The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

As hospitals in the US and elsewhere fill again with patients with covid-19, discussions about how to fairly allocate scarce medical resources have come to the fore once again. One frequently voiced concern is that non-covid-19 patients with urgent health needs are facing indefinitely postponed surgeries, long-distance hospital transfers, or even are unable to access medical treatment. In our view, a reserve or categorised priority system could help. It could be used to fairly distribute scarce medical capacity—such as staffing, physical (...) space, and medical treatments—between covid-19 and non-covid-19 patients, just as it has been used or proposed to allocate covid-19 therapeutics and vaccines. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

Along with the legal opinions, the juristic proofs presented to underpin these legal opinions also occupy an important place in uṣūl al-fiqh. Thus, scholars of uṣūl al-fiqh strived to propound the proofs indicating the relevant theoretical principles in an apparent and definite way. As a result, the disputed and undisputed proofs ranked among al-adilla al-shar‘iyya have been abundantly addressed in the classical uṣūl al-fiqh works. However, although it is not mentioned as a part of legal sources in the uṣul literature, (...) there has been another proof subjected to legal reasoning (istidlāl): the practice of the companions. In this study, “the practices of the companions” is used in the contextual meaing of the verbal and practical positions of the entire companions or some of them on a specific topic of uṣūl al-fiqh. By this definition, the concept of the practice of the companions is separated from the concepts of qawl al-ṣaḥābī, ʿamal ahl al-Madīnah and the ijmāʿ al-ṣaḥābah. As a matter of fact, the concept of qawl al-ṣaḥābī signifies an opinion narrated from a single companion and neither supported nor opposed by other companions, and subjected to use of legal inference for obtaining practical legal rulings. In return, the concept of the practice of the companions signifies the position that the companions hold on a topic of uṣūl al-fiqh and does not stipulate the conditions that it must be an opinion of a single companion and be neither supported nor opposed by other companions. In addition, as being related to the legal theoretical issues and not restricted to a certain region, the concept of the practice of the companions is distinct from the ‘amal ahl al-Madīnah. Likewise, it also differed from the ijmāʿ al-ṣaḥābah because the latter concept indicates the consensus of all companions on a practical legal ruling whereas the practice of the companions amounts to both the consensus of the companions and their individual opinions on the matters of uṣūl al-fiqh. Having said that, the concept of the practice of the companions has some overlaps with the qawl al-ṣaḥābī and ijmāʿ al-ṣaḥābah. It is observed in the Hanafi tradition of uṣūl al-fiqh that the practices of the companions are presented as a proof of many principles of uṣūl al-fiqh. This is because of the fact that the companions have a significant role as being the first practitioners of the revelation and the leading figures of the tradition of fiqh. Due to these significant roles of the companions, a central position is given to their interpretation method of the divine text and the technique of issuing legal opinions in determination of theoretical principles. In this study, I examine the impact of the practices of the companions on the Hanafi legal theory focusing on the work of al-Sarakhsī (d. 483/1090), al-Uṣūl, and try to identify how Hanafi legal theory was grounded, departing from, overall or particular, companions’ practices. This study consists of two main parts. First, I provide the conceptual framework by analyzing the concepts of the companion and the companions’ practice. Second, I discussed the theoretical issues rested evidentially on the companions’ practice. Hence, this study excludes the instances of qawl al-ṣaḥābī, ijmāʿ al-ṣaḥābah and the companions’ practice if they are not resorted in proving the uṣūl al-fiqh principles. This work deals with issues on which theoretical principles grounded in reference to the practice of the companions under the headings; Kitāb, Sunnah, qıyās, naskh and alfāz. When instances of the companions’ practice are in abundance in a case, I just focus on the highly representative ones and shortly refer to the others. In the conclusion part, I provide the consequences achieved by this research and some final remarks on the topic. (shrink)

In this study, we propose a new approach based on fuzzy TODIM (Portuguese acronym for interactive and multicriteria decision-making) for decision-making problems in uncertain environments. Our method incorporates group utility and individual regret, which are often ignored in traditional multicriteria decision-making (MCDM) methods. To enhance the analysis and application of fuzzy sets in decision-making processes, we introduce novel entropy and distance measures for q-rung picture fuzzy sets. These measures include an entropy measure based on the sine function and a distance (...) measure derived from the Jensen-Shannon divergence. In our methodology, incorporating the sine function into the entropy measure stands out as a distinctive decision, grounded in a profound understanding of the inherent characteristics of fuzzy sets. Utilizing the sine function proves especially advantageous when handling fuzzy sets that exhibit cyclical variations or fluctuations in their membership degrees. We effectively weight the criteria for an improved evaluation by using this new entropy measure. The introduced distance measure finds application in the TODIM approach, allowing the execution of TODIM method steps within a fuzzy environment until the determination of one alternative’s dominance over another—an advancement beyond traditional approaches. We apply our enhanced fuzzy TODIM method to a real-life construction project management problem from the literature and compare the results with those in the literature and obtained from other MCDM methods. Our proposed measures are robust, as demonstrated by the sensitivity analysis that varied the weights of group utility and individual regret, with the results visualized in a 3D sensitivity plot. The findings demonstrate the superiority of our method in providing a more comprehensive evaluation of alternatives, making it a useful tool for decision-makers facing complex and uncertain decision-making problems. (shrink)

In this paper, we introduce the concepts of Pythagorean fuzzy valued neutrosophic set (PFVNS) and Pythagorean fuzzy valued neutrosophic (PFVNV) constructed by considering Pythagorean fuzzy values (PFVs) instead of numbers for the degrees of the truth, the indeterminacy and the falsity, which is a new extension of intuitionistic fuzzy valued neutrosophic set (IFVNS). By means of PFVNSs, the degrees of the truth, the indeterminacy and the falsity can be given in Pythagorean fuzzy environment and more sensitive evaluations are made by (...) a decision maker in decision making problems compared to IFVNSs. In other words, such sets enable a decision maker to evaluate the degrees of the truth, the indeterminacy and the falsity as PFVs to model the uncertainty in the evaluations. (shrink)

Reserve systems are a tool to allocate scarce resources when stakeholders do not have a single objective. This paper introduces some basic concepts about reserve systems for pandemic medical resource allocation. At the onset of the Covid-19 pandemic, we proposed that reserve systems can help practitioners arrive at compromises between competing stakeholders. More than a dozen states and local jurisdictions adopted reserve systems in initial phases of vaccine distribution. We highlight several design issues arising in some of these implementations. We (...) also offer suggestions about ways practitioners can take advantage of the flexibility offered by reserve systems. (shrink)

Erken dönemlerden itibaren fıkhî meseleler üzerindeki tartışmalar, bir yönteme bağlı kalınarak icra edilmiştir. Tartışmalarda belirli soru ve cevap türlerine başvurulmuş, soruların tertibine özen gösterilmiştir. Bu sayede taraflar kendi görüşlerinin doğruluğunu, karşıt görüşün yanlışlığını çelişkiye düşmeden ortaya koymaya çalışmıştır. Bu çalışmada ilk olarak cedelden ve cedelin fıkha tatbikinden bahsedilmiş, sonrasında münâzaracı kimlikleriyle meşhur olan Hanefî fakihi Kudûrî ile Şâfiî fakihi Ebu’t-Tayyib et-Taberî arasında geçtiği rivayet edilen talâka dair bir münâzara inceleme konusu edilmiştir. Bu münâzarada, muhâlea ile boşanılan kadına, kadının iddeti esnasında (...) tekrardan ricî talâk yapılabileceğini savunan Kudûrî ile bu durumda talâkın geçersiz olacağını söyleyen Taberî’nin karşılıklı istidlal ve itirazları yer almaktadır. Bu tartışmanın temelini Kudûrî’nin muhâlea yapılan kadını ricî talâkla boşanan kadına kıyas etmesi oluşturmaktadır. Taberî bu kıyasın illetine yönelik mutâlebe, itirâz ve muâraza türü sorulara başvurmuş, Kudûrî ise kendi illetinin sıhhatini savunmaya çalışmıştır. Yer yer tartışma kurallarına atıfların yapılması yönüyle de önemli olan bu münâzara incelenirken, cedelin fıkha tatbikine dair kısımda zikredilen bilgilerin pratikte nasıl uygulandığına işaret edilmiştir. (shrink)

Les Prolegomenes a la Philosophie de Platon sont un manuel d'ecole neoplatonicien. Il s'inspire d'un modele dont Proclus a du etre l'auteur, mais l'origine de ce texte est presque surement alexandrine et doit dater de la premiere moitie du Vle siecle. Cette oeuvre est essentielle pour comprendre comment etait diffuse l'enseignement platonicien, et pour mieux saisir le mouvement des idees de l'Antiquite finissante. Dans une importante introduction, L. O. Westerink a retrace l'histoire de l'ecole d'Alexandrie et celle du genre litteraire (...) de ces introductions a Platon et a Aristote. (shrink)

Tuberculosis (TB) is a potentially fatal infectious disease that, in Aotearoa New Zealand (NZ), inequitably affects Asian, Pacific, Middle Eastern, Latin American, and African (MELAA), and Māori people. Medical research involving genome sequencing of TB samples enables more nuanced understanding of disease strains and their transmission. This could inform highly specific health interventions. However, the collection and management of TB isolate samples for research are currently informed by monocultural biomedical models often lacking key ethical considerations. Drawing on a qualitative kaupapa (...) Māori–consistent study, this paper reports on preliminary discussions with groups of Māori, Pacific, and Afghan people in NZ, whose communities have been harmed by TB and TB stigma. Participants’ discussions highlight key concerns and meanings that ought to inform the development of guidelines and a more robust consultative process for the governance of how TB isolate samples are collected and used both retrospectively and in future research. We argue for ethical processes to be culturally nuanced and community-generated, flexible and meaningful, and situated in relation to the physical and symbolic effects of TB. We discuss the significance of Indigenous data sovereignty, rights, and kāwanatanga (governorship) in shaping a multicultural data sovereignty model. (shrink)

are synthetic a priori judgements possible?" In both cases, i~thas usually been t'aken for granted in fife one case by Kant that synthetic a priori judgements were possible, and in the other case in contemporary,'d-". philosophical literature that contingent statements of identity are ppss. ible. I do not intend to deal with the Kantian question except to mention:ssj~".

Purpose. To examine the existential anthropology of G. Marcel and E. Minkowski, in order to demonstrate the necessity of distinguishing the universal-spiritual, as human in human being, apart from the individual-existential in him, and to reveal the hierarchical correlation of biosocial, existential and spiritual spheres in personality. Theoretical basis. Within existential philosophy the author differentiates two separate traditions and proceeds from the insufficiency of the distinction of existential sphere, proposed by phenomenological tradition, showing the necessity of its correlation with the (...) spiritual sphere as a sphere of humanity, proposed by non-phenomenological tradition of G. Marcel and E. Minkowski. Originality. The author presents the anthropological conception of G. Marcel and E. Minkowski, in which human personality is understood as unity of individual-existential and universal-spiritual, which requires a special trans-empirical field of culture, which contains senses, images and symbols of humanity. Also, the author presents the recent developments of existential thinkers in distinguishing existential and spiritual dimensions, both not reducible to the physical and social dimensions. Conclusions. In both existential traditions, the specifically human was founded as a trans-biological and trans-social phenomenon, which appears as indefinable and non-predetermined. But in first tradition, humanity is understood as an existence, as a unique individuality, "project", variant of humanity, equivalent to other variants, and universal is understood as a community of human condition in the world. While in the second tradition, the universal is understood as spiritual. Thus, horizontal level of our private existence, as the process of movement from birth to death, is supplemented by vertical of human, universal ideals and images. Humanity appears as a task, on the way to which human being transcends beyond the limits of his individual "self" to the "super-individual", through inclusion into spiritual community, into universal culture. (shrink)

Trope theory is a leading metaphysical theory in analytic ontology. One of its classic statements is found in the work of Donald C. Williams who argued that tropes qua abstract particulars are the very alphabet of being. The concept of an abstract particular has been repeatedly attacked in the literature. Opponents and proponents of trope theory alike have levelled their criticisms at the abstractness of tropes and the associated act of abstraction. In this paper I defend the concept of a (...) trope qua abstract particular by rejecting arguments that purport to show that tropes should not be understood as abstract and by arguing that the abstractness of tropes plays an indispensable role in one of our more promising trope-theoretic analyses of universals and of concrete objects. (shrink)

Modern scholars have been concerned with the hostility shown to Alexander by the Hellenistic schools of philosophy. Two literary portraits have been distinguished, the Peripatetic and the Stoic, the former deriving from Theophrastus' book on Callisthenes, or starting with this work the Peripatetics worked out a theory of and applied it to Alexander, in order to belittle his achievements. It was a case of giving sophisticated expression to the kind of crude resentment expressed by Demades.

The locus classicus for Plutarch's own views on his methods is in the Alexander He has begun by asking for the indulgence of his readers if they do not find all the exploits of Alexander and Caesar recounted by the biographer or if they discover him not reporting some famous incident in detail (); and he goes on to compare his own search for evidence which will indicate the kind of soul, with the activity of the painter, who, in order (...) to create a likeness, concentrates on the eyes and pays little attention to the other parts. Commentators and critics have been right to take this as a key text for the purpose of understanding Plutarch's attitude towards his biographical work; nevertheless there are other passages in the Lives where we can at least glimpse his attitude to his subject, and we can only see the Alexander-remarks in correct perspective if we take these other passages into account. I propose therefore, starting with the Alexander, to see how far these critical remarks apply to Plutarch's theory and practice elsewhere in the Lives. (shrink)

According to the Ars Amatoria the notorious rape took place on the occasion of a primitive dramatic entertainment staged in a theatre, in which the seats and furnishings were also primitive. There is no time for a description of the arts of the performers—a tibicen and a ludius—before the Romans, impatient for action, receive their signal from Romulus. Nor is there any mention of a god in whose honour the entertainment had been provided.