Traditional forms of farming, herding, and fishing are remarkably adapted to African conditions but these traditional approaches are being overtaken by modern pressures, particularly population growth. According to a report published by the Office of Technology Assessment (OTA), a nonpartisan analytical support agency of the U. S. Congress, one promising way to help African farmers and herders would be for development assistance organizations to focus more attention on the various forms of low-resource agriculture that predominate in Africa.In keeping with OTA's (...) mission and primary audience, “Enhancing Agriculture in Africa: A Role for U. S. Development Assistance” (1988) is a policy-oriented synthesis of available technical information. The report provides Congress with a range of options that, if pursued, could help Africans enhance agriculture, increase their food security, and improve their lives.This paper is drawn from the larger OTA report, and it focuses on the role technology might play in enhancing low-resource agriculture. Readers should see the full assessment (OTA, 1988) for more information on policy considerations; the specific technologies mentioned; or a complete list of advisory panel members, workshops and participants, and commissioned papers.OTA's report comes at a critical time: for a variety of reasons—ranging from changing values to increased budget constraints—U. S. foreign assistance policy is undergoing a fundamental reevaluation. This review of the potential of low-resource agriculture, and options the United States might pursue to enhance this approach, was intended to aid in this reevaluation. (shrink)

Extracorporeal membrane oxygenation (ECMO) is a form of life support for cardiac and/or pulmonary failure with unique ethical challenges compared to other forms of life support. Ethical challenges with ECMO exist when conventional standards of care apply, and are exacerbated during periods of absolute ECMO scarcity when “crisis standards of care” are instituted. When conventional standards of care apply, we propose that it is ethically permissible to withhold placing patients on ECMO for reasons of technical futility or when patients have (...) terminal, short-term prognoses that are untreatable by ECMO. Under crisis standards of care, it is ethically permissible to broaden exclusionary criteria to also withhold ECMO from patients who have a low likelihood of recovery, to maximize the overall number of lives saved. Unilateral withdrawal of ECMO against a patient’s preferences is unethical under conventional standards of care, but is ethical under crisis standards of care to increase access to ECMO to others in society. ECMO should only be rationed when true scarcity exists, and allocation protocols should be transparent to the public. When rationing must occur under crisis standards of care, it is imperative that oversight bodies assess for inequities in the allocation of ECMO and make frequent changes to improve any inequities. (shrink)

Offering philosophical insights into the popular morning brew, _Coffee -- Philosophy for Everyone_ kick starts the day with an entertaining but critical discussion of the ethics, aesthetics, metaphysics, and culture of coffee. Matt Lounsbury of pioneering business Stumptown Coffee discusses just how good coffee can be Caffeine-related chapters cover the ethics of the coffee trade, the metaphysics of coffee and the centrality of the coffee house to the public sphere Includes a foreword by Donald Schoenholt, President at Gillies Coffee Company.

Employing the National Institute of Mental Health-funded Prevention of Suicide in Primary Care Elderly Collaborative Trial as a case study, we discuss 2 sets of ethical issues: obtaining informed consent for a clinic-based intervention study and using treatment as usual (TAU) as the control condition. We then address these ethical issues in the context of the debate about the quality improvement efforts of health care organizations. Our analysis reveals the tension between ethics and scientific integrity involved with using TAU as (...) a control condition and the difficulty in designing high-quality research in a community-based setting. (shrink)

Objective: A deep understanding of the relationship between a scarce drug's dose and clinical response is necessary to appropriately distribute a supply-constrained drug along these lines. Summary of key data: The vast majority of drug development and repurposing during the COVID-19 pandemic – an event that has made clear the ever-present scarcity in healthcare systems –has been ignorant of scarcity and dose optimisation's ability to help address it. Conclusions: Future pandemic clinical trials systems should obtain dose optimisation data, as these (...) appear necessary to enable appropriate scarce resource allocation according to societal values. (shrink)

Employing the National Institute of Mental Health-funded Prevention of Suicide in Primary Care Elderly Collaborative Trial as a case study, we discuss 2 sets of ethical issues: obtaining informed consent for a clinic-based intervention study and using treatment as usual (TAU) as the control condition. We then address these ethical issues in the context of the debate about the quality improvement efforts of health care organizations. Our analysis reveals the tension between ethics and scientific integrity involved with using TAU as (...) a control condition and the difficulty in designing high-quality research in a community-based setting. (shrink)

It is widely assumed that there exist certain objects which can in no way be distinguished from each other, unless by their location in space or other reference-system. Some of these are, in a broad sense, 'empirical objects', such as electrons. Their case would seem to be similar to that of certain mathematical 'objects', such as the minimum set of manifolds defining the dimensionality of an R -space. It is therefore at first sight surprising that there exists no branch of (...) mathematics, in which a third parity-relation, besides equality and inequality, is admitted; for this would seem to furnish an appropriate model for application to such instances as these. I hope, in this work, to show that such a mathematics in feasible, and could have useful applications if only in a limited field. The concept of what I here call 'indistinguishability' is not unknown in logic, albeit much neglected. It is mentioned, for example, by F. P. Ramsey [1] who criticizes Whitehead and Russell [2] for defining 'identity' in such a way as to make indistinguishables identical. But, so far as I can discover, no one has made any systematic attempt to open up the territory which lies behind these ideas. What we find, on doing so, is a body of mathematics, offering only a limited prospect of practical usefulness, but which on the theoretical side presents a strong challenge to conventional ideas. (shrink)

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, the ACIP (...) violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. (shrink)

We propose 4 equity-advancing operational improvements to eligibility and sign-up processes at mass vaccination sites: (1) preregistration using existing information, (2) eligibility rules that recognize the greater burden of COVID-19 in underserved neighborhoods, (3) appointment assignment that prioritizes those with disadvantage, and (4) socioculturally informed outreach to lottery selectees.

This chapter contains sections titled: Socrates Café Café Philosophique Philosophy for Everyone Sophistry The Examined Life Oblivion Conclusion (Who is Ben's Mom?).

The central project of the Critique of Pure Reason is to answer two sets of questions: What can we know and how can we know it? and What can't we know and why can't we know it? The essays in this collection are intended to help students read the Critique of Pure Reason with a greater understanding of its central themes and arguments, and with some awareness of important lines of criticism of those themes and arguments.

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Scarce resource allocation policies vary across the United States. Little is known about regional variation in resource allocation protocols and variation in their application. We sought to evaluat...

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Review of The Clarendon Edition of Hume’s Essays, edited by Tom L. Beauchamp and Mark A. Box, with Michael Silverthorne, J. A. W. Gunn, and F. David Harvey. 2 volumes. Oxford: Clarendon Press, 2021. Pp. 1200. ISBN: 97880198847090.

Bradley’s philosophy of history, which was mostly embodied in his first published work, The Presuppositions of Critical History, has been the subject of a number of explanatory and critical pieces, several of them in the pages of this journal. In outlining the fundamentals of his approach to historical knowledge, therefore, I can be brief. He begins, ‘There is no history which in some respects is not more or less critical’, because selection of information is essential and the historian needs some (...) principle of selection. It is clear that Bradley includes selecting information not just from primary sources but from previous historians. And, ‘if we exclude or alter or rationalise to the very smallest extent then we have criticism at once.’ The criterion, or canon of selection has to be the historian himself. This has sometimes been dismissed as dangerously relativist, but such criticism misses the point that although the actual historian is the real criterion, ‘the historian as he ought to be’ is the ideal criterion; and ‘the historian who is true to the present is the historian as he ought to be.’ It is crucial to Bradley’s position and to the development of my argument in this paper to note that it is the historian who is true to the present, not to the past, who is the historian as he ought to be. For, as Bradley explained, ‘every man’s present standpoint ought to determine his belief in respect to all past events; but to no man do I dictate what his present standpoint ought to be. Consistency is the one word that I have emphasised.’ Bradley denied a correspondence theory of truth in favour of a coherence theory. Truth had to be constructed by the knower who was not a mere passive observer of reality.. (shrink)

Josiah Royce (1855-1916) was the leading American proponent of absolute idealism, the metaphysical view (also maintained by G. W. F. Hegel and F. H. Bradley) that all aspects of reality, including those we experience as disconnected or contradictory, are ultimately unified in the thought of a single all-encompassing consciousness. Royce also made original contributions in ethics, philosophy of community, philosophy of religion and logic. His major works include The Religious Aspect of Philosophy (1885), The World and the Individual (1899-1901), The (...) Philosophy of Loyalty (1908), and The Problem of Christianity (1913). Royce's friendly but longstanding dispute with William James, known as "The Battle of the Absolute," deeply influenced both philosophers' thought. In his later works, Royce reconceived his metaphysics as an "absolute pragmatism" grounded in semiotics. This view dispenses with the Absolute Mind of previous idealism and instead characterizes reality as a universe of ideas or signs which occur in a process of being interpreted by an infinite community of minds. These minds, and the community they constitute, may themselves be understood as signs. Royce's ethics, philosophy of community, philosophy of religion, and logic reflect this metaphysical position. (shrink)

Of the philosophers in recent times who have striven to heal this rupture between head and heart perhaps none has caught the fancy or stirred the hopes of the American philosophical community as Alfred North Whitehead has. But since the master started this task too late in life, it was left to his disciples to complete his work. And of those disciples who have continued the master's healing in theology, perhaps none has been so energetic or resourceful as Professor Charles (...) Hartshorne. While Professor Hartshorne has usually practised this therapy alone and unaided, he has on one notable occasion enlisted the aid both of another contemporary theological therapist, Professor William L. Reese, and also of most of the great philosophers in history. The fruit of this collaboration, Philosophers Speak of God, while not adding anything essentially novel to Professor Hartshorne's earlier work, presents the physician not only as an isolated laboratory researcher but also, with Professor Reese's help, in the process of actually confronting and healing his patients. Hence this book is an especially interesting and valuable case study of one type of contemporary attempt to cure theological schizophrenia. Theological therapists are to be found among scientists as well as among philosophers, moreover, for even in science the intellect does not- succeed in quieting the restless heart until it finds the God for which that restless heart seeks. Going "through the world with a reverent attitude yet an almost total absence of doctrine or belief--with a religious heart and a skeptical head... is," as we are told in a recent book representing this theological therapy from the point of view of a scientist--a biologist and natural historian--Alexander F. Skutch's The Quest of the Divine, "a most unsatisfactory way to live.". (shrink)

SenilityCalled from pleasuresI go tap-tapping down an old man’s backdown the skin of eighty summers wastingon a rib-ladder closingon a history of heart and lungs.These narrowly contracting bags I find, proclaim“Today his chest is clear as yours or mine.”This is the news requiredas the tide of vigilancelaps his sheets each surfacing dawn.“He’s doing very well.”He leans his gaze to the voice dintingthe routine of his roombut slides the focal point towards infinitypast those gatheredto the motes of memoryto wherepinned in the (...) windthrough their age and bondher sacrificial flags go flutteringbattered and fastened into the room’s cornerhinged haggard to his unhinging.In this too a workless son and centrelessclock-bound slaveto the incontinent brain and its seepage.Two tight-wire walkerswell talked out by nine each bed-wet daythe backyard hoist their prayer-wheel creaking.The sheets flap up the scent of their detentions.Time in its time will track them round their modest cornernovice at the f. (shrink)