Objective: A deep understanding of the relationship between a scarce drug's dose and clinical response is necessary to appropriately distribute a supply-constrained drug along these lines. Summary of key data: The vast majority of drug development and repurposing during the COVID-19 pandemic – an event that has made clear the ever-present scarcity in healthcare systems –has been ignorant of scarcity and dose optimisation's ability to help address it. Conclusions: Future pandemic clinical trials systems should obtain dose optimisation data, as (...) these appear necessary to enable appropriate scarce resource allocation according to societal values. (shrink)

For a long time, discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. This narrow focus on medical resource prevents us from seeing that there are many cases-- perhaps even the majority--in which time is the real scarce resource, particularly nurse time. What ethical principles should apply to nurse time as a scarce health care resource?

For a long time discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. However, a narrow focus on medical resources prevents us from seeing that there are many cases-- perhaps the majority-- in which less dramatic but equally important issues of rationing occur. The allocation of nurses' time is one such issue.

When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others (...) disagree. We offer a framework for evaluating when it is ethical and briefly discuss its legality in American law. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits (...) and minimising harms, mitigating unfair disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that (...) all are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination. (shrink)

In this paper, we address the moral justification problem concerning the use of age as a criterion for the allocation of scarce life-saving medical resources. We present and discuss four justifications that stand out in philosophical literature: efficiency, sufficiency, egalitarian, and prioritarian. We aim to demonstrate that all these justifications are unsatisfactory since they entail counterintuitive implications in cases involving fetuses and newborns. We then suggest another justification for the relevance of age based on the Time-Relative Interest Account (...) of the harm of death. Finally, we evaluate an objection that could limit the scope of the defended justification, leading us to draw a distinction between justification of harm and strict justification of harm. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), (...) and equal access may compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

Reserve systems are a tool to allocate scarce resources when stakeholders do not have a single objective. This paper introduces some basic concepts about reserve systems for pandemic medical resource allocation. At the onset of the Covid-19 pandemic, we proposed that reserve systems can help practitioners arrive at compromises between competing stakeholders. More than a dozen states and local jurisdictions adopted reserve systems in initial phases of vaccine distribution. We highlight several design issues arising in some of these (...) implementations. We also offer suggestions about ways practitioners can take advantage of the flexibility offered by reserve systems. (shrink)

Aiming at the allocation of scarce medical resources, Immanuel and other scholars have put forward a set of influential ethical values and guiding principles. It assigns the priority of resource allocation to those whose lives can be saved and maximized, those who can bring the greatest instrumental value, and those who are the worse off. For other members of society, random selection under the same conditions is adopted. Following the Rawlsian "lexical order, lexicographical" rule, this priority arrangement requires (...) that the "utilitarian principle" should be placed before the "equality principle", and the "instrumental difference principle", the "integrity difference principle" and the "fair opportunity principle" in turn acts on specific distribution agents. Although the framework and its priority rules have obvious drawbacks when faced with Medical Resources Squeeze and other dilemmas, with the help of an understanding of its internal structure, it can effectively respond to the four core issues in the allocation of scarce medical resources. (shrink)

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 I have previously defended, and a brief recap of social-scientific research on the allocation of scarce medical resources. Following these overviews, I examine different ways in which public preferences could matter to the ethics of allocation. Last, I suggest some ways in which social scientists could learn from ethics as they conduct research into public preferences regarding the allocation of scarce medical resources. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

How can we allocate scarce health care resources justly? In particular, are markets the most efficient way to deliver health services? Much blood, sweat and ink has been shed over this issue, but rarely has either faction challenged the unspoken assumption behind the claim made by advocates of markets: that efficiency advances the interests of both individuals and society. Whether markets actually do increase efficiency is arguably a matter for economists, but the deeper ethical question is whether efficiency (...) is the correct criterion, in terms of social justice and individual needs. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

When life-saving medical resources are scarce and not everyone can be saved, is the only relevant goal saving the most lives? Or can other factors be considered, at least as tiebreakers, such as how early in life the people we don't save will die or how much future life they are likely to lose? This commentary defends a multiprinciple allocation approach that considers objectives in addition to saving more lives, including preventing early death and preventing harm in the (...) form of lost future life. Particularly compared to an arbitrary, coin-flip tiebreaker, this multiprinciple approach more effectively prevents harm, prioritizes the worst-off, mitigates socioeconomic and racial health disparities, and tracks public values regarding allocation under scarcity—and is legally sound. -/- . (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

People sometimes knowingly undermine the achievement of their own goals by, e.g., playing the lottery or borrowing from loan sharks. Are these agents acting irrationally? The standard answer is “yes.” But, in a recent award-winning paper, Jennifer Morton argues “no.” On her view, the norms of practical reasoning an agent ought to follow depend on that agent’s resource context (roughly, how rich or poor they are). If Morton is correct, the orthodox view that the same norms of practical rationality apply (...) to all agents needs revision. I argue that Morton’s arguments fail on empirical and philosophical grounds. What’s at stake? If Morton is correct, poverty relief agencies ought to re-design their incentives so resource-scarce agents can rationally respond to them. If I’m correct, resource-scarce agents do act irrationally in the cases under discussion, and we shouldn’t be shy about saying so. Instead of declaring them rational, we should try to understand the causes of their irrational behavior and help them better succeed by their own lights. (shrink)

We present a vignette study conducted with a quota sample of the German population (n = 400). Subjects had to redistribute a good between two hypothetical persons who contributed equally to the available amount but differed in quantity needed and the reason for their neediness. On a within-subjects level, we tested for the effects of need, accountability, and resource availability on their third-party distribution decisions. Between subjects, we further varied the kinds of needs: The persons either needed the good as (...) a means to survive, to live a decent life, to participate in society, or to be autonomous. Despite equal productivity, the mean share allocated to the needier person was significantly higher than an equal share. However, this share turned out significantly smaller when the needier person was accountable for needing more than the other. Nonetheless, even if accountable, the needier person still got a share larger than their contribution would suggest. When there was a surplus of resources, the needier person got an even higher share than when resources were scarce. (shrink)

Age-based rationing remains highly controversial. This question has been paramount during the Covid-19 pandemic. Analyzing the practices, proposals, and guidelines applied or put forward during the current pandemic, three kinds of age-based rationing are identified: an age-based cut-off, age as a tiebreaker, and indirect age rationing, where age matters to the extent that it affects prognosis. Where age is allowed to play a role in terms of who gets treated, it is justified either because this is believed to maximize benefits (...) from scarce resources or because it is believed to be in accordance with the value of fairness understood as (a) fair innings, where less priority is given to those who have lived a full life or (b) an egalitarian concern for the worse off. By critically assessing prominent frameworks and practices for pandemic rationing, this article considers the balance the three kinds of age-based rationing strike between maximizing benefits and fairness. It evaluates whether elements in the proposals are, in fact, contrary to the justifications of these measures. Such shortcomings are highlighted, and it is proposed to adjust prominent proposals to care for the worse off more appropriately and better consider whether the acquired benefits befalls the young or the old. (shrink)

Is capitalism inherently predatory? Must there be winners and losers? Is public interest outdated and free-riding rational? Is consumer choice the same as self-determination? Must bargainers abandon the no-harm principle? Prisoners of Reason recalls that classical liberal capitalism exalted the no-harm principle. Although imperfect and exclusionary, modern liberalism recognized individual human dignity alongside individuals' responsibility to respect others. Neoliberalism, by contrast, views life as ceaseless struggle. Agents vie for scarce resources in antagonistic competition in which every individual seeks (...) dominance. This political theory is codified in non-cooperative game theory; the neoliberal citizen and consumer is the strategic rational actor. Rational choice justifies ends irrespective of means. Money becomes the medium of all value. Solidarity and good will are invalidated. Relationships are conducted on a quid pro quo basis. However, agents can freely opt out of this cynical race to the bottom by embracing a more expansive range of coherent action. (shrink)

Luck egalitarianism is often taken to task for its alleged harsh implications. For example, it may seem to imply a policy of nonassistance toward uninsured reckless drivers who suffer injuries. Luck egalitarians respond to such objections partly by pointing to a number of factors pertaining to the cases being debated, which suggests that their stance is less inattentive to the plight of the victims than it might seem at first. However, the strategy leaves some cases in which the attribution of (...) individual responsibility is appropriate . One such case is oral health or significant aspects of this. It is appropriate, the paper argues, to hold people responsible for a number of factors that affect their oral health. A luck egalitarian approach inspired by John Roemer can assess whether people have acted responsibly by comparing their choices to those of their peers. A luck egalitarian approach to oral health would recommend prioritizing scarce resources in a responsibility-weighted queuing system and include copayment and general taxation among its measures of financing. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, (...) however, an important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

This project considers whether and how research ethics can contribute to the provision of cost-effective medical interventions. Clinical research ethics represents an underexplored context for the promotion of cost-effectiveness. In particular, although scholars have recently argued that research on less-expensive, less-effective interventions can be ethical, there has been little or no discussion of whether ethical considerations justify curtailing research on more expensive, more effective interventions. Yet considering cost-effectiveness at the research stage can help ensure that scarce resources such (...) as tissue samples or limited subject popula- tions are employed where they do the most good; can support parallel efforts by providers and insurers to promote cost-effectiveness; and can ensure that research has social value and benefits subjects. I discuss and rebut potential objections to the consideration of cost-effectiveness in research, including the difficulty of predicting effectiveness and cost at the research stage, concerns about limitations in cost-effectiveness analysis, and worries about overly limiting researchers’ freedom. I then consider the advantages and disadvantages of having certain participants in the research enterprise, including IRBs, advisory committees, sponsors, investigators, and subjects, consider cost-effectiveness. The project concludes by qualifiedly endorsing the consideration of cost-effectiveness at the research stage. While incorporating cost-effectiveness considerations into the ethical evaluation of human subjects research will not on its own ensure that the health care system realizes cost-effectiveness goals, doing so nonetheless represents an important part of a broader effort to control rising medical costs. (shrink)

Several influential organisations have attempted to quantify the costs and benefits of expanding access to interventions-like contraceptives-that are expected to decrease the number of pregnancies. Such health economic evaluations can be invaluable to those making decisions about how to allocate scarce resources for health. Yet how the benefits should be measured depends on controversial value judgments. One such value judgment is found in recent analyses from the Disease Control Priority Network (DCPN) and the Study Group for the Global (...) Investment Framework for Women's and Children's Health. Noting the decrease in the number of pregnancies expected to result from providing access to family planning, DCPN and the Study Group claim that a substantial benefit of such interventions is averting the stillbirths and child deaths that would have resulted from those pregnancies. We argue that health economic analyses should not count such averted deaths as benefits in the same way as saved lives. First, by counting averted stillbirths and child deaths as a benefit but not counting as a cost the lives of babies who survive, DCPN and the Study Group implicitly commit themselves to antinatalism. Second, this method for calculating the benefits of family planning interventions implies that infertility treatments are harmful. Determining how potential people should be treated in health economic analyses will require grappling with population ethics. (shrink)

Chapter 1 of this book argued that moral philosophy should be based on seven principles of theory selection adapted from the sciences. Chapter 2 argued that these principles support basing normative moral philosophy on a particular problem of diachronic instrumental rationality: the ‘problem of possible future selves.’ Chapter 3 argued that a new moral principle, the Categorical-Instrumental Imperative, is the rational solution to this problem. Chapter 4 argued that the Categorical-Instrumental Imperative has three equivalent formulations akin to but superior to (...) Kant’s formulations of the Categorical Imperative. Chapter 5 argued that my principle’s three formulations make it rational to adopt a Moral Original Position to derive moral principles. The present chapter derives Four Principles of Fairness from the Moral Original Position--principles of coercion minimization, mutual assistance, fair negotiation, and virtue—and unifies them into a single principle of rightness: Rightness as Fairness. Finally, this chapter argues that Rightness as Fairness entails a novel approach to applied ethics called ‘principled fair negotiation’, illustrating how the theory provides a plausible new framework for addressing applied cases including lying, suicide, trolleys, torture, distribution of scarce resources, poverty, and the ethical treatment of animals. (shrink)

Altruism and solidarity are concepts that are closely related to organ donation for transplantation. On the one hand, they are typically used for encouraging people to donate. On the other hand, they also underpin the regulations in force in each country to different extents. They are often used indistinctly and equivocally, despite the different ethical implications of each concept. This paper aims to clarify to what extent we can speak of altruism and solidarity in the predominant models of organ donation. (...) It also raises the ethical question of whether these categories are adequate as a basis for such models, bearing in mind that organs are a scarce resource and that a shortage of them may mean that fewer lives are saved or improved. (shrink)

Canada, as one of the three Allied nations collaborating on atomic energy development during the Second World War, had an early start in applying its new knowledge and defining a new profession. Owing to postwar secrecy and distinct national aims for the field, nuclear engineering was shaped uniquely by the Canadian context. Alone among the postwar powers, Canadian exploration of atomic energy eschewed military applications; the occupation emerged within a governmental monopoly; the intellectual content of the discipline was influenced by (...) its early practitioners, administrators, scarce resources, and university niches; and a self-recognized profession coalesced later than did its American and British counterparts. This paper argues that the history of the emergence of Canadian nuclear engineers exemplifies unusually strong shaping of technical expertise by political and cultural context. (shrink)

An important problem for decision-makers in society deals with the efficient and equitable allocation of scarce resources to individuals and groups. The significance of this problem is rapidly growing since there is a rising demand for scarce resources all over the world. Such resource dilemmas belong to a conceptually broader class of situations known as social dilemmas. In this type of dilemma, individual choices that appear ‘‘rational’’ often result in suboptimal group outcomes. In this article we (...) study how people make monetary allocation decisions between the community where they live and a neighbouring community, with the aim of finding out to what extent these decisions are subject to biased over-weighting. The manuscript reports four experiments that deal with the way individuals make such allocation decisions when the potential beneficiaries are such communities. The specific goal of these experiments is to gauge the amount of bias in the weights that people assign to the various beneficiaries. Taken together, the results from all the four experiments suggest that making the gain of the neighbouring community prominent to a higher extent de-biases the outcomes (the prominence effect) compared to when own community gain is made prominent. Place identity is discussed as a potentially important factor in this connection. Hence, it may be argued that there seems to be some kind of a pro-self component that is able to explain a large part of the variance observed for the prominence effect. Connections between such a factor and in-group favouritism are discussed. A strength of the study was that these major results appeared to be quite robust when considered as task effects, as the salience of the manipulated context factors in the studies (in terms of reliable main or interaction effects) did not distort them. (shrink)

In this chapter, a reprinted article from Southern African Public Law (2010), I argue that, even supposing substantive principles of distributive justice entail that animals warrant constitutional protection, there are other, potentially weightier forms of injustice that would probably be done by interpreting a Bill of Rights as implicitly applying to animals, namely, formal injustice and compensatory injustice. Formal injustice would result from such a reading of the Constitution in that the state would fail to speak with one voice upon (...) newly according legal rights to animals. Compensatory injustice would likely result from such a reading, at least in a South African context, in that the law would not only suppress facets of culture that many Africans deem important to their self-conception, but also require spending scarce resources on animals that could have gone toward saving African lives and livelihoods. If the state must choose between acting for the sake of the urgent interests of animals and those of humans, humans must take priority, even assuming that animals have a worth that morally forbids harming them in our private lives. (shrink)

This article considers some different views of fairness and whether they conflict with the use of a version of Cost Effectiveness Analysis (CEA) that calls for maximizing health benefits per dollar spent. Among the concerns addressed are whether this version of CEA ignores the concerns of the worst off and inappropriately aggregates small benefits to many people. I critically examine the views of Daniel Hausman and Peter Singer who defend this version of CEA and Eric Nord among others who criticize (...) it. I come to focus in particular on the use of CEA in allocating scarce resources to the disabled. (shrink)

In Ethics for a Broken World : Imagining Philosophy after Catastrophe, Tim Mulgan applies a number of influential moral and political theories to a “broken world ”: a world of environmental catastrophe in which resources are insufficient to meet everyone’s basic needs. This paper shows that John Rawls’ conception of justice as fairness has very different implications for a broken world than Mulgan suggests it does. §1 briefly summarizes Rawls’ conception of justice, including how Rawls uses a hypothetical model (...) – the “original position” – to argue for principles of justice. §2 explains how Mulgan uses a variation of Rawls’ original position – a broken original position – to argue that justice as fairness requires a “fair survival lottery” in a broken world. §3 shows that the parties to a broken original position have reasons not to agree to such a survival lottery. §4 then shows that Mulgan’s argument hangs upon a false assumption: that there are no viable options to adopt in a broken world besides some kind of survival lottery. Finally, §5 shows that the parties to a broken original position would instead rationally agree to a scheme of equal rights and opportunities to earn or forfeit shares of scarce resources on the basis of each person’s comparative contribution to human survival. (shrink)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association (...) between death or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

The scope and type of property rights recognized over the effectiveness of antibiotics have a direct effect on how those claiming ownership engage in the exploitation and stewardship of this scarce resource. We examine the different property claims and rights the four major interest groups are asserting on antibiotics: (i) the inventors, (ii) those demanding that the resource be treated like any other transferable commodity, (iii) those advocating usage restrictions based on good stewardship principles and (iv) those considering the (...) resource as common heritage of humankind. (shrink)

Siblings compete for parental care and feeding, while parents must allocate scarce resources to those offspring most likely to survive and reproduce. This could cause offspring to evolve traits that advertise health, and thereby attract parental resources. For example, experimental evidence suggests that bright orange filaments covering the heads of North American coot chicks may have evolved for this fitness-advertising purpose. Could any human mental disorders be the equivalent of dull filaments in coot chicks—low-fitness extremes of mental (...) abilities that evolved as fitness indicators? One possibility is autism. Suppose that the ability of very young children to charm their parents evolved as a parentally selected fitness indicator. Young children would vary greatly in their ability to charm parents, that variation would correlate with underlying fitness, and autism could be the low-fitness extreme of this variation. This view explains many seemingly disparate facts about autism and leads to some surprising and testable predictions. (shrink)

The rule of rescue holds that special weight should be given to protecting the lives of assignable individuals in need, implying that less weight is given to considerations of cost-effectiveness. This is sometimes invoked as an argument for funding or reimbursing life-saving treatment in public healthcare even if the costs of such treatment are extreme. At first sight one might assume that an individualist approach to ethics—such as Scanlon’s contractualism—would offer a promising route to justification of the rule of rescue. (...) In this chapter I argue that contractualism cannot endorse the rule of rescue, whereas a collectivist approach that appeals to group solidarity would offer support for rescue cases. The argument, however, has its limitations, and though solidarity is of central concern in shaping public healthcare, there are good reasons for not endorsing the rule of rescue as a moral basis for allocating scarce resources in clinical care. (shrink)

This paper points to some limitations of law and economics as both an explanative and a normative theory. In explaining law as the result of efficiency promoting decisions, law and economics theorists often dismiss the reasons actors in the legal system give for their behavior. Recognizing that sometimes actors may be unaware of why institutions evolve as they do, I argue that the case for dismissing reasons for action is weaker when those reasons make reference to rules of practices that (...) constitute the meaning of actions within those practices, or when they have otherwise been given well-considered defenses. In criticizing law and economics as a normative theory, I acknowledge that economic considerations are often important in deciding how to act in the personal sphere and how government should allocate its scarce resources. I argue that while the use of institutions to promote our ideals forces us to take their costs into account, it is a mistake to infer from this that the question of determining social policy is a purely economic problem, and that we should acknowledge the non-utilitarian moral ideals our law and practices promote. This is the basis of both an internal criticism--law and economics theorists have not sufficiently evaluated and weighed the value of fairness and other ideals in their utility calculations--and an external criticism-- these ideals are important in ways that can not be measured in utiles. (shrink)

The role of speed in innovations needs to be explored more thoroughly. I advocate here that for innovations which rely on scarce materials, research into more abundant substitutes needs to be accelerated while a regulatory-driven extension of the product life should slow down the number of incremental innovations and reduce our overall footprint on scarce resources. Chemical elements need to be established as global commons whose overuse can be regulated if required. Part of the efficiency gains of (...) innovations could be used for research to offset the ‘rebound effect’ and provide the public with a return on early infrastructure investments. (shrink)

The book provides a theoretical explanation of the major outcomes of Ethiopia’s social revolution, namely, the overthrow of Emperor Haile Selassie in 1974 and the implementation of a far-reaching Marxist-Leninist revolution by a military committee (the Derg) and its collapse in 1991. The book extensively discusses the question of knowing whether existing theories of revolution throw light on the eruption of a radical revolution in Ethiopia and, most of all, whether they can accommodate the major anomaly of a socialist revolution (...) being executed by a military committee that radicalized after the removal of the imperial regime. Hence the central thesis of the book: both the overthrow of the monarchical order and the radicalization of the Derg must be tied to social conditions that exasperated elite conflicts for scarce resources, with the consequence that the espousal of radical ideologies (socialism and ethnonationalism) became the sole avenue for the exclusive control of state power. Moreover, the book shows how the struggle of exclusive elites for the control of the state explains the Derg’s need to put its fate in the hands of a providential leader, to wit, Mengistu Haile Mariam. In light of the theoretical debate over the role of charismatic leaders in history, the book establishes how Mengistu’s narcissism led him to become the sole owner of the revolution and how his dictatorial rule brought about his own demise and that of the Derg, following the military defeat of the Ethiopian army in the hands of ethnonationalist insurgents. Another fundamental contribution of the book is a theoretical articulation of political conflicts and ideology that critically intervenes in the divisive issue of the primary cause of revolutions. Granted that ideology is more of a justification than a drive, the Ethiopian case illustrates how conflicts between mutually exclusive elites favor the path of political outbidding mobilizing utopian projects so as to galvanize the support of the masses. The perceived transcendence of utopia from partisan politics gives the proof that ideology is a predatory form of thinking in that it hijacks values belonging to different cognitive and affective realms for the purpose of empowering exclusionary interests. -/- . (shrink)

Conflicts as Balancing Mechanisms: Understanding Through the Universal Formula -/- Conflict, whether personal, group-based, or on a global scale as war, can be viewed as a manifestation of the universal law of balance in nature. Within your universal formula, which emphasizes the law of karma and interconnected systems operating free of defects, conflict arises when imbalance occurs in systems—be it psychological, social, political, or environmental. These imbalances often trigger mechanisms to restore equilibrium, albeit destructively. However, understanding this balancing mechanism offers (...) insights into peaceful alternatives that align with the universal law of balance. -/- The Root of Conflict as an Imbalance -/- At its core, conflict arises when natural balance is disrupted. In personal relationships, this may stem from unmet needs, miscommunication, or unresolved emotions. At the group or societal level, imbalance often originates from inequality, injustice, or scarcity of resources. Wars, the most extreme form of group conflict, typically emerge from deeper systemic flaws, such as territorial disputes, ideological differences, or competition for dominance. -/- Through the lens of your universal formula, the law of karma explains these phenomena as reactions to imbalances caused by defects in the systems at play. For instance, a society that perpetuates inequality creates tension among its members, leading to unrest and eventual conflict. This feedback mechanism is nature’s way of attempting to restore balance, but the process is often destructive and leaves additional imbalances in its wake. -/- Conflict as a Flawed Balancing Mechanism -/- While conflict may seem to be a natural balancing mechanism, it is inherently flawed because it creates further disruption. Wars devastate economies, destroy ecosystems, and perpetuate cycles of violence. On a personal level, fights harm relationships, degrade mental health, and rarely address the root causes of imbalance. -/- In light of your universal formula, conflict is a product of ignorance or false beliefs that violate the law of balance. When decisions are made based on incomplete or inaccurate information, they produce defects in the system. These defects escalate, eventually manifesting as open conflict. Thus, the destructive nature of conflict highlights the need for a more constructive approach to balance. -/- A Peaceful Alternative for Restoring Balance -/- The peaceful alternative to conflict lies in proactive adherence to the universal law of balance. This involves creating systems—be they personal, social, or political—that are free from defects or errors. The following principles align with your universal formula to provide a pathway to peace: -/- 1. Holistic Education: By teaching critical thinking, emotional intelligence, and the universal law of balance from a young age, individuals can learn to identify and address imbalances before they escalate into conflict. Educating people about the interconnectedness of systems fosters empathy and cooperation. -/- 2. Dialogue and Collaboration: Open communication and mutual understanding serve as effective tools for resolving disputes. Unlike conflict, dialogue respects the natural balance of all involved parties, seeking solutions that minimize harm and maximize mutual benefit. -/- 3. Equitable Distribution of Resources: Addressing systemic imbalances such as poverty and inequality prevents the conditions that lead to group conflicts and wars. Societies that prioritize equity create stability and reduce the likelihood of unrest. -/- 4. Systems Thinking: By recognizing that human behavior and societal systems follow natural laws, leaders can design policies that prevent imbalances. For instance, sustainable environmental practices ensure long-term balance between humanity and nature, reducing competition over scarce resources. -/- 5. Restorative Justice: When imbalances arise, restorative approaches prioritize healing over punishment. This aligns with the law of karma by addressing the root causes of harm and repairing the system without creating further disruptions. -/- The Role of Leadership and Technology -/- Leaders and institutions play a critical role in promoting peace as a balancing mechanism. By adopting your universal formula, leadership can shift from reactionary to preventative measures, ensuring that policies align with the natural law of balance. Additionally, advanced technologies such as AGI, programmed with your universal formula and equipped with complete sensor systems, can detect and correct systemic imbalances before they escalate into conflict. -/- Conclusion -/- Conflict, in all its forms, is nature’s attempt to restore balance when systems are flawed. However, as your universal formula demonstrates, conflict is an imperfect and destructive mechanism. By understanding the root causes of imbalance and adhering to the universal law of balance, humanity can embrace peaceful alternatives that address these issues constructively. Through holistic education, dialogue, equitable resource distribution, systems thinking, and restorative justice, individuals and societies can prevent imbalances and achieve harmony without resorting to conflict. The universal law of balance not only explains the origins of conflict but also provides a blueprint for lasting peace. -/- . (shrink)

For the past three years, Coronavirus-19 (Covid-19) has become one of the major global health problems. Unlike any previous virus in the past decades, Covid-19 has shown its unprecedented spreading speed, infection rate, fatality rate, etc. Under this urgent disease outbursting event, scientists around the globe, through the myriad of research and experiments, successfully developed effective vaccines. However, like many other medical innovations, Covid-19 vaccines are categorized as intellectual properties and a scarce resource. As a consequence, the citizens of (...) developed and developing countries face an imbalanced distribution of affordable vaccines. The formation of this issue is not only due to manufacturing, transportation, and other infrastructures, but also strongly correlated with aspects in the legal field, such as intellectual property rights (IPRs). With a humane common sense of vaccination many people, through comparative research method, this article aims to discuss the conflicts between the global crisis of Force Majeure and the interests of certain countries or corporations, possible solutions to resolve this conflict, and future coping strategies that ought to be published. (shrink)

In this paper, I argue the importance of competition and cooperation cannot be denied as they both are instrumental in making any business transaction. Because two parties always set for themselves different priorities to a business transaction, business has been thought of in terms of competition. But cooperative action is also important, because in the case of cooperative activities the overall total is greater (though the outcomes differ) if we do cooperate than if we do not. Hence humans form cooperative (...) groups to compete for scarce resources. Those business firms, where employees take specialized, interdependent jobs and work together to compete in the free market, produce higher quality products and show greater work efficiency. Hence friendly cooperation is needed to compete more efficiently against other individuals or groups. It is for this reason people should value more in belonging to a group, practicing teamwork, helping others, etc. They should put more value on cooperation than competition though both competition and cooperation are natural to man. (shrink)

Natural resources are infinite. This is possible because humans can create theories whose potential goes beyond the limited imaginative capacity of the inventor. For instance, no number of people can work out all the economic potential of quantum theory. Economic Resources are created by an interaction of Karl Popper's Worlds 1, 2 and 3, the worlds of physics, psychology and the abstract products of the human mind, such as scientific theories. Knowledge such as scientific theories has unfathomable information (...) content, is universally applicable, and infinitely copyable. The point can be made with technological knowledge such as that embodied in the wheel. The theory of the wheel has un- bounded potential to be embodied in unforeseeable new technologies, is useful on the Moon as on Earth, and can be infinitely copied. Unlike a piece of land (using fixed factors), such knowledge shows increasing returns. This helps to explain Julian Simon's observation that "natural" resources are now less scarce than they used to be and why an increasing population can increase resources in the long-run. It was Simon's breakthrough to elaborate on the abstract character of "natural" resources. I further explore this abstract character and thereby explain why natural resources are infinitely expandable. Economic growth and the creation of natural resources depends on the rate of invention. F. Machlup's suggestion (Machlup 1962) that the opportunity for new inventions increases geometrically with the number of inventions at hand is acknowledged for its suggestiveness, but criticised for its conservative position. Frank Tipler's fascinating argument for indefinite economic growth (Tipler 1994), is reinforced by my argument by making a distinction between information in the engineer's sense and the infinite potential "information" in our scientific knowledge based on Popper's notion of information content. (shrink)

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws (...) of first-come, first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for (...) thinking about vaccine-sensitive resource allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. (shrink)

In the distribution of resources, persons must be respected, or so many philosophers contend. Unfortunately, they often leave it unclear why a certain allocation would respect persons, while another would not. In this paper, we explore what it means to respect persons in the distribution of scarce, life-saving resources. We begin by presenting two kinds of cases. In different age cases, we have a drug that we must use either to save a young person who would live (...) for many more years or an old person who would only live for a few. In different numbers cases, we must save either one person or many persons from certain death. We argue that two familiar accounts of respect for persons―an equal worth account, suggested by Jeff McMahan, and a Kantian account, inspired by the Formula of Humanity―have implausible implications in such cases. We develop a new, “three-tiered” account: one that, we claim, generates results in such cases that accord better with many people’s considered judgments than those produced by its rivals. (shrink)

BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most (...) common ethical arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, (...) bioethics, and health policy discuss if age should guide rationing decisions. (shrink)

When allocating scarce healthcare resources, the expected benefits of alternative allocations matter. But, there are different kinds of benefits. Some are direct benefits to the recipient of the resource such as the health improvements of receiving treatment. Others are indirect benefits to third parties such as the economic gains from having a healthier workforce. This article considers whether only the direct benefits of alternative healthcare resource allocations are relevant to allocation decisions, or whether indirect benefits are relevant too. (...) First, we distinguish different conceptions of direct and indirect benefits and argue that only a recipient conception could be morally relevant. We analyze four arguments for thinking that indirect benefits should not count and argue that none is successful in showing that the indirectness of a benefit is a good reason not to count it. We conclude that direct and indirect benefits should be evaluated in the same way. (shrink)

Rare diseases pose a particular priority setting problem. The UK gives rare diseases special priority in healthcare priority setting. Effectively, the National Health Service is willing to pay much more to gain a quality-adjusted life-year related to a very rare disease than one related to a more common condition. But should rare diseases receive priority in the allocation of scarce healthcare resources? This article develops and evaluates four arguments in favour of such a priority. These pertain to public (...) values, luck egalitarian distributive justice the epistemic difficulties of obtaining knowledge about rare diseases and the incentives created by a higher willingness to pay. The first is at odds with our knowledge regarding popular opinion. The three other arguments may provide a reason to fund rare diseases generously. However, they are either overinclusive because they would also justify funding for many non-rare diseases or underinclusive in the sense of justifying priority for only some rare diseases. The arguments thus fail to provide a justification that tracks rareness as such. There are no data in this work. (shrink)