Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

As biological and biomedical research increasingly reference the environmental context of the biological entities under study, the need for formalisation and standardisation of environment descriptors is growing. The Environment Ontology (ENVO) is a community-led, open project which seeks to provide an ontology for specifying a wide range of environments relevant to multiple life science disciplines and, through an open participation model, to accommodate the terminological requirements of all those needing to annotate data using ontology classes. This paper summarises ENVO’s motivation, (...) content, structure, adoption, and governance approach. (shrink)

This book was inspired originally by the debates at the turn of the century about placebo controlled trials of antiretrovirals in HIV positive pregnant women in developing countries. Moving forward from this one limited example, the book includes several additional controversial cases of clinical research conducted in developing countries, and asks probing philosophical questions about the ethics of such trials. All clinical research by its very nature uses people to acquire generalizable knowledge to help future people. But what sorts of (...) "use" are morally permissible? What is it to exploit people? Suppose that a trial conducted in a developing country would not be ethically permissible in the developed world. Can we automatically conclude from this that the trial is unethical, that some sort of morally problematic double standard is in operation? Or might the differences in the two settings justify differences in trial design? This collection of philosophical essays examines these important questions about what exploitation is and when clinical research counts as exploitative. -/- "This is an outstanding contribution to the growing literature on the ethics of research with human subjects and a fine example of what bioethics can offer at its best. Anyone with a serious interest in these issues will need to read this book from start to finish." -Daniel Wikler, Harvard School of Public Health "This book contributes significantly to the literature on exploitation in clinical research conducted in the developing world."--Patricia Marshall, Case Western Reserve University . (shrink)

Columbia University Press's multivolume _Prison Notebooks_ is the only complete critical edition of Antonio Gramsci's seminal writings in English. Based on the authoritative Italian edition of Gramsci's work, _Quaderni del Carcere_, this comprehensive translation presents the intellectual as he ought to be read and understood, with critical notes that clarify Gramsci's history, culture, and sources; an index of names; and a contextualization of the thinker's ideas against his earlier writings and letters. This set includes notebooks 1 through 8 with all (...) attendant notes and materials and is an indispensible resource for scholars in the humanities and social sciences. (shrink)

The contributors in _Expanding and Restricting the Erotic_ offer a multidisciplinary perspective on the ways in which what is considered acceptable within the realm of the erotic has altered over time to the current situation where the erotic is being both expanded and restricted.

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain burdens (...) they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

Como podemos observar na sociedade contemporânea, as relações de poder estão cada vez mais disseminadas por todos os lados, seja nas relações familiares, num grupo de amigos, numa instituição, numa empresa, em cargos públicos, etc, e essas relações podem-se caracterizar de forma simples (entre dois indivíduos) ou numa esfera mais complexa (empresa, cidade ou país). E cada uma dessas relações têm em comum o fato de servirem como meio de influência na consulta alheia. Na esfera social, são números demasiados de (...) exemplos ou formas de exercício do poder, todavia podemos destacar as que estão no pódio social, e que são as formas de poder predominantes, são eles: o poder econômico, o poder ideológico e o poder político. O primeiro baseia-se na posse de bens materiais, como meios de produção, à exemplo citado anteriormente o poder do patrão sobre seus empregados, o patrão exerce uma ordem (poder) que, caso não cumprida ou não realizada, o empregado pode até perder seu emprego, por isso o proletário é submetido ao patrão que submete suas leis e vontades sobre os empregados. O segundo exemplo, o poder ideológico, serve-se das ideias ou simplesmente de informações para influenciar, de forma direta ou indireta, a conduta e os princípios dos indivíduos, ou influenciar seus comportamentos sobre algo determinado, à exemplo dessa influência, citemos o papel hegemônico de determinados meios de comunicação sobre as pessoas, o poder que a mídia exerce sobre o comportamento humano é gigantesco. Como exemplo da inclusão mídia na mente humana, podemos citar uma família que se alimentou e se serve satisfeita após a refeição, porém ao assistir um programa e em seu comercial estiver passando a propaganda de um produto alimentício, é da natureza humana sentir fome novamente, e essas famílias irem atrás do produto na própria casa, ou em supermercados, restaurantes, etc, para conseguir o produto. O terceiro e último exemplo, o poder político, goza de ferramentas e variadas técnicas para alcançar a influência na conduta alheia, isto é, tentar mudar uma opinião já formada dos cidadãos sobre determinados assuntos, à exemplo o poder de convencimento de partidos políticos e seus candidatos sobre o eleitorado durante um pleito político ou eleições municipais, estaduais ou federais. Após essa iniciação sobre as três formas de exercício do poder, vamos destrinchar cada uma delas, facilitando a compreensão e os seus respectivos papéis no âmbito social. (shrink)

Volume 19, Issue 9, September 2019, Page 1-4.

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources should be spent. Should (...) additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children's educational attainment, or just focus on health outcomes? Does age matter for priority setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer? Global Health Priority-Setting provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policy-makers, and clinicians from around the world assess the state of current practice in national and global priority setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources. (shrink)

The article has two aims: (a) to show how the notion of self proposed by Zahavi allows to underlie different aspects of personal identity; (b) to provide some elements that strengthen and complement the arguments of the Danish philosopher. First, I begin with a phenomenological analysis of the acts. Second, I study the identity and the various levels of the self that underlie it. Finally, I present some elements to constitute a metaphysics of the human person as a complement to (...) Zahavi’s phenomenology, considering the philosophy of mind as a framework for reflection. (shrink)

The bridge between psychiatry and neuroscience is not the only one we have to build; it is also necessary to narrow the gap between neuroscience and philosophy. This does not imply reducing the latter to the former or vice versa, but rather linking each other without eliminating their own characteristics. Taking that into account, Dan Zahavi’s phenomenology of mind can make a great contribution by presenting itself like a different option within philosophy of mind, which up until the last few (...) years was dominated by the analytic tradition. In this chapter I present Zahavi’s proposal in four steps. Firstly, I clarify the term phenomenology. This question is not accidental because nowadays this concept is used by diverse traditions and with different meanings. Secondly, I make the fundamental distinction between first-person-perspective—which corresponds to Phenomenology—and third-person-perspective—compatible with neuroscience. Thirdly, I explain the methodological stages assumed by Zahavi from the Husserlian tradition. These stages enable him to study from the first-person-perspective rigorously: epoché, phenomenological reduction, eidetic variation, and intersubjective verification. Finally, I develop the issue of naturalization of Phenomenology in order to establish a dialogue between science and philosophy. For Zahavi that naturalization does not necessarily imply reductionism, but can be understood as something necessary for a fruitful exchange between those disciplines. (shrink)

Una de las características predominantes en la obra de Nicos Poulantzas es su marcada subjetividad, la cual estuvo atravesada por el momento histórico en que transcurrió su vida, pues se trataba de una época en donde los procesos revolucionarios perdían vigencia y quedaban amargas, pero al mismo tiempo, importantísimas lecciones; donde a pesar de la constante inestabilidad, el capitalismo lograba restaurarse y transformarse a expensas del Estado. El presente escrito explora la vigencia teórica de la obra intelectual de Poulantzas, su (...) originalidad distinguida por pertenecer a un marxismo heterodoxo más preocupado por la cuestión del Estado; al mismo tiempo, se incluyen explícitamente elementos de análisis como la dependencia, el desarrollo y la gestión global neoliberal del capital en la actualidad. Esto a partir de la lectura de su obra desde y con una perspectiva latino-mericana que permita concluir con algunos elementos teóricos para la construcción y actualización de una teoría del Estado que tenga en cuenta las particularidades de esta parte del mundo. (shrink)

El día 30 de Diciembre de 2004 se desataba un incendio provocado por una bengala en un recital que el grupo de rock Callejeros llevaba a cabo en el local La República de Cromañón, ubicado en el barrio porteño de Once frente a la plaza Miserere; en este hecho morían trágicamente 194 personas. Después de la tragedia, se encuentra hoy un espacio en homenaje a esas víctimas, donde sus familiares y amigos tienen la oportunidad de expresar sus sentimientos más profundos. (...) ¿Es Cromañón un símbolo de religiosidad popular? ¿Qué particularidades presenta y cuales son sus ritos más característicos? ¿Qué elementos dan origen a esta expresión? El objetivo de esta investigación es precisar si estamos frente a un fenómeno de religiosidad popular, bajo qué contextos opera, cuáles son sus ritos más comunes y como se han originado. Para analizar la religiosidad popular, se toman cinco elementos presentes en estos fenómenos: la sacralización de los muertos, la idea de conflicto social, el sincretismo, las fechas conmemorativas, y la promesa como relación entre el devoto y el santo. Mediante entrevistas en profundidad y otras técnicas cualitativas pudimos establecer una relación entre esas categorías teóricas y los hechos empíricos.On December 30, 2004 there was surfaced an untied fire provoked by a flare in a recital that Callejeros group of rock This was leading to end in the place Cromañón's Republic, located in the neighborhood of once opposite to the Miserere Square; in this fact tragically 194 persons were dying. After the tragedy, one finds today a space in honoring to these victims, where their parents and friends have the opportunity to express their most deeper feelings. Is Cromañón a symbol of popular religiousness? What does points present and which are its more typical rites? What elements have given origin to this expression? This investigation is aimed to clarify if we are before a phenomenon of popular religiousness, under which contexts it operates and which are its own more common rites and since they have originated. To analyze the popular religiousness, five present elements take in these phenomena: the sacralization of murders, the idea of social conflict, the syncretism, the commemorative dates, and the promise as relation among the devout one and the saint. By means of interviews in depth and other qualitative methods we could establish a relation among these theoretical categories and the empirical facts. (shrink)

En el presente estudio procuraremos determinar los dos ejes de la ética unamuniana, que, al estar vinculados con el dualismo antropológico “yo-íntimo” y “yo-público”, podríamos condensar en los conceptos de “bondad” y “obra”. Unamuno, en cuanto heredero del romanticismo y del existencialismo, consideró que lo fundamental, en términos axiológicos, era que los individuos aprendiesen a “ser buenos” y no a “hacer [meramente] el bien”, ya que solo a través de la pureza del sentir, es decir, de la “bondad ética”, el (...) “sujeto moral” podría constituirse como una “persona” a través de sus “obras”. En este aspecto, la relación de la ética unamuniana con los “oficios” es decisiva, ya que cada “individuo” a través de su “profesión” está llamado a formar su “persona”. (shrink)

It has become increasingly difficult for individuals to exercise meaningful control over the personal data they disclose to companies or to understand and track the ways in which that data is exchanged and used. These developments have led to an emerging consensus that existing privacy and data protection laws offer individuals insufficient protections against harms stemming from current data practices. However, an effective and ethically justified way forward remains elusive. To inform policy in this area, we propose the Ethical Data (...) Practices framework. The framework outlines six principles relevant to the collection and use of personal data—minimizing harm, fairly distributing benefits and burdens, respecting autonomy, transparency, accountability, and inclusion—and translates these principles into action-guiding practical imperatives for companies that process personal data. In addition to informing policy, the practical imperatives can be voluntarily adopted by companies to promote ethical data practices. (shrink)

Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.

Initial vaccine allocations for the coronavirus disease 2019 (COVID-19) will be limited. It is crucial to assess the ethical values associated with different methods of allocation, as well as important scientific and practical questions. This Viewpoint identifies three ethical values, benefiting people and limiting harm; prioritizing disadvantaged populations; and equal concern for all. It then explains why these values support prioritizing three groups: health care workers; other essential workers and people in high-transmission settings; and people with medical vulnerabilities associated with (...) poorer COVID-19 outcomes. In contrast, two other groups, people over 65 without medical vulnerabilities and participants in clinical research, present more complex ethical questions. This prioritization also encompasses valuing direct benefits to vaccinated individuals, indirect benefits to individuals protected from spread of infection, and indirect health and socioeconomic benefits to those protected from harm as health system and societal functioning improve. Vaccine allocation that recognizes important ethical values and avoids arbitrariness, waste, and corruption can ensure that the distribution of a COVID-19 vaccine is both fair and perceived as fair. (shrink)

In this article, cluster analysis is used to explore the conflicting results reported when the Defining Issues Test is used to explain moral reasoning ability in business situations. Using a convenience sample, gender, age, work experience, and ethics training were examined to determine their impact on the level of moral reasoning ability as measured by the Defining Issues Test. Using the whole sample, a significant difference was found for average P scores reported for males and females, but no significant differences (...) were found based on age, work experience, and ethics training. However, the sample fell into distinct clusters that identified distinct male and female groupings. While females naturally fell into two distinct high- and low-moral reasoning ability clusters, male clusters were dominated more by work experience and ethics training. Clearly there are other factors mitigating the level of moral reasoning ability for males which require further exploration. The findings suggest that while the P score provides an initial point of comparison, the real benefit to the test is in exploring what is different for males and females in terms of training needs, and the impact of work experience on the moral reasoning ability, and most importantly, how to make ethics training enticing. Recommendations for future research are also discussed. (shrink)

Objective Some researchers claim that the quality of informed consent of clinical research participants in developing countries is worse than in developed countries. To evaluate this assumption, we reviewed the available data on the quality of consent in both settings. Methods We conducted a comprehensive PubMed search, examined bibliographies and literature reviews, and consulted with international experts on informed consent in order to identify studies published from 1966 to 2010 that used quantitative methods, surveyed participants or parents of paediatric participants (...) in actual trials, assessed comprehension and/or voluntariness, and did not involve testing particular consent interventions. Forty-seven studies met these criteria. We compared data about participant comprehension and voluntariness. The paucity of data and variation in study methodology limit comparison and preclude statistical aggregation of the data. Results and Discussion This review shows that the assertion that informed consent is worse in developing countries than in developed countries is a simplification of a complex picture. Despite the limitations of comparison, the data suggest that: (1) comprehension of study information varies among participants in both developed and developing countries, and comprehension of randomisation and placebo controlled designs is poorer than comprehension of other aspects of trials in both settings; and (2) participants in developing countries appear to be less likely than those in developed countries to say they can refuse participation in or withdraw from a trial, and are more likely to worry about the consequences of refusal or withdrawal. (shrink)

Artificial intelligence surveillance can be used to diagnose individual cases, track the spread of Covid‐19, and help provide care. The use of AI for surveillance purposes (such as detecting new Covid‐19 cases and gathering data from healthy and ill individuals) in a pandemic raises multiple concerns ranging from privacy to discrimination to access to care. Luckily, there exist several frameworks that can help guide stakeholders, especially physicians but also AI developers and public health officials, as they navigate these treacherous shoals. (...) While these frameworks were not explicitly designed for AI surveillance during a pandemic, they can be adapted to help address concerns regarding privacy, human rights, and due process and equality. In a time where the rapid implementation of all tools available is critical to ending a pandemic, physicians, public health officials, and technology companies should understand the criteria for the ethical implementation of AI surveillance. (shrink)

The aim of this paper is to argue that lying differs from mere misleading in a way that can be morally relevant: liars commit themselves to something they believe to be false, while misleaders avoid such commitment, and this difference can make a moral difference. Even holding all else fixed, a lie can therefore be morally worse than a corresponding misleading utterance. But, we argue, there are also cases in which the difference in commitment makes lying morally better than misleading, (...) as well as cases in which the difference is not morally relevant. This view conflicts with the two main positions philosophers have defended in the ethics of lying and misleading, which entail either that lying is in virtue of its nature worse than misleading or that there is no morally relevant difference between lying and misleading. (shrink)

In the latter half of the 20th century, Western medicine moved death from the home to the hospital. As a result, the process of dying seems to have lost its spiritual dimension, and become a matter of prolonging material life by means of medical technology. The novel quandaries that arose led in turn to medico-legal regulation. This paper describes the recent regulation of dying in Israel under its Dying Patient Law, 2005. The Law recognizes advance directives in principle, but limits (...) their effect and form through complex medico-legal artifices. It reflects a culture that places high value on both scientific medicine and the sanctity of life as such, and illustrates a medical culture that pitches battle against death. At the same time, the Law constructs the will of the individual in a medico-legal language that is alien to the lay person. The paper suggests an alternative approach to advance care planning that is patient-centred and addresses the psycho-social needs of the individual in terms of her relational autonomy. From this perspective, advance care planning becomes an opportunity to extract the patient from the medical context and allow her to speak about her approaching death with close ones in her own terms of reference. To this end, there is a need for facilitation of an intimate encounter where patients can speak about their concerns with their loved ones. The paper also presents a methodological approach of attentive listening, which can be applied across diverse cultures and circumstances. (shrink)

Pilcher, Carmel Review(s) of: Aboriginal church paintings: Reflecting on our faith, by Eugene Stockton Editor with Terence O'Donnell (Lawson: Blue Mountain Education and Research Trust Publishers, 2010), pp.45, $20.00.

Pilcher, Carmel Review of: Earth unites with heaven: An introduction to the liturgical year, by Gerard More, Northcote, VIC: Morning Star, 2014, pp. 75, $12.95.

Anthony Collins is known mostly as an eighteenth-century freethinker who contributed to ideas of rational religion and religious toleration, as a close friend of John Locke, and as a necessitarian and materialist who held a significant correspondence with Samuel Clarke. Yet, his political philosophy has rarely received serious attention, and he remains a neglected figure in the history of political thought. This article attempts to recover Collins as a philosopher who developed a complex political theory, by focusing on his conceptions (...) of liberty and authority. It shows that he conceptualised liberty, and liberty of thought in particular, both as non-interference and non-domination, namely, an absence of censorship as well as an absence of continuous tyranny over the minds of humankind. Then, it shows that Collins also developed a thorough idea of civil authority, according to which even religious liberties may depend in some cases on the discretion of the civil sovereign. Finally, this article suggests that Collins’s multi-layered theory continued to develop after his lifetime, and that he therefore had a prominent place in eighteenth-century debates of liberty and authority. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in all three subjects combined (...) comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

The rapid development of assisted reproduction technologies for the treatment of infertility appears to empower women through expanding their individual choice, but it is also creating new forms of suffering for them and their collaborators, especially in the context of transnational third-party reproduction. This paper explores the possibility of framing the ethical discourse around third-party reproduction by bringing attention to concerns of altruistic empathy for women who collaborate in the reproductive process, in addition to those of individualistic choice. This would (...) entail moving beyond an ethic of liberty that is based on self-interest and the language of rights, to an alternative ethic of care that is based on self-restraint and the language of responsibilities. An ethic of care and responsibility would cultivate the empathetic self-reflection of the autonomous actor in relation to those others who are part of the enterprise of bringing a child into the world. (shrink)

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)