The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below that of (...) someone without a disability or illness. Hence we can, other things being equal, gain more QALYs by saving the lives of those without a permanent disability or illness than by saving the lives of those who are disadvantaged in these ways. But to do so puts these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, but because of it, a low priority is given to forms of health care that can preserve their lives. This, so the objection runs, is unjust or unfair. This article assesses this objection to the use of QALYs as a basis for allocating health care resources. It seeks to determine what is sound in the double jeopardy objection, and then to show that the defender of QALYs has an adequate response to it. (shrink)

DNA topoisomerases, capable of manipulating DNA topology, are ubiquitous and indispensable for cellular survival due to the numerous roles they play during DNA metabolism. As we review here, current structural approaches have revealed unprecedented insights into the complex DNA‐topoisomerase interaction and strand passage mechanism, helping to advance our understanding of their activities in vivo. This has been complemented by single‐molecule techniques, which have facilitated the detailed dissection of the various topoisomerase reactions. Recent work has also revealed the importance of topoisomerase (...) interactions with accessory proteins and other DNA‐associated proteins, supporting the idea that they often function as part of multi‐enzyme assemblies in vivo. In addition, novel topoisomerases have been identified and explored, such as topo VIII and Mini‐A. These new findings are advancing our understanding of DNA‐related processes and the vital functions topos fulfil, demonstrating their indispensability in virtually every aspect of DNA metabolism. (shrink)

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of (...) potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient. (shrink)

Harris argues that if QALYs are used only 50% of the population will be eligible for survival, whereas if random methods of allocation are used 100% will be eligible. We argue that this involves an equivocation in the use of "eligible", and provides no support for the random method. There is no advantage in having a 100% chance of being "eligible" for survival behind a veil of ignorance if you still only have a 50% chance of survival once the veil (...) is lifted. A 100% chance of a 50% chance is still only a 50% chance. We also argue that Harris provides no plausible way of dealing with the criticism that his random method of allocation may result in the squandering of resources. (shrink)

Within the increasingly complex picture which has emerged in recent years of the manuscript tradition of Ovid's Amores the relationship of the two earliest MSS appears to remain firm: cod. P or Puteaneus of the 9th or early 10th century, which begins at Am. 1.2.51, was copied, probably directly, from the second half of the 9th-century cod. R or Regius , whose first half now ends at Am. 1.2.50. This view, which originates in S. Tafel's dissertation of 1910 and lies (...) behind the stemma constructed by E. J. Kenney for his OCT edition of 1961 , has come to be taken by Ovidian scholars to be the truth. My purpose in this first section is to show that this idea is unlikely to be the truth and, in the form in which it has most strongly been put forward, cannot be the truth. In the second section consequences for the manuscript tradition as a whole are explored. First we shall need some details. P, the slightly later manuscript, consists in all of 99 folia, of which 1–54 contain most, but not all, of the Heroides — not all, because they are in a lacunose state, a point to which we shall return in greater detail later. Foll. 55–6 are blank sheets of paper, not parchment, clearly inserted at a much later date during rebinding. (shrink)

Within the increasingly complex picture which has emerged in recent years of the manuscript tradition of Ovid's Amores the relationship of the two earliest MSS appears to remain firm: cod. P or Puteaneus of the 9th or early 10th century, which begins at Am. 1.2.51, was copied, probably directly, from the second half of the 9th-century cod. R or Regius, whose first half now ends at Am. 1.2.50. This view, which originates in S. Tafel's dissertation of 1910 and lies behind (...) the stemma constructed by E. J. Kenney for his OCT edition of 1961, has come to be taken by Ovidian scholars to be the truth. My purpose in this first section is to show that this idea is unlikely to be the truth and, in the form in which it has most strongly been put forward, cannot be the truth. In the second section consequences for the manuscript tradition as a whole are explored. First we shall need some details. P, the slightly later manuscript, consists in all of 99 folia, of which 1–54 contain most, but not all, of the Heroides — not all, because they are in a lacunose state, a point to which we shall return in greater detail later. Foll. 55–6 are blank sheets of paper, not parchment, clearly inserted at a much later date during rebinding. (shrink)

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the (...) central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data. (shrink)

This paper continues the debate between myself and Peter Singer et al started in the Journal of Medical Ethics volume 21, no 3 about the ethical respectability of the use of QALYs in health care allocation. It discusses the question of what, in the way of health care provision, would be chosen by rational egoists behind a Rawlsian "veil of ignorance", and takes forward the vexed question of what is to count as "doing good" and hence as "doing the most (...) good" in health care. Most importantly, this paper argues that it would be unfair to discriminate against people because they have been disadvantaged by their genetic condition. It notes that McKie et al in their reply to my first contribution to this debate continue to fail to distinguish between chance and probability and it is argued that this failure causes them to miss the whole point of the argument. (shrink)

This paper develops a theory of propositional identity which distinguishes necessarily equivalent propositions that differ in subject-matter. Rather than forming a Boolean lattice as in extensional and intensional semantic theories, the space of propositions forms a non-interlaced bilattice. After motivating a departure from tradition by way of a number of plausible principles for subject-matter, I will provide a Finean state semantics for a novel theory of propositions, presenting arguments against the convexity and nonvacuity constraints which Fine (2016, 2017a,b) introduces. I (...) will then move to compare the resulting logic of propositional identity (PI) with Correia’s (2016) logic of generalised identity (GI), as well as the first degree fragment of Angell’s (1989) logic of analytic containment (AC). The paper concludes by extending PI to include axioms and rules for a subject-matter operator, providing a much broader theory of subject-matter than the principles with which I will begin. (shrink)

Susan Edwards-McKie interviews Professor Dr B. F. McGuinness on the occasion of his 90th birthday.

What proportion of available healthcare funds should be allocated to hip replacement operations and what proportion to psychiatric care? What proportion should go to cardiac patients and what to newborns in intensive care? What proportion should go to preventative medicine and what to treating existing conditions? In general, how should limited healthcare resources be distributed If not all demands can be met?

This chapter contains sections titled: Educational Technology as Revealing and Concealing Ontological Assumptions Critical Themes for Education Work and Play Imagination.

In the past decade structures and processes for the ethical review of UK health care research have undergone rapid change. Although this has focused users' attention on the functioning of review committees, it remains rare to read a substantive view from the inside. This article presents details of processes and findings resulting from a novel structured reflective exercise undertaken by a newly formed research ethics review panel in a university school of nursing and midwifery. By adopting and adapting some of (...) the knowledge to be found in the art and science of malt whisky tasting, a framework for critical reflection is presented and applied. This enables analysis of the main contemporary issues for a review panel that is primarily concerned with research into nursing education and practice. In addition to structuring the panel's own literary narrative, the framework also generates useful visual representation for further reflection. Both the analysis of issues and the framework itself are presented as of potential value to all nurses, health care professionals and educationalists with an interest in ethical review. (shrink)

Recent studies indicate that mammalian chromosomes contain discretecis‐acting loci that control replication timing, mitotic condensation, and stability of entire chromosomes. Disruption of the large non‐coding RNA gene ASAR6 results in late replication, an under‐condensed appearance during mitosis, and structural instability of human chromosome 6. Similarly, disruption of the mouse Xist gene in adult somatic cells results in a late replication and instability phenotype on the X chromosome. ASAR6 shares many characteristics with Xist, including random mono‐allelic expression and asynchronous replication timing. (...) Additional “chromosome engineering” studies indicate that certain chromosome rearrangements affecting many different chromosomes display this abnormal replication and instability phenotype. These observations suggest that all mammalian chromosomes contain “inactivation/stability centers” that control proper replication, condensation, and stability of individual chromosomes. Therefore, mammalian chromosomes contain four types ofcis‐acting elements, origins, telomeres, centromeres, and “inactivation/stability centers”, all functioning to ensure proper replication, condensation, segregation, and stability of individual chromosomes. (shrink)

J.L. Ackrill's work on Plato and Aristotle has had a considerable influence upon ancient philosophical studies in the late twentieth century. This volume collects the best of Ackrill's essays on the two greatest philosophers of antiquity. With philosophical acuity and philological expertise he examines a wide range of texts and topics--from ethics and logic to epistemology and metaphysics--that continue to be in the focus of debate.

Most countries appear to believe that their health system is in a state of semi-crisis with expenditures rising rapidly, with the benefits of many services unknown and with pressure from the public to ensure access to a comprehensive range of services. But whose values should inform decision-making in the health area, and should the influence of different groups vary with the level of decision-making? These questions were put to 54 members of the public and health professionals in eight focus groups. (...) Adopting a different perspective from other studies, participants were not asked if particular groups should be involved in decisions but rather through deliberation and discussion nominated their own potential decision makers. This delivered a clear message that participants saw a legitimate role for a broad range of stakeholders in priority-setting decisions so as to incorporate a diversity of expertise and opinion. Companion themes were the acknowledgment that decisions involve ethical judgments and are not purely technical, that the power of special interest groups (such as clinicians) should be kept in check, and that the process by which decisions are reached is important. The results suggest that qualitative methods of investigation have the potential to improve the legitimacy of policy decisions by contributing to a better understanding of the values of the public and health professionals, and by expanding the range of options available for further research. (shrink)