On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decision-makers using a question-and-answer format, in language that avoids philosophical and medical technicality. The (...) working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics. (shrink)

On 4th of August 2020, the Lebanese capital and port city, Beirut, was rocked by a massive explosion that has killed hundreds and injured thousands more, ravaging the heart of the city’s nearby downtown business district and neighbouring housing areas, where more than 750,000 people live. The waterfront neighbourhood and a number of dense residential neighbourhoods in the city’s eastern part were essentially flattened. Lebanese Government officials believe that the blast was caused by around 2,700 tonnes of ammonium nitrate stored (...) near the city’s cargo port without proper control for six years. -/- The disaster devastating Beirut’s port and city shows the latent danger of safe storage of potentially dangerous goods in modern ports, particularly ones located close to the heart of the city. The huge blast tore through major grain silos, stoking fears of shortages in a nation that imports nearly all its food and is already reeling from economic crisis. As the WFP (World Food Programme) said in a statement: the blast will “exacerbate the grim economic and food-security situation.” The Beirut blast also reminds us of the importance of ports in the contemporary globalized world. It calls our attention to safety and security, of governance and collaboration between port and city or region and of accessibility to the hinterland. What do local governments and port cities need to do to enhance the safety and security issues in port terminals? Or, to put it differently, how do we reconcile this challenge between the ports we need to feed us, serve us, provide us with medicines, equipment, etc. and the ports that threatens us? (shrink)

This paper provides a new rationale for equating brain death with the death of the human organism, in light of well-known criticisms made by Alan D Shewmon, Franklin Miller and Robert Truog and a number of other writers. We claim that these criticisms can be answered, but only if we accept that we have slightly redefined the concept of death when equating brain death with death simpliciter. Accordingly, much of the paper defends the legitimacy of redefining death against objections, before (...) turning to the specific task of defending a new rationale for equating brain death with death as slightly redefined. (shrink)

Clinical trials emerged in rapid succession as the COVID-19 pandemic created an unprecedented need for life-saving therapies. Fair and equitable subject selection in clinical trials offering investigational therapies ought to be an urgent moral concern. Subject selection determines the distribution of risks and benefits, and impacts the applicability of the study results for the larger population. While Research Ethics Committees monitor fair subject selection within each trial, no standard oversight exists for subject selection across multiple trials for the same disease. (...) Drawing on the experience of multiple clinical trials at a single academic medical centre in the USA, we posit that concurrent COVID-19 trials are liable to unfair and inequitable subject selection on account of scientific uncertainty, lack of transparency, scarcity and, lastly, structural barriers to equity compounded by implicit bias. To address the critical gap in the current literature and international regulation, we propose new ethical guidelines for research design and conduct that bolsters fair and equitable subject selection. Although the proposed guidelines are tailored to the research design and protocol of concurrent trials in the COVID-19 pandemic, they may have broader relevance to single COVID-19 trials. (shrink)

In recent decades, evidence-based medicine has become one of the foundations of clinical practice, making it necessary that healthcare practitioners develop keen critical appraisal skills for scientific papers. Worksheets to guide clinicians through this critical appraisal are often used in journal clubs, a key part of continuing medical education. A similar need is arising for health professionals to develop skills in the critical appraisal of medical ethics papers. Medicine is increasingly ethically complex, and there is a growing medical ethics literature (...) that modern practitioners need to be able to use in their practice. In addition, clinical ethics services are commonplace in healthcare institutions, and the lion’s share of the work done by these services is done by clinicians in addition to their usual roles. Education to support this work is important. In this paper, we present a worksheet designed to help busy healthcare practitioners critically appraise ethics papers relevant to clinical practice. In the first section, we explain what is different about ethics papers. We then describe how to work through the steps in our critical appraisal worksheet: identifying the point at issue; scrutinising definitions; dissecting the arguments presented; considering counterarguments; and finally deciding on relevance. Working through this reflective worksheet will help healthcare practitioners to use the ethics literature effectively in clinical practice. We also intend it to be a shared evaluative tool that can form the basis of professional discussion such as at ethics journal clubs. Practising these critical reasoning skills will also increase practitioners’ capacity to think through difficult ethical decisions in daily clinical practice. (shrink)

Australia’s punitive policy towards people seeking asylum deliberately causes severe psychological harm and meets recognised definitions of torture. Consequently, there is a tension between doctors’ obligation not to be complicit in torture and doctors’ obligation to provide best possible care to their patients, including those seeking asylum. In this paper, we explore the nature of complicity and discuss the arguments for and against a proposed call for doctors to boycott working in immigration detention. We conclude that a degree of complicity (...) is unavoidable when working in immigration detention, but that it may be ethically justifiable. We identify ways to minimise the harms associated with complicity and argue that it is ethical to continue working in immigration detention as long as due care and attention is paid to minimising the harms of complicity. (shrink)

Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to (...) measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC. (shrink)

This article describes the results of research that investigated whether student nurses identified the moral aspects of everyday nursing care situations and, if so, how they dealt with them. We intended to elucidate the role of mentoring situations in moral development. Student written documents reflecting discussions during mentoring situations were analysed quantitatively and qualitatively. The students studied in one of the three nursing schools involved in the research. In only a small proportion of cases (<13%) did the students identify the (...) ethical questions in those situations. The results indicate that the nursing students rarely identified moral issues, implying that there was little conscious moral reflection and deliberation in their mentoring situations dealing with their problematic experiences during their internship. Additional competences will be required for session leaders in order to allow mentoring situations to play a more prominent role in moral development. (shrink)

Char et al. describe an interesting and useful approach in their paper, “Identifying ethical considerations for machine learning healthcare applications.” Their proposed framework, which see...

The independence of research is a key strategic issue of modern societies. Dealing with it appropriately poses legal, economic, political, social and cultural problems for society, which have been studied by the corresponding disciplines and are increasingly the subject of reflexive discourses of scientific communities. Unfortunately, problems of independence are usually framed in disciplinary contexts without due consideration of other perspectives’ relevance or possible contributions. To overcome these limitations, we review disciplinary perspectives and findings on the independence of research and (...) identify interdisciplinary prospects that could inform a research programme. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 38-39, July 2012.

A model for the trapping of animals with a circular pitfall is formulated. The model's assumptions are: The animals move independently according to the same Brownian motions. The boundary of the pitfall acts as an absorbing or elastic barrier. Initially a fixed number of animals is independently homogeneously distributed over a finite study area, or the initial positions follow a homogeneous planar Poisson process. The model depends on three free parameters: the motility of the animals, their reaction to the pitfall, (...) the initial density.It appears that the catches in disjoint time intervals are multinomially or independently Poisson distributed. The parameters of these distributions are obtained by solving certain partial differential equations. (shrink)

Dans L’Anti-Œdipe, Deleuze s’oppose violemment à la psychanalyse freudienne. Il l’accuse de n’être au fond qu’un processus participant à la répression du désir. En lieu et place de la psychanalyse, Deleuze veut fonder la schizo-analyse. Celle-ci aurait la spécificité d’éviter la répression des machines désirantes par le signifiant. Elle se focaliserait plus sur la manière dont marchent les machines désirantes de chacun que sur une analyse schématique. Mais la nature exacte de cette schizo-analyse deleuzienne demeure difficile à déterminer.