Our Viewpoint argues that expanding access to less effective or more toxic treatments is supported not only by utilitarian ethical reasoning but also by two other ethical frameworks: those that emphasise equality and those that emphasise giving priority to the patients who are worst off. The inadequate resources available for global health reflect not only natural constraints but also unwise social and political choices. However, pitting efforts to reduce inequality and better fund global health against efforts to put available (...) resources to their best use mistakes complementary objectives for conflicting ones. (shrink)

Taking people’s longevity as a measure of good life, humankind can proudly say that the average person is living a much longer life than ever before. The AIDS epidemic has however for the first time in decades stalled and in some cases even reverted this trend in a number of countries. Climate change is increasingly becoming a major challenge for food security and we can anticipate that hunger caused by crop damages will become much more common. -/- Since many of (...) the challenges humanity faced in the past were overcome by inventive solutions coming from the life sciences, we are compelled to reconsider how we incentivize science and technology development so that those in need can benefit more broadly from scientific research. There is a huge portion of the world population that is in urgent need for medicines to combat diseases that are currently neglected by the scientific community and could immensely benefit from agricultural research that specifically targets their environmental conditions. At the same time efforts have to be made to make the fruits of current and future research more widely accessible. These changes would have to be backed by a range of moral arguments to attract people with diverging notions of global justice. This article explores the main ethical theories used to demand a greater share in the benefits from scientific progress for the poor. Since life sciences bring about a number of special concerns, a short list of conflictive issues is also offered. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and (...) Harvard University (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

Should involuntarily childless people have the sameopportunities to access parenthood as those who are not involuntarily childless? In the context of assisted reproductive technologies, affirmative answers to this question are often cashed out in terms of positive rights, including rights to third-party reproduction. In this paper, wecritically explore the scope and extent to which any such right would hold up morally. Ultimately, we argue for a departure away from positive parental rights. Instead, we argue that the state has an (...) imperfect duty to benefit involuntarily childless people in relation to their parental aspirations. (shrink)

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia towards access to prenatal testing and diagnostics in these countries. Semi-structured interviews were conducted with n = 18 gynecologists in Germany, Poland and Russia. The interviews were analyzed using the methods of content analysis and thematic analysis. (...) Visible in all three countries is a connection of prenatal medicine with the politically and socially contentious issue of pregnancy termination. Respondents in Poland and Russia concentrated on the topic of inadequate resources. Quality of information for expectant mothers is an important point in all three countries. Only in Germany was the issue of language barriers in communication raised. With regard to non-invasive prenatal testing (NIPT) respondents in Germany focused on the ethical issues of routinization of testing; in Poland and Russia they concentrated on fair access to NIPT. Challenges in all three countries arise from structural factors such as imprecise and prohibitive regulations, lack of resources or organization of healthcare services. These should be addressed on a political and medico-ethical level. (shrink)

Philosophy begins and ends in disagreement. Philosophers disagree among themselves in innumerable ways, and this pervasive and permanent dissent is a sign of their inability to solve philosophical problems and establish substantive truths. This raises the question: What should I do with my philosophical beliefs in light of philosophy's epistemic failure? In this open-access book, János Tozsér develops four possible answers into comprehensive metaphilosophical visions and argues that we cannot find peace either by committing ourselves to one of these (...) visions or by abandoning our philosophical beliefs. Tozsér calls this disheartening insight "the experience of breakdown", making the case that philosophy's truth-seeking and justificatory tools are unsuitable for establishing truths. Shedding light on the epistemic status of our philosophical beliefs, Tozsér adopts a broad approach to assess the metaphilosophical visions used by philosophers to interpret their own activity and determine their epistemic self-esteem. Open access was funded by the Research Centre for the Humanities, Hungary. (shrink)

The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of defenders of conscientious objection—being expected to participate (...) in the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected. (shrink)

As a result of the doctoral research developed by the main author (Vargas-Chaves, 2017), it was identified the evolution and perspectives of the pharmaceutical patent in the international trade system, as well as it future legal research needs in this topic, both immediate and long-term. Furthermore, a number of problems of public health were highlighted in which the patent-term-extension mechanisms have produced a lack of access to medicines.

Taking into consideration the extremely harsh public health conditions faced by the majority of the world population, the Health Impact Fund (HIF) proposal seeks to make the intellectual property regimes more in line with human rights obligations. While prioritizing access to medicines and research on neglected diseases, the HIF makes many compromises in order to be conceived as politically feasible and to retain a compensation character that makes its implementation justified solely on basis of negative duties. Despite that (...) current global health realities make such steps reasonable, the paper looks up the negative effects on one overlooked human right: the right to participate in scientific advancement. (shrink)

Because we tend to study fight books in isolation, we often forget how difficult it is to understand the precise place they occupy in the sociocultural and historical fabric of their time, and spill the many clues they inevitably contain on their owner, their local society, their precise purpose. In order to unlock that information, we need to study them in their broader sociocultural and historical context. This requires a background and research skills that are not always easily accessible to (...) everyone. To illustrate the point, in this paper I show in some detail what is required to make sense of the claim that Aristotelian philosophy and science influenced the medieval fight books in relevant ways, and that understanding this influence helps us to better understand the fight books per se. I give an outline of the general historical framework, and apply it to a testcase: Talhoffer’s Thott 290 2° Ms., with some interesting results. My hope is that this framework may be of some use to other researchers in HEMA Studies who want to dig deeper in sources of interest to them. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing (...) medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

Health development is faced with a variety of important issues including health status disparities; double burden of disease; quality, equity and affordability of health services; community protection in the field of medicine and food; and clean and healthy life behavior. Methods: The method used in this short communication is descriptive-comparative where we review Safety Culture in Indonesian Health Services in five aspects, namely Health Services for the Poor, nutritional problems that are never complete, Extraordinary Events of Communicable Diseases, Poor health (...) in Disaster areas, and finally the number of health workers still lacking and comparing the problem of Human Resources Health problems in Indonesia according to WHO (2011) and the Indonesian Ministry of Health (2009). Results: The results obtained in this brief communication are that we get new information in the form of problems encountered in Safety Culture in Indonesian Health Services, examples of cases that occur, policies taken by the government in handling them and the results obtained after the implementation of the policy. All of these are reviewed in five aspects. Conclusion: The conclusion we can take in this brief communication is that health problems that occur in Indonesia have not been resolved even though the government has implemented policies related to these problems but has not been resolved to date. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether the (...) functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

Mathematical knowledge and moral knowledge (or normative knowledge more generally) can seem intuitively puzzling in similar ways. For example, taking apparent human knowledge of either domain at face value can seem to require accepting that we benefited from some massive and mysterious coincidence. In the mathematical case, a pluralist partial response to access worries has been widely popular. In this paper, I will develop and address a worry, suggested by some works in the recent literature like (Clarke-Doane, 2020), that (...) connections between ought facts and action prevent us from giving a similarly pluralist response to moral access worries. (shrink)

This article proposes an approach to understanding life that overcomes reductionist and dualist approaches. Kant’s analysis of the conditions of knowing an organism shows that attempts to explain its teleology and autopoiesis from the interactions of its components is problematic. Based on an analysis by Van de Vijver and colleagues, a co-constitutive relationship between the cognitive activities of the observer and the living features of the organism is described. Using the example of a developmental series, it is shown that within (...) this active relational process, both autopoiesis and teleology of the organism manifest themselves on the mental level of the observer. The Kantian mode of objectification, which refers to the sensually perceptible appearance of an organism, can be supplemented by an active mode of relational objectification that encompasses the life of the organism. The analysis introduces a phenomenological first-person perspective on the study of life "from within", which enables an empirical investigation of the vital properties of an organism. (shrink)

Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize a (...) physician’s right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people. (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)

In this paper, I argue that content externalism and privileged access are compatible, but that one can, in a sense, have privileged access to the world. The supposedly absurd conclusion should be embraced.

Background: Despite the at least decades long record of philosophical recognition and interest, the intricacy of the deceptively familiar appearing concepts of ‘disease’, ‘disorder’, ‘disability’, etc., has only recently begun showing itself with clarity in the popular discourse wherein its newly emerging prominence stems from the liberties and restrictions contingent upon it. Whether a person is deemed to be afflicted by a disease or a disorder governs their ability to access health care, be it free at the point of (...) use or provided by an insurer; it also influences the treatment of individuals by the judicial system and employers; it even affects one’s own perception of self. -/- Aims: All existing philosophical definitions of disease struggle with coherency, causing much confusion and strife, and leading to inconsistencies in real-world practice. Hence, there is a real need for an alternative. -/- Materials & Methods: In the present article I analyse the variety of contemporary views of disease, showing them all to be inadequate and lacking in firm philosophical foundations, and failing to meet the desideratum of patient driven care. -/- Results: Illuminated by the insights emanating from the said analysis, I introduce a novel approach with firm ethical foundations, which foundations are rooted in sentience, that is the subjective experience of sentient beings. -/- Discussion: I argue that the notion of disease is at best superfluous, and likely even harmful in the provision of compassionate and patient-centred care. -/- Conclusion: Using a series of presently contentious cases illustrate the power of the proposed framework which is capable of providing actionable and humane solutions to problems that leave the current theories confounded. (shrink)

The public interest in the administration of justice requires access to justice for all. But access to justice must be “meaningful” access. Meaningful access requires procedures, processes, and institutional structures that facilitate communication among participants and decision-makers and ensure that judges and other decision-makers have the resources they need to render fully informed and sound decisions. Working from that premise, which is based on a reconceptualization of the objectives and methods of the justice process, the author (...) proposes numerous specific changes in decision-making processes and practices. These changes are required to achieve a standard of decision-making that is consistent with the public interest in the administration of justice within a constitutional framework under the social and political conditions of the early 21st century. The essay illustrates the application of the principles and methods of legitecture to analysis of problems of institutional design in law. (shrink)

This essay claims that ‘access to justice’ has erroneously been assumed to be synonymous with invisible concepts instead of access to a lawyer’s language. The Paper outlines how a language concerns the relation between signifiers, better known as word-images, on the one hand, with signfieds, better known as concepts, on the other. The signifieds are universal, artificial and empty in content. Taking the Canadian Charter of Rights and Freedoms as an example, officials have assumed that Charter knowledge has (...) involved signifieds (such as rules, principles, doctrines and tests) as if the signifiers were transparent. But any one signifier differs from another signifier without the lawyer ever accessing the invisible signifieds. Ironically, although the lawyer, law professor or law student believes that s/he is studying legal ‘practice’ and although legal knowledge has been considered a matter of signified concepts, the knowledge has really concerned the differentiating relations of signifiers. As a consequence, the moment of accessing the concepts (signifieds) has been forever deferred. ‘Access to justice’ has become access to the special language of signifiers, a language which lawyers alone are privileged to enforce. Turning to the Charter, lawyers claiming to know the special Charter language became indispensable to social life. Even the meaning-constituting human subject became a signifier, better known as ‘the legal person’ defined by Charter rights. Charter language, however, has deferred an access to the invisible concepts such as ‘freedom’ or ‘democracy’, terms in Section of the text. Access to justice’ has become access to the language of the privileged class of lawyers. The lawyer’s language has become a theoretical language in the name of access to justice. And yet, because the theoretical language has been propagated as concerned with ‘practice’, it has been difficult to challenge the social-cultural content of the language of lawyers. (shrink)

Socioeconomic status refers to the family's social and economic standing in society. It is measured by combining an individual or group's economic and social position, which is often based on income, education, and occupation. It significantly affects academic performance and even one's health status. The pandemic changed the educational system, causing a huge transition from traditional learning methods to online learning. This shift resulted in confusion, burden, and difficulty among students from different walks of life. This study was conducted to (...) determine the academic stress on online learning among nursing students in relation to their economic status and their ability to access technology. The study utilized a quantitative-correlational method aided by a standard questionnaire. Two hundred thirty-six University of Bohol nursing students enrolled in the second semester of SY 2021–2022 were included in the study by random selection. Data revealed a significant correlation between economic status and the level of stress related to academic expectations and a significant correlation between economic status and access to technology after being subjected to the Spearman rho test of correlation. However, no significant correlation was found between access to technology and the respondents' level of academic stress. (shrink)

Broadening access to both computational and educational resources is crit- ical to diffusing machine learning (ML) innovation. However, today, most ML resources and experts are siloed in a few countries and organizations. In this article, we describe our pedagogical approach to increasing access to applied ML through a massive open online course (MOOC) on Tiny Machine Learning (TinyML). We suggest that TinyML, applied ML on resource-constrained embedded devices, is an attractive means to widen access because TinyML leverages (...) low-cost and globally accessible hardware and encourages the development of complete, self-contained applications, from data collection to deployment. To this end, a collaboration between academia and industry produced a four part MOOC that provides application-oriented instruction on how to develop solutions using TinyML. The series is openly available on the edX MOOC platform, has no prerequisites beyond basic programming, and is designed for global learners from a variety of backgrounds. It introduces real-world applications, ML algorithms, data-set engineering, and the ethi- cal considerations of these technologies through hands-on programming and deployment of TinyML applications in both the cloud and on their own microcontrollers. To facili- tate continued learning, community building, and collaboration beyond the courses, we launched a standalone website, a forum, a chat, and an optional course-project com- petition. We also open-sourced the course materials, hoping they will inspire the next generation of ML practitioners and educators and further broaden access to cutting-edge ML technologies. (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)

In Québec, the Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information provides an exception to transparency to most public institutions where public health research is conducted by allowing them to not disclose their uses of personal data. This exceptionalism is ethically problematic due to important concerns and we argue that all those who conduct research should be transparent and accountable for the work they do in the public interest.

In this short paper, I critically examine Veli Mitova’s proposal that social-identity groups can have collective epistemic reasons. My primary focus is the role of privileged access in her account of how collective reasons become epistemic reasons for social-identity groups. I argue that there is a potentially worrying structural asymmetry in her account of two different types of cases. More specifically, the mechanisms at play in cases of “doxastic reasons” seem fundamentally different from those at play in cases of (...) “epistemic-conduct reasons”. The upshot is a need for further explanation of what unifies these dimensions of the account. (shrink)

In this paper we introduce two issues relevantly related to the cognitive phenomenology debate, which, to our minds, have not been yet properly addressed: the relation between access and phenomenal consciousness in cognition and the relation between conscious thought and inner speech. In the first case, we ask for an explanation of how we have access to thought contents, and in the second case, an explanation of why is inner speech so pervasive in our conscious thinking. We discuss (...) the prospects of explanation for both sides of the debate and argue that cognitive phenomenology defenders are in an overall advantageous position. We also propose an account of inner speech that differs from other influential explanations in some interesting respects. (shrink)

ABSTRACT Many recent articles argue that participants who seroconvert during HIV prevention trials deserve treatment when they develop AIDS, and there is a general consensus that the participants in HIV/aids treatment trials should have continuing post‐trial access. As a result, the primary concern of many ethicists and activists has shifted from justifying an obligation to treat trial participants, to working out mechanisms through which treatment could be provided. In this paper I argue that this shift frequently conceals an important (...) assumption: that if there is an obligation to supply treatment, then any party who could provide it may be prevailed upon to discharge the obligation. This assumption is false. The reasons why trial participants should get ART affect who has the duty to provide it. We should not burden governments with the obligations of sponsors, nor researchers with the obligations of the international community. And we should not deprive a group of treatment because their need is less salient than that of research participants. Insisting otherwise may lead to people being wrongfully deprived of access to antiretrovirals. (shrink)

Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was adopted recently by a team of informaticists designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when (...) principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and non-maleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper we show how using ethical principles can help in the design of EHRs by first, explaining how ethical principles can and should be used generally, and then by, discuss how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting further ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest. (shrink)

Rohingya refugee children in Bangladesh are forced into labour both inside and outside the camps for a wide range of reasons. This article examines this situation in relation to the access to education for those children living in the camps in Cox’s Bazar. Being informed by several perspectives concerning child labour and access to schooling in developing country contexts, this research work has adopted a qualitative approach to study various factors working behind this pressing issue. After collecting data (...) by means of qualitative methods, including non-participant observations and semi-structured interviews, the researcher has analyzed the findings with these informed perspectives. Results show that lack of formal identity, limited access to the formal labour market, absence of social sanctions against child employment, lack of aspirations, household composition, and substandard living conditions are some of the key factors that drive children to engage in various forms of labour, especially outside the camps. They often work in small workshops as labourers and in the host community households as domestic workers. Undocumented children are also reported to become victims of bonded labour, sex trade, and trafficking in the region. The author argues that a lack of formal education has compounded this issue into a severe humanitarian crisis which calls for immediate support and actions from local and international agencies. (shrink)

INTRODUCTION[|] Feminism was born as an ethical opposition to the women's oppression by patriarchal society in almost every aspects of life. Termination of an unwanted pregnancy is one such aspect of life where this oppression is felt most intensively both in the past and still today. The aim of this study is to analyze how the feminist theorists and their supporters percieve the issue of termination of pregnancy and with which arguments they defend or object it. [¤]METHODS[|]The texts and books (...) which were used in this study are accessed via my own personal library, Library of Marmara University Faculty of Medicine, Prof.Dr Orhan Oğuz Central Library of Marmara University and the remote access service to the databases of Marmara University Library which is offered by the library's itself.[¤]RESULTS[|]-[¤]DISCUSSION AND CONCLUSION[|] The study, in accordance with the neutral stance of the previous revisionary texts written on the termination of pregnancy, doesn't support any specific thought or side regarding feminist ethical approach to the termination of pregnancy. But the study shows that feminism has been in this world not more than 250 years and in the academic field not more than 50 years as a serious philosophical idea which gained supporters and a constructive stance by going beyond it's critical nature. Ergo, feminist views should be voiced more, should be taken more seriously and it's intellectual content should be improved whenever possible in the philosophical, medical, legal, etc. texts written on the termination of pregnancy.[¤]. (shrink)

This essay defends the controversial and indeed counterintuitive claim that there is a good argument to be made from a Lockean perspective for government action to guarantee access to health care. The essay maintains that this argument is in some regards more robust than the well-known argument in defense of universal health care spelled out by Norman Daniels, which this essay also examines in some detail. Locke's view that government should protect people's lives, property, and freedom–where freedom is understood (...) as independence and self-determination–justifies government action to ensure access to health care, because (roughly), just as individuals cannot protect themselves from crime and foreign invasion, so individuals are unable to provide for their own health care. Defense from disease is as important as defense from crime, and–although this is arguable–government action to guarantee access to health care does not itself undermine freedom. (shrink)

Luck egalitarianism provides a reason to object to conditionality in health incentive programmes in some cases when conditionality undermines political values such as solidarity or inclusiveness. This is the case with incentive programmes that aim to restrict access to essential healthcare services. Such programmes undermine solidarity. Yet, most people's lives are objectively worse, in one respect, in non-solidary societies, because solidarity contributes both instrumentally and directly to individuals' well-being. Because solidarity is non-excludable, undermining it will deprive both the prudent (...) and the imprudent citizens of its goods. Thereby, undermining solidarity can make prudent citizens worse off than they would have otherwise been, out of no fault or choice of their own, but rather as a result of somebody else's imprudent choice. This goes against the spirit of luck egalitarianism. Therefore (luck egalitarian) justice can require us to save the imprudent and avoid conditionality in access to essential healthcare services. (shrink)

Develops an empirical argument against naive realism-disjunctivism: if naive realists accept "internal dependence", then they cannot explain the evolution of perceptual success. Also presents a puzzle about our knowledge of universals.

An issue about the privacy of the clustered groups designed by algorithms arises when attempts are made to access certain pieces of information about those groups that would likely be used to harm them. Therefore, limitations must be imposed regarding accessing such information about clustered groups. In the discourse on group privacy, it is argued that the right to privacy of such groups should be recognised to respect group privacy, protecting clustered groups against discrimination. According to this viewpoint, this (...) right places a duty on others, for example, private companies, institutions, and governments, to refrain from accessing such information. To defend the idea that the right to privacy should be recognised for clustered groups, at least two requirements must be satisfied. First, clustered group privacy must be conceived of as either a collective good or a participatory good. Since these forms of good are of the type from which no member of a group can be excluded from benefiting, the right to them is defined as a group right. Second, there must be group interests on which to base a group right. Group interests can be either the interests of those members that are a result of their being in the group or the interests of the group as a whole that transcend the interests of its members. However, this paper argues that clustered group privacy cannot be conceived of as either a collective or a participatory good because it is possible for some individuals to be excluded from benefiting from it. Furthermore, due to the lack of awareness among individuals that they are members of a clustered group and the nature of a clustered group itself, such groups cannot have the group interests necessary to establish a group right. Hence, the group right to privacy cannot be recognised for these groups, implying that the group right cannot be considered a means to protect clustered groups against discrimination. Instead, this paper suggests that moral principles need to be articulated within an ethics of vulnerability to identify the moral obligations of protecting vulnerable clustered groups. The duty owed to the vulnerable should involve refraining from accessing certain information about clustered groups in specific contexts. This duty is not engendered by the right to privacy of such groups; it is the duty owed to the vulnerable. The findings highlight the need to articulate moral principles regarding privacy and data protection to protect clustered groups in contexts in which accessing information about them could constitute a reason for discriminatory targeting. (shrink)

There is widespread recognition at universities that a proper understanding of science is needed for all undergraduates. Good jobs are increasingly found in fields related to Science, Technology, Engineering, and Medicine, and science now enters almost all aspects of our daily lives. For these reasons, scientific literacy and an understanding of scientific methodology are a foundational part of any undergraduate education. Recipes for Science provides an accessible introduction to the main concepts and methods of scientific reasoning. With the help of (...) an array of contemporary and historical examples, definitions, visual aids, and exercises for active learning, the textbook helps to increase students’ scientific literacy. The first part of the book covers the definitive features of science: naturalism, experimentation, modeling, and the merits and shortcomings of both activities. The second part covers the main forms of inference in science: deductive, inductive, abductive, probabilistic, statistical, and causal. The book concludes with a discussion of explanation, theorizing and theory-change, and the relationship between science and society. The textbook is designed to be adaptable to a wide variety of different kinds of courses. In any of these different uses, the book helps students better navigate our scientific, 21st-century world, and it lays the foundation for more advanced undergraduate coursework in a wide variety of liberal arts and science courses. Selling Points Helps students develop scientific literacy—an essential aspect of _any_ undergraduate education in the 21 st century, including a broad understanding of scientific reasoning, methods, and concepts Written for all beginning college students: preparing science majors for more focused work in particular science; introducing the humanities’ investigations of science; and helping non-science majors become more sophisticated consumers of scientific information Provides an abundance of both contemporary and historical examples Covers reasoning strategies and norms applicable in all fields of physical, life, and social sciences, _as well as_ strategies and norms distinctive of specific sciences Includes visual aids to clarify and illustrate ideas Provides text boxes with related topics and helpful definitions of key terms, and includes a final Glossary with all key terms Includes Exercises for Active Learning at the end of each chapter, which will ensure full student engagement and mastery of the information include earlier in the chapter Provides annotated ‘For Further Reading’ sections at the end of each chapter, guiding students to the best primary and secondary sources available Offers a Companion Website, with: For Students: direct links to many of the primary sources discussed in the text, student self-check assessments, a bank of exam questions, and ideas for extended out-of-class projects For Instructors: a password-protected Teacher’s Manual, which provides student exam questions with answers, extensive lecture notes, classroom-ready Power Point presentations, and sample syllabi Extensive Curricular Development materials, helping any instructor who needs to create a Scientific Reasoning Course, ex nihilo. (shrink)

Over the past three decades, Vietnam has transitioned from an agrarian-based, centrally planned economy to a mixed economy with emerging market status. Additionally, projections indicate that Vietnam will be one of the world’s largest economies by 2050 if growth is sustained at present rates. The evolution of the financial sector, which began with the Doi Moi reforms in the mid-1980s, has been central to facilitating this growth. As the economy has expanded, Vietnam has maintained a gradualist approach to developing market-based (...) mechanisms of resource allocation. However, financial markets are still in an embryonic stage and substantial reform is required if the economy is to meet the expected rates of development. Against this backdrop, this dissertation critically evaluates trends and dynamics in Vietnam’s journey of financial development over the past three decades, with a particular emphasis on the experiences of small and medium-sized enterprises (SMEs). Drawing on quantitative analysis, secondary data and interviews conducted with a range of firms and stakeholders, I argue that financial development in Vietnam has had positive effects in terms of increasing access to funding for SMEs. As the financial system has developed, allocative efficiency has improved to the benefit of SMEs. However, some informants criticised the progress made to date, arguing that a funding mismatch still exists. Specifically, weak corporate governance, state-owned enterprises and a lack of derivatives have prevented effective capital market development. Given Vietnam’s high level of political corruption, this paper concludes that policy makers must place more attention on the political-economic structures of Vietnam if achieving middle-income status is to occur. Specifically, a tighter and more controlled effort to dismantle corporate bureaucracy and nepotism would allow better access to funding for Vietnamese SMEs. (shrink)

Jordan acceded to the WTO in 1999. In its accession Jordan agreed, for example, to reduce tariffs on imported products and open its services market; it also modified its intellectual property regime. Jordan enjoyed special and differential treatment in few areas and was not able to designate olive oil as a good eligible for special safeguards. The WTO agreements required fundamental changes in the domestic laws and regulations of Jordan. The article concludes by arguing that Jordan’s accession to the WTO (...) was a lengthy and costly process. Jordan agreed to an arduous package of legal and economic reforms. Given that Jordan agreed to greater commitments compared to the obligations of the original WTO members, the multilateral trading system witnessed an accession saga. (shrink)

Romanis has written another interesting and important paper on reproductive ethics entitled assisted gestative technologies.1 In this short commentary, I continue the discussion on the question of who should have access to AGTs. This commentary should not be understood as a critical reply but as a friendly extension of one of the paper’s themes. I am not trying to solve the question of who should have access to these technologies but I put forth some groundwork for future work. (...) Romanis calls AGTs new technologies that allow people to undertake gestation involving technological intervention—or to have another person or a device perform the reproductive and gestational labour on their behalf. People using AGTs might or might not use their own genetic material for reproduction. Romanis argues that these AGTs—such as uterus transplantation or artificial wombs—collectively raise ethical, legal and social issues that are distinct for example from assisted conception. One important question related to AGTs is who should have access to such technologies. This is crucial especially …. (shrink)

This article examines a fundamental question of justice in global health. Is it ethically preferable to provide a larger number of people with cheaper treatments that are less effective (or more toxic), or to restrict treatments to a smaller group to provide a more expensive but more effective or less toxic alternative? We argue that choosing to provide less effective or more toxic interventions to a larger number of people is favored by the principles of utility, equality, and priority for (...) those worst-off. Advocates are mistaken to demand that medical care provided in low-income and middle-income countries should be the same as in high-income countries. (shrink)

Typical philosophical discussions of physician-assisted death have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad on terminally (...) ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad. (shrink)

One of the most attractive, but nevertheless highly controversial proposals to alleviate the negative effects of today’s international patent regime is the Health Impact Fund (HIF). Although the HIF has been drafted to facilitate access to medicines and boost pharmaceutical research, we have analysed the burdens for the global poor a similar proposal designed to promote the use and development of climate-friendly technologies would have. Drawing parallels from the access to medicines debate, we suspect that an (...) analogous “Climate Impact Fund” will increase the already very high scientific and technological supremacy of the developed world over the Global South. We advocate countering this dominance on the ground that countries with scarce research and development capacities will be in a difficult position to reject technologies and will not have a say on how such technologies should look like. Further, addressing global hazards should be an inclusive endeavour and not only a privilege reserved for the developed world. Incentivizing grassroots innovation would be a major step to promote scientific and technological inclusion. (shrink)

Se hace un llamado de atención a través de este capítulo de libro a los gobiernos locales y la Academia, para proponer políticas públicas donde se incluyan bases o lineamientos para la estructuración de un derecho global de acceso a los medicamentos. Para estos efectos, se importan a manera de pilares, tres planteamientos desde la óptica de la justicia global, que consideramos pueden acoplarse a esta problemática, y que aportan elementos novedosos al abordaje de los numerosos obstáculos que se suelen (...) presentar en las discusiones, especialmente en lo que respecta a la regulación del monopolio de la patente, y al tratamiento diferenciado que se les da a los ciudadanos de países desarrollados y en desarrollo. (shrink)

The paper Post-Trial Acces To Treatment (PTA) offers an insight into current corporate policies and corporate best practices relating to the provision of PTA in low and middle income countries based on company sources. In these countries there is a greater appeal for pharmaceutical companies to take responsibility for providing PTA. However, the practice of providing PTA is the exception rather than the rule.

Recent studies have shown that recidivism scoring algorithms like COMPAS have significant racial bias: Black defendants are roughly twice as likely as white defendants to be mistakenly classified as medium- or high-risk. This has led some to call for abolishing COMPAS. But many others have argued that algorithms should instead be given access to a defendant's race, which, perhaps counterintuitively, is likely to improve outcomes. This approach can involve either establishing race-sensitive risk thresholds, or distinct racial ‘tracks’. Is there (...) a moral difference between these two approaches? We first consider Deborah Hellman's view that the use of distinct racial tracks (but not distinct thresholds) does not constitute disparate treatment since the effects on individuals are indirect and does not rely on a racial generalization. We argue that this is mistaken: the use of different racial tracks seems both to have direct effects on and to rely on a racial generalization. We then offer an alternative understanding of the distinction between these two approaches—namely, that the use of different cut points is to the counterfactual comparative disadvantage, ex ante, of all white defendants, while the use of different racial tracks can in principle be to the advantage of all groups, though some defendants in both groups will fare worse. Does this mean that the use of cut points is impermissible? Ultimately, we argue, while there are reasons to be skeptical of the use of distinct cut points, it is an open question whether these reasons suffice to make a difference to their moral permissibility. (shrink)

Advocates of physician-assisted suicide often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person’s decision-making capacity. Second, that we cannot have sufficient certainty that (...) a person’s psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable. (shrink)

Distributive Justice and Access to Advantage is the most recent anthology devoted to the work of the great and, sadly, late political philosopher G.A. Cohen. Wh.

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)

Introduction: There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. -/- Methods: The main documents discussing the (...) two strategies are examined with a qualitative content analysis. The ethical values reasonableness, openness and transparency, inclusiveness, responsiveness and accountability serve as categories for our ethical analysis. -/- Results: We observed that the decision-making processes in a legal solution to expand access to vaccines would be more transparent than in COVAX initiative, would be more inclusive, especially of nation states, and the values responsiveness and accountability could be easily incorporated in the development of a new regulation. -/- Discussion: A legal strategy that offers incentives to the pharmaceutical industry in return for global distribution of vaccines according to the Fair Priority Model is an innovative way to achieve global and equitable access to vaccines. However, in the long term, achieving the Sustainable Development Goals will require from all nations to work in solidarity to find durable solutions for global vaccine research and development. Interim solutions, such as our proposed legal strategy for equitable access to vaccines, and efforts to find long-term solutions must be advanced in parallel. (shrink)