A recent decision by several Australian State politicians to support a parliamentary review of artificial water fluoridation has an intensified debate on the public health intervention. While there is a majority agreement among Australian dentists and other health professionals that adequate enamel fluoride is essential for dental health, the ethics of artificial fluoridation of public water supplies as a contemporary vehicle for facilitating adequate supply of fluoride to teeth is highly contested. Opponents of artificial water fluoridation (...) insist that there are many alternative sources of fluoride, that mandatory water fluoridation violates the ethical principle of autonomy and that water fluoridation is not only expensive and unnecessary but also may endanger health by causing fluorosis and, potentially, hypothyroidism and pathological bone fractures. In contrast, proponents of water fluoridation posit that mandatory water fluoridation facilitates health equity and that the benefits accruing to society from prevention of dental caries (beneficence principle) outweighs impairment of individual autonomy. This article utilizes Childress’ ‘justificatory conditions’ to evaluate the ethical appropriateness of artificial water fluoridation in Australia. The author concludes that there is insufficient ethical justification for artificial water fluoridation in Australia. (shrink)

As climate change continues to pose global challenges, understanding how individuals perceive and respond to its effects is crucial for informed policymaking and community engagement. Conducting the Bayesian Mindsponge Framework (BMF) analysis on a dataset of 1,831 water users in Albuquerque, New Mexico, the study explores the intricate dynamics between climate change belief, awareness of water scarcity, and water conservation behaviors. Results reveal a complex relationship wherein residents with increased awareness of water scarcity demonstrate intensified (...) class='Hi'>water conservation behaviors, particularly when believing in climate change’s negative impacts on water supply. The moderating role of water scarcity awareness introduces complexity, suggesting that the correlation between residents' belief in climate change and their engagement in water conservation behaviors depends on their awareness of local water challenges. This study highlights the importance of appropriate interventions that consider both psychological and contextual dimensions in promoting sustainable water management practices. Policy recommendations emphasize integrated awareness campaigns, developing an eco-surplus mindset, and incorporating sustainability principles aligned with the Sustainable Development Goals. (shrink)

Urban and agricultural communities are interdependent but often differ on approaches for improving water quality impaired by nutrient runoff waterbodies worldwide. Current water quality governance involves an overlapping array of policy tools implemented by governments, civil society organizations, and corporate supply chains. The choice of regulatory and voluntary tools is likely to influence many dimensions of the relationship between urban and agricultural actors. These relationships then influence future conditions for collective decision-making since many actors participate for multiple (...) years in water quality improvement. In this policy analysis, we draw on our professional experiences and research, as well as academic and practitioner literatures, to investigate how different types of water quality interventions influence urban-agricultural relationships, specifically examining policy tools on a regulatory to voluntary spectrum. Interactions between farmers and other rural agricultural interests on one hand, and urban residents and their stormwater managers and wastewater treatment plants on the other, influence dynamics relevant for water quality improvement. We suggest that the selection of policy tools within complex governance contexts influence urban–agricultural relationships through financial exchange, political coalitions, knowledge exchange, interpersonal relationships, and shared sense of place. Policy tools that provide a means to build relationships and engage with people’s emotions and identities have potential to influence personal and community change and adaptive capacity, while processes such as lawsuits can catalyze structural change. Engaging these relationships is particularly critical given the need to move out of polarized positions to solve collective problems. (shrink)

Food fortification and water fluoridation are two public health initiatives that involve the passive consumption of nutrients through food and water supplies. While ethical analyses of food fortification and water fluoridation have been done separately, none have been done together. In this paper, we will consider whether the similarities between food fortification and water fluoridation override their differences and thus what ethical conclusions can be cross-pollinated between the two interventions. This study does three things: first, (...) we review the origin, reasoning and mechanisms behind food fortification and water fluoridation. From there, we deduce the primary ethical dilemma that overshadows food fortification and water fluoridation – they both require a form of deception and are consumed passively without the need for informed consent. Finally, we look at various approaches ethicists have taken to understand the ethical issues surrounding the programs. Two key ethical models appear in this discussion: the justificatory approach and the stewardship model. Beyond these two frameworks, one ethical analysis deduces from the Nuremberg Code that water fluoridation is unethical based on the definition of consent. As recent scientific papers and the general public have started discussing and debating the passive consumption of various drugs via public water supplies, it is prudent that we revisit the ethics behind food fortification and water fluoridation programs; this will ultimately allow us to better navigate complex problems in nutritional ethics and passive delivery. (shrink)

The central goal of this essay is to develop a theory of justified paternalism that will be useful in evaluating and designing paternalistic public policies. The theory is designed for a society that promotes the development of characteristics of autonomy in its members. In the opening chapter I analyze widely-held legal, familial and philosophic conceptions of paternalism, discuss the inadequacies of each of those conceptions and develop a "unified" conception of paternalism. In Chapter II I analyze what it means to (...) be "morally responsible" and base this analysis on the legal, psychological and psychiatric accounts of responsibility that inform an autonomist society. From these analyses I develop two principles which inform an autonomist society: Respect for Others and Non-Interference and discuss the restraints on justifiable paternalism entailed by them. In Chapter III I discuss the roles of voluntariness and consent in the legal, phychiatric and philosophic concepts of moral responsibility and turn to an analysis of the disappointing treatments of these concepts in traditional philosophic justifications for paternalism. I argue that "unencumbered consent" is an appropriate concept of consent to utilize in any philosophic justification for paternalism that would be consistent with the concepts of moral responsibility and autonomy and the principles of respect for others and of non-interference. Chapter IV offers a decision-theoretic model justifying acting paternalistically for others. Each of the necessary conditions for justified paternalism is drawn from the aforementioned concepts and principles. In Chapter V, I show that if Rawls is to be consistent, he must adopt a theory of paternalism similar to mine, and I argue that my theory of paternalism overcomes libertarian, utilitarian and statistical arguments against it. I then apply the theory to specific forms of paternalism including involuntary commitment and guardianship, mandatory blood transfusions, flouridation of public water supplies, mandatory motorcycle helmets and seatbelts, social security taxation, mandatory education of children and suicide intervention. A 267-entry bibliography is appended. (shrink)

Child mortality differentials according to water supply and sanitation in many urban areas of developing countries suggest that access to piped water and toilet facilities can improve the survival chances of children. The central question in this study is whether access to piped water and a flush toilet affects the survival chance of children under five in urban areas of Eritrea. The study uses data collected by the Demographic and Health Survey (DHS) project in Eritrea in (...) 1995. The results show that while the unadjusted effect of household environment (water supply and toilet facility) is large and statistically significant during the post[hyphen]neonatal and child periods, it is relatively small and statistically insignificant during the neonatal period. The effect of household environment remains substantial during the post[hyphen]neonatal and child periods, even when other socioeconomic variables are held constant. However, the household environment effect totally disappears during the neonatal period when the socioeconomic factors are controlled for. (shrink)

Constraints on the expansion of western water supply projects have turned the attention of urban water developers to market purchases of agricultural water supplies as a source of new water. The conventional wisdom of natural resource economics suggests that such shifts should have minimal impact on the agricultural area-of-origin, promote efficiency in water use, and provide an inexpensive and environmentally preferable alternative to building more dams and reservoirs. However the concentration of urban demand combines (...) with water-extensive irrigation practices in western agriculture and a characteristically bipolar economic and social structure in western irrigation communities to create a potential for severe stress on rural economies and communities. The adaptation of supply-oriented western water institutions to market-oriented functions has not provided a decision-making context that accounts for costs imposed on rural communities; moreover, historically water-rich rural communities have not evolved a water policy infrastructure capable of responding to stress. Before the promise of low-cost water supply through the market mechanism can be realized, the structural contradictions inherited from the traditional water-management institutions must be faced and dealt with by both rural source regions and urban water importers. (shrink)

The focus of this study was on adolescent mental health. More specifically, the relationship between strength-based parenting (SBP) and subjective wellbeing (SWB) during adolescence, as assessed by a sample of adolescents, was examined at three time points over 14 months (N = 202, Mage = 12.97, SDage =.91, 48% female). SBP was positively related to life satisfaction and positive affect at each of the three time points, and was negatively related to negative affect. SBP and SWB both declined significantly over (...) time. When examining the causal relationships between SBP and SWB, two different statistical models were applied: latent growth-curve models (LGM) and random-intercept cross-lagged panel models (RI-CLPM). The LGM revealed a strong positive relationship between changes in SBP and SWB. Specifically, this model showed that SBP at one time point predicted adolescent SWB at future time points. However, when the more stringent statistical test was completed through RI-CLPMs, no cross-lagged paths reached significance. Thus, while parenting is a significant predictor of wellbeing for pre-teens and teens in real time, it is not predictive of wellbeing at future time points. Parents, thus, cannot assume that their current levels of SBP are ‘banked’ by their children to support future wellbeing. Instead, SBP needs to be an ongoing, contemporary parenting practice. Furthermore, the fact that perceptions of SBP decline in this age bracket suggest that SBP interventions may be helpful in supporting adolescent mental health. (shrink)

The map of Jerusalem, which appeared in 1320 in Marino Sanudo's book, Liber secretorum fidelium crucis, has no obvious precursor, though it draws on textual sources from the works of Josephus to the thirteenth-century description of the Holy Land by Burchard of Mt. Sion. Surrounded by an irregular polygon of walls, the city is mapped in a style similar to the other maps in the book, drawn by the sea-chart maker Pietro Vesconte. These maps emphasize the contemporary, physical reality of (...) an area, the Holy Land, often seen through a romantic veil. Sanudo's book was a plea for the revival of the crusading movement and a programme of practical suggestions for its success. Of special interest on the map is the depiction of the city's water resources, important to future Crusaders. (shrink)

Commentaries on our target article raise further questions about the validity of an undifferentiated central executive that supplies resources to all verbal tasks. Working memory tasks are more likely to measure divided attention capacities and the efficiency of performing tasks within specific domains than a shared resource pool. In our response to the commentaries, we review and further expand upon empirical findings that relate performance on working memory tasks to sentence processing, concluding that our view that the two are not (...) strongly related remains viable in light of the material presented in the commentaries. We suggest that a productive research enterprise would be to develop the concept of working memory as a pool of resources in relation to specific tasks. (shrink)

Photo by Jonathan Ford on Unsplash ABSTRACT Since 2008, an average of twenty million people per year have been displaced by weather events. Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. This paper analyzes the idea of expanding a duty to rescue to climate migration. We address who should have (...) the duty and to whom the duty should extend. The paper discusses ways to define and apply the duty to rescue as well as its limitations, arguing that it may take the form of an ethical duty to prepare. INTRODUCTION Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. Examples of circumstances range from person-to-person intimate rescue to saving those in poverty, even in distant parts of the world.[1] Since 2008, an average of twenty million people per year have been displaced by weather events.[2] Circumstances like being thrust from homes under the threat of fire, mudslide, and flooding vary greatly from long-term changes like land becoming too arid for crops or temperatures increasing annually gradually pushing up the number of heat-related deaths, with the area slowly becoming uninhabitable. Imminence in fleeing affects resettling and need for rescue with important implications for how the duty to rescue might apply. This paper reevaluates the ethical framing of the duty to rescue and, while it is arguably a stretch, applies it to climate migration. Climate migration has become common and is expected to increase due to rises in sea level, increases in weather events that make areas uninhabitable, and changes to land that preclude farming or other necessary land uses. We argue that a duty to rescue may help highlight who has moral obligations to whom. Because the problem is so large in scope, we suggest a change in the ethical limits to humans' duty to rescue other humans who are in distress. We imagine an expansion or extension of the duty to rescue to meet some of the basic needs created by climate migration. Yet how it should expand, and how much depend on ethical framing and practical limitations. l. Expanding the Geographical Boundaries Two commonly recognized emergencies, Hurricane Katrina in the case of weather events and the current COVID-19 pandemic, provide a historical and current backdrop to evaluate ethical obligations as more disasters displace people. A significant reassessment of the ethical scope of an obligation to rescue in the case of weather events will be limited by the ability to render aid to those in distress in the case of a planet-wide weather catastrophe. The problems may overwhelm the ability to rescue or the reasonableness of attempting rescue. The extent of the moral obligation borne by humans to other humans in the case of a weather event has been largely defined by its locality and limited geographic influence. Whether we are imagining the scope of ethical obligation in the case of hurricane, flood, tornado, drought, or wildfire events, the perceived ethical obligation is significantly defined by the limited impact of these weather events on people outside the zone of the weather event's direct impact, yet close to that zone. A hurricane affecting New Orleans will not have immediate impact on the residents of California or even those on the northeast coast of the United States until a later time. Wildfires in the Pacific Northwest do not impair the ability of those in the rest of the country to come forward with assistance. But as climate migration crosses international borders, and climate events occur simultaneously in many regions, a more expansive duty to rescue may provide the ethical impulse to help those who live afar or migrate long distances. In this respect, the need for help in the event of widespread climate migration due to global warming is more like a pandemic than a weather event. Its broad impact area diminishes the capability of nearly the entire balance of the human population to help due to those populations' awareness that they will, in short order, have the same need for the same resources, from the same cause. Those living near current flood zones may find their historically safe havens are also a flood zone. Those previously best positioned to rescue may find themselves also needing to relocate. Thus, we may observe the need for new rescuers. ll. The Rule of Rescue The Rule of Rescue as defined by Al Jonsen describes the moral impetus or knee jerk reaction to save identifiable people facing death.[3] A duty to rescue has since been expanded beyond imminent death and beyond the near and identifiable. But there are limitations. For example, by most accounts, the ethical duty tends not to require extreme bodily risk or financial depletion. In comparing Good Samaritans to humanitarians, Scott M. James argues the duty to rescue arises from unique dependence, but the ethical obligation to help strangers through humanitarian aid is of a different nature.[4] The wrongness of failing to help is arguably more egregious when one is in a unique position to help. Like in the tragedy of the commons, where there is no unique positioning, when the global community is called upon to help, each individual in it may feel less obliged to do so. Climate migration falls in between—it requires helping strangers, yet it may move forward without anyone seeing themselves as uniquely positioned to help until those strangers become part of communities, at which time, there may be more moral justification to help a community member in need. Generally, arguments about Good Samaritans hinge on extraordinary acts, praiseworthy because they are acts of compassion, not obligation. Now all US states have Good Samaritan laws[5] which protect helpers from liability for help gone wrong or for a failure to succeed once engaged in an act of rescue. Extraordinary help as a moral good is thus somewhat encouraged through legal protection, but not imposed. Conversely, jobs like firefighting, search and rescue, and emergency medical care tend to oblige employees to take on risks that would be extraordinary if undertaken by the average bystander, yet they are rendered ordinary rescue as part of the job. Three states, Minnesota, Rhode Island, and Vermont have a broad duty to rescue, adding legal considerations to an otherwise moral conundrum. The laws do not require bystanders to take on risk for the sake of rescuing strangers.[6] The moral duty will require looking beyond law, but it is unclear how the moral duty to rescue should be distributed in the case of climate migration. A bare minimum would prevent taking advantage of newcomers, paying sub-minimum wage, and discriminating against them. Yet such a minimum is hardly rescue. lll. An Ethical Rather than Legal Duty The difficulty in defining the duty to rescue as a legal obligation is that it is difficult to determine the extent of risk a rescuer ought to be required to take. The nature of this ethical duty is also arguably tied to the experiences of both the rescuer and the rescued. There are subjective aspects like what someone perceives as a danger that make it difficult to write enforceable laws requiring rescue. It is one thing to expect a rescuer to step into several inches of relatively warm water to lift a person lying face down in a pond and enable them to breathe. It is something altogether different to expect that rescuer to dive into frigid water and attempt to extricate someone trapped in a submerged automobile. As the legal philosopher H.L.A. Hart observed, it is always easier to define application of the core intention of any rule, whether law or ethical norm. It is more difficult to create legal certainty about how the law applies to what he described as “penumbra circumstances”. In the case of a hurricane, it is easier to define what surplus resources are available in areas geographically remote from the impact of the storm and demand, as a moral obligation, that those nearby but outside the area provide assistance. It is more difficult to obligate people, organizations, or governments to supply a quantity of medication or some number of ventilators to an adjacent community when they expect to imminently need them for their own community. In the early stages of climate migration, the ethics of extreme weather event assistance, a common application of the duty to rescue, will be useful and appropriate. The rising sea levels first experienced by island nations in the South Pacific[7] will not render those living in other coastal communities, those with greater available “high ground”, unable to supply resources to those in need. But when sea level rise and climate change affect more communities simultaneously, albeit in varying degree, the task of defining what response is ethically obligatory becomes increasingly complicated. Pinpointing the obligations of those communities which are resource rich to those communities which are resource deprived, and of those partly affected to those more severely affected may become necessary. The limitations of the traditional duty to rescue could expand to meet the needs. lV. Contribution to the Problem Many argue that the duty to rescue may depend on any appropriate claim of those needing rescue. One issue is whether preferential claims among those who can identify the source of the harm should call for a greater duty or whether everyone in need should be approached as like candidates for rescue, shaping the duty as equal across those on the receiving end. As climate change does have human-made causes, there are strong arguments to impose a greater ethical duty on any entity that caused the climate-related problems leading to the mass exodus. While the global north is often implicated in pollution that causes migration, industries like energy, transportation, and agriculture are tied to climate change and associated with significant greenhouse gas emissions.[8] Practices like directing agriculture to less sustainable single crop growth generally made land less farmable. Yet it is difficult to place blame and identify specific causal relationships as most migration is due to many factors. A movement toward greater accountability can be reframed as a greater duty to rescue, a duty to engage in the extraordinary. The fossil fuel industry, for example, should have a larger obligation than the average person. Similarly, some may argue anyone unjustly enriching themselves while contributing to climate change or people who over-consume have an elevated duty to rescue.[9] Climate change lawsuits demonstrate an eagerness to hold governments and corporations accountable, despite difficulty proving causation. V. The Most Vulnerable One ethical dimension of climate migration that remains unexplored is how a duty to rescue applies to vulnerable populations who stand to be left behind or unable to migrate without assistance. Researchers from the Global North working across the Global South are increasingly observing the phenomenon of ethics dumping, where the research ethics of some countries are imposed on research subjects in other countries.[10] In that vein, rescuers should be careful not to impose unwelcome cultural standards or exploit people who are in the process of migrating. There is a gap in discussions reflecting voices that have been left out. The duty to rescue is incomplete without an attempt to understand the ethical experiences of those being rescued. The actual people affected by climate migration who are the least likely to have the means to migrate, or to do so without extreme hardship, should have a voice informing the global community including those in a position to carry out rescue. People who have the means and are young and healthy may easily make decisions to avoid the catastrophic consequences that climate migration brings. However, what about those who are left behind? For example, especially recognizing cultural differences, the homeless community, disabled community, refugees, the elderly community, and women[11] and children may suffer differently and call for more attention. In some parts of the world, human rights are severely constrained. An ethical duty to rescue, with many considerations and variables, may be more justified in the case of those most in need. As climate migration continues and increases significantly, it may be reasonable to ask the local and global community to focus on those least well positioned to migrate successfully. In this context, the use of phenomenology to understand the lived experiences of those migrating, sometimes termed “ethical experiences”, may help flesh out how a duty to rescue takes shape. The discussion of duty and obligation requires an articulation of the ethical experiences (how the local community in need of rescue views the proposed rescue). Then, the obligation to interpret the duty as ‘one shall not’ or ‘one must’ can be focused on the migrants’ needs rather than the rescuers’ feelings of obligation.[12] A revised theory of the duty to rescue taking into account the asymmetrical experiences of communities involved could ensure that the needs of people whose living situations, gender, ethnicity, age, or race impact their ability to even begin the migration process are considered. In this discussion, the rescuing is directed toward communities /collectives of persons migrating, whether at once or across a period of time. Often, the climate migrant may not be in a state to articulate the nature of this event when it happens, given its subjective proximity. Yet, when communities are given the space and opportunity to articulate their shared values, the ethical action of rescue derives its meaningfulness from the community rather than the rescuers. In other words, allowing climate migrants to explain their feelings can add complexity to what some see as a binary receiver-giver (of rescue) dynamic. This is necessary because the concept of vulnerable populations is fraught with problematic assumptions. There have been various definitions and criteria to determine what would constitute vulnerable populations.[13] For example, the United Nations Framework Convention on Climate Change[14] identifies and assesses vulnerable populations. These criteria may be helpful. However, they do not provide the full picture. Rather than identifying categorical criteria of vulnerable populations, engaging with people who are experiencing climate migration and listening to their current experiences and concerns helps determine need. Knowing what people need may prevent the kneejerk reaction to label people who are quite resilient yet have appropriate needs “vulnerable”. Proceeding with caution is important because the duty to rescue has hierarchical underpinnings of "us" and "them." Often when people swoop in to save, there are good and bad consequences of the intervention. We should proceed with caution because often the helper misses the actual needs of those in need. The only way to combat this would be to make sure that people are empowered to inform those agencies that are able to help. In addition to more practical approaches, large scale oral histories could allow those who have migrated already to share their experiences. It would be important to capture the lived experiences of people who are already experiencing the consequences of climate migration or of other migration like that due to political or economic extreme events. These experiences could shape our analysis of whether people in fact wish for rescue. If so, further conversations can determine best actions as well as give important insight into what resources might be necessary to empower people now and in the future. Vl. A Duty to Rescue as a Duty to Prepare If we view Good Samaritans as going above and beyond, then a duty to rescue, something ethically compelled, must bring rescue out of the framework of charity and place it in the context of humanity and obligations. Such a view would also support expanding the geographical reach of the otherwise more proximate duty. The duty may be stronger and take shape in a more workable way if it applies to preparing places expecting to see an influx of people due to climate migration and to helping those most in need. The duty may arise out of expectations of what type of community the place welcoming those migrating due to climate should be—does it want to offer good housing, schooling, and medical care as well as economic opportunity to new people? And if so, at what cost, or with which risks? If the newcomers are viewed as community members rather than strangers, a model of acceptance may lead to better preparation. Some considerations like whether the actions will reasonably help the persons in need of rescue[15] will shape the application of a duty to rescue in the context of climate migration. Similarly, ensuring that people have the chance to articulate their values may help communities support the newcomers. New relationships should not be defined as migrant and rescuer. Voluntariness in participation and not forcing any action deemed rescue would help ensure the human rights of those migrating. In the United States, President Biden issued an executive order addressing impending climate migration steeped in a duty to prepare by making plans for resettlement and to address the impact of climate migration.[16] Vll. At What Risk? As we investigate the ethical obligations to meet even basic needs, we must also ask what level of risk is ethically compelled. There is an extraordinary need to integrate newcomers successfully, but it is difficult to stretch an ethical duty to rescue to require all the prerequisites for successful climate migration. Even defining success would create deep ethical arguments. As observed in almost all migrations, extraordinary charitable acts may be the key to success, while an ethical duty to rescue must try to require the important government and community-based basics and ensuring respect for human rights. That is, the migrating people should be rescued from circumstances that contradict basic human rights. Rather than comparing communities to bystanders, mere places where people will arrive and need to hash out how to find housing, jobs, education, and opportunity, a duty of preparation may be the key to rescue those disenfranchised by migration. There are cultural, personal, physical, psycho-social, and geopolitical issues surrounding how to best help those needing to permanently relocate. Ethics arguments will certainly range from “do nothing”, which may fail people, to “do everything”, which could waste taxpayer money in futile over-preparation while failing to actually help. Communities must avoid planning exclusively for one scenario only to have it not take place. Striking the balance, a duty to rescue as it could apply to climate migration should set goals of societal integration, and providing the basics like education, housing, food, health care, and job opportunity, the precursors to flourishing. Recommending the extraordinary, morally preferred but perhaps not compulsory, when charitable actors are participating, or when wrongdoers are compensating, may be more workable than seeing the duty to rescue as compelling people or local governments to take on significant financial and personal risk for newcomers. While humanitarian ethics supports helping everyone, it is likely that people who resettle in advance of a need to flee will find themselves with more choices and opportunities. Help is warranted for those with more dire needs. Preparing for them may do just that. Vlll. Rescue Prior to Migration and Rescue in the Process of Resettlement The duty to enable the migration in the first-place hints to the inadequacy of a duty to prepare. The traditional duty to rescue perhaps steps in if rescue looks like those geographically just out of harm's way rescuing those in danger. That resembles the traditional moral requirement, or duty to rescue according to the Rule of Rescue. Humanitarian aid typically provided by many institutions makes sense and is in place, although financial support for additional humanitarian aid is always needed. Despite having moved to purportedly more capable communities, migrant communities may be able to develop more egalitarian orders of living. Rather than continually being identified as having been rescued, it is important to make sure people keep or make social ties during and after migration. Immigrants often face social isolation.[17] Small shifts in gestural language also have the potential to welcome people and show they are valued. For instance, some migrants may not like questions like “Where are you from?” and “What brings you here?” as they emphasize differences over fitting in. CONCLUSION The ethical duty to rescue should be expanded to better match those in need of relocation with a welcome environment and the resources needed to achieve success and fully integrate socially and culturally. Expanding a dialogue that includes the voices of people who have recently migrated whether due to violence, poverty, or climate, could properly frame the extent of the duty. If we are to apply the duty of rescue to climate migration, rescuers should avoid labeling people vulnerable, dependent, or needy, although there is reason to focus on those whose needs are the most dire. A soft duty to rescue people during the course of climate migration can come in the form of preparation. People will need help finding housing, education, access to food, and employment. Ultimately, to help them help themselves may be the best goal. While the obligations should be borne differently by people, whether due to a special responsibility, or a special relationship that creates a clearer duty, the global community must prepare for its role in rescuing those displaced by climate events. By helping those displaced at the start of the climate migration process according to a more commonly held notion of the duty to rescue, and by preparing to incorporate newcomers successfully according to an expanded duty to rescue, effectively a duty to prepare, countries that take on climate refugees may find themselves rewarded by the cultural diversity and workplace talents that people bring. A duty to those at a distance is a reasonable expansion of the duty to rescue. But what one ought to do in the global community varies somewhat from the traditional Rule of Rescue. - [1] Singer, P. (1972). Famine, Affluence, and Morality. Philosophy and Public Affairs, 1(3): 229-43. [2] Irfan, U. (2022, March 16). Why We Still Don’t Yet Know How Bad Climate Migration Will Get. Vox. https://www.vox.com/2022/3/16/22960468/ipcc-climate-change-migration-migrant-refugee, citing the International Panel on Climate Change (IPCC) (2022). Sixth Assessment Report, Climate Change 2022, Impacts, Adaptation, and Vulnerability. https://www.ipcc.ch/report/ar6/wg2/ [3] McKie, J., Richardson, J. (2003) The Rule of Rescue. Social Science & Medicine, 56(12): 2407-2419. https://doi.org/10.1016/S0277-9536(02)00244-7. [4] James, S.M. (2007). Good Samaritans, Good Humanitarians. Journal of Applied Philosophy, 24(3):238-254. [5] Overview of Good Samaritan laws. https://worldpopulationreview.com/state-rankings/good-samaritan-law-states [6] Fifield, J. (2017, Sept. 19). Why It’s Hard to Punish ‘Bad Samaritans’. Stateline Blog, Pew Charitable Trusts, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/19/why-its-hard-to-punish -bad-samaritans [7] Cassella, C. (2019). There’s a Climate Threat Facing Pacific Islands That’s More Dire Than Losing Land, Science Alert, https://www.sciencealert.com/pacific-islanders-are-in-a-climate-crisis-as-rising-sea-levels-threaten -water; Hassan, H. R., and Cliff, V. (2019). For Small Island Nations, Climate Change is not a Threat. It’s Already Here, World Economic Forum, https://www.weforum.org/agenda/2019/09/island-nations-maldives-climate-change/ [8] For example, Lyons, K. (2019). Australia Coal use is Existential threat to Pacific Islanders, The Guardian. https://www.theguardian.com/world/2019/aug/12/australia-coal-use-is-existential-threat-to-pacific-is lands-says-fiji-pm [9] Cripps, E. (2013). Climate Change and the Moral Agent: Individual Duties in an Interdependent World. Oxford: Oxford University Press. [10] Schroeder, D., Chatfield, K., Singh, M., Chennells, R., and Herissone-Kelly, P.. Ethics Dumping and the Need for a Global Code of Conduct. In Cham. (Ed.)(2019). Equitable Research Partnerships. SpringerBriefs in Research and Innovation Governance. Springer. 2019. https://doi.org/10.1007/978-3-030-15745-6_1 [11] Giudice L.C., Llamas-Clark E.F., DeNicola N., Pandipati, S., Zlatnik, M.G., Decena, D.C.D., Woodruff, T.J., Conry, J.A. (2021). Climate Change, Women’s Health, and the Role of Obstetricians and Gynecologists in Leadership, International J Gynecol Obstet, 155(3), 345-356. 10.1002/ijgo.13958 [12] See Ferrarello, S. and Zapien, N. (2020). Ethical Experience: A Phenomenology, Bloomsbury. (for understanding phenomenological determinants of ethical action). [13] McLeman, R.A., Hunter, L.M., (2010). Migration in the context of vulnerability and adaptation to climate change: insights from analogues. Wiley Interdiscip Rev Clim Change, 1(3): 450-461. [14] Least Developed Countries Expert Group. (2018). Considerations Regarding Vulnerable Groups, Communities and Ecosystems in the Context of the National Adaptation Plans: United Nations Framework Convention on Climate Change. [15] Jecker, N.S. 2013. "The Problem with Rescue Medicine." J Med Philos, 38(1):64-81. [16] White House Report. (February 9, 2021), Executive Order (E.O.) 14013, “Rebuilding and Enhancing Programs to Resettle Refugees and Planning for the Impact of Climate Change on Migration.” (calls on the National Security Advisor to prepare a report on climate change and its impact on migration. “This report marks the first time the U.S. Government is officially reporting on the link between climate change and migration.” https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/27/executive-order-on-tackling -the-climate-crisis-at-home-and-abroad/ [17] Torres, J.M., Casey, J.A. (2017) The centrality of social ties to climate migration and mental health. BMC Public Health, 17: 600. https://doi.org/10.1186/s12889-017-4508-0. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Comment on Hospice of Washington's PolicyJohn A. Robertson (bio)The recent history of medical ethics may accurately be described as a history of coming to terms with personal autonomy and informed consent across the range of medical practice. Nowhere has this recognition been more important than in decisions to withhold or withdraw life-sustaining medical procedures from terminal and chronically ill patients.Despite the widespread acceptance of autonomy in these decisions, many (...) people—physicians, families, and policymakers—have balked at extending it to the withdrawal of artificially supplied fluids and nutrition. The symbolic connotations of food and water have led some persons to perceive cessation of medically-supplied fluids and nutrition to be a cruel, barbarous act, rather than the merciful respect for the dying patient that such withdrawal usually represents.Two recent events might help resolve the controversy, and ensure that decisions about artificial fluid and nutrition are handled like any other medical intervention—according to patient and family choice and patient welfare. One event is the Supreme Court decision in Cruzan (Cruzan v. Director of Missouri Department of Health, 110 S.Ct. 2841, 1990). Although the Supreme Court upheld Missouri's constitutional power to require artificial nutrition for a patient in a persistent vegetative state, its decision was not based on the symbolic importance of artificial fluids and nutrition. No Supreme Court justice saw a significant difference between medically-supplied nutrition and hydration and other medical interventions, thus allowing them to be discontinued either directly or by advance directive on the same basis as other medical interventions.The second event is the publication of the statement of "Philosophy Regarding Medical Intervention to Supply Fluids and Nutrition" by Hospice of Washington (or similar statements by other organizations). This statement is useful and important because it removes the issue of food and water from its symbolic overlay [End Page 139] and places it in the real context of dying hospice patients. It makes clear that the overriding consideration should be benefit to the patient "in accord with the patient's wishes or those of the appropriate surrogate(s) for the patient." Depending on those wishes and their impact on the patient, this position may or may not involve medically-supplied fluids and nutrition.This statement is also helpful in showing the medical complexity of such decisions in terms of their actual effect on dying patients. Rather than an either/or position, it recognizes that fluids may harm a dying patient by increasing discomfort, and that "persons near death do not ordinarily tolerate substantial volumes of enteral feedings." Thus rather than adhere to a symbolically-based position about the meaning of food and water to a dying patient, the important thing is to look to that patient's needs and give fluids or not, as the patient's wishes and situation demand.Fortunately, the law in most jurisdictions will recognize such a position. In those few jurisdictions that have made a fetish of artificial fluids and nutrition, the law should be changed, for the HOW statement makes clear that such a position may actually end up harming dying patients. Patient welfare should be privileged above all else, and patient welfare may often entail that fluids and nutrition not be medically supplied. Even then, however, caregivers will look to patient comfort and remedy dry mouths and lips with lubricants and ice chips.The HOW statement is, in my view, a very useful guideline not only for hospices but for hospitals, too—for any situation in which a patient is terminally ill and soon to die. A somewhat different set of issues arises, however, when the patient is chronically ill and incompetent, and will survive for long periods with medically-supplied fluids and nutrition. Recognition of patient rights in those situation should also permit cessation of fluids and nutrition on the same basis that respirators, antibiotics, and other life-sustaining measures may be withheld. But the withholding of medically-supplied fluids and nutrition from a patient who no longer has interests in surviving in an extremely debilitated condition raises different issues from withholding fluids that could cause such discomfort and nutrition when the patient is imminently dying. In either case, patient... (shrink)

In times of pandemics or natural catastrophes, prices of commodities, such as water, food and medicines, tend to shoot up, in response to a surge in demand and depleting supplies. The government, in its misguided efforts to maintain “price affordability”, imposes price controls and anti-price-gouging legislation and bans the reselling of food and medical supplies. These interventions in the free market are the exact opposite of what the government should do, if it wants to ensure that enough commodities (...) go to people who need them, that people do not hoard all available goods on grocery shelves, and most importantly, that suppliers have the incentive to produce more goods to meet current and future demand at market prices. (shrink)

Contemporary food supply chains are generating externalities with high economic and social costs, notably in public health terms through the rise in diet-related non-communicable disease. The UK State is developing policy strategies to tackle these public health problems alongside intergovernmental responses. However, the governance of food supply chains is conducted by, and across, both private and public spheres and within a multilevel framework. The realities of contemporary food governance are that private interests are key drivers of food (...) class='Hi'>supply chains and have institutionalized a great deal of standards-setting and quality, notably from their locations in the downstream and midstream sectors. The UK State is designing some downstream and some midstream interventions to ameliorate the public health impacts of current food consumption patterns in England. The UK State has not addressed upstream interventions towards public health diet at the primary food production and processing stages, although traditionally it has shaped agricultural policy. Within the realities of contemporary multilevel governance, the UK State must act within the contexts set by the international regimes of the Common Agricultural Policy and the World Trade Organization agreements, notably on agriculture. The potential for further upstream agricultural policy reform is considered as part of a wider policy approach to address the public health externalities issuing from contemporary food supply chains within this multilevel governance context. (shrink)

In recent years, the postulation that deception is necessary for placebos to have an effect on pain relief or increased well-being has come into question. Latest studies have shown that an openly administered mock drug works just as well as a deceptively administered placebo on certain complaints. This open-label placebo effect has primarily been used in the area of pain treatment so far. This study is the first to examine the effect of such placebos on healthy individuals with the use (...) of drinking water. In two experiments, participants were required to use certain specified water bottles for their daily drinking water consumption. At the beginning of Experiment 1, all participants received one bottle of water, which they were asked to refill themselves each day during a 2-week intervention period. In Experiment 2, participants received a new sealed water bottle every day. In both experiments, participants were randomly assigned to one of four groups: no treatment, open-label placebo without rationale, open-label placebo with rationale, and open-label placebo with additional rationale in a suggested relaxed state. We conducted baseline and post-treatment measurements of the subjective perceived physical and mental well-being of the participants. In Experiment 1, only the OPR++ group reported enhanced vitality at the post-treatment level compared to the other groups. In Experiment 2, post-treatment measurements showed improvements for the OPR++ group in the Physical Performance Capability, Mental Performance Capability, Emotional Balance, Overall Recovery, Negative Emotional State, and Overall Stress categories compared to the other groups. Our results support the idea that placebos with an additional rationale in a suggestive relaxed state are more effective than with just a rationale in a normal state. Furthermore, our study shows the tendency that OLP++ in the form of water with health claims may be more effective when the water is given in several sealed bottles separately than in one sealed but refillable bottle. (shrink)

In a small village in the Nile Delta, Wamai is faced with a decision. His wife died three years ago in childbirth leaving him with two small children to raise, a small plot of land, and two goats. By local standards he is a well-off; his goats produce milk for his children and his land feeds his goats. He, his goats, and his children use the same water supply. Gaining access to water will cost him one goat (...) jeopardizing his milk supply and his ability to sustain his tiny hers. But Wamai also wants to marry again. The bride-price is two goats. (shrink)

Ethical approaches and the right development framework are critical in water use and conservation. Water as a resource is not unlimited. Darryl Macer et al. point to the necessity of understanding the basics of water, uses of water, water resource availability, and conflict. Water is a very precious resource that in the future can be a source of tension due to unabated urbanization. In the Kaliwa Dam Project in the Philippines, the Dumagat Tribe is (...) at the heart of the issue. If the right policies are not in place, progress can have a severe impact on communities. Water has become a commodity because urbanization has resulted in massive water use in big cities that do not have their own source. This means that urban centers need to get their water from somewhere else resulting in social discord and disputes pertaining to water rights. In addressing the issue of water supply and use, this paper examines the role of policy, efficient infrastructure, and good governance. (shrink)

The United Nations (UN) Universal Declaration of Human Rights engenders important state commitments to respect, fulfill, and protect a broad range of socio-economic rights. In 2010, a milestone was reached when the UN General Assembly recognized the human right to safe and clean drinking water and sanitation. However, water plays an important role in realizing other human rights such as the right to food and livelihoods, and in realizing the Convention on the Elimination of All Forms of Discrimination (...) against Women. These broader water-related rights have been recognized but have not yet been operationalized. This paper unravels these broader water-related rights in a more holistic interpretation of existing international human rights law. By focusing on an emerging approach to water services provision—known as ‘domestic-plus’ services—the paper argues how this approach operationalizes a comprehensive range of socio-economic rights in rural and peri-urban areas. Domestic-plus services provide water for domestic and productive uses around homesteads, which challenges the widespread practice in the public sector of planning and designing water infrastructure for a single-use. Evidence is presented to show that people in rural communities are already using their water supplies planned for domestic uses to support a wide range of productive activities. Domestic-plus services recognize and plan for these multiple-uses, while respecting the priority for clean and safe drinking water. The paper concludes that domestic-plus services operationalize the obligation to progressively fulfill a comprehensive range of indivisible socio-economic rights in rural and peri-urban areas. (shrink)

Water is the chemical matrix required for life, the molecular chain that connects all organisms on the planet. But in the twenty-first century, water may replace oil as the most prized of resources. Just as gas-guzzling SUVs use more than their share of fuel, water-guzzling regions threaten the water supply for the rest of the world. In Water, writers, scientists, architects, and artists consider the many aspects of water, at levels from the microscopic (...) to the global, touching on subjects that range from new water infrastructures to ancient bathing rituals. Water includes a chemist's accounting of the true cost of water; photographs taken inside a city's secret waterways; an urban planner's description of how Toronto, New York, Hamburg, and Seoul have redesigned and rethought their waterfront areas; a conceptual artist's series of water bottles "branded" with various modern credos; photographs of a water-damaged ledger from the 1905 Yukon gold rush; two architects' rethinking of how to collect, divert, and transport water from water-rich to water-poor regions; a philosopher's invocation of the spiritual lessons of water; and photographs of a disturbingly beautiful flooded landscape. (shrink)

The maintenance of safe and reliable water supplies presents a challenge for communities across the world. This paper responds by exploring how five large food and beverage producing organisations operating in Australia were able to develop some focus on water management at a time of acute drought. Despite weak economic and regulatory drivers, a heterogeneous range of responses was developing across all five organisations. Drawing on Laughlin’s :209–232, 1991) model of organisational change, we argue that each reshaped or (...) developed archetypes and subsystems to enable a focus on improving efficiencies. Some were motivated by little more than compliance and so the extent of change was limited. A sense of community pressure was able to drive some change to interpretive schemes in two of the five organisations. Broad cultural change, supported by clear board level mandate, became critical to the survival of new practices. We also demonstrate that management level staff with a passion to champion water efficiency can be instrumental in driving change. This paper contributes to our understanding of water management, and to the factors needed to embed developing practice. (shrink)

In the United States, public opinions about climate change have become polarized, with a stark difference in the belief in climate change. Climate change denialism is pervasive among Republicans, especially conservatives, contrasting the high recognition of human-induced climate change issues among Democrats. As the water crisis is closely linked to climate change, the current study aims to examine how the belief in climate change’s impacts on future water supply uncertainty affects water conservation behaviors and whether the (...) effect is conditional on being a Republican. The Bayesian Mindsponge Framework (BMF) analytics was performed on a dataset of 1831 water users in an arid region (Albuquerque, New Mexico). The analysis shows that water users’ belief in climate change’s impacts on future water supply uncertainty positively affects the number of water conservation behaviors they adopt, regardless of whether they are Republicans. Although being a Republican does not significantly negatively moderate the association between climate change belief and water conservation behaviors, the result still underscores the importance of fighting climate change denialism. Otherwise, it will not only hinder the climate change alleviation efforts but also exacerbate the water crisis. Several strategies to reduce climate change denialism are also recommended. (shrink)

For the past seventy years, a host of scientific and public health bodies in the United States have strongly endorsed the practice of adding fluoride compounds to public water supplies as a prophylactic against dental caries. Throughout that period, a constant undercurrent of skepticism and outright opposition has slowed the adoption of the practice in the United States and limited its spread to just a handful of countries around the world. One of the attractions of water fluoridation is (...) its affordability: the fluoride compounds are sourced from the phosphate and aluminum industries, for whom they would otherwise constitute an annoying toxic waste disposal problem. Despite this, proponents have nonetheless succeeded in shaping a narrative that casts fluoridation as “natural” or at least mimicking nature. I demonstrate how fluoridationists were able to persuasively argue that adding a pollutant to the water supply was safe and natural. In the process, I examine how environmental historians and historians of science approach topics such as fluoridation. I suggest that as a result of the influence of science and technology studies and an ontological turn toward hybridity, the two subdisciplines are becoming increasingly convergent. (shrink)

A variety of water-based livelihood activities undertaken by women and men in the villages of North Gujarat are under threat due to the unavailability of adequate water. Excessive groundwater withdrawal and limited recharge have led to shrinking water tables. With shrinking supply and growing sectoral demand, the competition for access to water is growing and women, who command less political and social power in the patriarchal communities of South Asia, often find themselves marginalized. Women are (...) basically considered domestic water users while men are seen as productive water users, despite the fact that women make significant use of water for productive purposes as well. This paper, drawing mainly on fieldwork undertaken in six villages of North Gujarat, India, tries to show how women use water for multiple purposes and help sustain the household economy. The paper argues that recognizing women’s roles as multiple water users will help promote the productive use of water in enhancing rural livelihood and sustaining the household economy. With special reference to women respondents, the paper examines gender roles of both domestic and productive water users and explores how these roles help women to improve their socio-economic status. The paper also analyzes operational income and expenditures associated with water-based home enterprise. Individual interviews, focus group discussions, participant observation, daily routine diagrams, and key informant surveys were administered to collect primary data. Key findings show that access of women to water for productive use not only increases their income earning potential, but also helps strengthen their bargaining positions. (shrink)

“Virtual water,” water needed for crop production, is now being mainstreamed in the water policy world. Relying on virtual water in the form of food imports is increasingly recommended as good policy for water-scarce areas. Virtual water globalizes discussions on water scarcity, ecological sustainability, food security and consumption. Presently the concept is creating much noise in the water and food policy world, which contributes to its politicization. We will argue that the virtual (...) water debate is also a “real water” and food and agricultural policy debate and hence has political effects. Decisions about food strategies and resource allocation play out on the national political economy, benefiting some while harming others. Therefore, a policy choice for virtual water is not politically neutral. “Real␣water” interventions are, likewise, inspired by economic as well as political considerations like control of the countryside, geopolitical strategy, and food sovereignty (independence from international political conditionality and market uncertainties). To illustrate these ideas, we look into case studies of Egypt and the State of Punjab in India. In India, a debate on the merits and demerits of a virtual water strategy is now emerging. In Egypt, which switched to food imports in the early 1970s, a long-standing taboo on debating virtual water is now being relaxed. (shrink)

Background The purpose of this systematic review is to examine cooling intervention research in outdoor occupations, evaluate the effectiveness of such interventions, and offer recommendations for future studies. This review focuses on outdoor occupational studies conducted at worksites or simulated occupational tasks in climatic chambers. -/- Methods This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched to identify original research on intervention studies (...) published in peer‐reviewed journals that aimed at reducing heat stress or heat‐related illness from January 2000 to August 2020. -/- Results A systematic search yielded a total of 1042 articles, of which 21 met the inclusion criteria. Occupations with cooling intervention studies included agriculture (n = 5), construction (n = 5), industrial workers (n = 4), and firefighters (n = 7). The studies focused on multiple types of cooling interventions cooling gear (vest, bandanas, cooling shirts, or head‐cooling gel pack), enhanced heat dissipation clothing, forearm or lower body immersion in cold water, water dousing, ingestion of a crushed ice slush drink, electrolyte liquid hydration, and modified Occupational Safety and Health Administration recommendations of drinking water and resting in the shade. -/- Conclusion Current evidence indicates that using multiple cooling gears along with rest cycles may be the most effective method to reduce heat‐related illness. Occupational heat‐related illnesses and death may be mitigated by targeted cooling intervention and workplace controls among workers of vulnerable occupational groups and industries. (shrink)

_Textile sector of Pakistan is one of the great contributors in country’s economy, and also the key contributor in making the environment polluted. Textiles have lengthy and complex supply chains (SC) which have crucial role in sustainability. Energy intensive business processes, excessive use of water and hazardous chemicals, use of synthetic yarns and fibers, make it crucial to implement sustainable practices in SC of textile industries. Pakistani textile sector does not fully adopt the sustainable practices that are being (...) used around the world and it is not immediately clear to what extent the practices used in the local industry benefit the environment. The objective of this study is the analysis of ongoing sustainable practices of Yunus Textile Mills (YTM), impact of those sustainable practices and review of international sustainable practices that can be implemented at YTM. In this research quantitative and qualitative research methods have been used along with Triple Bottom Line Approach of Sustainability. Data gathered through business publication, onsite surveys & interviews. Results obtained from the study shows that sustainable practices used by Yunus textile have positive impact on environment._. (shrink)

Water has been a critical resource for Anangu peoples across the remote inland for millennia, underpinning their ability to live in low rainfall environments. Anangu biocultural knowledge of kapi developed in complex ways that enabled this resource to be found. Such biocultural knowledge included deep understandings of weather patterns and of species behavior. Kapi and its significance to desert-dwelling peoples can be seen in ancient mapping practices, whether embedded in stone as petroglyphs or in ceremonial song and dance practices (...) associated with the Tjukurpa. While in the past the sustainability of kapi was facilitated by mobility that spread human dependence on this resource across multiple sites, since the 1940s Anangu have been coerced by the settler-colonial state to live a sedentary lifestyle in remote communities such as Haasts Bluff, Papunya and Yuendemu. In many of these communities the supply of kapi is becoming increasingly insecure in terms of viability of supply, cost, quality and threats from mining. This paper provides a brief insight into how kapi has become devalued in the context of contemporary remote communities with particular reference to my area of expertise – Aboriginal identity, well-being and Australian sports. (shrink)

Water saving irrigation is promoted as a strategy to mitigate future water stresses by the Chinese government and irrigation scientists. However, the dissemination of WSI in China has been slow and little is understood with respect to why farmers adopt WSI or how WSI interacts with the social and institutional contexts in which it is embedded. By analyzing qualitative data from 37 semi-structured and 56 unstructured interviews across 13 villages in northwest China, this paper examines smallholder farmers’ knowledge (...) and perceptions of WSI, and how WSI interacts with farmer livelihood decision-making and extant systems of land and water management. The results show that smallholders’ willingness to adopt and continuously use WSI was dampened by a lack of communal capital and measures for conflict resolution, a disconnect between the temporal demands of practicing WSI and the ways farmers prioritize different livelihood strategies, misconceptions about WSI systems and how they work, market risks, and landownership structure and economies of scale. These results suggest that programs for promoting WSI must be holistic in nature and address smallholders’ day-to-day problems. Understanding why WSI did not succeed in some places will help formulate policy interventions that avoid reproducing conflicts, risks, and technological malfunctions responsible for previous failure. (shrink)

The need for continuing provision of beneficial experimental interventions after research is concluded remains a controversial topic in bioethics for research. Based on the principle of beneficence, justice as reciprocity, concerns about exploitation and fair benefits, participants should be able to have continuing access to benefits beyond the research period. However, there is no consensus about whether or not post-trial provision of beneficial interventions should be mandatory for participants from developing countries. This paper summarises recommendations from international and (...) national guidelines. Ethical principles and practical issues relating to post-trial provision are also discussed. In conclusion, post-trial provision is not necessary in all situations and a set of criteria are proposed to identify the situations that beneficial interventions should be provided beyond the research period. However, mandatory post-trial supply of beneficial experimental interventions should be assured for those who still need and are able to benefit from them but have no alternative access. Mandatory provision is based on universal bioethical principles such as beneficence and justice. Furthermore, difficulties associated with implementation of post-trial provision are not unmanageable. Careful advanced planning and a comprehensive partnership among relevant parties would be very helpful in solving these difficulties in practice, which therefore should not be taken as an excuse to escape post-trial responsibility. (shrink)

In a recent paper, Hugh McLachlan argues from a deontological perspective that the most ethical means of distributing scarce supplies of an effective vaccine in the context of an influenza pandemic would be via an equal lottery. I argue that, even if one accepts McLachlan's ethical theory, it does not follow that one should accept the vaccine lottery. McLachlan's argument relies upon two suppressed premises which, I maintain, one need not accept; and it misconstrues vaccination programmes as clinical interventions (...) targeted solely at protecting the health of vaccinated individuals, rather than as public health interventions targeted at protecting the health of the population as a whole. (shrink)

Sustained peripheral somatosensory stimulations, such as high-frequency repetitive somatosensory stimulation (HF-RSS) and vibrated stimulation, are effective in altering the balance between excitation and inhibition in the somatosensory cortex (S1) and motor cortex (M1). A recent study reported that whole-hand water flow (WF) stimulation induced neural disinhibition in the M1. Based on previous results, we hypothesized that whole-hand WF stimulation would lead to neural disinhibition in the S1 because there is a strong neural connection between M1 and S1 and aimed (...) to examine whether whole-hand WF stimulation would change the neural balance between excitation and inhibition in the S1. Nineteen healthy volunteers were studied by measuring excitation and inhibition in the S1 before and after each of the four 15-min interventions. The excitation and inhibition in the S1 were assessed using somatosensory evoked potentials (SEPs) and paired-pulse inhibition (PPI) induced by single- and paired-pulse stimulations, respectively. The four interventions were as follows: control, whole-hand water immersion, whole-hand WF, and HF-RSS. The results showed no significant changes in SEPs and PPI following any intervention. However, changes in PPI with an interstimulus interval (ISI) of 30 ms were significantly correlated with the baseline value before whole-hand WF. Thus, the present findings indicated that the whole-hand WF stimulation had a greater decreased neural inhibition in participants with higher neural inhibition in the S1 at baseline. Considering previous results on M1, the present results possibly show that S1 has lower plasticity than M1 and that the duration (15 min) of each intervention may not have been enough to alter the balance of excitation and inhibition in the S1. (shrink)

The ArgumentThe impressive growth of the Swiss electricity supply industry in the late nineteenth cestury has usually been explained by Switzerland's abundant waterpower resouces, its well-equipped financial markets, and the mechanical skills of its Swiss workers and engineers. This article does not aim to deny the importance of these factors. Rather it seeks to explain how they developed synergetic effects and how they were knit together. The argument is put forward in three steps: First, I show the importance of (...) the new technology's discursive integration, arguing that the development of specialized electric discourse led to a social shaping of technology that was highly compatible with generalized cultural patterns of late nineteenth-century Swiss society. The expressive dispositions and instituted means of expression that constitiute the elextric discourse were constantly pursuing and achieving effective resonances in other discursive fields. This allowed for a solid integration of the electrotechnical discourse in late nineteenth-century Swiss society.Second, I argue that electrotechnology was modeled in such a way that it became coupled with existing technological practices, such as the national mapping endeavor, the urban gas and water supply, the sewer system, and the telegraphic networks. It is noteworthy that making electrotechnology compatible with other technological practices led not only to similar patterns in the design and management of both the old and the new technologies but also to operated with the existing water supply station.Using the example of the electrification of Zurich, I then, in a third step, combine the two elements – discursive accommodation and practical assimilation – to demonstrate their effects on the selection and construction of technology. The article's somewhat complex argumentative strategy allows for a differentiated interpretation of the phenomenon and shows the importance of taking into consideration the sociocultural dimension of economic growth that had its roots in the diffusion of a new technology. (shrink)