-/- This chapter evaluates the ethical issues that using cost-effectiveness considerations to set animal health priorities might present, and its conclusions are cautiously optimistic. While using cost-effectiveness calculations in animal health is not without ethical pitfalls, these calculations offer a pathway toward more rigorous priority-setting efforts that allow money spent on animal well-being to do more good. Although assessing quality of life for animals may be more challenging than in humans, implementing prioritization based on cost- (...) class='Hi'>effectiveness is less ethically fraught. (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)

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither (...) uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the health care system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry. (shrink)

The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost‐effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used (...) to save a greater number of other lives. This argument has not yet been advanced in debates over expanded procurement and could buttress existing concerns about expanded procurement. To support this argument, I review existing empirical data on the cost‐effectiveness of transplantation and compare them to data on interventions for other illnesses. These data should motivate utilitarians and others whose primary goal is maximizing population‐wide health benefits to doubt the merits of expanding organ procurement. I then consider two major objections: one makes the case that transplant candidates have a special claim to medical resources, and the other challenges the use of cost‐effectiveness to set priorities. I argue that there is no reason to conclude that transplant candidates’ medical interests should receive special priority, and that giving some consideration to cost‐effectiveness in priority setting requires neither sweeping changes to overall health priorities nor the adoption of any specific, controversial metric for assessing cost‐effectiveness. Before searching for more organs, we should first ensure the provision of cost‐effective care. (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)

This is a book about duties to help others. When do you have to sacrifice life and limb, time and money, to prevent harm to others? When must you save more people rather than fewer? These questions arise in emergencies involving nearby strangers who are drowning or trapped in burning buildings. But they also arise in our everyday lives, in which we have constant opportunities to give time or money to help distant strangers in need of food, shelter, or medical (...) care. With the resources available to you, you can provide more help or less. This book argues that it is often wrong to provide less help rather than more, even when the personal sacrifice involved makes it permissible not to help at all. It shows that helping distant strangers by donating or volunteering is morally more like rescuing nearby strangers than most of us realize. The ubiquity of opportunities to help others threatens to make morality extremely demanding, and the book argues that it is only thanks to adequate permissions grounded in considerations of cost and autonomy that we may pursue our own plans and projects. It concludes that many of us are required to provide no less help over our lives than we would have done if we were effective altruists. (shrink)

Demographic diversity might often be present in a group without group members noticing it. What are the epistemic effects if they do? Several philosophers and social scientists have recently argued that when individuals detect demographic diversity in their group, this can result in epistemic benefits even if that diversity doesn’t involve cognitive differences. Here I critically discuss research advocating this proposal, introduce a distinction between two types of detection of demographic diversity, and apply this distinction to the theorizing on diversity (...) in science. Focusing on ‘invisible’ diversity, I argue that in one common kind of group in science, if group members have full insight into their group’s diversity, this is likely to create epistemic costs. These costs can be avoided and epistemic benefits gained if group members only partly detect their group’s diversity. There is thus an epistemic reason for context-dependent limitations on scientists’ insight into the diversity of their group. (shrink)

Effective Altruism is a social movement which encourages people to do as much good as they can when helping others, given limited money, time, effort, and other resources. This paper first identifies a minimal philosophical view that underpins this movement, and then argues that there is an analogous minimal philosophical view which might underpin Effective Justice, a possible social movement that would encourage promoting justice most effectively, given limited resources. The latter minimal view reflects an insight about justice, and our (...) non-diminishing moral reason to promote more of it, that surprisingly has gone largely unnoticed and undiscussed. The Effective Altruism movement has led many to reconsider how best to help others, but relatively little attention has been paid to the differences in degrees of cost-effectiveness of activities designed to decrease injustice. This paper therefore not only furthers philosophical understanding of justice, but has potentially major practical implications. (shrink)

Civil disobedience, despite its illegal nature, can sometimes be justified vis-à-vis the duty to obey the law, and, arguably, is thereby not liable to legal punishment. However, adhering to the demands of justice and refraining from punishing justified civil disobedience may lead to a highly problematic theoretical consequence: the debilitation of civil disobedience. This is because, according to the novel analysis I propose, civil disobedience primarily functions as a costly social signal. It is effective by being reliable, reliable by being (...) costly, and costly primarily by being punished. My analysis will highlight a distinctive feature of civil disobedience: civil disobedients leverage the punitive injustice they suffer to amplify their communicative force. This will lead to two paradoxical implications. First, the instability of the moral status of both civil disobedience and its punishment to the extent where the state may be left with no permissible course of action with regard to punishing civil disobedience. Second, by refraining from punishing justified civil disobedience, the state may render uncivil disobedience—illegal political activities that fall short of the standards of civil disobedience—potentially permissible. (shrink)

Since the last ice age, when ice enveloped most of the northern continents, the earth has warmed by about five degrees. Within a century, it is likely to warm by another four or five. This revolution in our climate will have immense and mostly harmful effects on the lives of people not yet born. We are inflicting this harm on our descendants by dumping greenhouse gases into the atmosphere. We can mitigate the harm a little by taking measures to control (...) our emissions of these gases, and to adapt to the changes by, for instance, building sea walls around coastlines threatened by rising sea levels. But these measures will be very expensive, and the costs will be born by us, the present generation, whereas the benefits will come to future generations. How much should we sacrifice for the sake of the future? Economists and philosophers have independently worked on the question of our responsibility to future generations. This book brings their work together and applies it to global warming. It suggests a programme for future research on the economic and ethical issues. The book is intended for economists, and for philosophers and other social scientists who have a little knowledge of economic methods. (shrink)

We often remember in the company of others. In particular, we routinely collaborate with friends, family, or colleagues to remember shared experiences. But surprisingly, in the experimental collaborative recall paradigm, collaborative groups remember less than their potential, an effect termed collaborative inhibition. Rajaram and Pereira-Pasarin (2010) argued that the effects of collaboration on recall are determined by “pre-collaborative” factors. We studied the role of 2 pre-collaborative factors—shared encoding and group relationship—in determining the costs and benefits of collaborative recall. In Experiment (...) 1, we compared groups of strangers who encoded alone versus together, before collaborating to recall. In Experiment 2, we compared groups of friends who encoded alone versus together, before collaborating to recall. We found that shared encoding abolished collaborative inhibition in both Experiments 1 and 2. But prior relationship did not influence collaborative inhibition over and above the effects of shared encoding. Regardless of encoding condition, collaborative group recall contained fewer intrusions than nominal group recall, and these benefits continued in subsequent individual recall. Our findings demonstrate that pre-collaborative factors—specifically shared encoding—have flow-on benefits for group and individual recall amount, but not recall accuracy. We discuss these findings in terms of self- and cross-cuing in collaborative recall. (shrink)

This article presents two related challenges to the idea that, to ensure policy evaluation is comprehensive, all costs and benefits should be aggregated into a single, equity-weighted wellbeing metric. The first is to point out how, even allowing for equity-weighting, the use of a single metric limits the extent to which we can take distributional concerns into account. The second challenge starts from the observation that in this and many other ways, aggregating diverse effects into a single metric of evaluation (...) necessarily involves settling many moral questions that reasonable people disagree about. This raises serious questions as to what role such a method of policy evaluation can and should play in informing policy-making in liberal democracies. Ultimately, to ensure comprehensiveness of policy evaluation in a wider sense, namely, that all the diverse effects that reasonable people might think matter are kept score of, we need multiple metrics as inputs to public deliberation. (shrink)

Philosophy has the dubious distinction of attracting and retaining proportionally fewer women than any other field in the humanities, indeed, fewer than in all but the most resolutely male-dominated of the sciences. This short article introduces a thematic cluster that brings together five short essays that probe the reasons for and the effects of these patterns of exclusion, not just of women but of diverse peoples of all kinds in Philosophy. It summarizes some of the demographic measures of exclusion that (...) are cause for concern and identifies key themes that cross-cut these discussions: gender stereotypes and climate issues, ‘cognitive distortions’ and disciplinary norms. (shrink)

I defend the thesis that friendship can constitutively require epistemic irrationality against a recent, forceful challenge, raised by proponents of moral and pragmatic encroachment. Defenders of the "encroachment strategy" argue that exemplary friends who are especially slow to believe that their friends have acted wrongly are simply sensitive to the high prudential or moral costs of falsely believing in their friends' guilt. Drawing on psychological work on epistemic motivation (and in particular on the notion of "need for closure"), I propose (...) a different picture of what friendship requires in the doxastic realm. I argue that contrary to what the encroachment strategy suggests, exemplary friends‘ belief formation ought not be guided by a concern with accuracy or error avoidance, but instead by a need to avoid a "specific closure" – namely, a need to avoid concluding in their friends‘ guilt. I propose that exemplary friendship often generates a defeasible, doxastic obligation to exemplify such a need, despite its inherent corrupting effects on exemplary friends‘ epistemic faculties. (shrink)

The term unemployment is defined by the International Labour Organization (2010) as the scenario where people are without jobs and have been actively looking for work within the past four weeks. Unemployment has been a bone of contention the world over but due to its high prevalence in Zimbabwe, its effects have been grossly perceived in the various age groups ranging from 18-60 as citizen’s fall far below the daily living wage in the country due to unemployment (ZimStat, 2012). The (...) effects of unemployment are severely negative and this is further worsened by the high inflation rates in Zimbabwe thus leaving unemployed citizens living in squalor or abject poverty unable to afford food, cover school and hospital expenses making unemployed youths resort to crime such as theft and prostitution. The writing below will vividly portray the costs of unemployment in Zimbabwe from an individual, social and socio-political perspective. (shrink)

Mindfulness exercises are presented as being compatible with almost any spiritual, religious or philosophical beliefs. In this paper, we argue that they in fact involve imagining and conceptualising rather striking and controversial claims about the self, and the self’s relationship to thoughts and feelings. For this reason, practising mindfulness exercises is likely to be in tension with many people’s core beliefs and values, a tension that should be treated as a downside of therapeutic interventions involving mindfulness exercises, not unlike a (...) side effect. Clients ought to be informed of these metaphysical aspects of the exercises, and mental health providers ought to take them into account in assessing which course of treatment to recommend. Given these concerns, the casual way in which mindfulness exercises are presently distributed by mental health providers to the general public is inappropriate. (shrink)

Over the last decade, philosophers of science have extensively criticized the epistemic superiority of randomized controlled trials for testing safety and effectiveness of new drugs, defending instead various forms of evidential pluralism. We argue that scientific methods in regulatory decision-making cannot be assessed in epistemic terms only: there are costs involved. Drawing on the legal distinction between rules and standards, we show that drug regulation based on evidential pluralism has much higher costs than our current RCT-based system. We analyze (...) these costs and advocate for evaluating any scheme for drug regulatory tests in terms of concrete empirical benchmarks, like the error rates of regulatory decisions. (shrink)

The scalar approach to negative polarity item (NPI) licensing assumes that NPIs are allowable in contexts in which the introduction of the NPI leads to proposition strengthening (e.g., Kadmon & Landman 1993, Krifka 1995, Lahiri 1997, Chierchia 2006). A straightforward processing prediction from such a theory is that NPI’s facilitate inference verification from sets to subsets. Three experiments are reported that test this proposal. In each experiment, participants evaluated whether inferences from sets to subsets were valid. Crucially, we manipulated whether (...) the premises contained an NPI. In Experiment 1, participants completed a metalinguistic reasoning task, and Experiments 2 and 3 tested reading times using a self-paced reading task. Contrary to expectations, no facilitation was observed when the NPI was present in the premise compared to when it was absent. In fact, the NPI significantly slowed down reading times in the inference region. Our results therefore favor those scalar theories that predict that the NPI is costly to process (Chierchia 2006), or other, nonscalar theories (Giannakidou 1998, Ladusaw 1992, Postal 2005, Szabolcsi 2004) that likewise predict NPI processing cost but, unlike Chierchia (2006), expect the magnitude of the processing cost to vary with the actual pragmatics of the NPI. (shrink)

Three different types of low cost soil amendments, namely, EDTA, elemental S and N-fertilizer, were investigated with Vetiver grass, Vetiveria zizanioides (Linn.) Nash growing under highly mixed Cd–Pb contamination conditions. A significant increase (p < 0.05) in Cd and Pb accumulation were recorded in the shoots of all EDTA and N-fertilizer assisted treatments. The accumulation of Cd in 25 mmol EDTA/kg soil and 300 mmol N/kg soil showed relatively higher translocation factor (1.72 and 2.15) and percentage metal efficacy (63.25 (...) % and 68.22 %), respectively, compared to other treatments. However, it was observed that the increased application of elemental S may inhibit the availability of Pb translocation from soil-to-root and root-to-shoot. The study suggests that viable application of 25 mmol EDTA/kg, 300 mmol N/kg and 20 mmol S/kg soil have the potential to be used for soil amendment with Vetiver grass growing under contaminated mixed Cd–Pb soil conditions. (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)

I argue that, in the currently gender-unjust societies a basic income would not advance feminist goals. To assess the impact of a social policy on gender justice I propose the following criterion: a society is gender-just when the costs of engaging in a lifestyle characterized by gender-symmetry (in both the domestic and public spheres) are, for both men and women, smaller or equal to the costs of engaging in a gender-asymmetrical lifestyle. For a significant number of women, a basic income (...) would increase the costs of leading gender-symmetrical lifestyles because it would make it easier for both women and men to pursue gender-unjust preferences. I argue that preference satisfaction is distinct from justice. I conclude by showing why a basic income would lead to further privatisation of caregiving, and I outline the negative effects this would have on women. (shrink)

Suppose you want to do as much good as possible. What should you do? According to members of the effective altruism movement—which has produced much of the thinking on this issue and counts several moral philosophers as its key protagonists—we should prioritise among the world’s problems by assessing their scale, solvability, and neglectedness. Once we’ve done this, the three top priorities, not necessarily in this order, are (1) aiding the world’s poorest people by providing life-saving medical treatments or alleviating poverty (...) itself, (2) preventing global catastrophic risks, such as those posed by nuclear war or rogue artificial intelligence, and (3) ending factory farming. These claims are both plausible and striking. If correct, they should prompt a stark revision of how we approach our altruistic activities. However, the project of determining how to do the most good—as opposed to say, whether we should do the most good—has only recently, within the last ten years, become the subject of serious academic attention. Many key claims have not yet been carefully scrutinised. This is a cause for concern: are effective altruists doing good badly? In this thesis, I critique and develop some of the latest claims about how individuals can do the most good. I do this in three areas: the value of saving lives (preventing premature deaths), how best to improve lives (making people happier during their lives), and cause prioritisation methodology (frameworks for determining which problems are the highest priorities). In each case, I raise novel theoretical considerations that, when incorporated, change the analysis. Roughly speaking, my main conclusions are (1) saving lives is not as straightforwardly good we tend to suppose, may not be good at all, and is not clearly a priority; (2) happiness can be measured through self-reports and, based on the self-reported evidence, treating mental health stands out as an overlooked problem that may be an even more cost-effective way to improve lives than alleviating poverty; (3) the cause prioritisation methodology proposed by effective altruists needs to be moderately reconceptualised and, when it is, it turns out it is not as illuminating a tool as we might have thought and hoped. (shrink)

After the terrorist attacks of September 11, 2001, most legacy airlines filed for bankruptcy protection as a way to cut costs drastically, with the exception of American Airlines. This article applies the Principle of Double-Effect to the act of filing for Chapter 11 bankruptcy protection for reasons of management strategy, in particular, cost-cutting. It argues that the Principle can be a useful tool for discerning the ethicality of the action, and demonstrates the usefulness by proposing three double-effect criteria that, (...) when fulfilled, argues for the ethical justifiability the action in question. (shrink)

What endogenous factors contribute to minority (Red Queen) or majority (Red King) domination under conditions of coercive bargaining? We build on previous work demonstrating minority disadvantage in non-coercive bargaining games to show that under neutral initial conditions, majorities are advantaged in high conflict situations, and minorities are advantaged in low conflict games. These effects are a function of the relationship between (1) relative proportions of the majority and minority groups and (2) costs of conflict. Although both Red King and Red (...) Queen effects can occur, we further show that agents’ increased initial propensity toward conflict advantages majorities. (shrink)

The effective altruism movement aims to save lives in the most cost-effective ways. In the future, technology will allow radical life extension, and anyone who survives until that time will gain potentially indefinite life extension. Fighting aging now increases the number of people who will survive until radical life extension becomes possible. We suggest a simple model, where radical life extension is achieved in 2100, the human population is 10 billion, and life expectancy is increased by simple geroprotectors like (...) metformin or nicotinamide mononucleotide by three more years on average, so an additional 750 million people survive until “immortality”. The cost of clinical trials to prove that metformin is a real geroprotector is $65 million. In this simplified case, the price of a life saved is around eight cents, 10 000 times cheaper than saving a life from malaria by providing bed nets. However, fighting aging should not be done in place of fighting existential risks, as they are complementary causes. (shrink)

Tightened border controls, agile health departments, tech platforms, and a hand-washing song that went viral have added up to a frugal but highly effective response to the threat of COVID-19. The country's success provides a model that other developing and emerging economies should follow.

The study aimed to measure the effect of Crowdfunding financing on entrepreneurship aspirations in Arabic region. Population consists of members in (15) Crowdfunding Arabic platforms which are working with all models and online at (2018). Descriptive approach and a questionnaire used as a tool for this research. The results showed that Crowdfunding financing effect positively on entrepreneurship aspirations, Crowdfunding used mostly to finance small business or microfinance and charity. Add to that, Crowdfunding leads to financial efficiency and costs reduction, more (...) flexible payments methods and more opportunities for entrepreneurs. The study recommended the importance of entrepreneurship culture and its role in promoting entrepreneurs, the effect off Fintech and various e-banking and e-payments methods, and the need of more interest in innovation and creativity. (shrink)

This thesis consists of three papers examining determinants and implications of related party transactions (RPTs) in Vietnam, a transitional economy in South East Asia with features of concentrated state ownership and weak minority investor protection. Specifically, these papers describe RPTs and examine (i) the association between RPTs and state ownership, (ii) the association between the cost of corporate debt and RPTs, and the moderating role of state ownership on the association between the cost of debt and RPTs, and (...) (iii) the association between corporate tax avoidance and RPTs, and the moderating role of state ownership on this potential association. The first paper describes the nature and extent of RPTs in Vietnamese listed firms and examines the association between RPTs and state ownership. The results from this paper demonstrate that related party transactions are prevalent in Vietnam. Findings show that the presence of state ownership is related to a lower extent of RPTs. However, among firms with state ownership, the extent of RPTs is positively associated with percentage of state ownership. The second paper reveals that the cost of debt is higher in firms having a higher level of RPTs, implying that RPTs are viewed as a potential risk to firms from the point of view of lenders. However, the presence of state ownership can reduce the effect of RPTs on the cost of debt. The third paper provides evidence that firms with RPTs demonstrate more tax avoidance than their counterparts without RPTs. Further, among firms with RPTs, firms with a higher extent of related net credit and related sales are found to exhibit even higher levels of tax avoidance. However, the association between tax avoidance and RPTs is moderated by the presence of state ownership. Finally, in firms with RPTs, the presence of state ownership reduces tax avoidance measured by effective tax rates. (shrink)

Cyber attackers targeting large corporations achieved a high perimeter penetration success rate during 2013, resulting in many corporations incurring financial losses. Corporate information technology leaders have a fiduciary responsibility to implement information security domain processes that effectually address the challenges for preventing and deterring information security breaches. Grounded in corporate governance theory, the purpose of this correlational study was to examine the relationship between strategic alignment, resource management, risk management, value delivery, performance measurement implementations, and information security governance (ISG) (...) class='Hi'>effectiveness in United States-based corporations. Surveys were used to collect data from 95 strategic and tactical leaders of the 500 largest for-profit United States headquartered corporations. The results of the multiple linear regression indicated the model was able to significantly predict ISG effectiveness, F(5, 89) = 3.08, p = 0.01, R² = 0.15. Strategic alignment was the only statistically significant (t = 2.401, p <= 0.018) predictor. The implications for positive social change include the potential to constructively understand the correlates of ISG effectiveness, thus increasing the propensity for consumer trust and reducing consumers' costs. (shrink)

This article proposes a novel strategy, one that draws on insights from antidiscrimination law, for addressing a persistent challenge in medical ethics and the philosophy of disability: whether health systems can consider quality of life without unjustly discriminating against individuals with disabilities. It argues that rather than uniformly considering or ignoring quality of life, health systems should take a more nuanced approach. Under the article's proposal, health systems should treat cases where quality of life suffers because of disability-focused exclusion or (...) injustice differently from cases where lower quality of life results from laws of nature, resource scarcity, or appropriate tradeoffs. Decisionmakers should ignore quality-of-life losses that result from injustice or exclusion when ignoring them would improve the prospects of individuals with disabilities; in contrast, they should consider quality-of-life losses that are unavoidable or stem from resource scarcity or permissible tradeoffs. On this proposal, while health systems should not amplify existing injustice against individuals with disabilities, they are not required to altogether ignore the potential effects of disability on quality of life. (shrink)

The current increase of air pollution rates and its consequences of global warming, health problems and threats to human lives necessitate the continuous search for more efficient and cost effective gas monitoring devices. Devices that is easily available and implementable worldwide. In developing countries the cost and the availability of the equipment is one of the obstacles that contribute to not having an efficient monitoring system. Hence, modifying cheap and easily available devices to work as pollution monitoring system (...) will be an asset in this direction. In this work I am presenting the design of a computer based pollution detection and measuring system using cheap CO (Carbon Monoxide) alarms used in homes. The outcome is a cost-effective computer based CO monitoring system that is easily available and could be easily modified to work as a network based CO nose. A C# based program is also designed to show and log the sensor readings in an easy to use and read Window. (shrink)

Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the (...) overall impact of health policy. This chapter considers what weight health policy should give to its “spill-over effects,” namely non-health and indirect benefits. (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)

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity (...) criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (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)

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)

Future superintelligent AI will be able to reconstruct a model of the personality of a person who lived in the past based on informational traces. This could be regarded as some form of immortality if this AI also solves the problem of personal identity in a copy-friendly way. A person who is currently alive could invest now in passive self-recording and active self-description to facilitate such reconstruction. In this article, we analyze informational-theoretical relationships between the human mind, its traces, and (...) its future model; based on this analysis, we suggest the instruments to most cost-effectively collect quality data about a person for future resurrection. These guidelines form a “digital immortality protocol”. Digital immortality is plan C for achieving immortality, after plan A, life extension, and plan B, cryonics. (shrink)

Objectives -/- Surveys in various countries suggest 17% to 80% of doctors prescribe ‘placebos’ in routine practice, but prevalence of placebo use in UK primary care is unknown. Methods -/- We administered a web-based questionnaire to a representative sample of UK general practitioners. Following surveys conducted in other countries we divided placebos into ‘pure’ and ‘impure’. ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for suspected (...) viral infections. ‘Pure’ placebos are interventions such as sugar pills or saline injections without direct pharmacologically active ingredients for the condition being treated. We initiated the survey in April 2012. Two reminders were sent and electronic data collection closed after 4 weeks. Results -/- We surveyed 1715 general practitioners and 783 (46%) completed our questionnaire. Our respondents were similar to those of all registered UK doctors suggesting our results are generalizable. 12% (95% CI 10 to 15) of respondents used pure placebos while 97% (95% CI 96 to 98) used impure placebos at least once in their career. 1% of respondents used pure placebos, and 77% (95% CI 74 to 79) used impure placebos at least once per week. Most (66% for pure, 84% for impure) respondents stated placebos were ethical in some circumstances. Conclusion and implications -/- Placebo use is common in primary care but questions remain about their benefits, harms, costs, and whether they can be delivered ethically. Further research is required to investigate ethically acceptable and cost-effective placebo interventions. (shrink)

The policy makers or lawyers may face the need of legal research for reasons. The congressmen may plan to make new laws to address the challenges of their constituent or to the interest of nation. The lawyers may need to serve their clients who like to know the legal issues involved, the strategies to deal with their loss and recovery, and prospect for winning the case if the dispute has gotten worse. The lawyers may practice in a solo business or (...) might work as an associate lawyer in the law firms. A senior lawyer or partner in some cases may like to exploit the junior work force about the problems or grievances from the potential clients. Since he needs to focus their attention on other matters, such as the business expansion of his law firm or more lucrative cases in need of career hands, he may tap the junior lawyer for the legal research, who could assist with the basis of his final legal opinion. The memorandum, opinion letter and brief would be such forms of professional communication for the lawyers and legal researchers. The congressman also can be supplemented with the aid of staffs in terms of his legal expertise and grasp of the issues standing for carrying their responsibility more effectively. For the lawyers and legal researchers, the structure of state and federal legal system is the kind of important variants to orient their work direction and basic frame for the most efficient and adequate scope of search and analysis. The paradigm change also is revolutionary to impact the general base of people. Decades ago, the research or researcher only related with the class of professionals, such as professors, lawyers, career officers and cadres of enterprises. They would enjoy insulation and exploit their research work as an entrance barrier from lay people. Their large shelves at home study or in the room or corner of office thrust an impression that he or she is learned and knowledgeable. This impliedly communicates his or her prestige of social or professional success. The books and articles seem to symbolize a kind of monopoly which bears to exclude unclassified or non-professional workers. The change is remarkable that every citizen could benefit from the on-line sources of information, which, of course, is generally true of professional knowledge. Now professors fear of plagiarism that students often are the kind of suspect. The legal research would turn on the help of digitization which revolutionizes to incur a new mode of research operation. About the query, the citizens and people can readily verify its truth or falsity with one clique within the personal computer. An enormous amount of information is currently flowing on the internet and on-line sources of reference, which shapes an informative and knowledgeable society. As the medical doctors warned decades ago, the precept is any most effective, “forbear from your intelligence or knowledge work for your health.” Many of them now spend long hours a day to satisfy their curiosity and intelligent search. He or she may be well awarded an academic degree if to recognize their hard work on his PC. Nevertheless, this information age does not always bring a positive progress, which arouses the kind of issues, say, right of privacy, on-line fraud. In some cases, this transformation may lead to an inferior attitude of researcher. My today’s experience is one of exotic case. I have received an e-mail from Google CEO stating that I have been selected as one of twelve winners from the pool of Google users. The award money is enormous which stalls me for some time. The authenticity and reliability have hit my head, and I utilized a verification service website managed by the team of lawyers. It costs five dollars and remaining 24 dollars would be processed upon the progress of interaction. I am waiting for an answer from the team. Then the research nowadays is not limited to the basic context of our subsistence, but influences in any depth into the professional lives. (shrink)

Biomedical ontologies exist to serve integration of clinical and experimental data, and it is critical to their success that they be put to widespread use in the annotation of data. How, then, can ontologies achieve the sort of user-friendliness, reliability, cost-effectiveness, and breadth of coverage that is necessary to ensure extensive usage? Methods: Our focus here is on two different sets of answers to these questions that have been proposed, on the one hand in medicine, by the SNOMED (...) CT community, and on the other hand in biology, by the OBO Foundry. We address more specifically the issue as to how adherence to certain development principles can advance the usability and effectiveness of an ontology or terminology resource, for example by allowing more accurate maintenance, more reliable application, and more efficient interoperation with other ontologies and information resources. Results: SNOMED CT and the OBO Foundry differ considerably in their general approach.Nevertheless, a general trend towards more formal rigor and cross-domain interoperability can be seen in both and we argue that this trend should be accepted by all similar initiatives in the future. Conclusions: Future efforts in ontology development have to address the need for harmonization and integration of ontologies across disciplinary borders, and for this, coherent formalization of ontologies is a prerequisite. (shrink)

The Australian Federal Government has announced a two-year trial scheme to compensate living organ donors. The compensation will be the equivalent of six weeks paid leave at the rate of the national minimum wage. In this article I analyse the ethics of compensating living organ donors taking the Australian scheme as a reference point. Considering the long waiting lists for organ transplantations and the related costs on the healthcare system of treating patients waiting for an organ, the 1.3 million AUD (...) the Australian Government has committed might represent a very worthwhile investment. I argue that a scheme like the Australian one is sufficiently well designed to avoid all the ethical problems traditionally associated with attaching a monetary value to the human body or to parts of it, namely commodification, inducement, exploitation, and equality issues. Therefore, I suggest that the Australian scheme, if cost-effective, should represent a model for other countries to follow. Nonetheless, although I endorse this scheme, I will also argue that this kind of scheme raises issues of justice in regard to the distribution of organs. Thus, I propose that other policies would be needed to supplement the scheme in order to guarantee not only a higher number of organs available, but also a fair distribution. (shrink)

Recently many methods for reducing the risk of human extinction have been suggested, including building refuges underground and in space. Here we will discuss the perspective of using military nuclear submarines or their derivatives to ensure the survival of a small portion of humanity who will be able to rebuild human civilization after a large catastrophe. We will show that it is a very cost-effective way to build refuges, and viable solutions exist for various budgets and timeframes. Nuclear submarines (...) are surface independent, and could provide energy, oxygen, fresh water and perhaps even food for their inhabitants for years. They are able to withstand close nuclear explosions and radiation. They are able to maintain isolation from biological attacks and most known weapons. They already exist and need only small adaptation to be used as refuges. But building refuges is only “Plan B” of existential risk preparation; it is better to eliminate such risks than try to survive them. (shrink)

Recently, a number of philosophers have argued that we can and should “consequentialize” non-consequentialist moral theories, putting them into a consequentialist framework. I argue that these philosophers, usually treated as a group, in fact offer three separate arguments, two of which are incompatible. I show that none represent significant threats to a committed non-consequentialist, and that the literature has suffered due to a failure to distinguish these arguments. I conclude by showing that the failure of the consequentializers’ arguments has implications (...) for disciplines, such as economics, logic, decision theory, and linguistics, which sometimes use a consequentialist structure to represent non-consequentialist ethical theories. (shrink)

A principal challenge facing the progressive bioethics project is the crafting of a consistent message on biopolitical issues that divide progressives. -/- The regulation of enhancement technologies is one of the issues central to this emerging biopolitics, pitting progressive defenders of enhancement, “technoprogressives,” against progressive critics. This essay [PDF] will argue that technoprogressive biopolitics express the consistent application of the core progressive values of the Enlightenment: the right of individuals to control their own bodies, brains and reproduction according to their (...) own conscience, under democratic states that work for the public good. -/- Insofar as left bioconservatives want to ensure the safety of therapies and their equitable distribution, these concerns can be addressed by thorough and independent regulation and a universal health care system, and a progressive bioethics of enhancement can unite both enthusiasts and skeptics. Insofar as bioconservative concerns are motivated by deeper hostility to the Enlightenment project however, by assertion of pre-modern reverence for human uniqueness for instance, then a common program is unlikely. -/- imageAfter briefly reviewing the political history and contemporary landscape of biopolitical debates about enhancement, the essay outlines three meta-policy contexts that will impact future biopolicy: the pressure to establish a universal, cost-effective health insurance system, the aging of industrial societies, and globalization. Technoprogressive appeals are outlined that can appeal to key constituencies, and build a majority coalition in support of progressive change. Finally, some guiding principles for a technoprogressive approach to biopolicy are offered. (shrink)

When an activity is unwanted, administrators often adopt a zero tolerance policy towards that activity. The background assumption is that, by adopting a zero tolerance policy, one is doing everything that one can to reduce or eliminate the activity in question. Yet which policy best serves to reduce an unwanted behavior is always an empirical question. Thus, those who adopt a zero tolerance policy towards some behavior without first investigating and finding that they are in a set of circumstances where (...) that policy is the most cost-effective way of reducing or eliminating the undesirable behavior are committing the zero tolerance fallacy. (shrink)

In carrying out cost-benefit or cost-effective analysis, a discount rate should be applied to some kinds of future benefits and costs. It is controversial, though, whether future health is in this class. I argue that one of the standard arguments for discounting (from diminishing marginal returns) is inapplicable to the case of health, while another (favouring a pure rate of time preference) is unsound in any case. However, there are two other reasons that might support a positive discount (...) rate for future health: one relating to uncertainty, and the other relating to the instrumental benefits of improved health. While the latter considerations could be modelled via a discount rate, they could alternatively be modelled more explicitly, in other ways; I briefly discuss which modelling method is preferable. Finally, I argue against the common claims that failing to discount future health would lead to paradox, and/or to inconsistency with the way future cash flows are treated. (shrink)

Contrary to popular belief, population-wide preventive measures are rarely cost-reducing. Yet they can still be cost-effective, and indeed more cost-effective than treatment. This is often true of preventive measures that work by slightly reducing the already low risks of death faced by many people. This raises a difficult moral question: when we must choose between life-saving treatment, on the one hand, and preventive measures that avert even more deaths, on the other, is the case for prevention weakened (...) when it works by reducing many healthy people’s already low risks by a further tiny amount? I argue the answer is no. (shrink)

The zero tolerance fallacy occurs when someone advocates or adopts a zero tolerance policy towards some activity or behaviour without seeing if there is evidence to support the view that such a policy is the best or most cost-effective way of preventing or reducing the unwanted behaviour. This paper explores the idea that, instead of thinking about what the zero tolerance fallacy is, argumentation theorists should try to characterize what features good arguments for zero tolerance policies must have.

Most current techniques to deal with invasive species are ineffective or have highly damaging side effects. To this end suppression-drives based on clustered regularly inter-spaced short palindromic repeats (CRISPR/Cas9) have been touted as a potential silver bullet for the problem, allowing for a highly focused, humane and cost-effective means of removing a target species from an environment. Suppression-drives come with serious risks, however, such that the precautionary principle seems to warrant us not deploying this technology. The focus of this (...) paper is on one such risk – the danger of a suppression-drive escaping containment and wiping out the target species globally. Here, I argue that in most cases this risk is significant enough to warrant not using a gene-drive. In some cases, however, we can bypass the precautionary principle by using an approach that hinges on what I term the ‘Worst-Case Clause’. This clause, in turn, provides us with a litmus test that can be fruitfully used to determine what species are viable targets for suppression-drives in the wild. Using this metric in concert with other considerations, I suggest that only three species are currently possible viable targets – the European rabbit, ship rat and Caribbean Tree Frog. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)