Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different (...) from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: (1)prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and (2)prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies—while potentially resulting in care that deviates from usual standards–support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers. (shrink)

Throughout the world, research ethics committees are relied on to prevent unethical research and protect research subjects. Given that reliance, the composition of committees and the manner in which decisions are arrived at by committee members is of critical importance. There have been Instances in which an inadequate review process has resulted in serious harm to research subjects. Deficient committee review was identified as one of the factors In a study in New Zealand which resulted in the suffering and death (...) of many women diagnosed with carcinoma in situ. (shrink)

Throughout the world, research ethics committees are relied on to prevent unethical research and protect research subjects. Given that reliance, the composition of committees and the manner in which decisions are arrived at by committee members is of critical importance. There have been Instances in which an inadequate review process has resulted in serious harm to research subjects. Deficient committee review was identified as one of the factors In a study in New Zealand which resulted in the suffering and death (...) of many women diagnosed with carcinoma in situ. (shrink)

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

Teaching is not testimony. Although both convey information, they have different uptake requirements. Testimony aims to impart information and typically succeeds if the recipient believes that informationon account of having been told by a reliable informant. Teaching aims to equip learners to go beyond the information given—to leverage that information to broaden, deepen, and critique their current understanding of a topic. Teaching fails if the recipients believe the information only because it is what they have been told.

Smoking is frequently presented as being particularly problematic when the smoker is a pregnant woman because of the potential harm to the future child. This premise is used to justify targeting pregnant women with a unique approach to smoking cessation including policies such as the routine testing of all pregnant women for carbon monoxide at every antenatal appointment. This paper examines the evidence that such policies are justified by the aim of harm prevention and argues that targeting pregnant women in (...) this way is likely to do more harm than good. Routine carbon monoxide testing is particularly problematic as it sends a message to pregnant women that they cannot be trusted either to truthfully answer questions as to whether or not they smoke, or to make decisions in the best interests of themselves and their future children in the way that non-pregnant individuals are. Further, if the aim is to reduce rates of prenatal harm, the evidence suggests that adopting a supportive and empowering approach to prenatal care is the most effective way to achieve this, something that the current policies aimed at pregnant women are in conflict with. (shrink)

In this paper, I argue for an account of metaphorical content as what is said when a speaker utters a metaphor. First, I show that two other possibilities—the Gricean account of metaphor as implicature and the strictly semantic account developed by Josef Stern—face several serious problems. In their place, I propose an account that takes metaphorical content to cross-cut the semantic-pragmatic distinction. This requires re-thinking the notion of metaphorical content, as well as the relation between the metaphorical and the literal.

_After Writing_ provides a significant contribution to the growing genre of works which offers a challenge to modern and postmodern accounts of Christianity.

Testimony consists in imparting information without supplying evidence or argument to back one’s claims. To what extent does testimony convey epistemic warrant? C. J. A. Coady argues, on Davidsonian grounds, that (1) most testimony is true, hence (2) most testimony supplies warrant sufficient for knowledge. I appeal to Grice’s maxims to undermine Coady’s argument and to show that the matter is more complicated and context-sensitive than is standardly recognized. Informative exchanges take place within networks of shared, tacit assumptions that affect (...) the scope and strength of our claims, and the level of warrant required for their responsible assertion. The maxims explain why different levels of warrant are transferred in different contexts. (shrink)

Issues of balancing data accessibility with ethical considerations and governance of a genomics research biobank, Generation Scotland, are explored within the evolving policy landscape of the past ten years. During this time data sharing and open data access have become increasingly important topics in biomedical research. Decisions around data access are influenced by local arrangements for governance and practices such as linkage to health records, and the global through policies for biobanking and the sharing of data with large-scale biomedical research (...) data resources and consortia. We use a literature review of policy relevant documents which apply to the conduct of biobanks in two areas: support for open access and the protection of data subjects and researchers managing a bioresource. We present examples of decision making within a biobank based upon observations of the Generation Scotland Access Committee. We reflect upon how the drive towards open access raises ethical dilemmas for established biorepositories containing data and samples from human subjects. Despite much discussion in science policy literature about standardisation, the contextual aspects of biobanking are often overlooked. Using our engagement with GS we demonstrate the importance of local arrangements in the creation of a responsive ethical approach to biorepository governance. We argue that governance decisions regarding access to the biobank are intertwined with considerations about maintenance and viability at the local level. We show that in addition to the focus upon ever more universal and standardised practices, the local expertise gained in the management of such repositories must be supported. A commitment to open access in genomics research has found almost universal backing in science and health policy circles, but repositories of data and samples from human subjects may have to operate under managed access, to protect privacy, align with participant consent and ensure that the resource can be managed in a sustainable way. Data access committees need to be reflexive and flexible, to cope with changing technology and opportunities and threats from the wider data sharing environment. To understand these interactions also involves nurturing what is particular about the biobank in its local context. (shrink)

There have been a number of criticisms, based on visual processes, of the Australian view that colour is an objective property of the world. These criticisms have led to subjective theories about colour. These visual processes (metamers, retinex theory, opponent processes, simultaneous contrast, colour constancy, subjective colours) have been examined and it is suggested that they do not carry their supposed critical weight against an objective theory. In particular, it is argued that metamers don’t occur in nature and primate colour (...) vision evolved without metamers. Thus normal colour vision occurs without the problem of metamers. This argument, in conjunction with evidence against the critical roles of opponent processes and retinex theory in colour vision, is taken to suggest that colour can be given a photon energy/wavelengthrealism explanation. This proposal allows an account of the many microstructural bases of colour generation put forward by Nassau (1983). It is argued that neither disjunctive realism or reflectance realism are adequate objective explanations of colour. (shrink)

This article brings together two excerpts from the forthcoming book, The Weary Sons of Freud (Verso/new Left Books, 1987) by Catherine Clément, translated from the French by Nicole Ball. It also includes an edited version of the book's Introduction by Ann Rosalind Jones. Feminist Review would like to thank her for her help in editing this piece, and also Verso/new Left Books for permission to reproduce these extracts.

Clinical research is a necessity if effective and safe treatments are to be developed. However, this may well include the need for research that is best described as ‘invasive’ in that it may be associated with some discomfort or inconvenience. Limitations in the undertaking of invasive research involving people with intellectual disabilities (ID) are perhaps related to anxieties within the academic community and among ethics committees; however, the consequence of this neglect is that innovative treatments specific to people with ID (...) may not be developed. Such concerns are likely to continue while there is limited published knowledge regarding the actual experiences of people with ID who have participated in invasive clinical research. As part of a pilot study trialling the novel use of a surgically inserted device to curb overeating in people with Prader–Willi syndrome (PWS) we have investigated the experience of research through semistructured qualitative interviews involving three participants and their carers. Thematic analysis revealed that the adults with PWS and their family carers rated their participation positively, seeing it as a rewarding and enriching experience. This brief report discusses findings from our interview data in order to highlight strategies which may ensure that research is acceptable to participants, meets the necessary ethical standards and is able to achieve the aims set out by the researchers. To our knowledge, this is the first study to record experiences directly from people with PWS and their carers regarding their involvement in invasive clinical research. (shrink)

I start by asking what Aristotle knew (or thought) about Heraclitus: what were the key features of Heraclitus's philosophy as far as Aristotle was concerned? In this section of the paper I suggest that there are some patterns to Aristotle's references to Heraclitus: besides the classic doctrines (flux, ekpyrosis and the unity of opposites) on the one hand, and the opening of Heraclitus's book on the other, Aristotle knows and reports a few slightly less obvious sayings, one of which is (...) in my title. Secondly, I ask some further questions. Is there any systematic connection between the bits that Aristotle reports? Do they hang together? Ought we to see here some relic of an Aristotelian understanding of what made Heraclitus tick? If we juxtapose these themes and Aristotle's comments on them, I suggest, we can generate some suggestive motifs, in particular a rather curious fascination with smoking, and the pleasures of inhaling. Finally, I suggest that smells (and the way the world would be if smells were the only differences to be discerned) are important in understanding what Heraclitus was doing. (shrink)

Comment répondre à la crise environnementale et aux menaces qu’elle fait peser sur la poursuite de notre mode de vie? Devons-nous mobiliser nos forces pour lutter contre la crise, changer radicalement nos comportements? Ne faudrait-il pas plutôt veiller à nous adapter à une situation transformée? Ces deux pôles sont présents dans les politiques environnementales. Pour répondre au changement climatique on envisage à la fois des politiques d’atténuation (mitigation) des émissions de gaz à ef...

Name der Zeitschrift: Semiotica Jahrgang: 2015 Heft: 207 Seiten: 279-301.

While we may use the Gospels and Paul’s letters to justify eating with wild abandon and enjoying every bite, we should revisit the greater principle in the New Testament: to feed others to the point of self-sacrifice in order to honor the integrity of the community.

How could it happen that the very processes intended to assure ethical research in Australia might, themselves, undermine good research practice?This paper describes one PhD candidate’s recent experiences of multicentre review for a Human Research Ethics Committee approved, low/negligible risk, qualitative study, at the crossroad of health services research and organisational research.A retrospective review of international literature about multi-centre review processes revealed that many of these experiences were not unique and might have been expected, notwithstanding Australian efforts at harmonisation of (...) multi-centre review. This paper examines not only the burden of red-tape that was applied to a small doctoral study, but also the way in which the red-tape threatened the anonymity of potential study participants and risked exposing them to undue pressure and distress.These experiences support the view that harmonisation initiatives have not yet developed as the Australian National Health and Medical Research Council may have hoped and that further attention is needed to harmonise research governance processes. (shrink)

The popularization of the term “clinical death” for the absence of vital signs suggests the possibility of a radical change in our understanding of death. While death used to be considered something that we do not have the power to reverse, contemporary optimism suggests that we may be able to restore life to a dead organism. In this article, I examine how the term “death” is used today to clarify what kind of irreversibility we ought to assign to it. I (...) conclude that the kind of irreversibility closest to our concept of death is one that depends on implicit metaphysical commitments: we generally treat death as though it were metaphysically irreversible, and therefore not reversible by us. (shrink)

As a response to Moran's (1994) recommendation that Heidegger's Destruktion be extensively elaborated and critiqued, this paper suggests a way in which Heidegger's thinking can be more clearly understood as a search for how better to ‘say' the destruction. By briefly tracing how Heidegger's thinking on the Destruktion repeatedly turns against itself throughout his writings, it is demonstrated that Heidegger does indeed revise the notion by abandoning the term in his later writing; to replace it first with the concept of (...) ‘overcoming', and subsequently with the notion of Verwindung . This self-critical reworking of the Destruktion is evident in his turning towards these concepts; which is taken up by Derrida's deconstruction in its simultaneous turning towards and away from Heidegger's Destruktion . South African Journal of Philosophy Vol. 27 (1) 2008 pp. 52-68. (shrink)

The article explores the problem of nursing as a practical discipline and suggests that there are several kinds of nursing science. Following the lead of Jacques Maritain and Yves R. Simon, the authoress begins with an account of the distinguishing characteristics of theoretical knowledge, to which the term “science” has historically been applied, and distinguishes it from practical knowledge or prudence. Next she reviews Maritain and Simon’s discussion of two intermediate levels of inquiry that share some characteristics of both science (...) and practical knowledge. Finally, using the writings of several nurse theorists whose seminal ideas in this area have established a basis for nurse theorist’s discussion of these issues, she distinguishes four kinds of nursing inquiry which range from the very theoretical to the very practical. (shrink)