The organ shortage is commonly presented as having a clear solution, increase the number of organs donated and the problem will be solved. In the light of the Northern Ireland Assembly’s consultation on moving to an opt-out organ donor register this article focusses on the social factors and complexities which impact strongly on both the supply of, and demand for, transplantable organs. Judging by the experience of other countries presumed consent systems may or may not increase donations but have (...) not met demand. Donation rates have risen considerably in all parts of the UK recently but there is also an increasing demand for organs. Looking at international donation rates and attitudes, future demand for organs and education on donation, the question is whether the organ shortage could ever be met. The increase in longevity, in rates of diabetes and obesity and in alcohol related liver disease all contribute both to increased demand for transplants, and re-transplants, and a reduction in the number of usable organs. It is unlikely that demand could ever be met, since, if supply was unlimited, the focus would move to financial resources and competing demands on the health care budget in a publicly funded health system. These factors point to the need to focus on ways of reducing, or at least stabilizing, demand where lifestyle factors contribute to the underlying disease. (shrink)

The debate over financial incentives and market models for organ procurement represents a key trend in recent bioethics. In this paper, we wish to reassess one of its central premises—the idea of organ shortage. While the problem is often presented as an objective statistical fact that can be taken for granted, we will take a closer look at the underlying framework expressed in the common rhetoric of “scarcity”, “shortage” or “unfulfilled demand”. On the basis of theoretical considerations (...) as well as a socioempirical examination of public attitudes, we will argue that this rhetoric has an economic subtext that imbues the debate with normative premises that have far-reaching social and ethical consequences and need to be made explicit and discussed. (shrink)

Globally there is a shortage of organs available for transplant resulting in thousands of lives lost as a result. Recently in the United Kingdom 457 people died as a result of organ shortage in just 1 year. 1 NHS Blood and Transplant suggest national debates to test public attitudes to radical actions to increase organ donation should be considered in addressing organ shortage. The selling of organs for transplant in the United Kingdom is prohibited under the Human (...) Tissue Act 2004. This discussion paper considers five ethical objections raised in the United Kingdom to paid donation and discusses how these objections are addressed within the only legal and regulated paid living unrelated renal donation programme in the world in Iran, where its kidney transplant list was eliminated within 2 years of its commencement. This article discusses whether paid living unrelated donation in Iran increases riskier donations and reduced altruistic donation as opponents of paid donation claim. The paper debates whether objections to paid donation based upon commodification arguments only oppose enabling financial ends, even if these ends enable beneficent acts. Discussions in relation to whether valid consent can be given by the donor will take place and will also debate the objection that donors will be coerced and exploited by a paid model. This article suggests that exploitation of the paid donor within the Iranian model exists within the legally permitted framework. However, paid living kidney donation should be discussed further and other models of paid donation considered in the United Kingdom as a radical means of increasing donation. (shrink)

ABSTRACT:Officials must understand why and how the public lost confidence in the federal government’s ability to manage financial turmoil. Officials outsourced to private parties responsibility for monitoring and policing the safety-net exposures that were bound to be generated by weaknesses in the securitization process. When the adverse consequences of this imprudent arrangement first emerged, officials claimed for months that the difficulties that short-funded, highly leveraged firms were facing in rolling over debt reflected only a shortage of aggregate liquidity (...) and not individual-firm shortages of economic capital. Then, in September 2008, the president and other officials created an unwise sense of urgency that delays in implementation show to have been greatly exaggerated.That authorities and financiers violated common-law duties of loyalty, competence, and care they owe to taxpayers indicates a massive incentive breakdown in industry and government. Taxpayers deserve a thorough-going reorientation of: (1) how regulatory agencies report on their regulatory performance and back-room interactions with Congress and the Treasury, and (2) the contract structures and performance measures used by the financial industry and its government overseers. (shrink)

Minsky proposed classifying firms in three categories: hedge finance units which borrow no more than they are able to service in interest and principal out of operating cash flows, speculative finance units which are overleveraged to the point where they can service interest on their debt out of operating cash flows, but cannot repay the principal, and thus must continually roll over their existing debt, and Ponzi finance units, whose operating cash flows are inadequate even to service interest on their (...) debt. In Minsky’s financial instability hypothesis protracted prosperity leads endogenously to firms overleveraging themselves and transforming a market dominated by hedge finance into one dominated by speculative and Ponzi finance. Since Ponzi finance units are forced to sell off assets to service their existing interest payments, once the market is sufficiently dominated by Ponzi finance units, this creates an oversupply of assets offered for sale, and the resulting debt deflation causes a financial crisis and drastic shortage of liquidity. It appears this crisis state can be brought about by a deceptively low critical mass of Ponzi and speculative finance units. This paper uses a large 2002–2009 quarterly data set of all publicly traded North American firms and foreign firms traded on North American exchanges, a total of 8,905 stocks. Financial ratios are used to classify these firms in each quarter according to Minsky’s FIH categories. Market value is used to weight the categories, and average betas are computed as measures of volatility. Results provide dramatic support for the FIH. The FIH is then reinterpreted in terms of Austrian business cycle theory, which depends on inflationary credit expansion to drive the unsustainable prosperity. According to Minsky’s FIH, unsustainable prosperity emerges endogenously as long periods of economic expansion make borrowers and lenders alike more willing to engage in investment activities for which they fail to see the inherent risk. It becomes clear that this process is amplified and exacerbated by credit expansion. Minsky’s FIH helps flesh out some of the missing dynamics of the malinvestment liquidation phase of ABC theory, and the two views turn out to be surprisingly complementary. (shrink)

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only (...) one ‘buyer’—in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England. (shrink)

Over the past decade, US patients and clinicians have endured medication shortages of nearly every class, including many lifesaving medications. These shortages have persisted despite determined efforts by federal, academic, and professional organizations. Medication shortages have resulted in lost lives, medication errors, and substantial financial cost. Economic drivers are the primary cause for drug shortages, exacerbated by manufacturing and quality problems, and unreliable and uncertain sources for many raw materials required to synthesize these drugs. Drug shortages force clinicians to (...) make untenable choices and decide which of their patients should receive a lifesaving scarce medication. The COVID-19 pandemic has stressed many hospitals’ ability to provide basic care and aggravated existing drug shortages. The influx of patients suffering from COVID-19 has exposed flaws in the fractured manner in which essential medications reach patients. The unique nature of COVID-19, often requiring prompt and decisive clinical decision-making, challenges the accepted approach for ethical analysis adopted by clinical ethicists. The author, a clinician and bioethicist, notes the ethical challenges he and other frontline providers have faced in deciding which patients are “more deserving” of a scarce medication. (shrink)

Chronic shortage in organs for transplantation worldwide is leading many policy-makers to consider various incentives that may increase donation rates.1 These range from giving holders of donor cards some priority on the transplant waiting list or a discount on health insurance premiums, to giving families who consent to donation a medal of honour, reimbursement of funeral expenses, tax incentives or even financial compensation.2–4 Of the various proposed incentive mechanisms, the one that has consistently garnered the most criticism and (...) objection in the literature is that of paying families who consent to donate the organs of a deceased loved one.Arguments against such a policy abound: it could exploit the poor, influence the family to prematurely withdraw care, encourage families to withhold medical information that would result in transplant-transmission of disease, and finally, it would commercialise the value of human life and result in the perception of human organs as commodities. Indeed, to date no Western country has adopted a policy of financial compensation to families for consenting to organ donation.2Recently, a country suffering from severe shortage in organs has implemented a policy of financial incentives that uses cash payments. Wu and Fang5 describe a recent pilot programme in China that compensates families for postmortem donation, through an independent third party and based on consent or presumed consent of the deceased. The particular context within which this programme is implemented validates and even exacerbates some ethical concerns that have been voiced in the Western medical and bioethics …. (shrink)

A shortage or backlog of inventory can easily occur due to the backward forecasting method typically used, which will affect the normal flow of funds in pharmacies. This paper proposes a replenishment decision model with back propagation neural network multivariate regression analysis methods. With the regular pattern between sales and individual variables, supplemented with the safety stock empirical formula, an accurate replenishment quantity can be obtained. In the case analysis, this paper takes the sales situation of a pharmacy as (...) an example and tests the accuracy and stability of the model. The results show that the model has good prediction accuracy which can be introduced into the intelligent pharmacy system and used in the replenishment of the intelligent pharmacy to prevent overstocking or a shortage of stock, thus improving the financial situation, reducing the manpower burden of typical retail pharmacy, and helping residents buy medicines. (shrink)

In view of the aging and dejuvenation of the working population and the expected shortages in employees’ skills in the future, it is of utmost importance to focus on older workers’ employability in order to prolong their working life until, or even beyond, their official retirement age. The primary aim of the current study was to examine the relationship between older workers’ employability (self-)perceptions and their intention to continue working until their official retirement age. In addition, we studied the role (...) of potential antecedents of their perceived employability at three different levels: training and education in current expertise area as well as in an adjacent expertise area (individual level factor), learning value of the job (job level factor), and organizational career management practices (organizational level factor). Data were collected by means of e-questionnaires that were distributed among two groups of Dutch older (45-plus) white collar workers. The samples consisted of 223 employees of an insurance company, and 325 university workers, respectively. Our research model was tested separately in each sample using Structural Equation Modeling. We controlled for effects of respondents’ (self-)perceived health and (self-)perceived financial situation. Similar results were found for both samples. First, the relationship of perceived employability with the intention to continue working until one’s retirement age was positive, whereas the relationship between a perceived good financial situation with the intention to continue working until one’s retirement age was negative. Secondly, as regards the potential antecedents, results showed that the learning value of the job was positively related to perceived employability. In addition, an employee’s perception of good health is a relevant correlate of perceived employability. So, whereas perceived employability contributes to the intention to continue working until one’s retirement age, a good financial situation is a push factor to retire early. In order to promote the labor participation of older workers, this study indicates that organizations should focus on the learning possibilities that are inherent to one’s job rather than on providing additional training or career management. Further research is needed to test the generalizability of our results to other samples. (shrink)

With the intensifying shortage of care-providers and mounting financial burden of an aging population in Japan, artificial intelligence (AI) offers a potential solution through AI-driven robots, chatbots, smartphone apps, and other AI medical services. Yet Japanese acceptance of medical AI, especially patient care, largely depends on the degree of ‘humanness’ that can be integrated into intelligent technologies. As empathy is considered a core value in the practice of healthcare workers, artificially intelligent agents must have the ability to perceive (...) human emotions and respond in an affective, human-like manner. This paper presents the results of a nationwide survey in Japan 2023 about the public perception of the use of emotionalized AI (EAI) in healthcare. The sample included 2000 Japanese citizens from 20 to 69 years old with an average age of 45 years. The questionnaire included 65 items in six categories: demographic, perception of the existing healthcare system, attitude towards the use of AI, and EAI in healthcare, trust and privacy concerns and fear of AI, and seeking literacy on new technologies. The analysis of the responses demonstrates that overall, the Japanese population has a limited knowledge of AI, EAI, and smart technologies but trusts the healthcare system, physicians, and staff to use it properly, with little worries over the potential pitfalls related to data security and safety. However, they prefer the use of more human resources and are concerned about privacy and the high cost of new technology, and believe little information is being provided to them through government and media. (shrink)

In a recent study by Cai et al. about water shortages in Beijing-Tianjin-Hebei urban areas, virtual water has become the central concept of the groundwater security strategy by suggesting increasing imports of water-intensive agricultural products instead of utilizing the depleted groundwater resources for production. However, despite reviewing the content, we could not see how the authors discussed the households’ economic and financial issues from both production and consumption perspectives.

The article highlights the practical realization of synergies, to improve social infrastructure in rural areas. The paper analyzes trends and positive consequences of the involvement of community organizations to improve rural infrastructure component elements. The research emphasizes that the financial and labor cooperation and the bulk of local authorities is the positive step towards improving social infrastructure in rural areas under the shortage of budgetary funds.

In order to accommodate for the present shortage of oocyte donors, oocyte-donation programs place ads in college newspapers and provide large monetary compensation to encourage participation. Large compensation acts as a strong incentive for young women to undergo the potentially risky procedure of donation. In this enticing situation, it is particularly important for programs to fully inform prospective donors of the risks of the procedure so that they can accurately weigh the costs and benefits of donating. However, because oocyte-donor (...) programs must alleviate the shortage of donors if they wish to maintain a financially viable business, there is reason to fear that they may minimize or misrepresent risks when recruiting egg donors. In this pilot study, the risk information provided by programs (n=19) to prospective oocyte donors in a preliminary phone call inquiry was investigated. The majority of the programs provided incomplete and/or inaccurate risk information. Policy changes are recommended to reduce the potential for undue influence and to standardize and regulate the risk information provided to prospective egg donors. (shrink)

In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced (...) clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians’ duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them. (shrink)

There is a widely acknowledged shortage of and an increasing demand for transplantable human organs and tissues (e.g., kidney, heart, lung, liver, cornea) in developed and developing countries around the world. In response to this need, Lott and Savulescu (2007) propose the creation of a human embryonic stem (hESC) bank to facilitate the equitable and efficient dissemination of human leukocyte anti- gen (HLA) matched tissues and organs to patients in need of replacement. Although not an unreasonable proposal, the authors (...) go on to make a much stronger claim. They argue that hESCs are such important tools for addressing the massive unmet global need for organs that it is ethically justified to require mandatory banking of spare embryos, and they argue for the use of financial (or other) inducements to procure embryos for the derivation of hESCs. (shrink)

Rural, remote, and northern Indigenous communities in Canada frequently face limited access to healthcare services with ongoing physician and staff shortages, inadequate infrastructure, and resource challenges. These healthcare gaps have produced significantly poorer health outcomes for people living in remote communities than those living in southern and urban regions who have timely access to care. Telehealth has played a critical role in bridging long-standing gaps in accessing healthcare services by connecting patients and providers across distance. While the adoption of telehealth (...) in Northern Saskatchewan is growing, its initial implementation faced several barriers related to limited and stretched human and financial resources, infrastructure challenges such as unreliable broadband, and a lack of community involvement and engaged decision-making. Emerging ethical issues during the initial implementation of telehealth in community contexts have been wide ranging including concerns around privacy that have also shaped patients’ experiences and particularly the need to consider place and space within rural contexts. Drawing from a qualitative study with four Northern Saskatchewan communities, this paper offers critical perspectives on the resource challenges and place-based considerations that are shaping telehealth in the Saskatchewan context and provides recommendations and lessons learned that could inform other Canadian regions and countries. This work responds to the ethics of tele-healthcare in rural communities in Canada and contributes perspectives of community-based service providers, advisors, and researchers. (shrink)

There is a world-wide shortage of kidneys for transplantation. Many people will have to endure lengthy and unpleasant dialysis treatments, or die before an organ becomes available. Given this chronic shortage, some doctors and health economists have proposed offering financial incentives to potential donors to increase the supply of transplantable organs. In this paper, I explore objections to the practice of buying and selling organs from the point of view 1) justice, 2) beneficence and 3) Commodification. Regarding (...) objection to the Commodification of transplant organs, I examine a number of possible justifications of this objection but conclude that each of these would, if true, rule out the donation of transplant organs or the selling of numerous accepted commodities, or is implausible for some other reason. (shrink)

Willingness and readiness of people to do their jobs are among the key factors of a successful enterprise. In XXI century intellectual human labour is gaining unprecedented value and is being developed actively. The demand for intellectual labour calls forth an increasing number of jobs and professions that require an extensive preparation, a large number of working places, high level of integration of joint human efforts, growth of social welfare. These trends are becoming ever more pervasive and are spreading widely (...) in service industries, and that explains the rapid development of the latter when compared to the traditional areas of human activity. In its turn, it heightens the need for staff in service companies, supported by significant personnel turnover and a certain shortage of skilled professionals. These circumstances determine the need for developing a new concept of fostering staff motivation at the enterprises in the sphere of services. In order to reach the stated purpose while conducting our research into tourism and hospitality industry, as well as retail chains, we have examined the problems that arise in the process of staff motivation, and studied the foreign practice of motivating staff in hotels. The obtained analysis results enabled us to work out practical recommendations on improvement of the mechanism of tangible and intangible rewards in service companies, which are based on external and internal motivational factors. Additional attention in the article is paid to the statement that financial incentives should be based on key performance indicators (KPI). We give a detailed consideration to the classification of internal motivation incentives of the staff according to the terms of their realization, and give a schematic representation of the performance dynamics of the internal motivation model in service businesses. (shrink)

Background: It is often claimed that a regulated kidney market would significantly reduce the kidney shortage, thus saving or improving many lives. Data are lacking, however, on how many people would consider selling a kidney in such a market. Methods: A survey instrument, developed to assess behavioural dispositions to and attitudes about a hypothetical regulated kidney market, was given to Swiss third-year medical students. Results: Respondents’ median age was 23 years. Their socioeconomic status was high or middle. 48 considered (...) selling a kidney in a regulated kidney market, of whom 31 would sell only to overcome a particularly difficult financial situation. High social status and male gender was the strongest predictor of a disposition to sell. 32 of all respondents supported legalising a regulated kidney market. This attitude was not associated with a disposition to sell a kidney. 5 respondents endorsed a market and considered providing a kidney to a stranger if and only if paid. 4 of those 5 would sell only under financial duress. Conclusions: Current understanding of a regulated kidney market is insufficient. It is unclear whether a regulated market would result in a net gain of kidneys. Most possible kidney vendors would only sell in a particularly difficult financial situation, raising concerns about the validity of consent and inequities in the provision of organs. Further empirical and normative analysis of these issues is required. Any calls to implement and evaluate a regulated kidney market in pilot studies are therefore premature. (shrink)

Although excess blood collection has characterized U.S. national disasters, most dramatically in the case of September 11, periodic shortages of blood have recurred for decades. In response, I propose a new model of medical philanthropy, one that specifically uses charitable contributions to health care as blood donation incentives. I explain how the surge in blood donations following 9/11 was both transient and disaster-specific, failing to foster a greater continuing commitment to donate blood. This underscores the importance of considering blood donation (...) incentives. I defend charitable incentives as an alternative to financial incentives, which I contend would further extend neoliberal market values into health care. I explain my model's potential appeal to private foundations or public–private partnerships as a means for expanding both the pool of blood donors and the prosocial benefit of each act of blood donation. Finally I link my analysis to the empirical literature on blood donation incentives. (shrink)

One of the more polarizing policies proposed to alleviate the organ shortage is financial payment of donors in return for organs. A priori and empirical investigation concludes that such systems are ethically inadequate. A new methodological approach towards policy formation and implementation is proposed which places ethical concerns at its core. From a hypothetical secular origin, the optimal ethical policy structure concerning organ donation is derived. However, when applied universally, it does not yield ideal results for every culture (...) and society due to region-specific variation. Since religion holds significant influence in the organ donation debate, three religions-Catholicism, Islam, and Shinto-were examined in order to illustrate this variation. Although secular ethical concerns should rest at the core of policy construction, certain region-specific contexts require cultural and religious competence and necessitate the adjustment of the optimal template policy accordingly to yield the best moral and practical results. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, (...) 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

Edward Hemmerde and Francis Neilson were both Liberal MPs at the outbreak of the First World War, bound together by a common commitment to the principle of land taxation. A shortage of money, at a time when MPs had only just started to receive salaries, led them into extra-parliamentary co-operation in the joint authorship of plays. But the two men fell out over the profits from their literary endeavours. One or other was clearly not telling the truth. Although he (...) gave up his parliamentary career in opposition to British involvement in the war, Neilson later prospered greatly as a writer in the United States. Meanwhile, Hemmerde turned to his career as Recorder of Liverpool, but the wealth that he craved eluded him. This article reminds us that financial impropriety among MPs is no new phenomenon, while highlighting the difficulty of establishing certain historical truth in the face of conflicting documentary evidence. (shrink)

We analyze the transition of central banks from lenders to market makers of last resort. The adoption of unconventional monetary policies characterizes this transition. In their new role as market makers, central banks engage in the latter by extending and reinforcing interventions in other markets than the traditional bank reserves market. We then explain that the difference between the two roles is one of degree rather than kind. In both cases, the prevention of liquidity shortages is a primary concern. As (...) conventional policies become inadequate, central banks resort to unconventional policies to escape a general liquidity shortage at the zero lower bound. However, these unconventional policies do not solve the structural problems in financial and real markets. Both conventional and unconventional monetary policies cause price distortions, in particular on asset markets. The policies of the market maker of last resort prevent necessary readjustments of cyclical divergences between real and financial markets. (shrink)

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or “regulated markets” in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie—at least in (...) part—in facilitating so-called “altruistic donation;” harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed “chronologically incompatible donation” is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ “banking” from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs. (shrink)

As the aging population problem intensifies, many emerging economies are caught in labor shortage and rising labor costs, thus improving the corporate labor investment efficiency is crucial for these countries. In this context, we take China as an example to explore the influence of the current booming digital finance on corporate LIE. This paper, which enriches the existing literature, is one of the few studies that explores the link between macroeconomic policies and firms’ LIE. Our research adopts the baseline (...) methodology of ordinary least squares regression, and the data comprise 23,503 observations for Chinese A-share listed businesses from 2011 to 2020. In addition, we use fixed effects regression, instrumental variables method and substitution of independent variables to deal with endogeneity and test the robustness. The outcomes suggest that DF may significantly increase corporate LIE. Further results from the path mechanism study suggest that DF could alleviate financing constraints and optimize human capital structure, both of which have a favorable effect on the LIE. Last but not least, the heterogeneity results imply that DF can more effectively encourage LIE of firms in economically underdeveloped regions and of private nature. The study recommends that emerging economies should pay attention to strengthening regulation to avoid financial risks while vigorously promoting DF. In addition, enhancing the level of human capital and optimizing human capital allocation are also essential. (shrink)

Acts of helping others are often based on mixed motivations. Based on this claim, it has been argued that the use of a financial reward to incentivize organ donation is compatible with promoting altruism in organ donation. In its report Human Bodies: Donation for Medicine and Research, the Nuffield Council on Bioethics uses this argument to justify its suggestion to pilot a funeral payment scheme to incentivize people to register for deceased organ donation in the UK. In this article, (...) I cast a sceptical eye on the above Nuffield report's argument that its proposed funeral payment scheme would prompt deceased organ donations that remain altruistic . Specifically, I illustrate how this scheme may prompt various forms of mixed motivations which would not satisfy the report's definition of altruism. Insofar as the scheme produces an expectation of the reward, it stands diametrical to promoting an ‘altruistic perspective’. My minimal goal in this article is to argue that altruism is not motivationally compatible with reward as an incentive for donation. My broader goal is to argue that if a financial reward is used to incentivize organ donation, then we should recognize that the donation system is no longer aiming to promote altruism. Rewarded donation would not be altruistic but it may be ethical given a persistent organ shortage situation. (shrink)

This paper aims to determine the major axes of the economic policy implemented by the Walloon Region since it acquired significant powers in january 1989. A brief summary of the mechanisms introduced by the Special Financing Law demonstrates how much federal entities suffer from financial constraints imposed by the budgetary sourcing from the National Government. As a result the resources made available are lower than 1988 expenditure on items which have since been 'federalized". The balance will have to be (...) financed by Regional borrowing.We discuss several budgetary policies scenarios and their effects. The Walloon Region has chosen a middle way between two extremes. It has avoided an unchanged expenditure policy, which would have led to an undesirable increase in the debt of the Region, followed by a chronic budgetary shortage. neither has it introduced an excessively strict policy - obtaining a balanced budget by 1996 would have meant a 20% cut in current expenditures. The Walloon Region has opted for a policy of distributing growth between the present and the future by accepting a reasonable level of debt with borrowing limited to the financing of investments which increase the Region's earning assets.When it comes to the budgetary policy of the French Community, we confine ourselves to a brief presentation of the budget because of uncertainty about how it will be made up. (shrink)

According to the Economic Survey of India, 2012–2013, the real estate sector contributed 5.9 % of the India’s total Gross Domestic Product in the Financial Year 2011–2012, while remaining the second largest employment generator after agriculture in India. The urban population in India is projected to touch 600 million by 2030, from 377 million in 2011, thereby fuelling a housing shortage of around 26 million. However, the perception of Construction industry, like other sectors of the economy, is that (...) of creating “human habitat in a manner generally focussed on profitability without consideration of its long-term impacts.” Under such circumstances, Tata Housing Development Company Limited, a closely held Public Limited Company under 99.86 % subsidiary of Tata Sons, is the first Indian real estate company to have reported the triple bottom-line Global Reporting Initiative G4 Sustainability Reporting Guidelines in its Sustainability Report FY 2013–2014. THDCL aims to volunteer its resources to the extent it can reasonably afford, to sustain the environment and to improve the quality of life of the people of the area in which it operates. This Situational Case Study, targeted towards management students and practitioners, and social and developmental workers in the areas of Corporate Governance, Strategic Management, Business Environment, Business Policy and Community Welfare, aims to identify the community engagement model of THDCL; analyse it in terms of its implementation and impact; and initiate discussion about the role of strategic partnerships under Corporate Social Responsibility in an emerging economy. This work may be used for developmental related workshops/training programmes for students and working professionals of innovation, CSR, sustainability, social and developmental sectors and shared, among others, in various Chambers of Commerce and Academic forums on the same. It is, however, not intended to serve as an endorsement, source of data or illustration of effective or ineffective management. Certain names and information could have been disguised for confidentiality. (shrink)

Sigrid Fry-Revere’s The Kidney Sellers: A Journey of Discovery in Iran, an allegedly first-hand examination of the Iranian paid kidney donation model, has been criticized by Koplin in an essay formerly published in the Monash Bioethics Review. Koplin especially challenges Fry-Revere’s claim that financially compensating kidney vendors might facilitate altruistic kidney donation. The current situation in Iran, according to Koplin, suggests that the market model has undermined altruistic donation. On this point, this commentary tries to show that healthcare policymakers in (...) Iran no longer see the Iranian paid kidney donation model as a sustainable and ethically justifiable status quo. Briefly touching on the criticisms that have been made even by some positive commentators of the Iranian model, this commentary aims to call attention to the fact that the current dynamic within healthcare policymaking in Iran seeks primarily to decrease its reliance on the organ market instead of revising and modifying it. This complicates the plausibility of any kind of extrapolation, replication or extracting empirical support from the Iranian model to create organ markets in other countries, for example, as Fry-Revere suggests to conduct a trial of a financially incentivized kidney donation scheme in the US. The conclusion is that the Iranian healthcare system should tackle the organ shortage through increasing altruistic living and postmortem kidney donations. This might also provide, finally, a space for conducting extensive and long-term follow-up studies on well-being, satisfaction and social integration of Iranian kidney vendors. (shrink)

In times of modern information technology, the world of science is becoming smaller. Does this mean that there will be no more provinces? We do not think so. Setting out from Leszek Nowak's thought “province is where one thinks not on one's own account but on account of another,” we indicate a number of processes that perpetuate provinces. These processes are driven by specific access to scientific knowledge, by education, by new forms of communication, by shortage of financial (...) support and the concentration of resources. We look at the interplay between criteria of theory choice and location on the scientific map. Next, we explore the connection between geo-social and scientific provinces, taking into consideration political and cultural parameters. The conceptual framework of metropolises and provinces in science turns out to be, though not all-embracing, an extremely fruitful one. (shrink)

Turkey has been hosting a large number of Syrian refugees since 2011 and has allowed Syrians to integrate into the general education system alongside Turkish students since 2016. This situation suggests that Turkey offers a unique experience in the education of Syrian refugees. However, Syrian girls may face disadvantages in their education due to traditional gender roles. Based on this premise, this study aims to examine the educational processes of Syrian girls during the COVID-19 pandemic from the perspectives of teachers, (...) parents, and the students themselves. Therefore, this research seeks to identify the educational experiences of Syrian girls during the pandemic period in Turkey and to evaluate the contribution of religious culture and ethics (RCE) teachers to their ability to receive proper education. The participants of this research, which followed a qualitative design, included 10 students, 5 parents, and 5 RCE teachers selected through snowball sampling. The study's findings reveal that Syrian girls encountered difficulties in accessing and continuing distance education effectively. The data obtained were analyzed by considering the educational challenges experienced by refugee girls during the quarantine period from the perspectives of students, parents, and teachers, and discussed within psychological, social, and cultural contexts. Among these challenges, economic hardships, technical deficiencies, inadequacies in the physical environment, and social adjustment problems emerged as prominent issues. It was found that Syrian refugee girls struggled with limited financial resources, a lack of technological devices such as tablets and computers, inadequate internet access, and a shortage of appropriate learning environments. They also experienced psychological challenges, including isolation and a longing for social interaction, along with shifts in family dynamics. On the other hand, it was observed that Syrian girls and their parents frequently communicated with religious, cultural, and moral education teachers to address these issues. A significant finding that distinguishes this study from similar ones is that Syrian refugee girls, through their participation in both distance and face-to-face education, began to adapt to Turkish culture and lifestyle. According to the perspectives of both students and teachers, Syrian refugee students have become more socially integrated compared to their parents. As a result, it can be concluded that RCE teachers have assumed new, supportive roles in the education of Syrian refugee students. (shrink)

Nursing has improved over the centuries from the physician's handmaiden to a recognised profession. Yet, the image of a nurse is often associated with notions of caring and nurturing‐ attributes considered feminine. Indeed, cultural, and societal biases exist that can deter men from entering the nursing profession where their sense of masculinity is questioned. Several studies have highlighted the existence of gender‐based stereotypes, stigma, rejection, loneliness and discrimination which impact the retention of men in the nursing profession. Despite the established (...) evidence regarding negative experiences, it appears limited attention has been paid to the men who decide to stay in nursing: how do they thrive in a profession wherein biases are evident within and in the wider societal context? Undoubtedly, several factors such as job security and financial incentives may contribute to men remaining in nursing. Beyond these, we borrow the notion of ‘constructive resistance’ to underscore that though the biases may be apparent, male nurses are able to construct alternatives that accommodate the image of a man in the nursing profession. Strategies such as developing the image as a ‘super nurse’ can create opportunities for male nurses to be preferred by other healthcare providers as well as female nurses. Thus, although resistance may usually appear as a negative phenomenon, constructive resistance represents hidden advantages which offers an opportunity to retain male nurses. These need to be highlighted and explored more as they can offer deeper insight into strategies that can be employed to improve retention and representation of men in nursing particularly at a time when the impact of nursing shortage remains a global issue. (shrink)

A large share of countries is struggling to provide adequate care to their older populations. To deal with this challenge, philosopher Ingrid Robeyns has advocated legislation that requires (most) citizens to spend 1 year of their life providing dependency care. My aim of this contribution is to strengthen the case for this proposal, which I will refer to as a ‘universal care conscription’. I do so by defending this type of conscription against various alternative ways of addressing care-deficits that have (...) been proposed. As I show, not only is it doubtful whether pursuing these alternatives will always, or even generally, suffice to prevent and/or alleviate care-deficits at reasonable financial and moral cost, a universal care conscription has significant civic benefits in an age of polarization that count strongly in its favour. (shrink)

After a crisis, broad and sweeping reforms are enacted to restore trust. Following the 2007-2008 Great Financial Crisis, the European Union has engaged in an ambitious overhaul of banking regulation. One of its centerpieces, the 2013 Fourth Capital Requirements Directive, tackles, amongst other things, the perceived pre-crisis failings in the governance of banks. We focus on the provisions that are aimed at reshaping bank boards’ composition, functioning, and their members’ liabilities, and argue that they are unlikely to improve bank (...) boards’ effectiveness or prevent excessive risk-taking. We criticize some of them for mandating solutions, like board diversity and the separation of chairman and CEO, that may be good for some banks but are bad for others, in the absence of any convincing argument that their overall effect is positive. We also criticize enhanced board liability by showing that it may increase the risk of herd behavior and lead to more serious harm in the event of managerial mistakes. We also highlight that the push towards unfriendly boards will negatively affect board dynamics and make boards as dysfunctional as when the CEO dominates them. We further argue that limits on directorships and diversity requirements will worsen the shortage of bank directors, while requirements for induction and training and board evaluation exercises will more likely lead to tick-the-box exercises than under the current situation in which they are just best practices. We conclude that European policymakers and supervisors should avoid using a heavy hand, respectively, when issuing rules implementing CRD IV provisions with regard to bank boards and when enforcing them. (shrink)

Moral injury occurs when a person perpetrates, bears witness to, or fails to prevent an act that transgresses their deeply held moral beliefs. The deeply held moral belief that physicians share is the oath they take when completing their lengthy training and embarking on their career: Put the needs of patients first. In today's American healthcare system, doctors, nurses, and other healthcare providers are increasingly forced to consider the demands of other stakeholders -- insurers, hospitals, even their own financial (...) security -- before the needs of their patients. Whenever they are forced to make a decision that contravenes their patient's best interest, they feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury. Moral injury and its causes help explain why healthcare workers started leaving the field in droves long before the COVID-19 pandemic exposed weaknesses in the US system, why a rich country has such poor outcomes in certain categories, why there is a shortage of young doctors training for critical areas, and why patients feel so frustrated. In If I Betray These Words, Wendy Dean explores and exposes the impacts of moral injury through vividly told stories that are at once bewildering and eye-opening. Her book serves as a roadmap through a healthcare landscape that can be confounding, and at times even hellish, for those who must navigate it, and it suggest alternative routes for healers and their patients. (shrink)

Definition of the problem: Rationing medical health care has been debated in the industrialized Western hemisphere for at least two decades. Many factors have contributed to the fact that medical care can no longer be provided free of charge, which used to be an explicit political goal in all countries with a well-established welfare system. Considerable shortage of public financial resources is now generally accepted to pertain also to the health care system. Arguments: So far, efforts have been (...) made to rationalize various medical procedures both with regard to specific medical treatment strategies and to administrative support processes. However, these means are limited in their effects to curb medical costs at a significant level. Thus, rationing medical health care is necessary to further enable the reimbursement system to cover expensive diagnostics and treatment that would exceed the individual’s capability to pay. Rationing can occur explicitly or implicitly. Implicit rationing has to be regarded as an unfair procedure and should be rejected on ethical grounds. Conclusion: Distributive justice in medical care can only be accomplished if the reimbursement system is based on a new theoretical foundation. This entails a stronger emphasis on individual responsibility for one’s own life and health and the insight that health is an individual rather than a collective good. Nevertheless, a mutual insurance-based collective health care system should not be abolished as long as it is thoroughly reformed. As a minimum requirement, it must provide incentives to spend money on preventive health measures. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 53-64 [Access article in PDF] Incentives for Providing Organs Patricia Milmoe McCarrick and Martina Darragh After a contentious debate at its 2002 annual meeting, the American Medical Association's House of Delegates voted to endorse the opinion of its Council on Ethical and Judicial Affairs that the impact of financial incentives on organ donation should be studied (Josefson 2002). The shortage (...) of organs for transplantation has been an ongoing problem for more than 20 years. In June1981, Representative Philip Crane (R-IL) introduced legislation in the U.S. House of Representatives proposing a $25,000 income tax deduction and a $25,000 estate tax exclusion for donating an organ (Tax Incentives 1981). Still the National Organ Transplant Act enacted in October 1984 prohibited the offering of any "valuable consideration" in return for organs (United States 1984).The developments of a legal market for tissues in the United States and a black market for organs around the world have raised the question of whether donation without compensation is the only ethically viable option. Some critics of the current system claim reliance on donation actually promotes a black market in organs (Kaserman and Barnett 2002, p. 38; Palmer 1999, p. 36). In addition, a new set of compensation issues has arisen as living kidney donor transplantations begin to rival those performed with cadaveric organs (United States 2001).As a result, current suggestions for incentives go far beyond the traditional death benefit payment to include such ideas as medals of honor for donors, reimbursement for funeral expenses, exchange programs for organ donation, and special medical insurance for living organ donors. Numerous bills introduced into the 107th Congress have proposed such incentives (Delmonico et al. 2002.) In October 2002, the U.S. Department of Health and Human Services awarded $5.2 million in grants to study both clinical and behavioral interventions for increasing organ donations that do not involve incentives. The inspiration for some of the funded proposals comes from the successes of Spain's social services and the United Kingdom's clinical administration of organ procurement programs (Robeznieks 2002). [End Page 53]With a nod to evidence-based medicine, the underlying concern expressed in much of the current literature is that no idea for increasing the supply of organs should be discounted before it is studied. This bibliography provides a short introduction to the range of opinions expressed on the issue of incentives for providing organs.al-Mousawi, M.; Samhan, M.; al-Mezairee I.; Razzak, M.A.; and Khawari, F. Cadaver Organ Procurement in Kuwait. Transplantation Proceedings 31 (8): 3375-76, 1999.The authors describe a protocol that significantly increased cadaveric organ donation and credit it with fostering the expansion of an organ sharing program among the Arab Gulf states. Developed by Kuwaiti neurologists and anesthetists after a continuing education course on transplantation, the protocol places a special emphasis on the role of local transplant coordinators who facilitate the investigation of brain death cases by neurologists.Arnold, Robert; Bartlett, Steven; Bernat, James; et al. [Ethics Committee of the American Society of Transplant Surgeons] Financial Incentives for Cadaver Organ Donation: an Ethical Reappraisal. Transplantation 73 (8): 1361-67, 27 April 2002.To prepare for proposed studies of financial incentives for organ donation, the American Society of Transplant Surgeons convened a panel to develop a methodology for evaluating the ethics of such research. Comprised of organ procurement organization executives, physicians, surgeons, and ethicists, the panel generated a list of nine criteria for use in judging any incentives proposal. While opposed to direct payment or tax incentives for organ donation, a majority of the members support funeral expense reimbursement or charitable contributions as incentives that would not violate or undermine the ideal of altruism.Cameron, J. Stewart, and Hoffenberg, Raymond. The Ethics of Organ Transplantation Reconsidered: Paid Organ Donation and the Use of Executed Prisoners as Donors. Kidney International 55 (2): 724-32, February 1999.After reviewing arguments for and against payment for organ procurement, the authors apply these arguments to the specific case of obtaining organs from executed... (shrink)

The world is beset by what seem to be an interminable set of problems. Many of these, increasingly, are transnational, which is to say, that they transcend the borders of individual nations. Issues such as climate change and apparent global warming are fiercely debated, with many arguing that without a change in the way in which human beings abuse the environment, we are all doomed. The crisis surrounding the destruction of the nuclear reactor in Fukuyama, Japan as a result of (...) the devastation wrought by the massive earthquake and tsunami points to human powerlessness in the face of the forces of nature. It also points to the need to show respect for those same forces. Other crises, such as the global financial crisis, also have had a profound impact on human lives. While it is difficult to quantify, the global financial crisis has undoubtedly been responsible for many deaths also, as aid money decreases and projects which may have helped solve housing shortages, provided sanitation and clean water are unable to proceed. There is a need to reconfigure capitalism so that it serves the common good, rather than the self indulgent needs of venal speculators. Glaring inequalities in the distribution of the common wealth of countries are just as evil in the United States, China, India, Australia and the United Kingdom, to name a few of the G20 nations, as they are anywhere else. The recent wave of protest throughout the Middle East which saw the ousting of the Libyan dictator, Gaddafi and the Egyptian president Mubarak, should not be seen as simply a sign of the inherent instability in those countries, but as a sign that oppressive policies wherever they are met will eventually result in the overthrow of corrupt regimes.The situation in Syria is, of course, particularly parlous and points to the need for stronger international law. This paper argues that philosophy has a serious role to play in thinking about global issues and, using the example of global ethics, shows how it is central in the explication of the values that underpin proposed solutions to global problems. Though cultures are different, it is proposed, recent history shows that human beings share common values and purpose. (shrink)

Introduction Paul Boshears The following excerpt from Paul Amitai's In Between States: Field notes and speculations on postwar landscapes (2012) confounds its reader. Presenting an alternate history of the State of Israel as a space station orbiting Earth, the excitement of possibilities crackles across the texts and images. Like Chris Marker's La Jeteé , the accompanying static images distort the viewer's temporality: are these archaeological items, images from a past, or a future? Why isn't this our future? In Between States (...) can also be seen as complementing Larissa Sansour's provocative science fiction works, Space Exodus (2009) which "documents" the Palestinian space program, and her Nation Estate (2012), in which Palestine is relocated into a skyscraper. Amitai's vision opens onto an intergalactic diaspora, wherein the refugees of World War II are given the stars as Western Europe continues to fight over terrestial colonies. —PFB Auditorium, Hoechst AG headquarters, Industriepark-Höchst, 2011. In 1941 an investigation by the US Justice Department exposed a marriage cartel between John D. Rockefeller’s Standard Oil (now ExxonMobil) and I.G. Farben. The two corporations had formed a joint operation in 1927 called Standard IG Farben. It was revealed that the two had shared patents in order to control prices and markets in their respective regions. Standard was accused of hiding patents from the US Navy and supplying fuel to German submarines, which lead to charges of criminal conspiracy. The Pentagon intervened, requesting that President Roosevelt stop the investigation in order to protect war production and oil supply. Roosevelt agreed, and the Senate committee investigating the matter, headed by Senator Harry Truman, was halted. Standard Oil paid a fine of $5000 and promised to stop supplying fuel to the enemies. Auditorium, Hoechst AG headquarters, Industriepark-Höchst, 2011. Furious at the decision to terminate the investigation of acts he considered treason, Truman initiated a new inquiry into Standard Oil’s war-time practices after succeeding Roosevelt as president in 1945. With the chief executives of I.G Farben simultaneously on trial at Nuremburg, Truman brokered a deal with the Allies that reduced or withdrew criminal charges leveled against both corporations in exchange for Standard Oil and I.G. Farben’s sponsorship of one of Truman’s most ambitious postwar projects—the relocation of the Jewish people. Detail, Sanofi-Aventis advertisement, 2011. The third critical player in this bold experiment was the nascent North Atlantic Space Agency. Formed by Allied forces using the seized assets and engineering expertise of Hitler’s hitherto classified space program (conquer Earth, then the stars), the North Atlantic Space Agency was a pre-NATO foray into interstellar nation building, with orbital occupation as the first point of order. By 1947, NASA was nearly ready to deploy the first manned space station. Standard Oil and I.G. Farben’s advanced fuel refinement capacities and deep, war-enriched financial resources allowed NASA to speed up their launch schedule significantly. Detail, Sanofi-Aventis advertisement, 2011. Diplomatic efforts to establish a Jewish homeland in Palestine were failing to gain traction, while post-colonial England held its ground on immigration restrictions and bands of Jews and Arabs battled over territory on the ground. More immediate was the issue of temporarily housing Holocaust survivors and refugees across scorched Europe. Leaders of the continental nations demonstrated, at best, reluctance to accommodate the Jews, who in turn were, at the least, resistant to returning to the same bloody cocktail from which they had fled. Truman used the impasse to advance a plan for NASA’s space station to be put to use as a temporary Jewish outpost, an orbital displaced persons camp, to be operated by the US Army. Detail, Infaserv Höchst advertisement, 2011. Final preparations advanced rapidly. Viewing the orbital displaced persons (ODP) camp as a solution to their immigration problem both at home and abroad, England came on board as a willing partner. Spaceship Exodus was positioned for takeoff on German farmland 20 kilometers southwest of Frankfurt. On December 30, 1947, one month after the UN General Assembly voted down the separation plan for Palestine, Exodus rocketed into the atmosphere hauling the first module of barracks designed to house 1,500 refugees. Transport vehicles arrived shortly thereafter, loaded down with leftover wartime military rations and 3,000 Jews of Russian and Polish origin. Detail, Infaserv Höchst advertisement, 2011. "The camp is the space that is opened when the state of exception begins to become the rule."—Giorgio Agamben, Homo Sacer , trans. Daniel Heller-Roazen, (Stanford: Stanford University Press, 1995), 96. Detail, Infaserv Höchst advertisement, 2011. The ODP camp proved to be a longer-term solution than originally envisioned. Additional installations were positioned to form swollen clusters of interlocking units – sleeping quarters, schools, clinics, canteens. The UN was brought in to monitor the camp following two chaotic years of US Army control in which food shortages, pandemic diseases, and rampant black market trade had brought the camp to near total collapse. No less bureaucratic or ineffectual, the UN relief agency at least had prior experience facilitating contexts of a similar magnitude and could potentially predict outcomes. Detail, Infaserv Höchst advertisement, 2011. What had been unexpected was the degree to which the camp would evolve into its own self-regulated, hive-like ecosystem where previously accepted rules of conduct were not applicable. The ODP camp was an exceptional space, a riverboat casino, an offshore research lab of social experimentation and entrepreneurial innovation. No longer Earth-bound, touching soil knotted by prescripts of Talmudic law, the camp residents were able to rationalize loopholes and detonate barriers standing in the way of absolute production. The Jewish archipelago was renamed Israel after the ancient homeland. If the temple couldn’t be rebuilt in the motherland, a post-national rhizome would sprout up in its stead. Eyes everywhere, beyond all borders. More information on the project at the author's site. (shrink)

Renal replacement therapy is the indicated treatment for individuals with chronic kidney disease (CKD) to survive. However, not all sick people have access to the same treatment. This study compares renal care in two developing countries with different health systems. Specifically, it explores hemodialysis treatment from the perspective of low‐income individuals. A qualitative, comparative study was performed in Brazil and Mexico. Using purposive sampling, the research was based on open‐ended interviews with nineteen participants with kidney failure undergoing hemodialysis treatment in (...) public hospitals and ten relatives. According to our results, Brazilian participants perceived hemodialysis care as satisfactory because of health personnel courtesy as well as free access to dialysis treatment, prescription drugs, hospitalization and transportation. However, they reported deficiencies in the care they were receiving due to shortages of specialists, prescription drugs, laboratory tests and transportation. Mexican participants, in contrast, highlighted the catastrophic costs of medical care because they had no free access to renal therapy, nor adequate financial resources. Our findings suggest that low‐income Brazilian CKD sufferers experience renal care differently, as they are more satisfied and face less obstacles with hemodialysis compared with those of Mexico. More studies on the topic are needed. (shrink)

There is no lack of criticisms frequently levelled against the international pharmaceutical industry (Big Pharma): excessive profits, dubious or even dishonest practices, exploiting the sick and selective use of research data. Neither is there a shortage of examples used to support such opinions. A recent book by Brody (Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry, 2008) provides a précis of the main areas of criticism, adopting a twofold strategy: (1) An assumption that the special nature and human (...) need for pharmaceutical medicines requires that such products should not be treated like other commodities and (2) A multilevel descriptive approach that facilitates an ethical analysis of relationships and practices. At the same time, Brody is fully aware of the nature of the fundamental dilemma: the apparent addiction to (and denial of) the widespread availability of gifts and financial support for conferences etc., but recognises that ‘Remove the industry and its products, and a considerable portion of scientific medicine’s power to help the patient vanishes’ (Brody 2008, p. 5). The paper explores some of the relevant issues, and argues that despite the identified shortcomings and a need for rigorous and perhaps enhanced regulation, and realistic price control, the commercially competitive pharmaceutical industry remains the best option for developing safer and more effective medicinal treatments. At the same time, adoption of a broader ethical basis for the industry’s activities, such as a triple bottom line policy, would register an important move in the right direction and go some way toward answering critics. (shrink)

The academic standing of the staff working in vocational higher education must be judged as unsatisfactory according to two possible criteria: the traditional criteria, which are derived from the universities operating within the previous unitary higher education system; and the criteria outlined by the bill of the Law of Higher Education Institutions. The latter derive from the same historical institutional pattern.There are many reasons to conclude that, academically, in most fields of study, the new institutions do not reach the level (...) of the old ones. However, the mission of the new sector—the second-rank academic institutions in the eyes of the traditional academic community—is at least debatable, if not mistaken. The public university sector appears to be in deep crisis, with academics so attached to the Humboldtian university that they ignore the claims for social relevance in education.8 This is further complicated by deepening financial hardship.Using traditional criteria, it is possible that Estonia will be left with two socially irrelevant higher education sectors, instead of one functioning sector. It is also possible that the second sector, which does not fit these criteria, will be eliminated. However, the fault does not lie wholly with the dominance of traditional university attitudes. It also lies in a lack of vision on the part of the new institutions. As children of the proletariat society, they fail to recognise their vocational orientation as a benefit, and instead try to hide it. They are developing theoretically overloaded four- to five-year study programmes. None of these institutions has solved the problem of balancing the requirement of employing 50 per cent faculty full time and maintaining a satisfactory academic level. The need to demonstrate that part-time employees may actually benefit the vocational sector has not yet been understood.9As long as the sector continues to accept the rules forced upon it by the old universities, it probably has no useful role in Estonia. Its institutions, especially the public institutions, cannot compete with the traditional universities in academic fields. The universities, on the other hand, are beginning to understand that the policy they proclaimed some years ago, which was based on the clear distinction between two sectors on the German pattern, does not work in a small country with very limited resources, and an inheritance from the previous regime of a large university sector with an enrolment rate of more than 20 per cent of the age group. The universities have agreed to offer their own non-degree courses at diploma level, and now seriously threaten the small new institutions. From the financial point of view, the universities' expressed desire to swallow the small vocational institutions is beneficial since the small institutions have no clearly distinct role of their own.The private vocational higher education institutions do not conceal the fact that, according to their own vision, they have little place in the vocational sector. Some of them would like an official status equal to that of the universities, the right to offer graduate and postgraduate courses as well as diploma courses, and the registration of their diplomas and certificates on an equal basis with the public universities in the Register of Diplomas and Certificates at the Ministry of Culture and Education. In other words, they are interested in becoming fully accredited universities. This increases competition for students and—given the Estonian mechanism of public financing of higher education based on the number of students admitted provided by the Ministry of Culture and Education10—there will be less money for public universities. Here lies the origin of the principle that the universities are established by parliament and the vocational higher education institutions by executive action by the government.The existence of the new sector is seriously threatened. The current pattern of postgraduate studies has blocked the preparation of a sufficient number of research-degree holders, even at master's level.11 The new institutions cannot train their own faculty. The recent experience of Concordia International University—which depends greatly on staff with bachelor's and master's degrees from the United States, who form some 80 per cent of the faculty—demonstrates that the participation of first- or even second-rank Western academics in Estonian higher education can never be very high. If the system cannot accept experienced local staff for legal appointments in the vocational sector, unless they have a research degree, these institutions will not survive for long. Society will be back to the position where there are a large number of underpaid or unemployed academics, but a shortage of qualified individuals who could be self-employed and capable of running small and medium-size enterprises. (shrink)

Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...) make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)

The inherent complexity of modern financial systems, and their basis in human behavior, make it hard to establish unequivocally the “who, what, where, when, and why” of the global financial crisis. However, after almost a decade, we know enough to discard much of what has, in the meantime, become folk wisdom about the causes of the debacle, including Wall Street bonus culture, bankers’ greed, the moral hazard of “too big to fail,” government intervention (“too much government”) and deregulation (...) (“not enough government”). While each of these factors may have played some role, the crisis can be much more accurately described as one of ignorance than malevolence. The common thread tying the emergence of the bubble to the disastrous consequences of its bursting is the misunderstanding of correlation and causation links in three key domains: economic policy, financial modeling, and the regulatory framework. These misunderstandings helped fuel the housing bubble and introduced fragility into the system, making it vulnerable to the bubble’s subsequent, unavoidable burst. (shrink)

The practice of paying prisoners to for their participation in research has long been debated, and the controversy is reflected in the differing policies in the U.S. prison systems. Empirical study of financial payments to inmates who enroll in research has focused on whether this practice is coercive. In this study, we examined whether monetary incentives have the potential to be unduly influential among fifty HIV‐positive prisoners. The majority of prisoners surveyed believed that inmates should receive some compensation for (...) their involvement in research and disagreed with statements suggesting that the offer of payment constitutes undue influence. However, a sense of potentially being susceptible to undue influence was significantly higher among participants who had spent a longer time in prison and had less education. Overall, our findings suggest that most prisoners feel that they would be able to make a decision about research enrollment that is not solely based on an offer of monetary payment. (shrink)

Many higher-income countries have shortages of care-workers, which is unlikely to change in the foreseeable future as virtually all of these societies are ageing. The philosophical literature on this problem has concentrated mostly on the merits and demerits of different policy solutions, especially on the recruitment of foreign care-workers and on investments in care robots and other relevant technologies. However, the question of what moral duties, if any, private individuals have to help address care-worker shortages has been entirely neglected. In (...) this article, I help to fill this lacuna by arguing that some inhabitants of higher-income countries have moral duties to age abroad in order to reduce the pressure on the aged care-systems of their current societies, whereby ‘ageing abroad’ is defined narrowly as moving to a foreign country to receive residential or non-residential aged care. As I show, these duties are dependent on a number of conditions being met, including the requirement that the host populations not be made worse off. (shrink)