This book intervenes in contemporary debates about the threat posed to democratic life by political emergencies. Must emergency necessarily enhance and centralize top-down forms of sovereignty? Those who oppose executive branch enhancement often turn instead to law, insisting on the sovereignty of the rule of law or demanding that law rather than force be used to resolve conflicts with enemies. But are these the only options? Or are there more democratic ways to respond to invocations of emergency politics? (...) Looking at how emergencies in the past and present have shaped the development of democracy, Bonnie Honig argues that democracies must resist emergency's pull to focus on life's necessities because these tend to privatize and isolate citizens rather than bring us together on behalf of hopeful futures. Emphasizing the connections between mere life and more life, emergence and emergency, Honig argues that emergencies call us to attend anew to a neglected paradox of democratic politics: that we need good citizens with aspirational ideals to make good politics while we need good politics to infuse citizens with idealism.Honig takes a broad approach to emergency, considering immigration politics, new rights claims, contemporary food politics and the infrastructure of consumption, and the limits of law during the Red Scare of the early twentieth century. Taking its bearings from Moses Mendelssohn, Franz Rosenzweig, and other Jewish thinkers, this is a major contribution to modern thought about the challenges and risks of democratic orientation and action in response to emergency. (shrink)

This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s self-determination, the patient’s best interest, the carer’s professional ideals, the (...) carer’s professional role and self-identity, significant others and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. It is often argued that prehospital care is unique in comparison with other forms of care. However, in this article we do not find support for the idea that ethical conflicts occurring in prehospital care are unique, even if some may be more common in this context. (shrink)

Emergency care providers regularly deal with ethical dilemmas that must be addressed. In comparison with in-hospital nurses, emergency medical service personnel are faced with more problems such as distance to resources including personnel, medico-technical aids, and information; the unpredictable atmosphere at the scene; arriving at the crime scene and providing emergency care for accident victims and patients at home. As a result of stressfulness, unpredictability, and often the life threatening nature of tasks that ambulance professionals have to (...) deal with every day, ethical decision-making has become an inevitable challenge. The content analysis approach was used to conduct the present qualitative study in Iran. The participants consisted of 14 EMS personnel selected through purposive sampling, which continued until the data became saturated. Data were collected using semi-structured interviews and analyzed concurrently with their collection through the constant comparison method. The process of data analysis resulted in the emergence of 3 main categories “respecting client’s values”, “performing tasks within the professional manner”, “personal characteristic”, and the emergence of eight sub-categories signifying participants’ experiences with regard to EDM. According to the results, when EMS personnel are faced with ethical dilemmas, they consider the client’s values and professional dignity, and perform the assigned tasks within the framework of the regulation. The findings also suggest that pre-hospital care providers assess legal consequences before making any decision. Further studies should be conducted regarding the experiences of the subordinates and other related parties. (shrink)

Background: Whenever there has been a worldwide contagious disease outbreak, there have been reports of infection and death of healthcare workers. Particularly because emergency nurses have contact with patients on the front line, they experience ethical problems in nursing while struggling with infectious diseases in an unfavorable environment. Objective: The objective of this study was to explore emergency nurses’ ethical problems and to identify factors influencing these problems during the outbreak of Middle East respiratory syndrome–coronavirus in Korea. Design (...) and sample: For this cross-sectional study, a questionnaire survey was conducted with emergency nurses working in six hospitals selected through convenience sampling from the hospitals designated for Middle East respiratory syndrome–coronavirus patients in the capital area. Methods: Data were collected from 169 emergency nurses in Korea during August 2015. Ethical considerations: This research was approved by the Institutional Review Board of G University in Korea. Results: The findings of this study suggest that during the Middle East respiratory syndrome–coronavirus outbreak, emergency nurses experienced ethical problems tied to a mind-set of avoiding patients. Three factors were found to influence emergency nurses’ ethical problems (in order of influence): cognition of social stigmatization, level of agreement with infection control measures, and perceived risk. Conclusion: Through this study, we obtained information on emergency nurses’ ethical problems during the Middle East respiratory syndrome–coronavirus outbreak and identified the factors that influence them. As found in this study, nurses’ ethical problems were influenced most by cognitions of social stigmatization. Accordingly, to support nurses confidently care for people during future health disasters, it is most urgent to promote appropriate public consciousness that encourages healthcare workers. (shrink)

McCLOSKEY R. Nursing Inquiry 2011; 18: 154–164The ‘mindless’ relationship between nursing homes and emergency departments: what do Bourdieu and Freire have to offer?This paper explicates the long-standing and largely unquestioned adversarial relationship between nurses working in the nursing home (NH) and the emergency department (ED). Drawing on the author’s own research on resident ED transfers, this paper reports on the conflict and tension that can arise when residents transfer between the two settings. The theoretical concepts of mindlessness, habitus, (...) social capital and oppression are deployed to understand the contextual nature of the social relations that exist between NH and ED practitioners and between practitioners and residents. This theoretical discussion offers the potential to uncover the social relations that give rise to problematic transfers which may lead to alternative and more productive NH to ED transfers. (shrink)

Background: Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals. Aim: To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations. Methods: Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group. Ethical considerations: Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research. Result/conclusion: Two categories emerged: one (...) in ‘ethical issues’ and one in ‘emotions and feelings in caring’. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse’s ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients’ care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with ‘end-of-life’ care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient’s ‘previous wishes’ in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient’s advocate. The nurses express feelings of distress, suffering, anger and helplessness. (shrink)

How should the hospital’s ethics consultation service respond to this request from the Emergency Department for advice about “how to proceed” in caring for ED patient Benjamin? In order to off...

He describes this most private work of Heidegger's philosophy as "a dissonant symphony that imperfectly weaves together its moments into a vast fugue, under the ...

The term “climate emergency” was employed in the 2008 book Climate Code Red as both a problem statement and a solutions strategy. The core propositions – that the biophysical circumstances were worse than generally understood, that the 2°C goal was dangerously high, and that the time for incremental change had expired – are re-examined in light of events over the last decade and the growing existential risk. The failure to recognise and respond to the climate emergency, and the (...) incapacity of markets to do so, means that widespread social, economic, and physical disruption is now inevitable. An emergency mode of response, characterised by decisive state leadership and market intervention which challenges the dominant economic paradigm, is now necessary to protect contemporary civilisation. (shrink)

The paucity of research data to guide current paediatric practice has led to children being termed therapeutic orphans. This difficulty is especially pertinent to research in emergency situations, such as acute resuscitation or critical care, where accepted ethical standards for overall research, have historically created practical difficulties for researchers. The welcome establishment of organisations to support UK paediatric research is helping to ensure safer and more effective medications for children, however as the balance between protection and access at the (...) heart of the paediatric research ethical debate shifts to ever increasing access for researchers to children, it remains crucial to ensure the protection for these vulnerable participants. The fundamental protection for research subjects, namely their full informed consent before any recruitment, is not tenable in true emergency situations and so other approaches are warranted if standards are to be improved by human subjects research in such areas. Proxy, deferred and retrospective consent have all been advocated as solutions to this difficulty and this paper explores the ethical justification for these approaches and their utility in safeguarding children and families in emergency situations when traditional informed consent, as currently defined, cannot be obtained in the necessary time frame to enable research. (shrink)

The COVID-19 pandemic created a situation for the implementation of emergency remote learning. This meant that as a lecturer at a traditionalist University of contact sessions, the pandemic forced us to teach remotely through online methods of communication, using online lectures, narrated powerpoints, voice clips, podcasts, interviews and interactive videos. The assessments were conducted online from assignments to multiple choice questions, which forced the lecturers to think differently about the way the assessments were presented, in order to avoid easy (...) access to answers found in a textbook and online. This meant that more application questions of theory to practice were assessed in a more challenging way to prevent cheating and collaboration with peers. Formal assessments completed during emergency remote learning, have become the past practice, as innovative methods have been adopted for learning and for assessment purposes in order to preserve the integrity and attainment of the degree through online modes of learning. The aim of the paper investigates and explores the methods of teaching, together with the results obtained from the students of 2019 and 2020 in their final year relating to two final year modules against the literature relating to learning processes and methodologies. (shrink)

Any plausible position in the ethics of war and political violence in general will include the requirement of protection of civilians (non-combatants, common citizens) against lethal violence. This requirement is particularly prominent, and particularly strong, in just war theory. Some adherents of the theory see civilian immunity as absolute, not to be overridden in any circumstances whatsoever. Others allow that it may be overridden, but only in extremis. The latter position has been advanced by Michael Walzer under the heading of (...) “supreme emergency.” In this paper, I look into some of the issues of interpretation and application of Walzer’s “supreme emergency” view and some of the criticisms that have been levelled against it. I argue that Walzer’s view is vague and unacceptable as it stands, but that the alternatives proposed by critics such as Brian Orend, C.A.J. Coady, and Stephen Nathanson are also unattractive. I go on to construct a position that is structurally similar to Walzer’s, but more specific and much less permissive, which I term the “moral disaster” view. According to this view, deliberate killing of civilians is almost absolutely wrong. (shrink)

Winner of the 2020 European Walter Benjamin Prize, The Revolution is the Emergency Break is a rich compilation of Walter Benjamin's lesser-known writings by renowned social scientist Michael Löwy. Translated into several languages but available in English for the very first time, Löwy brings together the philosophical, literary, theological, and cultural aspects of Benjamin's writings, including his relation to figures such as Gershom Scholem and Franz Rosenzweig, his interpretation of historical materialism, surrealism, anti-fascism and anarchism, his contribution to understanding (...) capitalism as a religion, and his relevance for Latin America and ecology today. The concept of revolution in his writings - not only the political ones, but also those that deal with art, literature or theology, run through the work connecting the various chapters. The Revolution is the Emergency Break also features four new chapters this collection. Written in a clear-eyed, accessible language, The Revolution is the Emergency Break is a must-read for researchers, teachers, and students interested in the works of this influential German intellectual. (shrink)

Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders (...) in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration. (shrink)

Abstract:The straightforward normative importance of emergencies suggests that empirically engaged political theorists and philosophers should study them. Indeed, many have done so. In this essay, however, I argue that scholars interested in the political and/or moral dimensions of large-scale emergencies should shift their focus from emergencies to emergency claims. Building on Michael Saward’s model of a “representative claim,” I develop an account of an emergency claim as a claim that a particular (kind of) situation is an emergency, (...) made by particular actors against particular background conditions to particular audiences, which in turn accept, ignore, or reject that claim. Emergency politics, in turn, consists of many different actors making and not making, accepting, and rejecting, a wide range of overlapping and competing emergency claims. I argue that scholars should shift their focus to emergency claims because doing so helps us see the fraught implications of emergency politics for marginalized groups. I examine three such implications: emergency claims are often “Janus-faced,” meaning that they function simultaneously as “weapons of the weak” and weapons of the strong; they are often regressive, including by discriminating against victims of chronic bad situations, and they often perpetuate and exacerbate existing social hierarchies. Noticing these troubling features of emergency politics raises a question that I do not address here: What might plausible alternatives to emergency politics look like? (shrink)

Both Rawls and Walzer argue for a supreme emergency exemption and are commonly thought to do so for the same reasons. However, far from ‘aping’ Walzer, Rawls engages in a reconstruction of the exemption that changes its focus altogether, making clear its dependence on an account of universal human rights and the idea of a well-ordered society. This paper is therefore, in the first instance, textual, demonstrating that Rawls has been misinterpreted in the case of supreme emergency. In (...) the second instance the approach is reconstructive, providing a reinterpretation of Rawls that fits his treatment of supreme emergency with his broader commitments in just war and international relations. This reinterpretation enables us to draw out a pattern of argument that Rawls appears to share with a much more strident liberal cosmopolitanism. (shrink)

In this article, we discuss the ethics of research suspensions in animal research facilities and the consequent (mis)treatment of laboratory animals during emergencies. Through a case study from Switzerland during the COVID-19 pandemic, we articulate ethical principles and moral considerations that ought to guide the treatment and care of laboratory animals within animal research facilities during emergencies. They include a principle of preparedness, the importance of recognizing animal laboratory personnel as essential workers and conducting a Harm-Benefit Analysis in the case (...) of an emergency, assigning responsibilities in a clear way, and providing psychological support in the aftermath of an emergency. More generally, we suggest that the pandemic should be taken as a learning opportunity for critically re-evaluating and improving emergency planning within animal research institutions worldwide, in view of mitigating risks to both human and animal well-being in future emergencies. (shrink)

This study appeared in full in the last issue of Research Ethics Review (2009; 5(2): 83). Based on prior research that has indicated it may be beneficial, a researcher wants to administer a heart medication to patients who have suffered lung injuries in car crashes. Due to the emergency nature of the research, seeking consent either from the research participants or, at least initially, their next of kin is difficult.

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a "community" within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between "autonomy" and "community." The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. (...) Part II examines a clinical trial for the blood substitute PolyHeme® (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of "community." The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment. (shrink)

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, (...) codified and triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

This article addresses the rise of faith-based emergency relief by examining the US President’s Emergency Plan for HIV/AIDS (PEPFAR), a public health intervention focused on the AIDS epidemic in sub-Saharan Africa. It argues that the theological turn in humanitarian aid serves to amplify ongoing dynamics in the domestic politics of sub-Saharan African states, where social services have assumed the form of chronic emergency relief and religious organizations have come to play an increasingly prominent role in the provision (...) of such services. In the context of an ongoing public health crisis, PEPFAR has institutionalized the social authority of the Pentecostal and charismatic churches, leading to a semantic confluence between the postcolonial politics of emergency and the Pentecostal/Pauline theology of kairos or event. Far from being confined to the space of foreign aid, however, the faith-based turn in humanitarianism is in keeping with ongoing reforms in domestic social policy in the United States. While on the one hand the sustained welfare programmes of the New Deal and Great Society have been dismantled in favour of a system of emergency relief, on the other hand the federal government has intensified its moral, pedagogical and punitive interventions into the lives of the poor. The wilful transfer of welfare services to overtly religious service providers has played a decisive role in this process. The article concludes with a critical appraisal of the links between African and North American Pentecostal-evangelical churches and questions the revolutionary mission ascribed to Pauline political theology in recent political theory. (shrink)

More than any other aspect of the Second Scientific Revolution, the remarkable revitalization or British mathematics and mathematical physics during the first half of the nineteenth century is perhaps the most deserving of the name. While the newly constituted sciences of biology and geology were undergoing their first revolution, as it were, the reform of British mathematics was truly and self-consciously the story of a second coming of age. ‘Discovered by Fermat, cocinnated and rendered analytical by Newton, and enriched by (...) Leibniz with a powerful and comprehensive notation’, wrote the young John Herschel and Charles Babbage of the calculus in 1813, ‘as if the soil of this country [was] unfavourable to its cultivation, it soon drooped and almost faded into neglect; and we now have to re-import the exotic, with nearly a century of foreign improvement, and to render it once more indigenous among us’. (shrink)

ArgumentHijōji was an important keyword in the militarist Japan of the 1930s. Previous scholarship has assumed that such language sprung from the global financial crisis of 1929, and subsequent diplomatic events. Our article demonstrates, however, that a full-bodied language of emergency was crafted well before the collapse of the global economy, and against the backdrop of the Great Kanto Earthquake of 1923, which destroyed the Japanese capital. While previous “great earthquakes” had been opportunities to strengthen Japanese participation in the (...) global project of science, this one led more dramatically to a crisis of reason, and indirectly contributed to the spiritual, anti-western, and anti-rational rhetoric of what became the “Showa Restoration.” This and other post-disaster landscapes, we argue, should be examined as compelling sites for the crafting of political language – sites of opportunity and meaning as well as trial. While the phrase “state of emergency” was coined under very different circumstances in post-war Britain, it gained power and charisma in Japan, and likely other places around the world, by its association with natural catastrophe. Thus did modern politics establish a new connection with the traditional realm of the sublime, and in the case of Japan, the supernatural. Emergency's ability to associate politics with nature would never disappear, and has perhaps even strengthened in the early twenty-first century. (shrink)

: On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of (...) rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion. (shrink)

High degrees of uncertainty and a lack of effective therapeutic treatments have characterized the COVID-19 pandemic and the provision of drug products outside research settings has been controversial. International guidelines for providing patients with experimental interventions to treat infectious diseases outside of clinical trials exist but it is unclear if or how they should apply in settings where clinical trials and research are strongly regulated. We propose the Professional Oversight of Emergency-Use Interventions and Monitoring System as an alternative pathway (...) based on guidance developed for the ethical provision of experimental interventions to treat COVID-19 in Singapore. We support our proposal with justifications that establish moral duties for physicians to record outcomes data and for institutions to establish monitoring systems for reporting information on safety and effectiveness to the relevant authorities. Institutions also have a duty to support generation of evidence for what constitutes good clinical practice and so should ensure the unproven intervention is made the subject of research studies that can contribute to generalizable knowledge as soon as practical and that physicians remain committed to supporting learning health systems. We outline key differences between POEIMS and other pathways for the provision of experimental interventions in public health emergencies. (shrink)

Background: Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity. Aim: This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction. Research design: This research employed a descriptive and cross-sectional design. Participants and research context: This study was conducted with a sample of 236 nurses, all of whom worked (...) in emergency service between 24 July 2015 and 28 April 2016. Data were collected using the Moral Sensitivity Questionnaire, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale. Ethical considerations: This study was approved by the Institutional Ethics Review Board of Ondokuz Mayıs University. Findings: There was a weak and negative correlation (r = –0.158, p = 0.015) between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores. There was also a weak and negative correlation (r = –0.335, p < 0.001) between the Maslach Burnout Inventory and Minnesota Job Satisfaction Scale scores. Discussion and conclusion: Decreased job satisfaction and increased burnout levels among emergency service nurses might result in them indulging in improper practices, frequently facing ethical problems, and a decrease in the overall quality of service in hospitals. In order for emergency service nurses to recognize ethical problems and make the most accurate decisions, a high level of ethical sensitivity is critical. In this respect, it is suggested that continuing education after graduation and training programs should be organized. (shrink)

This study aims to the role of emergency paramedics in transporting cases to hospitals, the rate of completion of emergency paramedics in transporting cases to hospitals in record time, the role of emergency paramedics in saving people’s lives, a questionnaire was prepared via Google Drive and distributed to the population aged 25-55 years, men and women, in the city of Mecca. As for the questionnaire, it was distributed via the social networking program (WhatsApp) for the purpose of (...) distancing for fear of the presence of the Corona virus. 400 questionnaires were distributed, and 380 responses were obtained via email to the principal researcher. The paramedic writes a brief report and sends it with the injured person when he is transported to the doctor or to the hospital? Yes 91.1%. From the participants’ opinions, we it concluded that the role of the emergency paramedic is extremely important in saving people’s lives. (shrink)

Improving the treatment of life threatening emergency illness or disease requires that new or novel therapies be assessed in clinical trials. As most subjects for these trials will be incapacitated there is some controversy about they might best protected whilst still allowing research to continue. Recent European and UK clinical trials legislation, which has effectively stopped research into emergency conditions, is discussed. Possible changes to these regulations are proposed.

Few novel or emerging infectious diseases have posed such vital ethical challenges so quickly and dramatically as the novel coronavirus SARS‐CoV‐2. The World Health Organization declared a public health emergency of international concern and recently classified Covid‐19 as a worldwide pandemic. As of this writing, the epidemic has not yet peaked in the United States, but community transmission is widespread. President Trump declared a national emergency as fifty governors declared state emergencies. In the coming weeks, hospitals will become (...) overrun, stretched to their capacities. When the health system becomes stretched beyond capacity, how can we ethically allocate scarce health goods and services? How can we ensure that marginalized populations can access the care they need? What ethical duties do we owe to vulnerable people separated from their families and communities? And how do we ethically and legally balance public health with civil liberties? (shrink)

Terrorist violence is often condemned for targeting innocents or non-combatants. There are two objections to this line of argument. First, one may doubt that terrorism is necessarily directed against innocents or non-combatants. However, I will focus on the second objection, according to which there may be exceptions from the prohibition against killing the innocent. In my article I will elaborate whether lethal terrorism against innocents can be justified in a supreme emergency. Starting from a critique of Michael Walzer’s account (...) of supreme emergency, I will argue that the supreme emergency exemption justifies the resort to terrorism against innocents to avert moral disasters such as genocide and ethnic cleansing, provided that the criteria of last resort, proportionality and public declaration are satisfied. (shrink)

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.

The Emergency Department is a crucial medical treatment unit of hospital specializing in emergency medicine. EDs are responsible for providing immediate healthcare facilities to patients arriving without prior appointment. Thus, evaluating patient satisfaction is of immense importance for efficient service delivery. Very few studies are found in Pakistan, related to patients’ satisfaction and utilization of ED services both from demand and supply perspective of ED-Services Supply Chains. Data was collected to assess 200 patient’s satisfaction towards quality of healthcare (...) services of ED of Sindh Government Qatar Hospital, Orangi town-a tertiary care hospital in Karachi. Structured questionnaire was developed to interview patients and their attendants. Results of SPSS analysis revealed that 55% of patients were transferred to ED within 5 minutes, which shows efficient patient queues and flow management. 64.5% patient’s average LOS was between 40-60 minutes. 71% get the availability of basic facilities in ED. Majority of patients i.e. 96.5% and 90.5%, showed satisfaction with the time spent and treatment given by the doctor. Majority of the patients are satisfied with the services and performance of ED of a tertiary care hospital and 76% patients showed willingness to recommend ED of Government Qatar Hospital, Karachi to others. (shrink)

There is a class of actions — reflex actions — which seem not to spring from any intention, but for which we nevertheless wish to take responsibility. It is suggested that these actions are appropriately said to be done intentionally, in spite of our never having an intention to do them. And this grammatical anomaly indicates that the behavior in question requires a special kind of account; one which might be characterized as derivative: parasitic on the more paradigmatic sort of (...) action explanation. (shrink)

This paper focuses on an emergency basic income as a tool for avoiding financial insecurity during the time of pandemic. The authors argue that paying each resident a monthly cash amount for the duration of the crisis would serve to protect them from the economic fallout.They suggest three reasons why the EBI proposal is particularly well-suited to play an important role in a comprehensive public health response to COVID-19: it offers an immediate and agile response; it prioritizes the most (...) vulnerable in the affected population; and it promotes a solidaristic response to the pandemic crisis. To go beyond the need to shut down and restart an EBI assistance scheme each time a pandemic hits, the authors propose considering turning the program into a permanent feature. (shrink)

BackgroundHealth research often uses health information, a subcategory of personal information, collected during clinical encounters. Conditions under which such health information can be used for the secondary purpose of research are set out in state, national and international law. In Australia, consent is required or the relevant conditions for a waiver of consent must be met and approved by a human research ethics committee (HREC). Consent for use of health information for research is rarely sought at an emergency department (...) (ED) presentation. Research often occurs after the index visit and gaining consent can be difficult. Waiver of consent provisions are frequently used, but acceptability of this approach to patients is unclear.ObjectiveTo identify ED patients’ knowledge and attitudes towards the use of health information for research, consent preferences and acceptability of waiver of consent.MethodsAn online, anonymous survey of adult patients attending two large EDs in Melbourne, Australia.Results103 patients completed the survey. We found that 52% were unaware that health information might be used for research. A majority (77%) felt that HREC approval for use of health information without consent was acceptable. However, 36% would prefer to be contacted regarding consent.ConclusionThese findings suggest a lack of awareness that health information can be used for research and that waiver of consent is acceptable, but not necessarily preferred, in most of the ED patient population. Efforts to increase awareness and provide opportunities to express preferences about health information use for research are needed. (shrink)

Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case (...) at hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples. (shrink)

This essay attempts to articulate three authors who have tried to think about the present time in its form of permanent crisis. Paulo Arantes with his theory of the age of emergency, Joshua Clover with his theory of the age of riots, and Wolfgang Streeck and the age of entropy. Arantes will serve as our theoretical foundation, while Clover will help us think about the informal masses that form in the riots while Streeck will help us think about the (...) excessive individualism of the present situation. It is in the latter that we recover the idea of the need to think about improvisation to conclude with what could be the general features of this. (shrink)

The paper investigates the kind of collective feeling – or, better, atmosphere – that is generated by the situation of protracted emergency. After asking whether ours is in general an age marked by (media) emergency, what are the structural char-acteristics distinguishing short-term emergency from protracted emergency and to what extent we can speak of an effectively shared collective feeling of “emer-gency”, the analysis focuses on the atmospheric properties of this collective affec-tive situation and shows what are (...) the possible resources to escape from it (at least in part). Irreducible to the classic phenomenological intentionality, the at-mosphere of protracted emergency (whose case study here is that of the COVID 19 pandemic, which is also related to the “terror from the air” theorised by Sloterdijk) proves to be a chaotic situation that establishes with those who experi-ence it a very particular felt-bodily communication, based essentially on narrow-ness and hypochondria. It is an invisible atmosphere of which it is fairly easy to identify the markers on the phenomenal level, whereas it is largely impossible to anticipate the long-term (affective, social, cognitive) effects. (shrink)

Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients’ to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of (...) Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants’ consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant’s consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities. (shrink)

Across the world, pain is under-treated in emergency departments. We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under-treatment in the ED is due partly to an epistemic preference for signs over symptoms on the part of some practitioners, and some ED practices that themselves worsen (...) pain by increasing patients' anxiety and fear. Our argument includes the following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under-treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four ED practices that may be contributing to the under-treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include failing to provide orienting information and partially objectifying patients so as to problem-solve along lines pre-established by modern medical science. We conclude by touching on some potential solutions for ED practice. (shrink)

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and (...) concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested. (shrink)

Emergency medicine research requires the enrollment of subjects with varying decision-making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration's (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the (...) relevant federal research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision-making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems. (shrink)

The COVID-19 pandemic has raised many intriguing questions both in the EU and globally, from the critical task of safeguarding lives to technical legal issues about competences to regulate health as well as the boundaries of emergency laws. This paper is interested in the connection between non-domination theory and the EU’s constitutional structure in the context of emergency laws. A key theme of the paper is that risk and emergencies are nothing new in an EU context, but concepts (...) used by the legislator in a wide range of policy areas which give rise to a number of constitutional challenges. The paper sketches out the main characteristics of non-domination and republication theory and addresses the question of how and why the notion of non-domination may be useful for understanding the EU constitutionalism venture in the framework of risk and emergency laws. (shrink)