Background: There is a growing need to offer appropriate services to persons with mild cognitive impairment and dementia who are faced with depression and anxiety distresses beyond traditional pharmacological treatment. Dance-based interventions as multi-dimensional interventions address persons' physical, emotional, social, and spiritual aspects of well-being. However, no meta-analysis of randomized controlled treatment trials has examined the effectiveness of dance-based interventions on depression and anxiety among persons with MCI and dementia, and the results of RCTs are inconsistent. The study aimed to (...) examine the effectiveness of dance-based interventions on depression and anxiety among persons with MCI and dementia.Methods: A systematic review with meta-analysis was conducted. The inclusion criteria were: population: people of all ages with MCI and dementia; intervention: dance-based interventions; control group: no treatment, usual care, or waiting list group; outcome: depression and anxiety; study design: published or unpublished RCTs. Seven electronic databases were searched from 1970 to March 2021. Grey literature and reference lists from relevant articles were also searched and reviewed. The Cochrane “Risk of Bias” tool was used to assess study quality. RevMan 5.4 was used for meta-analysis and heterogeneity was investigated by subgroup and sensitivity analysis. GRADE was applied to assess the evidence quality of depression and anxiety outcomes.Results: Five randomized controlled trials were identified. Sample sizes ranged from 21 to 204. The risk of bias was low, except for being rated as high or unclear for most included studies in two domains: allocation concealment, blinding participants and personnel. Meta-analysis of depression outcome showed no heterogeneity, indicating that the variation in study outcomes did not influence the interpretation of results. There were significant differences in decreasing depression in favor of dance-based interventions compared with controls [SMD = −0.42, 95% CI, p < 0.0001] with a small effect size ; Compared with the post-intervention data, the follow-up data indicated diminishing effects. Dance-based interventions were more effective in reducing depression for persons with dementia than with those having MCI, and were more effective with the delivery frequency of 1 h twice a week than 35 min 2–3 times a week. Also, one included RCT study showed no significant benefit on anxiety rating scores, which demonstrated small effect sizes at 6 weeks and 12 weeks. GRADE analysis indicated the evidence quality of depression was moderate, and the evidence quality of anxiety was low.Conclusions: Dance-based interventions are beneficial to alleviate depression among persons with MCI and dementia. More trials of high quality, large sample sizes are needed to gain more profound insight into dance-based interventions, such as their effects of alleviating anxiety, and the best approaches to perform dance-based interventions. (shrink)

It is human nature to try to recognize patterns and to make sense of that which we observe. Unfortunately, our intuition is often wrong, and so there is a need to impose some objectivity on the methods by which observations are converted into knowledge. One definition of biostatistics could be precisely this, the rigorous and objective conversion of medical and/or biological observations into knowledge. Both consumers of biostatistical principles and biostatisticians themselves vary in the extent to which they recognize the (...) need to continue the improvement. Some may not recognize the need for (some or all of) the methods that have already been developed; others may accept these as they find them completely sufficient; still others recognize both the value and the shortcomings of these methods, and seek to develop even better methods to ensure that future medical conclusions are less subject to biases than current ones are. (shrink)

A pandemic may cause a sudden imbalance between available medical resources and medical needs where fundamental care to a patient cannot be delivered. Inability to fulfil a professional commitment to deliver care as needed can lead to distress among caregivers and patients. This distress is sometimes alleviated through mechanisms that hide the facts that care is rationed and not all medical needs are met. We have identified three mechanisms that jeopardise accountable and optimal allocation of resources: (1) hidden value (...) judgements that allow rationing under the disguise of triage or prioritisation, (2) disguised conflict of interest between societal and individual patient’s needs and (3) concealed biases in the application of medical tools. Under these three pitfalls decisions of resource allocation and who gets treated are handled as medical decisions: normative decisions are concealed and perceived as falling with the realm of medical judgement. Value judgements and moral agency are hidden to offer a ‘false sense of medical judgement’, while in fact there are several ethical judgements and biases at stake. The three pitfalls entail hidden normative deliberation and are inappropriate for sustainable healthcare delivery and resource allocation. We believe it is necessary to maintain transparency in decision making under conditions of insufficient resources to maintain trust in professional care givers and secure fair treatment allocation. Recognition of the pitfalls, by applying our recommendations, may help to ensure transparent and accountable distribution of care and contribute to public acceptance of the ethics behind rationing. (shrink)

The terminology of “lives not worth living,” “worthwhile lives,” and “unworthwhile lives,” used by John Harris and many others, has become an accepted linguistic convention in bioethical discussions. These terms are used to distinguish lives of overwhelming negative experience from lives that are or are expected to be of overall positive value. As such, this terminology seems helpful in discussions around resource allocation, end-of-life decision making and questions of when it might be acceptable (and unacceptable) to reproduce. This paper (...) argues that there is, however, a problematic ambiguity inherent in these general terms that is particularly evident when it comes to discussing reproductive choices. It is suggested that in this context, this ambiguity can conceal authoritarian eugenic motivations that are difficult to justify and that many using these terms would not adhere to. As a result, it is argued that we should replace these terms with the terms “intrinsically valuable” and “intrinsically harmful.” This would make it more explicit what exactly is meant and would allow these matters to be debated with greater clarity. (shrink)

Objectives—To assess the relationship between the approval of trials by a research ethics committee and the fact that informed consent from participants was obtained, with the quality of study design and methods.Design—Systematic review using a standardised checklist.Main measures—Methodological and ethical issues of all trials published between 1993 and 1995 in the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association and the British Medical Journal were studied. In addition, clinical trials conducted in Spain and published (...) by at least one Spanish author during the same period in any other journal were also included.Results—We studied the published articles of 767 trials and found the following indicators of lower methodological quality to be independent predictors for failure to disclose REC approval or ICP: absence of concealment of allocation, lack of justification for unblinded trials, not using a treatment for the patients in the control group, absent information on statistical methods, not including sample size estimation, not establishing the rules to stop the trial, and omitting the presentation of a baseline comparison of groupsConclusion—Trials of higher methodological and scientific quality were more likely to provide information about their ethical aspects. (shrink)

This paper argues first that Armstrong is led to see natural resources primarily as objects of consumption. But many natural resources are better seen as objects of enjoyment, where one person’s access to a resource need not prevent others from enjoying equal access, or as objects of production, where granting control of a resource to one person may produce collateral benefits to others. Second, Armstrong’s approach to resource distribution, which requires that everyone must have equal access to welfare, conceals an (...) ambiguity as to whether this means equal opportunity for welfare, or simply equal welfare – the underlying issue being how far individuals should be held responsible for the use they make of the resources they are allocated. Third, when Armstrong attacks arguments that appeal to ‘improvement’ as a basis for claims to natural resources, he treats them as making comparative desert claims: if country A makes a claim to the improved resources on its territory, it must show that their comparative value accurately reflects the productive deserts of its members compared to those of countries B. But in fact, A needs only to make the much weaker claim that its members have done more than others to enhance the value of its resources. Overall, Armstrong’s welfarist approach fails to appreciate the dynamic advantages of allocating resources to those best able to use them productively. (shrink)

“Run-in” and “washout” periods involving the withholding of medication are widely used in drug research trials in pursuit of both patient safety and scientific reliability. Such no-medication periods can be justified ethically provided that they are apparent to patients, who can thereby properly consent to undergoing them. Less widespread, but still common, is the practice of “single blinding” no-medication periods, concealing them from patients by means of placebo. Whilst all placebos involve a measure of concealment, their use is typically (...) justified in drug research trials by their preserving the uncertainty generated by the random allocation of different treatments within a drug trial; and by the researchers openly declaring both the randomisation process and the chances of receiving placebo. In the single blind placebo “run-in” or “washout”, neither of these conditions is met.This paper considers three possible defences of the practice of using single blind placebo “run-ins” or “washouts” and finds them all to fail; the practice appears ethically unjustified. (shrink)

The purpose of this paper is to provide a normative model for the assessment of the exercise of power by Big Pharma. By drawing on the work of Steven Lukes, it will be argued that while Big Pharma is overtly highly regulated, so that its power is indeed restricted in the interests of patients and the general public, the industry is still able to exercise what Lukes describes as a third dimension of power. This entails concealing the conflicts of interest (...) and grievances that Big Pharma may have with the health care system, physicians and patients, crucially through rhetorical engagements with Patient Advocacy Groups that seek to shape public opinion, and also by marginalising certain groups, excluding them from debates over health care resource allocation. Three issues will be examined: the construction of a conception of the patient as expert patient or consumer; the phenomenon of disease mongering; the suppression or distortion of debates over resource allocation. (shrink)

Rationing health care is not new. As governments world wide struggle to contain the costs of health care, health policy analysts debate how rationing should be done. However, they too often neglect how the mechanisms for funding and allocating health care resources are themselves vehicles for rationing treatment. In the UK, where health care rationing debates currently abound, there has been no formal evaluation of the role of the market in allocating scarce health care resources.The market in health care has (...) increased administration, fragmented services, eroded local accountability, and decreased choice.This fragmentation, and the associated competition between purchasers and providers, means that resource allocation can no longer be monitored and evaluated in a national context. The loss of a population focus has left a vacuum in planning. Services cannot be planned rationally, and so are not able consistently to avoid duplication or to respond cogently to estimates of need.The loss of accountability means that decisions about the allocation of health care resources are no longer open to scrutiny by local people. Increasingly, especially in social and long term care the cost of care is being transferred to the individual. The new mechanisms for resource allocation are distributing resources unfairly: away from the poor, the sick and the elderly.The great myth of the market is that it has enabled decision-making to become explicit. This is not the case. To make health care resource allocation appear rational and acceptable to the public, health authorities have resorted to exercises in consumer consultation, and value laden guidelines where clinical cloaks are used to disguise political decisions on funding. In the UK, until the true role of the internal market is acknowledged, myths and subterfuge will conceal the winners and losers in the new system of rationing health care. (shrink)

Concealed questions are determiner phrases that are naturally paraphrased as embedded questions (e.g., John knows the capital of Italy ≈ John knows what the capital of Italy is). This paper offers a novel account of the interpretation of concealed questions, which assumes that an entity-denoting expression α may be type-shifted into an expression ?z.P(α), where P is a contextually determined property, and z ranges over a contextually determined domain of individual concepts. Different resolutions of P and the domain of z (...) yield a wide range of concealed question interpretations, some of which were not noted previously. On the other hand, principled constraints on the resolution process prevent overgeneration. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of (...) current practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

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)

This article addresses conceal and carry laws on higher education campuses as ethical and social dilemmas. The Second Amendment reads, “A well regulated Militia, being necessary to the security of a Free State, the right of the people to keep and bear Arms, shall not be infringed” (U. S. Const. amend. II 1791 ). Proponents for conceal and carry laws on college and university campuses often interpret the Second Amendment as an overarching right to have weapons, regardless of location. Opponents (...) of such legislation argue that allowing guns on campuses would be a mistake and student safety can be addressed in other ways. Throughout the 2010–2011 legislative sessions Arizona and Texas have been on the cusp of passing pro conceal and carry laws which would allow higher education students to carry weapons on campus. Over two decades states have increased access to weapons, while most in the U.S. have sentiments against their neighbors carrying arms (Kranz 2006 ). While the Second Amendment provides the right for individual to carry arms, higher education campuses are regarded as a subset of the population, a space for maturing adults and not a place for concealed weapons. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

After biologist Deborah Gordon made a series of experimental discoveries in the 1980s, she argued that a change in terminology regarding the division of labor among castes of specialists was needed. Gordon’s investigations of the interactive effects of ants in colonies led her to believe that the established approach Edward O. Wilson had pioneered was biased in a way that made some alternative candidate adaptive explanations invisible. Gordon argued that this was because the term “division of labor” implied a division (...) among specialists that was unwarranted, and proposed “task allocation” as a better description that did not bias research against the alternative causes she had discovered. Gordon’s empirical findings and theoretical proposals also vindicate the initial critics of Wilson’s human sociobiology who have been dismissed as political radicals, but her proposals have been widely misunderstood by many contemporary behavioral ecologists. The terminological and methodological confusions rampant in contemporary discourse can be clarified by applying a framework developed by Elisabeth Lloyd involving an analysis of the constraints imposed by different research questions. Applying this framework will show how the methodological problems involving description raised by the initial critics of Wilson’s human sociobiology extended to his analysis of ants, indicating that they were not challenging Wilson’s naturalistic approach to the study of human evolution, but rather his methods. It will also show how confusion over how Gordon’s proposed research questions have been conflated with the possible answers she has argued ought to be investigated. This in turn will clarify contemporary disputes over her proposal to abandon the term “division of labor.”. (shrink)

The COVID-19 pandemic has forced clinicians, policy-makers and the public to wrestle with stark choices about who should receive potentially life-saving interventions such as ventilators, ICU beds and dialysis machines if demand overwhelms capacity. Many allocation schemes face the question of whether to consider age. We offer two underdiscussed arguments for prioritising younger patients in allocation policies, which are grounded in prudence and fairness rather than purely in maximising benefits: prioritising one’s younger self for lifesaving treatments is prudent (...) from an individual perspective, and prioritising younger patients works to narrow health disparities by giving priority to patients at risk of dying earlier in life, who are more likely to be subject to systemic disadvantage. We then identify some confusions in recent arguments against considering age. (shrink)

Concealment -- Part of eloquence is to hide eloquence -- The concealed ornament -- Art or nature? -- In the garden -- Iki -- Those who cannot dissimulate cannot rule either -- True eloquence mocks eloquence -- Ready-mades.

This paper presents a novel treatment of quantified concealed questions , examining different types of NP predicates and deriving the truth conditions for pair-list and set readings. A generalization is proposed regarding the distribution of the two readings, namely that pair-list readings arise from CQs with relational head nouns, whereas set readings arise from CQs whose head nouns are not relational. It is shown that set readings cannot be derived under the ‘individual concept’ approach, one of the most influential analyses (...) of CQs on the market. The paper offers a solution to this problem. It shows that once we adopt an independently motivated view of traces—according to which traces are copies with descriptive content —nothing else needs to be postulated to derive set readings within an individual-concept-based analysis. Thus, what seemed to be a challenge for this type of analysis turns out to be an argument in its favor. (shrink)

This book presents a novel analysis of concealed-question constructions, reports of a mental attitude in which part of a sentence looks like a nominal complement, but is interpreted as an indirect question. Such constructions are puzzling in that they raise the question of how their meaning derives from their constituent parts. In particular, how a nominal complement, normally used to refer to an entity ends up with a question-like meaning. In this book, Ilaria Frana adopts a theory according to which (...) noun phrases with concealed question meanings are analysed as individual concepts. The traditional individual concept theory is modified and applied to the phenomena discussed in the recent literature and some new problematic data. The end result is a fully compositional account of a wide range of concealed-question constructions. The exploration of concealed questions offered in the book provides insights into both issues in semantic theory, such as the nature of quantification in natural languages and the use of type shifter in the grammar, and issues surrounding the syntax-semantics interface, such as the interpretation of copy traces and the effects on semantic interpretation of different syntactic analyses of relative clauses. The book will interest scholars and graduate students in linguistics, especially those interested in semantics and the syntax-semantics interface, as well as philosophers of language working on the topic of intensionality. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

In our reply to critiques of our GLP-1 receptor agonist allocation framework, we explain that using potential years of life lost (PYLL) as a metric addresses racial health disparities without explicitly allocating resources based on race. This approach is "racism-conscious" and has legal and ethical challenges over race-based approaches. Meanwhile, though acknowledging the importance of cardiovascular risk assessment, we maintain in response to other interlocutors that focusing solely on immediate risk would ignore the broader goal of mitigating disadvantage. We (...) emphasize that our framework balances multiple ethical objectives beyond just maximizing medical benefits. (shrink)

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....

This monograph is a critical assessment of the foundations of microeconomic theory, rationality, welfare resource allocation and capital reproduction. It examines the various concepts of rationality that have been constructed by 20th-century economists.

Crosslinguistically, causative constructions conform to the following generalization: If the causal relation is syntactically concealed, then it is semantically direct. Concealed causatives span a wide syntactic spectrum, ranging from resultative complements in English to causative subjects in Miskitu. A unified type-driven theory is proposed which attributes the understood causal relation—and other elements of constructional meaning—to type lifting operations predictably licensed by type mismatch at LF. The proposal has far-reaching theoretical implications not only for the theory of compositionality and causation, but (...) also for the underlying theory of events, space, and time, in natural language discourse. (shrink)

This paper is concerned with Noun Phrases (NPs, henceforth) occurring in two constructions: concealed question NPs and NP subjects of specificational sentences. The first type of NP is illustrated in (1). The underlined NPs in (1) have been called ‘concealed questions’ because sentences that embed them typically have the same truth-conditional meaning as the corresponding versions with a full-fledged embedded interrogative clause, as illustrated in (2) (Heim 1979).

The self-concealing of being is a primary preoccupation of Heidegger's later thought, but neither Heidegger nor his interpreters have made clear precisely what it is. In this paper, I identify the self-concealing of being as the concealing of the worlding of the world, which is essential to and simultaneous with that worlding. In order to establish this, I sketch a taxonomy of the various phenomena of concealing and concealment in Heidegger's work by building on Mark Wrathall's four ‘planks’ of (...) unconcealing and concealment. Importantly, I distinguish the procedurally prior concealment that all unconcealing presupposes from the simultaneous concealing that Heidegger frequently confuses it with. This distinction not only allows us to get clear on what it means to say that being conceals itself but also reveals various confusions and obscurities in Heidegger's own thought as well as in that of his readers. (shrink)

Our evaluation of questions and knowledge attributions may vary relative to the way in which the relevant objects are identified. In the first part, the article proposes a theory that represents different methods of trans-world identification and is able to account for their impact on interpretation. In the second part, the same theory is used to account for the meaning of concealed questions. On the proposed account, the interpretation of a concealed question results from the application of a type-shifting operation (...) mapping an individual denoting expression into an identity question interpreted relative to a contextually selected identification method. (shrink)

This article considers the possible relation between the idea of parity and some past work on the allocation of scarce resources. Parity of value is first connected with the idea of some goods being irrelevant in interpersonal comparisons. The notion of moral parity is introduced to describe the recognition that people who are moral equals (even when they are not on a par in terms of value) as not substitutable. The relation between a Separability Test and nonsubstitutability of persons (...) is considered. These ideas are then used to discuss various cases in which one must choose to whom to provide medical assistance, including whether and when to distinguish morally between a disabled and a nondisabled person. (shrink)

There are now several proposals for introducing random elements into the process of funding allocation for research, and some initial implementation of this policy by funding bodies. The proposals have been supported on efficiency grounds, with models, including social epistemology models, showing random allocation could increase the generation of significant truths in a community of scientists when compared to funding by peer review. The models in the literature are, however, fairly abstract. This paper introduces some of the considerations (...) that are required to build on the modelling work towards a fully-fledged policy proposal, including issues of cost and fairness. (shrink)

Everyone knows that something has gone wrong, in the United States, with the conventions of privacy. Along with a vastly increased tolerance for variation in sexual life we have seen a sharp increase in prurient and censorious attention to the sexual lives of public figures and famous persons, past and present. The culture seems to be growing more tolerant and more intolerant at the same time, though perhaps different parts of it are involved in the two movements.

During the twelfth and thirteenth centuries, great new trends of Jewish thought emerged whose widely varied representatives--Kabbalists, philosophers, and astrologers--each claimed that their particular understanding revealed the actual secret of the Torah. They presented their own readings in a coded fashion that has come to be regarded by many as the very essence of esotericism. Concealment and Revelation takes us on a fascinating journey to the depths of the esoteric imagination. Carefully tracing the rise of esotericism and its function (...) in medieval Jewish thought, Moshe Halbertal's richly detailed historical and cultural analysis gradually builds conceptual-philosophical force to culminate in a masterful phenomenological taxonomy of esotericism and its paradoxes. Among the questions addressed: What are the internal justifications that esoteric traditions provide for their own existence, especially in the Jewish world, in which the spread of knowledge was of great importance? How do esoteric teachings coexist with the revealed tradition, and what is the relationship between the various esoteric teachings that compete with that revealed tradition? Halbertal concludes that, through the medium of the concealed, Jewish thinkers integrated into the heart of the Jewish tradition diverse cultural influences such as Aristotelianism, Neoplatonism, and Hermeticisims. And the creation of an added concealed layer, unregulated and open-ended, became the source of the most daring and radical interpretations of the tradition. (shrink)

The COVID-19 pandemic will likely recede only through development and distribution of an effective vaccine. Although there are many unknowns surrounding COVID-19 vaccine development, vaccine demand will likely outstrip early supply, making prospective planning for vaccine allocation critical for ensuring the ethical distribution of COVID-19 vaccines. Here, we propose three central goals for COVID-19 vaccination campaigns: to reduce morbidity and mortality, to minimise additional economic and societal burdens related to the pandemic and to narrow unjust health inequalities. We evaluate (...) five prioritisation approaches, assess their likely impact on advancing the three goals of vaccine allocation and identify open scientific questions that may alter their outcomes. We argue that no single prioritisation approach will advance all three goals. Instead, we propose a multipronged approach that considers the risk of serious COVID-19 illness, instrumental value and the risk of transmission, and is guided by future research on COVID-19-specific clinical and vaccine characteristics. While we focus this assessment on the USA, our analysis can inform allocation in other contexts. (shrink)

The novel COVID-19 pandemic has placed medical triage decision-making in the spotlight. As life-saving ventilators become scarce, clinicians are being forced to allocate scarce resources in even the wealthiest countries. The pervasiveness of air travel and high rate of transmission has caused this pandemic to spread swiftly throughout the world. Ethical triage decisions are commonly based on the utilitarian approach of maximising total benefits and life expectancy. We present triage guidelines from Italy, USA and the UK as well as the (...) Jewish ethical prospective on medical triage. The Jewish tradition also recognises the utilitarian approach but there is disagreement between the rabbis whether human discretion has any role in the allocation of scarce resources and triage decision-making. (shrink)

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens (...) in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties. (shrink)

Resource Allocation Mechanisms derives the general welfare properties of systems in which individuals are motivated by self-interest. Satisfactory outcomes will emerge only if individual incentives are harnessed by means of a communication and payoff process, or mechanism, involving every agent. Professor Campbell employs a formal and abstract model of a mechanism that brings into prominence the criteria by which the performance of an economy is to be judged. The mechanism approach is used to prove some fundamental theorems about the (...) possibility of designing an economic system satisfying the criteria. It also establishes a way of thinking about economic issues that is becoming increasingly useful in special branches of economics, such as industrial organization and public finance. This book can be viewed as two different texts: one constitutes an introduction to the theory of mechanism design and the other is a treatment of welfare economics with conventional emphasis on Pareto optimality as well as providing substantial material on incentives, uncertainty, and existence of equilibrium. (shrink)

Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of the research enterprise (...) when allocating scarce biospecimens. We provide an ethical framework for assessing the social value of proposed research projects and describe how the framework could be implemented. (shrink)

Feminists have long argued that women who offend are judged by who they are, not what they do, with idealised images of femininity and motherhood used as measures of culpability. The ability to meet the expectations of motherhood and femininity are particularly difficult for women who experience a crisis pregnancy, as evident in cases where women have been convicted of concealment of birth. The offence prohibits the secret disposal of the dead body of a child, to conceal knowledge of (...) its birth. Traditionally used to prosecute women suspected of killing their newborn children, analysis of court transcripts suggests the offence is also used to punish women who fail to meet expectations of motherhood. This paper analyses three contemporary cases in light of the historical origins of the offence, illustrating the legacy of prejudice against ‘deviant’ mothers. Finally, it questions the continued existence of this archaic offence. (shrink)

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

In a much cited phrase in the famous English ‘Child B’ case, Mr Justice Laws intimated that in life and death cases of scarce resources it is not sufficient for health care decision-makers to ‘toll the bell of tight resources’: they must also explain the system of priorities they are using. Although overturned in the Court of Appeal, the important question remains of the extent to which health-care decision-makers have a duty to give reasons for their decisions. In this paper, (...) I examine the philosophical foundations of the legal obligation to give reasons in English law. Why are judges sometimes supportive of the imposition of a duty to give reasons and sometimes not? What is it about the context of life and death health care allocation problems that makes it unsuitable in their view for such a duty; and is this stance justified? What is it to give a reason for a decision? I examine Frederick Schauer’s account of reason-giving in terms of generalisation and commitment and I suggest that it provides an overstated account of what giving a reason commits one to. I go on to examine an idea of judicial creation: that where value judgements are “inexpressible” there is a strong reason not to impose a duty to give reasons on to public bodies. The strongest case for a duty to give reasons is in terms of the value of respect for citizens. I argue that there is nothing in the very nature of reason-giving that ought to preclude the imposition of such a duty in this context, but concede that there is a serious danger of legalism that could result in a hamstringing of health care decision-making. It is up to judges and lawyers to seek to avoid this danger. (shrink)

Resource allocation has always been a key technology in wireless sensor networks, but most of the traditional resource allocation algorithms are based on single interface networks. The emergence and development of multi-interface and multichannel networks solve many bottleneck problems of single interface and single channel networks, it also brings new opportunities to the development of wireless sensor networks, but the multi-interface and multichannel technology not only improves the performance of wireless sensor networks but also brings great challenges to (...) the resource allocation of wireless sensor networks. Edge computing changes the traditional centralized cloud computing processing method into a method that reduces computing storage capacity to the edge of the network and faces users and terminals. Realize the advantages of lower latency, higher bandwidth, and fast response. Therefore, this paper proposes a joint optimization algorithm of resource allocation based on edge computing. We establish a wireless sensor allocation model and then propose our algorithm model combined with the advantages of edge computing. Compared with the traditional allocation algorithm, it can further improve the resource utilization, reduce the network energy consumption, increase network capacity, and reduce the complexity of the schemes. (shrink)

The valence–space metaphor research area investigates the metaphorical mapping of valenced concepts onto space. Research findings from this area indicate that positive, neutral, and negative concepts are associated with upward, midward, and downward locations, respectively, in the vertical plane. The same research area has also indicated that such concepts seem to have no preferential location on the horizontal plane. The approach–avoidance effect consists in decreasing the distance between positive stimuli and the body and increasing the distance between negative stimuli and (...) the body. Thus, the valence–space metaphor accounts for the mapping of valenced concepts onto the vertical and horizontal planes, and the approach–avoidance effect accounts for the mapping of valenced concepts onto the “depth” plane. By using a cube conceived for the study of allocation of valenced concepts onto 3D space, we show in three studies that positive concepts are placed in upward locations and near the participants’ body, negative concepts are placed in downward locations and far from the participants’ body, and neutral concepts are placed in between these concepts in both planes. (shrink)

Waiting lists are a standard approach to managing excess demand in elective health care. While waiting times are an important policy issue, the ethical validity of the first come, first served (FCFS) principle as such is rarely questioned. Presenting a psychiatric day hospital where all eligible patients have roughly equal claims as a case study, we criticize the reflex use of FCFS for allocation of elective psychiatric care, consider conditions under which this may not be the optimal strategy, and (...) discuss alternatives. We conclude that in our example prioritizing more recent referrals (last come, first served [LCFS]) makes more sense, clinically and ethically. Where several referrals arrive (near-)simultaneously under LCFS, we propose that a higher level of scrutiny be applied to detect possible good reasons for prioritizing one of them. We believe that our observations can be applied to other health care settings that share relevant characteristics with our case. (shrink)

Volume 20, Issue 9, September 2020, Page 31-33.

ABSTRACT This study examined how lifestyle factors and gender affect kidney allocation to transplant patients by 99 British and Singaporean participants. Thirty hypothetical patients were generated from a combination of six factors and randomly paired four times. Participants saw 60 patient pairings and, in each pair, chose which patient would receive treatment priority. A Bradley-Terry model was used to derive coefficients for each factor per participant. A mean factor score was then calculated across all participants for each factor. Participants (...) gave lower priority to patients who drank more, were overweight, smoked more and exercised less. A patient’s diet and gender had no significant effect on allocation. There were no significant cross-cultural differences. There were moderate correlations between participants’ self-reported pre- and post-experiment ordering of decision criteria, and these measures and factor coefficients, suggesting a modest level of decision-making consistency. Between participants, moderate levels of concordance with respect to factor importance were observed for self-reported orderings of factors, and weaker agreement for model-derived coefficients. Very similar results were obtained for both British and Singaporean participants, and the implications of the findings are discussed. (shrink)