As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that (...) bear a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

After biologist Deborah Gordon made a series of experimental discoveries in the 1980s, she argued that a change in terminology regarding the division of labor among castes of specialists was needed. Gordon’s investigations of the interactive effects of ants in colonies led her to believe that the established approach Edward O. Wilson had pioneered was biased in a way that made some alternative candidate adaptive explanations invisible. Gordon argued that this was because the term “division of labor” implied a division (...) among specialists that was unwarranted, and proposed “task allocation” as a better description that did not bias research against the alternative causes she had discovered. Gordon’s empirical findings and theoretical proposals also vindicate the initial critics of Wilson’s human sociobiology who have been dismissed as political radicals, but her proposals have been widely misunderstood by many contemporary behavioral ecologists. The terminological and methodological confusions rampant in contemporary discourse can be clarified by applying a framework developed by Elisabeth Lloyd involving an analysis of the constraints imposed by different research questions. Applying this framework will show how the methodological problems involving description raised by the initial critics of Wilson’s human sociobiology extended to his analysis of ants, indicating that they were not challenging Wilson’s naturalistic approach to the study of human evolution, but rather his methods. It will also show how confusion over how Gordon’s proposed research questions have been conflated with the possible answers she has argued ought to be investigated. This in turn will clarify contemporary disputes over her proposal to abandon the term “division of labor.”. (shrink)

Using a fair allocation approach, this paper identifies and examines important concerns arising from the Philippines’ COVID‐19 response while focusing on difficulties encountered by various sectors in gaining fair access to needed societal resources. The effectiveness of different response measures is anchored on addressing inequities that have permeated Philippine society for a long time. Since most measures that are in place as part of the COVID‐19 response are meant to be temporary, these are unable to resolve the inequities that (...) have led to the magnitude of morbidity and mortality associated with the pandemic. These cannot improve the country’s readiness to deal with pandemics and other emergencies in the future. Transition to a new normal recognizes the possibility that other infectious diseases could come and endanger our health security. Our pandemic experiences are proving that having an egalitarian society will serve the interests not only of disadvantaged sectors but also of everybody else, including the privileged. Response measures should thus take the opportunity to promote equity by giving importance to the concerns of the underprivileged and vulnerable while giving preference to initiatives that can be sustained beyond the period of the current pandemic. (shrink)

There are now several proposals for introducing random elements into the process of funding allocation for research, and some initial implementation of this policy by funding bodies. The proposals have been supported on efficiency grounds, with models, including social epistemology models, showing random allocation could increase the generation of significant truths in a community of scientists when compared to funding by peer review. The models in the literature are, however, fairly abstract. This paper introduces some of the (...) considerations that are required to build on the modelling work towards a fully-fledged policy proposal, including issues of cost and fairness. (shrink)

How does morality allocate responsibility for what it requires? I am concerned here with one fundamental part of this question, namely, how morality determines responsibility when multiple agents are capable of contributing to or completing a moral task, and special relationships capable of generating duties with respect to the task are non-existent, insufficient as a moral response, or partly indeterminate. On one view, responsibility falls to the agents who can bear it with the least burden. I show why this is (...) initially attractive and mistaken. Instead, I defend an equity-based approach that accommodates the intuitions that both support and trouble the least-cost principle. One upshot is that sometimes we ought prefer a distribution of responsibility that is more expensive and less local than needed to complete the task. I illustrate the practical significance of the argument in terms of the human rights of refugees. (shrink)

After initially emerging in China, the coronavirus outbreak has advanced rapidly. The World Health Organization has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, (...) and this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of ‘equals should be treated equally’ may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians. (shrink)

We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer (...) and Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person’s initial health state and a person’s CTB per resource unit expended: allocate resources so as to most closely equalize final health states and allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person’s initial health state and a person’s CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit’s thought on Prioritarianism. Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types. (shrink)

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

During the COVID-19 public health crisis, market failures such as shortage of supplies and soaring prices of anti-epidemic materials – with masks as the core – have occurred. In essence, such anti-epidemic materials have the dual nature of necessities with low elasticity of demand and private products with positive externalities. This research explores the understanding of anti-pandemic materials and how different initiatives, and evaluation to increase availability of necessary resources can be effective in curbing a pandemic. Market regulation results in (...) a non-Pareto optimal allocation of resources and the difficulty of exerting the positive externalities of products. However, in China, the market failure of anti-epidemic materials was quickly resolved, due to the institutional advantages of socialism with Chinese characteristics, the social responsibility drive of domestic enterprises, and cultural genes that focus on equity and concern for the disadvantaged. The optimal allocation of anti-epidemic materials gave access to exerting efficiency and fairness effects, positive external effects, and public effects. (shrink)

Using a fair allocation approach, this paper identifies and examines important concerns arising from the Philippines’ COVID‐19 response while focusing on difficulties encountered by various sectors in gaining fair access to needed societal resources. The effectiveness of different response measures is anchored on addressing inequities that have permeated Philippine society for a long time. Since most measures that are in place as part of the COVID‐19 response are meant to be temporary, these are unable to resolve the inequities that (...) have led to the magnitude of morbidity and mortality associated with the pandemic. These cannot improve the country’s readiness to deal with pandemics and other emergencies in the future.Transition to a new normal recognizes the possibility that other infectious diseases could come and endanger our health security. Our pandemic experiences are proving that having an egalitarian society will serve the interests not only of disadvantaged sectors but also of everybody else, including the privileged. Response measures should thus take the opportunity to promote equity by giving importance to the concerns of the underprivileged and vulnerable while giving preference to initiatives that can be sustained beyond the period of the current pandemic. (shrink)

We propose and axiomatically analyze a class of rational solutions to simple allocation problems where a policy-maker allocates an endowment $E$ among $n$ agents described by a characteristic vector c. We propose a class of recursive rules which mimic a decision process where the policy-maker initially starts with a reference allocation of $E$ in mind and then uses the data of the problem to recursively adjust his previous allocation decisions. We show that recursive rules uniquely satisfy rationality, (...) c-continuity, and other-c monotonicity. We also show that a well-known member of this class, the Equal Gains rule, uniquely satisfies rationality, c-continuity, and equal treatment of equals. (shrink)

The COVID-19 Vaccines Global Access Facility represents an unprecedented global collaboration facilitating the development and distribution of vaccines for COVID-19. COVAX pools and channels funds from state and non-state actors to promising vaccine candidates, and has started to distribute successful candidates to participating states. The WHO, one of the leaders of COVAX, recognised vaccine doses would initially be scarce, and therefore, prepared a two-staged allocation mechanism they considered fair. In the first stage, vaccine doses are distributed equally among participating (...) countries, while in the second stage vaccine doses will be allocated according to a country’s need. Ethicists have questioned whether this is the fairest distribution—they argue a country’s need should be taken into account from the start and correspondingly, have proposed a framework that treats individuals with equal moral concern, aims to minimise harm and gives priority to the worst-off. In this paper, we seek to explore these concerns by comparing COVAX’s allocation mechanism to a targeted allocation based on need. We consider which distribution would more likely maximise well-being and align with principles of equity. We conclude that although in theory, a targeted distribution in proportion to a country’s need would be more morally justifiable, when political realities are taken into account, an equal distribution seems more likely to avert a greater number of deaths and reduce disparities. (shrink)

BackgroundECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international (...) exploratory survey of ECMO clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations.MethodsAn online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic.ResultsWhen initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%).ConclusionsWe found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic. (shrink)

COVID-19-related controversies concerning the allocation of scarce resources, travel restrictions, and physical distancing norms each raise a foundational question: How should authority, and thus responsibility, over healthcare and public health law and policy be allocated? Each controversy raises principles that support claims by traditional wielders of authority in “federal” countries, like federal and state governments, and less traditional entities, like cities and sub-state nations. No existing principle divides “healthcare and public law and policy” into units that can be allocated (...) in intuitively compelling ways. This leads to puzzles concerning (a) the principles for justifiably allocating “powers” in these domains and (b) whether and how they change during “emergencies.” This work motivates the puzzles, explains why resolving them should be part of long-term responses to COVID-19, and outlines some initial COVID-19-related findings that shed light on justifiable authority allocation, emergencies, emergency powers, and the relationships between them. (shrink)

In order to slow down the inexorable increase in spending on health care, the British government has implemented an initiative proposed by Griffiths. This initiative is designed to make doctors more accountable for the decisions they may take. In this essay I argue first, that the conflation of two decisions (financial and clinical) leads to unnecessary ethical dilemmas and secondly, that as psychologically it is difficult to take two decisions simultaneously, inevitably the clinician is forced to name either the financial (...) or the clinical decision as the prior problem. To decide for the former inevitably strains the traditional doctor/patient relationship of mutual trust. (shrink)

:Robert Nozick allegedly introduced his liberal theory of private ownership as an objection to theories of end-state justice. Nevertheless, we show that, in a stylized framework for the allocation of goods in joint ventures, both approaches can be seen as complementary. More precisely, in such a context, self-ownership followed by voluntary transfer can lead to end-state fairness. Furthermore, under a certain solidarity condition, the only way to achieve end-state fairness, following Nozick’s procedure, is to endorse an egalitarian rule for (...) the initial assignment of rights. (shrink)

The implementation of a new kidney allocation algorithm by Eurotransplant was a ‘rule choice’ with serious ethical, legal, and political implications. Eurotransplant made that choice in view of a careful analysis of empirically predictable consequences of alternative rule specifications. This paper studies in a stylized way how the decision on the allocation algorithm emerged. Hopefully an understanding of central features of the described successful case of initiating improvements may be helpful in other cases with a similar structure.

In lieu of an abstract, here is a brief excerpt of the content:A Just Share: Justice and Fairness in Resource Allocation*Pat Milmoe Mccarrick (bio) and Martina Darragh (bio)Each of us has some basic sense of what the words “fair” or “just” or “fairness” or “justice” mean. Each of us probably also has an idea of what is “fair” in health care. The attempt by the state of Oregon in the mid-1980s to quantify this notion made a previously private exercise (...) a public one. This transition has been chronicled in the bioethics literature that focuses on resource allocation. These works examine both theories of justice and concepts of “health”; the fair distribution of health resources has been of continuing interest since the beginning of bioethics in the 1960s. Early writing on justice includes authors Tom L. Beauchamp, Robert H. Blank, James F. Childress, H. Tristram Engelhardt, Paul T. Menzel, Paul Ramsey, and Robert M. Veatch (VII).During the 1980s, bioethicists such as Daniel Callahan and Norman Daniels proposed thinking of health care decisions not as moments of personal crisis but as choices that span a lifetime, possibly involving tradeoffs in other areas of one’s life, e.g., education. The Oregon experience added another dimension to the discussion. The initial rank-ordering of health services by cost produced a skewed list—for example, surgery for life-threatening conditions ranked below minor, elective procedures. For the project to make sense, the ranking algorithm could not be based on cost alone, but rather on a combination of costs and benefits both to individuals and to the community—“concatenations of individual and group goods” (I, Jecker and Jonsen 1995). Various metaphors have been used in the literature to facilitate discussion of this shift from individual to individual/community trade-offs: medical services as a “commons” (I, Asch 1995, Jecker and Jonsen 1995, Michels 1994); resource allocation as a “lifeboat” (I, Campbell 1995; III, Kaveny 1994); medical care as “shares” in a community health (III, Nelson 1992, Ford and Kissick 1995; II, Anderson 1993); and rationing as traveling through the desert with one jug of water for two people (a story from the Halachah literature) (I, Zoloth-Dorfman 1995). [End Page 81]Such metaphors do not promote any one “theory of justice” but rather draw from the work of a number of bioethicists as well as from theological, sociological, economic, and business literature. The five major conceptions of justice that are referenced most frequently are: “(1) a libertarian conception, which takes liberty to be the ultimate political ideal; (2) a socialist conception, which takes equality to be the ultimate political ideal; (3) a welfare liberal conception, which takes contractual fairness or maximal utility to be the ultimate political ideal; (4) a communitarian conception, which takes the common good to be the ultimate political ideal; and (5) a feminist conception, which takes a gender-free society to be the ultimate political ideal” (I, Sterba 1995).The use of new metaphors also draws on expanded concepts of “health.” “As health care is currently practiced, the most powerful symbols for public and professional alike are those that promise the defeat of time” (I, Campbell 1995). When medical care is perceived as an unrelated series of individual cures, the fact that health care resources are finite cannot be addressed.Reflections concerning the difficulties in limiting the use of health care resources have an ancient lineage and reveal a tight bond with the obsession to postpone death at all costs. Plato in Book 3 of the Republic recognizes the quandary of infinite expectations and finite resources that characterizes the challenge of health care choices. (I, Engelhardt 1996)The proliferation of expensive medical technologies and the loss of autonomy by health care professionals further complicates perceptions of the crucial issues at hand. Some have said that Americans place too much emphasis on individualism to address these issues. Daniels et al. believe that this is too pessimistic a view and that the American commitment to protecting equal opportunity for all provides a firm basis for developing a public consensus on what is fair in health care (III, Daniels, Light, and Caplan 1996). Finally, several authors suggest that the nature of all four principles of medical ethics, not justice alone, must be... (shrink)

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)

This study looked for evidence of biases in the allocation and disengagement of attention in dysphoric individuals. Participants studied images for a recognition memory test while their eye fixations were tracked and recorded. Four image types were presented (depression-related, anxiety-related, positive, neutral) in each of two study conditions. For the simultaneous study condition, four images (one of each type) were presented simultaneously for 10 seconds, and the number of fixations and the total fixation time to each image was measured, (...) similar to the procedure used by Eizenman et al. (2003) and Kellough, Beevers, Ellis, and Wells (2008). For the sequential study condition, four images (one of each type) were presented consecutively, each for 4 seconds; to measure disengagement of attention an endogenous cuing procedure was used (Posner, 1980). Dysphoric individuals spent significantly less time attending to positive images than non-dysphoric individuals, but there were no group differences in attention to depression-related images. There was also no evidence of a dysphoria-related bias in initial shifts of attention. With respect to the disengagement of attention, dysphoric individuals were slower to disengage their attention from depression-related images. The recognition memory data showed that dysphoric individuals had poorer memory for emotional images, but there was no evidence of a conventional mood-congruent memory bias. Differences in the attentional and memory biases observed in depressed and dysphoric individuals are discussed. (shrink)

The COVID-19 pandemic was a global health crisis that required US residents to understand the phenomenon, interpret the cues, and make sense within their environment. Therefore, how the communication of COVID-19 was framed to stakeholders during the early stages of the pandemic became important to guide them through specific actions in their state and subsequently with the sensemaking process. The present study examines which frames were emphasized in the states' press releases on policies and other COVID information to influence stakeholders (...) on what to focus on to help with sensemaking during the crisis. We conducted content analysis on 602 press releases from 50 US states using an unsupervised machine learning approach called Latent Dirichlet Allocation (LDA). The results show that health communication using press releases to help the public make sense of the crisis were framed to include health frames as well as economic frames. Health communication messages are typically framed with health and safety measures; however, this study shows that economic frames were emphasized more than public health frames in the government's health communication for COVID-19, which forced both large and small businesses to engage in specific socially responsible activities that were previously voluntary to support public health safety. (shrink)

While previous studies have discussed how much should be given by firms, less is known about how firms would spend these investments, such as strategically allocating these philanthropy activities across geographic markets. This study examines the impact of multimarket contact on corporate philanthropy in different geographic markets. Using Chinese property insurance firms from 2007 to 2015 as samples, the results show that firms are less likely to initiate philanthropy activities in geographic markets with high multimarket contact. We also found that (...) the negative impact of multimarket competition on corporate philanthropy is stronger in highly concentrated markets. Moreover, this negative relationship is stronger when institutional distance at a firm level is low. Our study contributes to the literature on corporate philanthropy and multimarket contact. (shrink)

Accelerated COVID-19 vaccine development represents an important accomplishment and a milestone in the history of vaccine evolution. However, the vaccine’s scarcity made its equitable global allocation and distribution ambiguous. Despite the initial pledges from wealthy countries for fairness and inclusivity towards the poorer ones, the policies followed diverged significantly. Wealthy countries have vastly superior access to vaccines in a reality likened to an ethical disaster. This paper calls for the need for fair global vaccine allocation and distribution (...) and examines the barriers that were met along the way, originating from different points, such as the nationalistic approach on the matter that most wealthy countries have adopted or the inability of poor countries to purchase or manufacture vaccines. Further, a suggestion regarding the ethical principles and values that ought to guide global vaccine allocation and distribution is provided with a higher priority given to helping the worst-off, saving the most lives, protecting people in high risk, such as frontline healthcare professionals, and minimising social gaps, along with an ethical theoretical background for each prioritisation. It is not too late for wealthy countries to realise that vaccine inequity prolongs pandemics, so that they change their policies in favour of the global common good that will not only provide immediate universal benefits but will also serve as a guide for future pandemic crises. (shrink)

One characteristic of tradeable emission permits is that efficiency and justice considerations can be separated. While Pareto optimality is an accepted efficiency principle, there is not a consensus on a 'best' equity principle. In this article, conventional justice principles are used to evaluate alternative allocation rules for tradeable CO₂ permits, and a distribution proportional to population is recommended. Arguments against the population rule are discussed, especially those pertaining to political feasibility. While justice and political feasibility may indeed contrast, it (...) still may be possible to emphasise the population rule in the future. (shrink)

Vaccines can be an appropriate tool for combating pandemics. Accordingly, expectations were high when the first Covid-19 vaccines were administered. However, even though the vaccines have not met these high initial expectations, vaccine manufacturers and their investors were making large profits, while most of the associated economic risks have remained with the taxpaying public. Thus, this paper applies the concept of social impact bonds to mass vaccination programs by conceptualizing vaccine impact bonds (VIBs) as an alternative to the advance (...) purchase agreements (APAs) for Covid-19 vaccines. Rather than rewarding vaccine manufacturers and their investors based on the quantity of doses distributed, VIBs intend to link the real-world vaccine impact to the financial returns of vaccine manufacturers and their investors. This paper indicates that VIBs can theoretically shift the economic risks of mass vaccination programs from the taxpaying public to private investors, thereby aligning commercial and public interests. However, it also identifies several major weaknesses such as the complexity of defining and evaluating the vaccine impact as well as the inherent trade-off between relieving taxpayers (through VIBs) and allowing innovation. As these substantial drawbacks outweigh the theoretical strengths of VIBs, this paper calls for further research in order to identify better alternatives to the Covid-19 vaccine contracts. (shrink)

No período em que a Igreja Católica vivia um processo conhecido como romanização, no Brasil começaram a surgir Faculdades e Universidades Católicas. Adjetivadas, tais instituições de ensino superior implicavam a alocação de recursos os mais variados por parte do aparelho eclesiástico, pois a qualificação atribuída era acompanhada da expectativa de um desempenho específico dentro do mais amplo processo de romanização. Este artigo objetiva abordar o contexto eclesial da época e, nele, a compreensão da Igreja acerca da sua relação com a (...) sociedade recifense, tendo como viés a atuação da Universidade Católica de Pernambuco, na cidade, e sua correspondência ao cenário estabelecido. Para escrevê-lo o autor fez revisão da literatura e pesquisa nos arquivos da própria UNICAP e da Vice-província do Brasil Setentrional da Companhia de Jesus; além disso, recorreu a depoimentos orais de ex-alunos e ex-professores. A análise empreendida permite afirmar que, em sua trajetória inicial, a Universidade correspondeu ao ser católico, se ele for entendido como sintonia com o modelo eclesial predominante na Igreja e ao papel dele decorrente. Palavras-chave : Igreja católica. Modelos eclesiais. Educação.During the period of time in which the Catholic Church experienced a process known as Romanization, there began to emerge Catholic colleges and universities in Brazil. Once having received the adjective Catholic, these institutions of higher education demanded of the ecclesiastic apparatus the allocation of the most varied resources, because the attributed qualification was accompanied by the expectancy of a specific performance inside the most ample process of Romanization. This article aims at accosting the ecclesiastic context of the time and, in it, the Churche’s understanding of its relationship with Recife’s society, taking as bias the acts of the Catholic University of Pernambuco (UNICAP) in the city and its correspondence to the established scenario. To write it, the author revised the literature and research in the archives of the UNICAP itself and of the vice-province of Northern Brazil of the Society of Jesus; furthermore, he analyzed the oral testimony of former students and teachers. The analysis undertaken allows us to affirm that during its initial steps the university fulfilled the exigencies made for being Catholic, if this term was being understood as being in tune with the ecclesiastic model predominant in the Church at the time and the role corresponding to it. Keywords : Catholic Church. Ecclesiastic models. Education. (shrink)

One characteristic of tradeable emission permits is that efficiency and justice considerations can be separated. While Pareto optimality is an accepted efficiency principle, there is not a consensus on a 'best' equity principle. In this article, conventional justice principles are used to evaluate alternative allocation rules for tradeable CO2 permits, and a distribution proportional to population is recommended. Arguments against the population rule are discussed, especially those pertaining to political feasibility. While justice and political feasibility may indeed contrast, it (...) still may be possible to emphasise the population rule in the future. (shrink)

The question whether corporations should be used as a means for administering distributive justice is crucial. There are two fundamental issues associated with this. Firstly, would the introduction of rules have any distributional effect? Secondly, what would be the efficiency cost? In this paper, we explore both questions with reference to a job-security corporate rule. We show that the job-security rule will always produce distributional consequences which are consistent with its objectives. However, whether or not it is a socially desirable (...) policy depends on whether the economy is at an efficient allocation and what motivated the policy. It can be shown that under some conditions, even if the initial allocation is efficient, yet not the socially desirable one, a corporate rule—like the job security one—may produce socially desirable gains. The same can be said in the case where the initial allocation is inefficient even in the presence of competitive markets (dueto incompleteness problems). However, these social gains would come at the expense of competitiveness. In an internationally open environment this may offset the initial social gains from this policy. Whether or not this happens would then depend on whether agents have a social dimension to their preferences or not. If they do, their response to the initiative may offset the initial loss of competitiveness. Alternatively, society may face the dilemma whether to remain open to uphold local conceptions of distributive justice. (shrink)

In this comment, we pick up three points raised by Ohndorf et al. (Clim Chang 133:385–395, 2015) in their reply to our ethical assessment of the German Advisory Council’s Budget Approach (WBGUBA). First, we discuss and clarify the relationship between ethics and political feasibility, highlighting that the way Ohndorf et al. use feasibility creates an unwarranted status quo bias. Second, we explain the proper place historical responsibility should have within the WBGUBA, stressing the fact that the reasons why we choose (...) one policy proposal over another matter. Third, we analyze the limited extent to which a normative heuristic should motivate an ethically ambitious policy proposal like the WBGUBA. (shrink)

The notion of optimality is often invoked informally in the literature on metacognitive control. We provide a precise formulation of the optimization problem and show that optimal time allocation strategies depend critically on certain characteristics of the learning environment, such as the extent of time pressure, and the nature of the uptake function. When the learning curve is concave, optimality requires that items at lower levels of initial competence be allocated greater time. On the other hand, with logistic (...) learning curves, optimal allocations vary with time availability in complex and surprising ways. Hence there are conditions under which optimal strategies will be relatively easy to uncover, and others in which suboptimal time allocation might be expected. The model can therefore be used to address the question of whether and when learners should be able to exercise good metacognitive control in practice. (shrink)

The initial surge of COVID19 patients in New York, created a surge of unprecedented numbers in the largest integrated hospital system of the New York City and surrounding Long Island region. Due to innovation and clinician ingenuity ventilator allocation was going to have an easier solution than alleviating the moral distress of overworked and understaffed clinicians. Through the innovative work of clinicians, leadership and the leadership of Governor Cuomo and hospital executives, the need for triaging ventilators did not (...) become a reality. Yet the need for ethicists to support and aid clinicians in the discernment and need for escalation for scarce ICU resources and personnel was key. The transition from an allocation strategy of ventilators organically occurred as rapidly as the surge of COVID19 as it became clear that addressing clinician distress was imperative to maintain the level of human capital. An allocation strategy was envisioned that would assess the urgency of need for intensive care resources utilizing established decision aid calculators. In a mixed method quantitative and qualitative review, this article utilizes descriptive data to illustrate the lessons learned from utilizing ethics consultants to review pandemic decision making and alleviate clinician moral distress. (shrink)

Initial vaccine allocations for the coronavirus disease 2019 (COVID-19) will be limited. It is crucial to assess the ethical values associated with different methods of allocation, as well as important scientific and practical questions. This Viewpoint identifies three ethical values, benefiting people and limiting harm; prioritizing disadvantaged populations; and equal concern for all. It then explains why these values support prioritizing three groups: health care workers; other essential workers and people in high-transmission settings; and people with medical vulnerabilities (...) associated with poorer COVID-19 outcomes. In contrast, two other groups, people over 65 without medical vulnerabilities and participants in clinical research, present more complex ethical questions. This prioritization also encompasses valuing direct benefits to vaccinated individuals, indirect benefits to individuals protected from spread of infection, and indirect health and socioeconomic benefits to those protected from harm as health system and societal functioning improve. Vaccine allocation that recognizes important ethical values and avoids arbitrariness, waste, and corruption can ensure that the distribution of a COVID-19 vaccine is both fair and perceived as fair. (shrink)

Introduction: There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. -/- Methods: The main documents discussing the two (...) strategies are examined with a qualitative content analysis. The ethical values reasonableness, openness and transparency, inclusiveness, responsiveness and accountability serve as categories for our ethical analysis. -/- Results: We observed that the decision-making processes in a legal solution to expand access to vaccines would be more transparent than in COVAX initiative, would be more inclusive, especially of nation states, and the values responsiveness and accountability could be easily incorporated in the development of a new regulation. -/- Discussion: A legal strategy that offers incentives to the pharmaceutical industry in return for global distribution of vaccines according to the Fair Priority Model is an innovative way to achieve global and equitable access to vaccines. However, in the long term, achieving the Sustainable Development Goals will require from all nations to work in solidarity to find durable solutions for global vaccine research and development. Interim solutions, such as our proposed legal strategy for equitable access to vaccines, and efforts to find long-term solutions must be advanced in parallel. (shrink)

Many industry leaders and academics from the field of machine ethics would have us believe that the inevitability of robots coming to have a larger role in our lives demands that robots be endowed with moral reasoning capabilities. Robots endowed in this way may be referred to as artificial moral agents. Reasons often given for developing AMAs are: the prevention of harm, the necessity for public trust, the prevention of immoral use, such machines are better moral reasoners than humans, and (...) building these machines would lead to a better understanding of human morality. Although some scholars have challenged the very initiative to develop AMAs, what is currently missing from the debate is a closer examination of the reasons offered by machine ethicists to justify the development of AMAs. This closer examination is especially needed because of the amount of funding currently being allocated to the development of AMAs coupled with the amount of attention researchers and industry leaders receive in the media for their efforts in this direction. The stakes in this debate are high because moral robots would make demands on society; answers to a host of pending questions about what counts as an AMA and whether they are morally responsible for their behavior or not. This paper shifts the burden of proof back to the machine ethicists demanding that they give good reasons to build AMAs. The paper argues that until this is done, the development of commercially available AMAs should not proceed further. (shrink)

Women entrepreneurs innovate, initiate, engage, and run business enterprises to contribute the domestic development. Women entrepreneurs think and start taking risks of operating enterprises and combine various factors involved in production to deal with the uncertain business environment. Entrepreneurship and technological innovation play a crucial role in developing the economy by creating job opportunities, improving skills, and executing new ideas. It has a significant impact on the income of the household. The study focused on investigating the role of women’s entrepreneurship (...) and innovation technologies in contributing to household income in the challenging situation of the pandemic COVID-19. The paper emphasized identifying the determinants of female entrepreneurial contribution toward household income. This study collected data from selected rural and urban areas of district Faisalabad through a self-administered questionnaire. Investigators interviewed female entrepreneurs and chose them through the snowball sampling technique from a population of purposively selected female-run businesses. Interviews were conducted with women entrepreneurs to gather relevant information for the survey investigation at their workplaces and home. The effects of various factors, including age, education, family size, income from other sources, time allocated to entrepreneurial activity, firm size, and location were estimated empirically using an ordered logit model. The study findings exhibited a positive and significant role of respondents’ education, family size, time allocated to entrepreneurial activities, and firm size. The survey outcomes also indicated that the contribution of entrepreneurial income to household income in the rural areas is significantly higher than that in urban areas. This study signifies that regulations against gender discrimination in public and private institutions are helpful. Besides, encouraging an environment for entrepreneurial culture among women in the country would increase family income. The study’s findings and policy implications directly link to Sustainable Development Goal 5 of Gender Equality and SDG 8 related to decent work and economic growth. (shrink)

This work is an initial step toward developing a cognitive theory of cyber deception. While widely studied, the psychology of deception has largely focused on physical cues of deception. Given that present‐day communication among humans is largely electronic, we focus on the cyber domain where physical cues are unavailable and for which there is less psychological research. To improve cyber defense, researchers have used signaling theory to extended algorithms developed for the optimal allocation of limited defense resources by (...) using deceptive signals to trick the human mind. However, the algorithms are designed to protect against adversaries that make perfectly rational decisions. In behavioral experiments using an abstract cybersecurity game (i.e., Insider Attack Game), we examined human decision‐making when paired against the defense algorithm. We developed an instance‐based learning (IBL) model of an attacker using the Adaptive Control of Thought‐Rational (ACT‐R) cognitive architecture to investigate how humans make decisions under deception in cyber‐attack scenarios. Our results show that the defense algorithm is more effective at reducing the probability of attack and protecting assets when using deceptive signaling, compared to no signaling, but is less effective than predicted against a perfectly rational adversary. Also, the IBL model replicates human attack decisions accurately. The IBL model shows how human decisions arise from experience, and how memory retrieval dynamics can give rise to cognitive biases, such as confirmation bias. The implications of these findings are discussed in the perspective of informing theories of deception and designing more effective signaling schemes that consider human bounded rationality. (shrink)

The standard allocative efficiency criteria used by economists (Pareto efficiency and Kaldor-Hicks efficiency) are fundamentally unable to rank a slave-labor system against a free-labor system. Given either set of initial property rights assignments the market can reach (or fail to reach) allocative efficiency (that is, allocate resources to their highest-valued uses), but welfare economics provides no meta-framework for ranking initial assignments. This finding underscores the limits to the usefulness of efficiency criteria: they cannot settle all questions, and unfortunately (...) are least decisive just where the stakes are greatest (namely, where wealth effects of alternative assignments are greatest). Explicitly ethical criteria are needed to make the ranking. Key Words: Pareto efficiency • Kaldor-Hicks efficiency • property rights • welfare economics. (shrink)

Many industry leaders and academics from the field of machine ethics would have us believe that the inevitability of robots coming to have a larger role in our lives demands that robots be endowed with moral reasoning capabilities. Robots endowed in this way may be referred to as artificial moral agents. Reasons often given for developing AMAs are: the prevention of harm, the necessity for public trust, the prevention of immoral use, such machines are better moral reasoners than humans, and (...) building these machines would lead to a better understanding of human morality. Although some scholars have challenged the very initiative to develop AMAs, what is currently missing from the debate is a closer examination of the reasons offered by machine ethicists to justify the development of AMAs. This closer examination is especially needed because of the amount of funding currently being allocated to the development of AMAs coupled with the amount of attention researchers and industry leaders receive in the media for their efforts in this direction. The stakes in this debate are high because moral robots would make demands on society; answers to a host of pending questions about what counts as an AMA and whether they are morally responsible for their behavior or not. This paper shifts the burden of proof back to the machine ethicists demanding that they give good reasons to build AMAs. The paper argues that until this is done, the development of commercially available AMAs should not proceed further. (shrink)

With the limited initial availability of COVID-19 vaccines in the first months of 2021, decision-makers had to determine the order in which different groups were prioritized. Our aim was to find out what normative approaches to the allocation of scarce preventive resources were embedded in the national COVID-19 vaccination schedules. We systematically reviewed and compared prioritization regulations in 27 members of the European Union, the United Kingdom, and Israel. We differentiated between two types of priority categories: groups that (...) have increased infection fatality rate (IFR) compared to the average for the general population and groups chosen because their members experience increased risk of being infected (ROI). Our findings show a clear trend: all researched schedules prioritized criteria referring to IFR (being over 65 years old and coexisting health conditions) over the ROI criteria (eg occupation and housing conditions). This is surprising since, in the context of treatment, it is common and justifiable to adopt different allocation principles (eg introducing a saving more life-year approach or prioritizing younger patients). We discuss how utilitarian, prioritarian, and egalitarian principles can be applied to interpret normative differences between the allocation of curative and preventive interventions. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens (...) of ongoing intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

“Agent-centered” approaches to global poverty insist that effective arguments for poverty reduction must specify the concrete duties of particular duty-bearers. This article takes up a recent, influential, version of this view, Thomas Pogge’s human rights-based argument for global economic reforms to reduce chronic deprivation. While signaling a welcome shift from the diffuse allocation of responsibilities common to much philosophical writing on poverty, I argue that Pogge’s approach too readily assigns to powerful institutions in the global North the role of (...) devising and directing anti-poverty initiatives. In so doing, he overlooks the agency—actual and potential—of the poor themselves, as evidenced by poor-led political movements and poor-centered, participatory models of poverty reduction in development theory and practice. While agent-oriented approaches are right to focus our attention on structures that cause poverty, they ought not to assume that the powerful agents responsible for these are the only—or most appropriate—agents to lead the way to poverty reduction. Just as development organizations working in the global South have come to recognize that the participation of poor communities is critical to the success of development strategies, so should normative theorists writing about global injustice acknowledge the importance of the poor as active agents in poverty reduction efforts. (shrink)

BackgroundBalancing the rights and obligations of custodians and applicants in relation to access to biobanks is of utmost importance to guarantee trust and confidence. This study aimed to reveal which issues divide different stakeholders in an attempt to determine the rights and/or obligations held on human biological materials and data.MethodsTwenty-eight informants in the Benelux and Scandinavia were interviewed in order to capture the perspectives of experts and stakeholders in relation to the rights and obligations held by custodians and applicants with (...) respect to access to HBM and data.ResultsThere was no consensus among the informants on whether the custodian of a biobank should decide upon the scientific merits and the utility of an access request. Nearly all informants agreed that a new request or an amendment to the initial request has to be submitted when an applicant wants to use leftover HBM in a new or follow-up project. Several informants felt that it might be justified to charge higher access fees to external or industrial applicants that did not contribute to the collection of HBM and data. Most informants agreed that a custodian of a biobank could request the sharing and return of research results. It was furthermore argued that some of the benefits of research projects should be fed back into biobanks.ConclusionsThe interviews revealed a rather complex web of rights and obligations allocated to the custodian and the applicant in relation to access to HBM and data stored in biobanks. Some rights and obligations are negotiated on a case-by-case basis, while others are stipulated in access arrangements. We did find a consensus on the attribution of certain general rights to the custodians and the applicant. (shrink)

The claim that the human cognitive system tends to allocate resources to the processing of available inputs according to their expected relevance is at the basis of relevance theory. The main thesis of this chapter is that this allocation can be achieved without computing expected relevance. When an input meets the input condition of a given modular procedure, it gives this procedure some initial level of activation. Input-activated procedures are in competition for the energy resources that would allow (...) them to follow their full course. What determines which of the procedures in competition get sufficient resources to trigger their full operation is the dynamics of their activation. This dynamics depend both on the prior degree of mobilisation of a modular procedure and on the activation that propagates from other active modules. It is quite conceivable also that the mobilisation of some procedures has inhibitory effects on some others. The relevance-theoretic claim is that, at every instant, this dynamics of activation provides rough physiological indicators of expected relevance. The flow of energy in the system is locally regulated by these indicators. As a result, those input-procedure combinations that have the greatest expected relevance are the more likely ones to receive sufficient energy to follow their course. (shrink)

In 2001, France became one of the few countries to require corporate social responsibility reporting through its Nouvelles Régulations Économiques #2001-420. However, initial compliance with the statute was low, a factor implying the law lacked normativity. In this exploratory study, we attempt to determine whether there is movement toward normativity by examining the change in CSR disclosure from 2004 in comparison to 2010 for a sample of 81 publicly traded French firms. We measure both the space and the quality (...) of CSR disclosures, including in the latter a measure based on informational quality attributes as discussed by the International Accounting Standards Board, the Financial Accounting Standards Board, and the Global Reporting Initiative. We find significant increases in the space allocated to CSR disclosure, as well as some evidence of increased quality; although the informational quality of the disclosures remains quite low and fewer firms are including negative performance information in their reports. Finally, we document that differences in disclosure space and quality in 2004 appeared to be associated with legitimacy-based variables and that those relations remain largely unchanged in 2010. As such, it appears that the NRE’s goals of increased transparency remain unmet. (shrink)

Safety-critical systems manufacturers have the duty of care, i.e., they should take correct steps while performing acts that could foreseeably harm others. Commonly, industry standards prescribe reasonable steps in their process requirements, which regulatory bodies trust. Manufacturers perform careful documentation of compliance with each requirement to show that they act under acceptable criteria. To facilitate this task, a safety-centered planning-time framework, called ACCEPT, has been proposed. Based on compliance-by-design, ACCEPT capabilities permit to design Compliance-aware Engineering Process Plans, which are able (...) to show the planning-time allocation of standard demands, i.e., if the elements set down by the standard requirements are present at given points in the engineering process plan. In this paper, we perform a case study to understand if the ACCEPT produced models could support the planning of space software engineering processes. Space software is safety and mission-critical, and it is often the result of industrial cooperation. Such cooperation is coordinated through compliance with relevant standards. In the European context, ECSS-E-ST-40C is the de-facto standard for space software production. The planning of processes in compliance with project-specific ECSS-E-ST-40C applicable requirements is mandatory during contractual agreements. Our analysis is based on qualitative criteria targeting the effort dictated by task demands required to create a CaEPP for software development with ACCEPT. Initial observations show that the effort required to model compliance and processes artifacts is significant. However, such an effort pays off in the long term since models are, to some extend, reusable and flexible. The coverage level of the models is also analyzed based on design decisions. In our opinion, such a level is adequate since it responds to the information needs required by the ECSS-E-ST-40C framework. (shrink)

“Agent-centered” approaches to global poverty insist that effective arguments for poverty reduction must specify the concrete duties of particular duty-bearers. This article takes up a recent, influential, version of this view, Thomas Pogge’s human rights-based argument for global economic reforms to reduce chronic deprivation. While signaling a welcome shift from the diffuse allocation of responsibilities common to much philosophical writing on poverty, I argue that Pogge’s approach too readily assigns to powerful institutions in the global North the role of (...) devising and directing anti-poverty initiatives. In so doing, he overlooks the agency—actual and potential—of the poor themselves, as evidenced by poor-led political movements and poor-centered, participatory models of poverty reduction in development theory and practice. While agent-oriented approaches are right to focus our attention on structures that cause poverty, they ought not to assume that the powerful agents responsible for these are the only—or most appropriate—agents to lead the way to poverty reduction. Just as development organizations working in the global South have come to recognize that the participation of poor communities is critical to the success of development strategies, so should normative theorists writing about global injustice acknowledge the importance of the poor as active agents in poverty reduction efforts. (shrink)

“Agent-centered” approaches to global poverty insist that effective arguments for poverty reduction must specify the concrete duties of particular duty-bearers. This article takes up a recent, influential, version of this view, Thomas Pogge’s human rights-based argument for global economic reforms to reduce chronic deprivation. While signaling a welcome shift from the diffuse allocation of responsibilities common to much philosophical writing on poverty, I argue that Pogge’s approach too readily assigns to powerful institutions in the global North the role of (...) devising and directing anti-poverty initiatives. In so doing, he overlooks the agency—actual and potential—of the poor themselves, as evidenced by poor-led political movements and poor-centered, participatory models of poverty reduction in development theory and practice. While agent-oriented approaches are right to focus our attention on structures that cause poverty, they ought not to assume that the powerful agents responsible for these are the only—or most appropriate—agents to lead the way to poverty reduction. Just as development organizations working in the global South have come to recognize that the participation of poor communities is critical to the success of development strategies, so should normative theorists writing about global injustice acknowledge the importance of the poor as active agents in poverty reduction efforts. (shrink)

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The (...) findings revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

We ordinarily suppose that there is a difference between having and failing to exercise a rational capacity on the one hand, and lacking a rational capacity altogether on the other. This is crucial for our allocations of responsibility. Someone who has but fails to exercise a capacity is responsible for their failure to exercise their capacity, whereas someone who lacks a capacity altogether is not. However, as Gary Watson pointed out in his seminal essay ’Skepticism about Weakness of Will’, the (...) idea of an unexercised capacity is much more difficult to make sense of than it initially appears. The aim of ’Rational Capacities’ is to provide the needed explication of this idea. (shrink)

BackgroundIn the initial phase of the Covid-19 pandemic, difficult decisions had to be made on the allocation of testing resources. Similar situations can arise in future pandemics. Therefore, careful consideration of who should be tested is an important part of pandemic preparedness. We focus on four ethical aspects of that problem: how to prioritize scarce testing resources, the regulation of commercial direct-to-consumer test services, testing of unauthorized immigrants, and obligatory testing.Main textThe distribution of scarce resources for testing: We (...) emphasize the use of needs-based criteria, but also acknowledge the importance of choosing a testing strategy that contributes efficiently to stopping the overall spread of the disease. Commercial direct-to-consumer test services: Except in cases of acute scarcity, such services will in practice have to be allowed. We propose that they should be subject to regulation that ensures test quality and adequate information to users. Testing of unauthorized immigrants, their children and other people with unclear legal status: Like everyone else, these individuals may be in need of testing, and it is in society’s interest to reach them with testing in order to stop the spread of the disease. A society that offers comprehensive medical services to unauthorized immigrants is in a much better position to reach them in a pandemic than a society that previously excluded them from healthcare. Obligatory testing: While there are often strong reasons for universal testing in residential areas or on workplaces, there are in most cases better ways to achieve testing coverage than to make testing mandatory.ConclusionIn summary, we propose (1) decision-making primarily based on needs-based criteria, (2) strict regulation but not prohibition of direct-to-consumer test services, (3) test services offered to unauthorized immigrants, preferably as part of comprehensive medical services, and (4) broad outreach of testing services whenever possible, but in general not obligatory testing. (shrink)