In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails (...) a commitment to both distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

The COVID-19 (Coronavirus disease of 2019) pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation (...) pools and that triage protocols should be immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

In "Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?," Wilkinson (2021) argues that the use of frailty scores in ICU triage does not necessarily involve discrimination on the basis of disability. In support of this argument, he claims, “it is not the disability per se that the score is measuring – rather it is the underlying physiological and physical vulnerability." While we appreciate the attention Wilkinson explicitly pays to disability in this piece, we find the (...) distinction between disability and underlying vulnerability untenable both theoretically and practically. In this peer commentary, we begin with a brief overview of research in philosophy of disability concerning the meaning of the concept itself. We argue that this research demonstrates that many forms of disability do not involve underlying vulnerabilities, and, furthermore, that Wilkinson equivocates between "disability" understood as a medical category vs. "disability" understood as a feature of lived experience. We reject Wilkinson’s distinction on these grounds and offer further considerations to avoid disability discrimination in emergency and crisis standards of care contexts. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

A central feature of experimental development economics is the use of randomized controlled trials (RCTs) to evaluate the effectiveness of prospective socioeconomic interventions. The use of RCTs in development economics raises a host of ethical issues which are just beginning to be explored. In this article, I address one ethical issue in particular: the routine use of the status quo as a control when designing and conducting a development RCT. Drawing on the literature on the principle of standard (...) class='Hi'>care in medical research ethics, as well as considerations of distributive justice in non-ideal circumstances, I argue that the practice of using the status quo as a control is ethically justifiable. However, I add an important qualification based on the natural duty of rescue to address the concern that my account is overly permissive. (shrink)

During the current financial crisis, the need for an alternative to a laissez-faire ethics of capitalism (the Milton Friedman view) becomes clear. I argue that we need an order ethics which employs economics as a key theoretical resource and which focuses on institutions for implementing moral norms. -/- I will point to some aspects of order ethics which highlight the importance of rules, e.g. global rules for the financial markets. In this regard, order ethics (“Ordnungsethik”) is the complement of (...) the German conception of “Ordnungspolitik” which also stresses the importance of a regulatory framework. This framework is needed not to tame the market, but to make it more profitable in the long run. -/- The conception of order ethics relies heavily on contractarianism, especially on James Buchanan’s work. Unlike many other conceptions of ethics, it does not start with an aim to achieve, but rather with an account of what the social world – in which ethical norms have to be implemented – is like. Our social world is different from the pre-modern one. Pre-modern societies played zero-sum games in which people could only gain significantly at the expense of others. And the types of ethics that we are still used to today have been developed within these pre-modern societies. -/- Modern societies, by contrast, can be characterised – by economists and other social theorists alike – as societies with continuous growth. This growth has only been made possible by the modern competitive market economy which enables everyone to pursue his own interests within a carefully devised institutional system. In this system, positive sum games are played, which makes it in principle possible to improve the position of every individual at the same time. Most kinds of ethics, however, resulting from the conditions of pre-modern societies, ignore the possibility of win-win-situations and instead require us to be moderate, to share, to sacrifice, as this would have been functional in zero-sum games. These conceptions distinguish – in more or less strict ways – between self-interest and altruistic motivation. Self-interest, more often than not, is ultimately seen as something evil. -/- Such an ethics cannot be functional in modern societies. Ethical concepts lag behind. Within zero-sum games, it was necessary to call for temperance, for moderate profits, or for a condemnation of lending money at interest. Within positive-sum games, however, the morally desired result of a social process cannot be brought about by changes in motivation, by switching from ‘egoistic’ to ‘altruistic’ motivation. The second theoretical element introduced by order ethics is the distinction between actions and rules, which was already mentioned. Traditional ethics concerns actions: It calls directly for changes in behaviour. This is a consequence of pre-modern conditions as reconstructed before: People in the pre-modern world were only able to control their actions, not so much however the conditions of their actions. In particular, rules like laws, constitutions, social structures, the market order, and also ethical norms have remained stable for centuries. In modern societies, this situation has changed entirely. The rules governing our actions have increasingly come under our control. -/- In this situation, ethics has to focus on rules. Morality must be incorporated in incentive-compatible rules. Direct calls for changes in behaviour without changes in the rules lead only to an erosion of compliance with moral norms. Individuals that continue to behave ‘morally’ will be singled out, because the incentives have not been changed. Moral norms which are to be justified cannot require people to abstain from pursuing their own advantage. People abstain from taking ‘immoral’ advantages only if adherence to ethical norms yields greater benefits over the planned sequence of actions than defection in the single case. Thus ‘abstaining’ is not abstaining in the long run, it is rather an investment in expectations of long-term benefits. By adhering to ethical norms, I become a reliable partner for interactions. The norms do indeed constrain my actions, but they simultaneously expand my options in interactions. And people consent to rules only if these rules hold greater advantages for them, at least in the long run. -/- In general, ethics cannot require people to abandon their individual calculation of advantages. However, it may suggest improving one’s calculation, by calculating in the long run rather than in the short run, and by taking into account the interests of our fellows, as we depend on their acceptance for reaching an optimal level of well-being, especially in a globalized world full of interdependence. -/- The problem of implementation can now be placed at the beginning of a conception of order ethics, justified with reference to the conditions of modern societies I have sketched. Under the conditions of pre-modern societies, an ethics of temperance had evolved that posed simultaneously the problems of implementation and justification. The implementation of well-justified norms or standards could then be regarded as unproblematic, because the social structures allowed for a direct face-to-face enforcement of norms. Pre-modern societies not only favored an ethics of temperance, they also had the instrument of face-to-face-sanctions within their smaller and non-anonymous communities. This instrument is no longer functional in modern anonymous societies, and so we have to face up to the problem of implementation right at the start of our ethical conception. Simultaneously, an order ethics relies on the implementation of sanctions for enforcing incentive-compatible rules. In modern societies, rules and institutions, to a large extent, must fulfil the tasks that were, in pre-modern times, fulfilled by moral norms, which in turn were sanctioned by face-to-face sanctions. Norm implementation in modern societies thus works by setting adequate incentives in order to prevent the erosion of moral norms, which would happen if ‘moral’ actors were systematically threatened with exploitation by other, less ‘moral’ actors. -/- This conception of order ethics is then elaborated further in the area of business ethics. -/- . (shrink)

That a standard of medical care must outline services that benefit the patient is relatively uncontroversial. However, one must determine how the practices outlined in a medical standard of care should benefit the patient. I will argue that practices outlined in a standard of medical care must not detract from the patient’s well-functioning and that clinicians can refuse to provide services that do. This paper, therefore, will advance the following two claims: (1) a (...) class='Hi'>standard of medical care must not cause dysfunction, and (2) if a physician is medically rational to not provide some service which fails to meet the above condition (i.e. fails to be a standard of medical care), then she may refuse to do so. I then apply my thesis to the prescription of puberty blockers to children with gender dysphoria. (shrink)

Though the duties of care owed toward innocents in war and in civil life are at the bottom univocally determined by the same ethical principles, Bazargan-Forward argues that those very principles will yield in these two contexts different “in-practice” duties. Furthermore, the duty of care we owe toward our own innocents is less stringent than the duty of care we owe toward foreign innocents in war. This is because risks associated with civil life but not war (a) (...) often increase the expected welfare of the individuals upon whom the risk is imposed, (b) are often imposed with consent, and (c) are often imposed reciprocally. The conclusion—that we have a pro tanto reason for adopting a more stringent standard of risk imposition toward foreign innocents in war—has implications for not only what standards of risk we should adopt in war, but also how we should weigh domestic versus foreign civilian lives. (shrink)

COVID-19 demonstrated a global catastrophe that touched everybody, including the scientific community. As we respond and recover rapidly from this pandemic, there is an opportunity to guarantee that the fabric of our society includes sustainability, fairness, and care. However, approaches to environmental health attempt to decrease the population burden of COVID-19, toward saving patients from becoming ill along with preserving the allocation of clinical resources and public safety standards. This paper explores environmental and public health evidence-based practices toward responding (...) to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward reretrieving research publications, “grey literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which includes effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy making; conducting sound evaluation; do thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision-makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioural, environmental, social as well as systems interventions (BESSI) toward reducing transmission. (shrink)

Current health care standards, in many countries, Australia included, are regrettably poor. Surprisingly, practitioners and treating teams alike in mental health and disability sectors, in particular, make far too many basic care-related mistakes, in addition to the already abundant diagnostic mistakes that cause and amplify great harm. In part, too many practitioners also fail to distinguish adverse effects for what they are and all too often treat adverse effects, instead, as comorbidities. Diagnostic failures are dangerous, the result of (...) which generates and perpetuates harms that are extremely costly in terms of patient welfare, in addition to the financial burden placed on everyone. In this essay, I contend that the authority bestowed upon psychiatry is misplaced. Subsequently, this misplaced authority affects the governing and investigatory institutions reliant and informed by psychiatry. The examination process undertaken in this investigation traces the metaphysics of psychiatric disorders relative to the Diagnostic-Statistical-Manual (DSM) in all its iterations and to the epistemological construction process that serves to underpin the fundamentals of psychiatric practice. There exists a crisis of confidence in psychiatric practice and I urge drastic reform be undertaken to arrest the damage. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical (...) support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

This chapter offers a plea for the media to reframe its coverage of campus controversies from free expression to academic freedom. These freedoms are entwined, but distinct. Freedom of expression is extended to all persons with no expectation of quality control, apart from legal prohibitions against defamation, threats, etc. By contrast, academic freedom is a cluster of freedoms afforded to scholarly personnel for a particular purpose – namely, the pursuit of universities’ academic mission to seek truth and advance understanding in (...) the service of society. An academic freedom framing better reflects the distinctive social purpose around which universities are organized, as well as universities’ duty of care to employees and students. While universities have a legal and moral duty of care to all employees and students, the unjust, exclusionary past and present of higher education arguably makes that duty particularly acute in the case of equity-deserving (e.g., racialized, Indigenous, disabled or 2SLGBTQ+) people. Finally, academic freedom framing for campus media stories is less monolithic than free expression framing, allowing for a more nuanced understanding of campus controversies while keeping universities accountable to the public they serve. In this chapter, I survey three very different campus controversies at a single Canadian university, and the media response each received. I show how an academic freedom frame for those stories would have produced better reportage while reducing opportunities for bad actors to manipulate both universities and the media. At the end of the day, the real crisis at universities isn’t the cancellation of ill-judged events that were never a part of the academic mission; it is the ongoing erosion of academic freedom. (shrink)

Are the standards of reasoning and rationality in divination, religious practice, and textual exegesis different from those in the sciences? Can there be different standards of reasoning and rationality at all? The intense “rationality debate” of the 1960s, 70s, and 80s focused on these questions and the related problems of relativism across cultures and systems of practice. Although philosophers were at the center of these debates at the time, they may appear to have abandoned the question in recent years. On (...) the contrary, I discuss recent developments in philosophy that approach the issue from a number of new directions, changing our understanding of reasoning and rationality. I argue that, in comparing the diviner to the scientist, focusing on reasoning is likely to be a red herring. Instead, I argue that a careful treatment of rationality, paying particular attention to its context-dependence, untangles longstanding confusions. Moreover, it points the way forward to investigating modest but interesting ways for there to be alternative standards of rationality. (shrink)

We propose to understand the global financial crisis of 2008 as an historical event marked by public decisions, economic evaluations and ratings, and business practices driven by a sense of subjugation to powerful others, uncritical conformity to serendipitous rules, and a levelling down of all meaningful differences. The crisis has also revealed two important things: that the free-market economy has inherent problems highlighting the limits of (financial) business, and, consequently, that the business organisation is not as strong as (...) is usually assumed. We reconstruct some of the most dramatic events of that time by using the narratives of two former Lehman Brothers insiders. We then provide an interpretation of that world by using Heidegger’s notions of being and care. Our investigation uncovers persistent inauthentic relationships nourished by the public structure of the financial market, which, drawing on Heidegger, we call the they. In the financial market the what of the world becomes more important than authentic being and self. But a hitch-free switch to authenticity becomes possible through anxiety and the call of conscience. (shrink)

The emergence of the COVID-19 pandemic initiated major disruptions to higher education systems. Physical spaces that previously supported interpersonal interaction and community were abruptly inactivated, and faculty largely took on the responsibility of accommodating classroom structures in rapidly changing situations. This study employed interviews to examine how undergraduate Science, Technology, Engineering, and Mathematics (STEM) instructors adapted instruction to accommodate the mandated transition to virtual learning and how these accommodations supported or hindered community and belonging during the onset of the pandemic. (...) Interviews with 25 STEM faculty at an undergraduate Hispanic Serving Institution revealed a wide range of accommodations they made to their courses and how they managed communication with students. Faculty strived to support student belonging with responses ranging from caring to crisis management, though some faculty expressed feelings of powerlessness when unable to accommodate certain challenges. The case of a responsive and flexible instructor is presented to highlight a productive response to a crisis. These retrospective findings point to strategies to support faculty teaching in virtual learning environments in the future; increasing opportunities for student–student and student–faculty interaction, supporting faculty in learning technologies that support these interactions and addressing faculty’s feelings of powerlessness. (shrink)

The context of international health research involving human subjects, and this should appear obvious, is the human community. As such, basic questions of how human beings should be treated by other human beings, particularly in situations of unequal power – e.g., in the form of control, choice, or opportunity – lay at the foundations of related ethical discourse when ethics are discussed at all. I trace a narrative that follows upon a recent revision process of international guidelines for biomedical research (...) involving human subjects. I focus in particular upon the issue of a standard of care. In the second section, I draw upon philosophers John Rawls, Claudia Card, and Allen Buchanan to discuss concerns regarding the 'least advantaged members of society' in the context of global inequality. The paper includes reflections upon pedagogy in courses focused upon international health research involving human subjects. (shrink)

This article focuses on the ethical implications of so-called ‘collateral damage’. It develops a moral typology of collateral harm to innocents, which occurs as a side effect of military or quasi-military action. Distinguishing between accidental and incidental collateral damage, it introduces four categories of such damage: negligent, oblivious, knowing and reckless collateral damage. Objecting mainstream versions of the doctrine of double effect, the article argues that in order for any collateral damage to be morally permissible, violent agents must comply with (...) high standards of care. In order for incidental harm to be permissible, an agent must take pains to avoid such harm even at higher cost to him- or herself. It is argued that accidentally but negligently caused collateral damage may be just as difficult to excuse as incidental harm. Only if high precautionary standards of care are met, can unintended harm to innocents – incidental or accidental – be permissible. In practice, such a strong commitment to avoiding harm to civilians may well lead us to question more generally and rethink more radically how violent conflicts ought to be fought, how military violence ought to be used and whether there are better ways of achieving those aims that we think are legitimate than those we are currently using. (shrink)

This article presents the topic of crisis in the context of prevention in pastoral workers. It points to the possibility of coping with crisis and thus offers a theological view of overcoming it. It is based on the theoretical points of view and practical experience of pastoral workers. Selected aspects, types, preventions and therapies of crisis at the psychotherapeutic or spiritual-theological level are presented in this paper. -/- .

A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance of research (...) to improve emergency care in low-income and middle-income countries (LMICs) and the widely acknowledged ethical challenges, very little has been written on the ethics of emergency care research in LMICs. This paper examines the ethical and regulatory challenges to conducting emergency care research with human participants in LMICs. We outline key challenges, present potential solutions or frameworks for addressing these challenges, and identify gaps. Despite the ethical and regulatory challenges, conducting high-quality, ethical emergency care research in LMICs is possible and it is essential for global health. (shrink)

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.2-7 Yet medical participation (...) in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.8-11 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. -/- The 2016 release of previously classified portions of guideline from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. (shrink)

The notion of self-care—like its precursor, self-help—has emerged due to a spiritual vacuum in the contemporary world. The burgeoning mental health crisis that is prevalent today appears inseparable from the broader existential predicament facing humanity. Mainstream psychology and its therapies have not been able to address these challenges, in response to which we have seen the inevitable rise of self-care remedies. Across humanity’s diverse spiritual cultures, these have always been available, yet they were invariably grounded in a (...) religious tradition and its sacred psychology. The more we are marginalized from such roots, the more self-care is required—our current obsession with which is the unacknowledged search for wholeness due to modern people having lost their sense of the sacred. (shrink)

According to the care crisis in modern medicine, the existential needs of patients are not sufficiently satisfied. One idea is that to address the crisis physicians should be educated to be virtuous. This suggestion is helpful but incomplete. It does not take into account the part of (non-)human factors, including (medical) technologies. In particular, the paper focuses on online caring forums and argues that they are technological factors that can play the role of focal things, in which (...) the members gather together to do a care-related focal practice. Furthermore, we empirically study the online forums of Ninisite, a popular Persian website on pregnancy, childbirth, and parenting, and suggest that these forums shape focal practices that are helpful in alleviating the care crisis. (shrink)

Starting from two observations regarding nursing ethics research in the past two decades, namely, the dominant influence of both the empirical methods and the principles approach, we present the cornerstones of a foundational argument-based nursing ethics framework. First, we briefly outline the general philosophical–ethical background from which we develop our framework. This is based on three aspects: lived experience, interpretative dialogue, and normative standard. Against this background, we identify and explore three key concepts—vulnerability, care, and dignity—that must be (...) observed in an ethical approach to nursing. Based on these concepts, we argue that the ethical essence of nursing is the provision of care in response to the vulnerability of a human being in order to maintain, protect, and promote his or her dignity as much as possible. (shrink)

The paper addresses the nature of duties grounded in human rights. Rather than being protections against harm, per se, I contend that human rights largely shield against risk impositions to protected interests. “Risk imposition” is a normative idea requiring explication, but understanding dutiful action in its terms enables human rights to provide prospective policy guidance, hold institutions accountable, operate in non-ideal circumstances, embody impartiality among persons, and define the moral status of agencies in international relations. Slightly differently, I indicate a (...) general understanding of dutiful action that permits human rights to see to the tasks of an institutional morality. (shrink)

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, (...) for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers. (shrink)

The population ageing of Chinese society is deepening. The elderly care policy is a policy standard formulated by the government to protect the rights and interests of older people in the process of actively coping with the population ageing. It has crucial guiding significance for improving the elderly care services and carrying out pension practice. Since the reform and opening-up, China’s elderly care policy system has gone through three stages of initial construction, development, and transformation, showing (...) a development direction from aid to service, from one to multiple, from unique to general. In general, China has primarily formed a complete framework of the elderly care policy system, the rights, and interests of older people have been strongly guaranteed, the elderly care service industry has developed rapidly, and the quality of elderly care service has been effectively improved. However, in the process of policy development, there are still problems such as difficulty in implementing policies, low effectiveness, vague content, and fragmentation of policies. In the future, it is urgent to establish a complete, scientific, reasonable, and effective elderly care policy system. It should further expand the scope of benefits of old-age care policies, promote the coordinated development of the elderly care policies between urban and rural areas and among regions, strengthen the guiding and leading role of the government, and refine policies on personnel training, so as to form a powerful driving force for old-age care. (shrink)

I intend to: a) clarify the origins and de facto meanings of the term relativism; b) reconstruct the reasons for the birth of the thesis named “cultural relativism”; d) reconstruct ethical implications of the above thesis; c) revisit the recent discussion between universalists and particularists in the light of the idea of cultural relativism.. -/- 1.Prescriptive Moral Relativism: “everybody is justified in acting in the way imposed by criteria accepted by the group he belongs to”. Universalism: there are at least (...) some judgments which are valid inter-culturally Absolutism: there are at least some particular prescriptions which are valid without exception everywhere and always -/- 2. The traditional proof of prescriptive moral relativism: the argument from variability: Judgments, rules, and shared values are de facto variable in time and space. The traditional counter-proof: examples of variability do not prove what skeptics contend. -/- 3. Pre-history of the doctrine -Ancient sophists: either immoralist or contractualist -Modern moral scepticism (xvii c.): variability as an historical and ethnographic fact supports a sceptical conclusion more moderate than sheer immoralism. - Voltaire, Kant, Reid counter-attack pointing at a universally shared moral sense - Romantics and idealists stage an even more moderate reformulation: instead of universally shared moral sense they point at the Spirit of a People which is: a)alternative to abstract and universal philosophical systems as far as it is lived ‘culture’; b) indivisible unity with an inner harmony and a source of normative standards; c) dynamic, in so far as it is a manifestation of the Spirit through the becoming of National cultures. -/- 4. The birth of Cultural Relativism and its ethical implications 4.1. The 18th c. doctrine was the noble savage (a non-historical doctrine: state of nature vs. social state) 4.2 Edward Tylor (1832-1817) and ethnocentric historicism Savage moral standards are real enough, but they are far and weaker than ours. 4.3 Boas and Malinowski and an holistic reaction to ethnocentric historicism -/- Franz Boas (1858-1942): a) Development of civilizations is not ruled by technical progress nor does it follow a one-way path; instead there are parallel developments (for ex. Agriculture does not follow stock-raising); b) racial characters have no relevance in development of civilization; c) we are not yet in a position to compare externally identical kinds of behaviour till we have not yet understood beliefs and intentions laying at their roots (for ex.: “From an ethnological point of view murder cannot be considered as a single phenomenon”; d) we should distinguish among different practices which are only superficially similar (fro ex. practices traditionally classified under the label “tabù”); e) there is as a fact just one normative ethic, constant in its contents but varying in its extension; f) the implication is not that we cannot judge behavior by members of other groups; it is only a recommendation of caution. -/- Bronislaw Malinowski (1884-1942): a) against Tylor’s and Frazer’s “magpie” methodology, field-work is required, a culture as a whole should be observed from inside; individual elements are incomprehensible; b) a culture is an organic whole; c) its elements are accounted for by their function (economy), avoiding non-observables (empio-criticism). -/- Ruth Benedict and Melville Herskovitz identify Boas’s approach with “cultural relativism”. Benedict: what is normal and abnormal is to be judged on a culture’s own standards, not on our own (“Anthropology and the Abnormal”). Herskovits: “Boas adumbrates what we have come to call cultural relativism” (The Mind, p. 10); “Judgements are based on experience, and experience is interpreted by each individual in terms of his own enculturation” (Man and his Works). -/- 4. How analytic philosophy understood and misunderstood the discussion 4.1. At the beginning of the 20th c., the new view in ethics was non-cognitivism (emotivist and subjectivist). Eric Westermark combines this view with an old-style ethnographic approach in support of relativity of moralities. Moralities are codes, or systems of emotive ‘disinterested’ reactions selected by evolution on their usefulness in terms of survival value for the society that is the carrier of such systems or codes. The moral relativity thesis: there are cases of disagreement that cannot be settled even after agreement about facts. 4.2 Anti-realists Brandt, Mackie, Gilbert, Harman adopt Westermark’s approach in a more sophisticated version: a) moralities are codes with an overall function and may be appraised only as wholes; b) variability is an argument for moral subjectivism; c) apparent legitimacy of deriving shift from ought is legitimized only within one institution d) morality should not be described but instead made, and existing moralities may be improved. Is it ‘real’ relativism? It is clearly subjectivism (a metaethical thesis). The normative thesis is that there better and worse codes, and survival values is the normative standard. -/- 4.3 Particularists MacIntyre, Sandel, Taylor, Wiggins, McDowell ‘Wittgensteinian’ prospectivist arguments bent to support weak-relativist claims MacIntyre: there is ‘incommensurability’ between different theoretical systems in both science and ethics. No argument is possible through different systems Different traditions may coexist for a long time without being able to bring their conflicts to a rational solution. -/- 4.4 Kantian universalists Baier, Gewirth, Rawls, Apel, Habermas Shared claim: justice concerns the right and is universal in so far as it may be based on minimal assumptions Other virtues are relative to context in so far as they are related to comprehensive views of the good - O’Neill criticism: a) it is an assumption shared by both alignments; b) after an alleged crisis brought about by alleged loss of metaphysical certainties, theories of justice have dropped demanding assumptions and kept universalism, virtue theories have kept demanding assumptions and dropped universalism; c) the opposition of virtue and justice has arisen in an unjustified way. O’Neill’s positive proposal: ‘constructive’ procedures may be adopted both (i) concerning all the range of virtues and (ii) across cultures once we abandon idealization and confine ourselves to abstraction from real-world cases. -/- 4.5 A metaethical relativist and anti-relativist normative ethicists: Bernard Williams Williams: vulgar relativism may be assumed to claim that: a) 'just' means 'just in a given society'; b) 'just in a given society' is to be understood in functionalist sense; c) it is wrong for one society’s members to condemn another society’s values. It is inconsistent since in (c) uses ‘just’ in a non-relative way that has been excluded in (a). William’s positive proposal: i) keep a number of substantive or thick ethical concepts that will be different in space and time; ii) admit that public choices are to be legitimized through recourse to more abstract procedures and relying on more thin ethical concepts. -/- 5. Critical remarks 5.1 The only real relativism available is ‘vulgar’ relativism (Westermark?) 5.2. Descriptive universalism (or absolutism) has a long pedigree, from Cicero on, reaching Boas himself but it is useless as an answer to normative questions 5.3. Twentieth-century philosophical discussion seems to discuss an ad hoc doctrine reconstructed by assembling obsolete philosophical ideas but ignoring the real theory of cultural relativism as formulated by anthropologists. -/- 6. A distinction between ethoi and ethical theories as a way out of confusions a)There are systems of conventions de facto existing. These may be studies from outside as phenomena or facts. b)There is moral argument and this, when studies from outside, is a fact, but this does not influence in any degree the possible validity of claims advanced. c) the difference between the above claims and Mackie’s criticism to Searle’s argument of the promising game is that promises, arguments etc. are also phenomena, but they are also communicative phenomena with a logical and pragmatic structure. -/- 7.Conclusions: a) cultural relativism, as a name for Boas’s methodology is a valuable discovery, and in this sense we are all relativists; b) ethical relativism, as an alleged implication of cultural relativism, has been argued in a philosophically quite unsophisticated way by Benedict and Herskovits; philosophers apparently discussed ethical relativism in the basis of a rather faint impression of what cultural relativism had been. c) a full-fledged ethical relativism has hardly been defended by anybody among philosophers; virtually no modern philosopher really argued a prescriptive version of the thesis; d) we may accept the grain of truth in ethical relativism by including relativist critique to ethical absolutism into a universalist normative doctrine that be careful in separating open-textured formulations of universal claims from culturally conditioned particular prescriptions. -/- . 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Background: Tuberculosis is among the major causes of illness and death worldwide especially in Asia. Smoking is associated with recurrent tuberculosis and its related mortality. Also, it could affect clinical manifestations, bacteriological conversion and outcome of treatment. This study aimed to evaluate the pattern of tobacco smoking, history of previous quit attempts and attitude towards quitting in tuberculosis patients. Materials and Methods: It was a cross-sectional study done amongst tuberculosis patients presented to DOTS corner of Rajshahi Medical College Hospital. 315 (...) patients entered the study as "First Come First Serve". Selfreported questionnaires were designed according to the standard questionnaires of smoking pattern. Results: Sixty one percent (61%) patients (n=192) were smoker before the diagnosis of tuberculosis. 51.1% were current smokers at the time of interview and were continuing smoking after the diagnosis of tuberculosis. Only 10.2% discontinued smoking after diagnosis. 68.2% smokes less than 10 cigarettes per day. 53.1% was between 31-50 age group. 21-30 is the commonest age group (62%) to start smoking is and 66.1% smoked less than 10 years before diagnosis. To reduce stress was the most common cause to continue smoking (48.9%). 71.9% smokers showed keen interest to stop smoking. Conclusion: Considering the prevalence of smoking in tuberculosis patients, evaluation of tobacco smoking status in such patients and motivating them to quit smoking could be considered as important steps in their treatment process. (shrink)

In the last 10 years, after becoming the official member of WTO in 2007, Vietnam has made commitments to the comply with the US-Vietnam Bilateral Trade Agreement and other international economic agreements. Vietnam has also become a member of the AEC and entered into important free trade agreements, notably the Trans-Pacific Partnership. The financial integration of Vietnam in the global economy has been increasing rapidly. However, Vietnam also witnesses the unexpected economic fluctuations domestically and internationally. The global financial crisis, (...) especially the US financial crisis, exerts a major impact on Vietnam’s economy and its banking system. Accordingly, the real estate market, stock market and banking system in Vietnam have fluctuated remarkably. This article discusses the causes of the US financial crisis and analyses the US government’s solutions. The causes of the US financial crisis are distributed to lax lending standards, failures in regulations of derivates financial instruments, and lack of state control of banking systems. In this respect, recommendations are made for Vietnam’s case. (shrink)

Criminal courts make decisions that can remove the liberty and even life of those accused. Civil trials can cause the bankruptcy of companies employing thousands of people, asylum seekers being deported, or children being placed into state care. Selecting the right standards when deciding legal cases is of utmost importance in giving those affected a fair deal. This Element is an introduction to the philosophy of legal proof. It is organised around five questions. First, it introduces the standards of (...) proof and considers what justifies them. Second, it discusses whether we should use different standards in different cases. Third, it asks whether trials should end only in binary outcomes (e.g. guilty or not guilty) or rather use more fine-grained or precise verdicts. Fourth, it considers whether proof is simply about probability, concentrating on the famous 'Proof Paradox'. Finally, it examines who should be trusted with deciding trials, focusing on the jury system. (shrink)

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand (...) in a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant. (shrink)

For the last ten years, within molecular life sciences, the reproducibility crisis discourse has been embodied as a crisis of trust in scientific images. Beyond the contentious perception of “questionable research practices” associated with a digital turn in the production of images, this paper highlights the transformations of gel electrophoresis as a family of experimental techniques. Our aim is to analyze the evolving epistemic status of generated images and its connection with a crisis of trust in images (...) within that field.From the 1980s to the 2000s, we identify two key innovations (precast gels and gel docs) leading to a “two‐tiered” gel electrophoresis with different standardization procedures, different epistemic statuses of the produced images and different ways of generating (dis)trust in images. The first tier, exemplified by differential gel electrophoresis (DIGE), is characterized by specialized devices processing images as quantitative data. The second tier, exemplified by polyacrylamide gel electrophoresis (PAGE), is described as a routine technique making use of image as qualitative “virtual witnessing.” The difference between these two tiers is particularly apparent in the ways images are processed, even though both tiers involve image digitization. Our account thus highlights different views on reproducibility within the two tiers. Comparability of images is insisted upon in the first tier while traceability is expected in the second tier. It is striking that these differences occur not only within the same scientific field, but even within the same family of experimental techniques. In the second tier, digitization entails distrust, whereas it implies a collective sentiment of trust in the first tier. (shrink)

The main aim of this paper is to consider how various types of social crises create contexts in which the general assumption comes to full expression that without knowledge of relevant data, correct decisions cannot be made or adequate measures taken to overcome the crisis. Such contexts, on the one hand, increase the importance of successful discovery of the truth both for individuals and for society as a whole, which affects the tightening of epistemic standards, while on the other (...) hand they enlarge some old or bring new cognitive barriers that negatively affect the reliability of various cognitive methods. The key role of epistemic responsibility is illustrated with the examples of two crises that have befallen us during the last few years: the migrant crisis and the pandemic crisis. (shrink)

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other relevant (...) information—in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness. (shrink)

Statistics play a critical role in biological and clinical research. However, most reports of scientific results in the published literature make it difficult for the reader to reproduce the statistical analyses performed in achieving those results because they provide inadequate documentation of the statistical tests and algorithms applied. The Ontology of Biological and Clinical Statistics (OBCS) is put forward here as a step towards solving this problem. Terms in OBCS, including ‘data collection’, ‘data transformation in statistics’, ‘data visualization’, ‘statistical data (...) analysis’, and ‘drawing a conclusion based on data’, cover the major types of statistical processes used in basic biological research and clinical outcome studies. OBCS is aligned with the Basic Formal Ontology (BFO) and extends the Ontology of Biomedical Investigations (OBI), an OBO (Open Biological and Biomedical Ontologies) Foundry ontology supported by over 20 research communities. We discuss two examples illustrating how the ontology is being applied. In the first (biological) use case, we describe how OBCS was applied to represent the high throughput microarray data analysis of immunological transcriptional profiles in human subjects vaccinated with an influenza vaccine. In the second (clinical outcomes) use case, we applied OBCS to represent the processing of electronic health care data to determine the associations between hospital staffing levels and patient mortality. Our case studies were designed to show how OBCS can be used for the consistent representation of statistical analysis pipelines under two different research paradigms. By representing statistics-related terms and their relations in a rigorous fashion, OBCS facilitates standard data analysis and integration, and supports reproducible biological and clinical research. (shrink)

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order (...) to argue how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident. (shrink)

When we abandon the neoliberal fiction that one is independent on the grounds that it is a-historic and antisocial, we realize that everyone is dependent and interdependent. In a media-driven society the self-identity of the individual is formed within the framework of the culture-ideology of consumerism from early childhood. As a result, both the environmental and social destruction have intensified. In the global era, or in the era of the global environmental crisis, self-identity as a precondition for environmentally sustainable (...) care of the self should be based on the culture-ideology of human rights and responsibilities, and on conscious self-limitation which realizes that one’s prosperity and security cannot come at the expense of others. Care of the self is about ensuring the habitability of the global environment as the primary interest of each individual. (shrink)

Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. (...) would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed. (shrink)

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy (...) surrounding medical decisions. In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

In the last 10 years, after becoming the official member of WTO in 2007, Vietnam has made commitments to the comply with the US-Vietnam Bilateral Trade Agreement and other international economic agreements. Vietnam has also become a member of the AEC and entered into important free trade agreements, notably the Trans Pacific Partnership. The financial integration of Vietnam in the global economy has been increasing rapidly. However, Vietnam also witnesses the unexpected economic fluctuations domestically and internationally. The global financial (...) class='Hi'>crisis, especially the US financial crisis, exerts a major impact on Vietnam’s economy and its banking system. Accordingly, the real estate market, stock market and banking system in Vietnam have fluctuated remarkably. This article discusses the causes of the US financial crisis and analyses the US government’s solutions. The causes of the US financial crisis are distributed to lax lending standards, failures in regulations of derivates financial instruments, and lack of state control of banking systems. In this respect, recommendations are made for Vietnam’s case. (shrink)

Dilip Ninan has raised a puzzle for centered world accounts of de re attitude reports extended to accommodate what he calls “counterfactual attitudes.” As a solution, Ninan introduces multiple centers to the standard centered world framework, resulting in a more robust semantics for de re attitude reports. However, while the so-called multi-centered world proposal solves Ninan’s counterfactual puzzle, this additional machinery is not without problems. In Section 1, I present the centered world account of attitude reports, followed by the (...) extension to counterfactual attitudes which Ninan targets with his puzzle. In Section 2, I pose the counterfactual puzzle and present Ninan’s multi-centered world solution, emphasizing similarities and differences between multi-centered and centered world accounts of attitude reports. In Section 3, I argue the counterfactual attitude wishing falls under the purview of the multi-centered proposal, but that the proposal generates false predictions for wish reports concerning unsatisfiable content. I canvass responses, ultimately concluding Ninan’s proposal requires substantial revisions. (shrink)

The paper presents the outlines of an ontology of plans and guidelines, which is then used as the basis for a framework for implementing guideline-based systems for the management of workflow in health care organizations. The framework has a number of special features, above all in that it enables us to represent in formal terms assignments of work-items both to individuals and to teams and to tailor guideline to specific contexts of application in health care organizations. It is (...) designed also to enable implementations to do justice to the fact that the processes carried out in health care organizations may deviate in different ways from the norms set forth in corresponding guideline definitions. This means that implementations built in conformity with the framework will be marked by a type of flexibility that might make them more likely to be accepted by healthcare professionals than are standard guideline-based management systems. (shrink)

The foundations of research ethics are riven with fault lines emanating from a fear that if research is too closely connected to weighty social purposes an imperative to advance the common good through research will justify abrogating the rights and welfare of study participants. The result is an impoverished conception of the nature of research, an incomplete focus on actors who bear important moral responsibilities, and a system of ethics and oversight highly attuned to the dangers of research but largely (...) silent about threats of ineffective, inefficient, and inequitable medical practices and health systems. -/- In For the Common Good: Philosophical Foundations of Research Ethics, Alex John London defends a conception of the common good that grounds a moral imperative with two requirements. The first is to promote research that generates the information necessary to enable key social institutions to effectively, efficiently, and equitably safeguard the basic interests of individuals. The second is to ensure that research is organized as a voluntary scheme of social cooperation that respects its various contributors' moral claims to be treated as free and equal. Connecting research to the goals of a just social order grounds a framework for assessing and managing research risk that reconciles these requirements and justifies key oversight practices in non-paternalistic terms. Reconceiving research ethics as resolving coordination problems and providing credible assurance that these requirements are being met expands the issues and actors that fall within the purview of the field and provides the foundation for a more unified and coherent approach to domestic and international research. -/- This is an open access title available under the terms of a CC BY-NC-ND 4.0 license. It is free to read at Oxford Scholarship Online and offered as a free PDF download from OUP and selected open access locations. (shrink)

Background: As part of a consistent effort to examine and provide integrative medical approaches to the therapeutic offering for psychophysical health, this study investigates the utilization of Olfactory Virtual Reality (OVR) in an inpatient psychiatry unit, more specifically in the Shepardson 3 Inpatient Psychiatry Unit at the University of Vermont Medical Center, in Burlington, VT, USA. Objectives: The purpose of this protocol is to explore the therapeutic value of olfactory virtual reality (OVR) in the above described population, and to collect (...) statistically significant data to determine the feasibility of potential future OVR studies. Method: Direct subject observation and monitoring in the context of Olfactory Virtual Reality (OVR) sessions and Qualitative data collection via the administration of subject surveys, subdivided in: a) Pre-OVR experience, b) Immediate post-OVR experience, and c) 1-to-3-hour post-OVR experience questionnaires. Results: The research yielded positive outcomes in all areas investigated, despite challenges related to the utilization of the device itself, issues in individual olfactory threshold, and COVID-19 restrictions and limitations. Conclusion: The outcome of this study indicates that the utilization of olfactory virtual reality technologies is a safe and effective integrative approach to target several aspects of psychological and physical health such as anxiety, stress, and pain, in combination with the psychotherapeutic and pharmacological standards of care in inpatient psychiatry. (shrink)

Joshua Mezrich is a practicing transplant surgeon who draws on his experiences, and those of his patients, to provide a "here's where we're at" moment in the story of transplant medicine. In so doing, he explains what it is like to practice while telling the stories of his patients, donors, and the pioneering surgeons who persisted in the face of failure to make what Mezrich does a work of healing. Written for a popular audience, When Death Becomes Life is perhaps (...) the most accessible work yet on the modern history of organ transplantation and what the current "standard of care" actually looks like. Indeed, it rounds out a "trinity" of quality books about the transplant experience, this one from the surgeon's... (shrink)

The standard argument for longtermism assumes that we should care as much about far future people as about our contemporaries. I challenge this assumption. I first consider existing interpretations of ‘temporal discounting’, and argue that such discounting seems either unwarranted or insufficient to block the argument. I then offer two alternative reasons to care less about far future people: caring as much about them as about our contemporaries would make our lives less authentic and less meaningful. If (...) I’m right, this undermines at least the strongest versions of longtermism. Plausibly, we should do much more for the far future than we’re currently doing. Still, we often ought to act for contemporaries’ sakes, even if longtermist actions would expectably do more good. (shrink)

This work, in English "Struggle for power, organic crisis and judicial independence", has its origin in research academics of the IAEN carried out to provide expert advise to the Inter American Court of Human Rights in the case Quintana and others (Supreme Court of Justice) vs the State of Ecuador. The research is about the nature of the evolution of the ecuadorian state, the dynamics of its institutions, its players, parties, laws, its factors of instability, the way rights have (...) been deployed since the return to democracy in 1979, those who have benefited from neoliberal democracy and those who have paid the costs, and where in all this was the Supreme Court of Justice. The Introduction takes a look at this origin of the work and its intellectual import, provides a brief characterization of the Inter American Sistem of Human Rights Protection, how the Quintana Case fits within it, and an overview of the chapters and their logic. The first chapter analyzes the institutional and sociological factors that have contributed to Ecuador's historically unstable state, based primarily in an antagonistic struggle for power between the Executive and Legislative branches. The second chapter analyzes the economic and political factors that provoked an organic crisis, or crisis of hegemony, between 1997 and 2007 in Ecuador. The third chapter analyzes the evolution of the way in which judges are selected in Europe, the outcomes they have generated, and how they compare with the ecuadorian systems of judge selection in terms of securing judicial independence. The fourth chapter develops a theory of judicial independence in democracy and analyzes how Ecuador measures up to that standard, from when it became a neoliberal minimal democracy in 1981, to when it became a neoliberal false democracy as a consequence of instalation of a system evidently lacking in the people's support under the guise of the 1998 Constitution and its system of judge selection, and the new democratic horizons set by the 2008 Constitution, and the judicial system that springs from it. (shrink)

Marine ecosystems are under increasing pressure from human activity, yet successful management relies on knowledge. The evidence-based policy (EBP) approach has been promoted on the grounds that it provides greater transparency and consistency by relying on ‘high quality’ information. However, EBP also creates epistemic responsibilities. Decision-making where limited or no empirical evidence exists, such as is often the case in marine systems, creates epistemic obligations for new information acquisition. We argue that philosophical approaches can inform the science-policy interface. Using marine (...) biosecurity examples, we specifically examine the epistemic challenges in the acquisition and acceptance of evidence to inform policy, discussing epistemic due care and biases in consideration of evidence. (shrink)

An alliance of established experts on critical care, Front Line COVID-19 Critical Care Alliance (FLCCC), has published two protocols for treatment of COVID-19. The first one, methylprednisolone, ascorbic acid, thiamine, and heparin (MATH+), is intended for hospital and intensive care unit treatment of pulmonary phases of the disease. It is based on affordable, commonly available components: anti-inflammatory corticosteroids (methylprednisolone, "M"), high-dose vitamin C infusion (ascorbic acid, "A"), vitamin B1 (thiamine, "T"), anticoagulant heparin ("H"), antiparasitic agent ivermectin, and (...) supplemental components ("+") including melatonin, vitamin D, elemental zinc, and magnesium. -/- The MATH+ protocol has received scarce attention due to the World Health Organization (WHO) advising against the use of corticosteroids in the beginning of the pandemic. In addition, randomized controlled clinical trials were required as a condition for adoption of the protocol. As the hospital mortality rate of MATH+ treated patients was approximately a quarter of the rate of patients receiving a standard of care, the authors of the protocol considered performing such trials unethical. Other parties have later performed clinical trials with corticosteroids and anticoagulants, which has led to a more widespread adoption of these components. -/- In October 2020, ivermectin was upgraded from an optional component to an essential component of the protocol. According to the authors, ivermectin is considered the first agent effective for both prophylaxis (prevention) of COVID-19 and for treatment of all phases of COVID-19 including outpatient treatment of the early symptomatic phase. Therefore, at the end of October 2020, a separate ivermectin-based I-MASK+ protocol for prophylaxis and early outpatient treatment of COVID-19 was published. (shrink)

It is widely assumed that emotions are evaluative. Moreover, many authors suppose that emotions are important or valuable as evaluations. According to the currently dominant version of cognitivism, emotions are evaluative insofar as they make us aware of value properties of their intentional objects. In attributing to emotions an epistemic role, this view conceives of them as epistemically valuable. In this paper, I argue that proponents of this account mischaracterize the evaluative character of emotions and, a fortiori, their value. Moreover, (...) I propose an alternative view of emotional evaluation, according to which emotions are practically rather than epistemically important. As I argue, emotions are ways of acknowledging their intentional objects as (dis)valuable. As such, they do not apprehend values but make them count. I elaborate this idea by drawing an analogy with legal and political sanctions. The resulting view has it that emotions are practically important in that they affirm the cares and concerns which serve as standards of emotional evaluation. (shrink)