences About Fairness and the Ethics of Allocating Scarce Medical Interventions.Govind Persad - 2017 - In Meng Li & David Tracer (eds.), Interdisciplinary Perspectives on Fairness, Equity, and Justice. pp. 51-65.
    This chapter examines how social- scientific research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientific researchers might find an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by first distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarce medical interventions, including an approach—the complete lives system—which (...)
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  • Bursting Bubbles? QALYs and Discrimination.Ben Davies - 2019 - Utilitas 31 (2):191-202.
    The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead and Ord have identified a problem, it (...)
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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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  • Ethical Considerations in Uterus Transplantation.Kavita Kavita Shah Arora, Jessica Woessner & Valarie Blake - forthcoming - Medicolegal and Bioethics:81.
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  • What Is the Relevance of Procedural Fairness to Making Determinations About Medical Evidence?Govind Persad - 2017 - AMA Journal of Ethics 19 (2):183-191.
    Approaches relying on fair procedures rather than substantive principles have been proposed for answering dilemmas in medical ethics and health policy. These dilemmas generally involve two questions: the epistemological (factual) question of which benefits an intervention will have, and the ethical (value) question of how to distribute those benefits. This article focuses on the potential of fair procedures to help address epistemological and factual questions in medicine, using the debate over antidepressant efficacy as a test case. In doing so, it (...)
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  • 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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  • Prioritization of Referrals in Outpatient Physiotherapy Departments in Québec and Implications for Equity in Access.Simon Deslauriers, Marie-Hélène Raymond, Maude Laliberté, Anne Hudon, François Desmeules, Debbie E. Feldman & Kadija Perreault - 2018 - Canadian Journal of Bioethics / Revue canadienne de bioéthique 1 (3).
    In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in 2015 across publicly (...)
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  • Iranian Intensive Care Unit Nurses' Moral Distress: A Content Analysis.F. A. Shorideh, T. Ashktorab & F. Yaghmaei - 2012 - Nursing Ethics 19 (4):464-478.
    Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of (...)
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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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  • 'Playing God Because You Have To': Health Professionals' Narratives of Rationing Care in Humanitarian and Development Work.C. Sinding, L. Schwartz, M. Hunt, L. Redwood-Campbell, L. Elit & J. Ranford - 2010 - Public Health Ethics 3 (2):147-156.
    This article explores the accounts of Canadian-trained health professionals working in humanitarian and development organizations who considered not treating a patient or group of patients because of resource limitations. In the narratives, not treating the patient(s) was sometimes understood as the right thing to do, and sometimes as wrong. In analyzing participants’ narratives we draw attention to how medications and equipment are represented. In one type of narrative, medications and equipment are represented primarily as scarce resources; in another, they are (...)
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  • A Costly Separation Between Withdrawing and Withholding Treatment in Intensive Care.Dominic Wilkinson & Julian Savulescu - 2014 - Bioethics 28 (3):127-137.
    Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively (...)
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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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