There is asbestos under the eaves of my house, outside my bedroom and bathroom. Imagine I want to remove it. I know there is a danger with asbestos removal causing asbestosis and mesothelioma. I do...

Traditionally many systems subjected public employees to a separate and more restrictive labour law regime than their private sector counterparts. However, these status-based restrictions were generally modified or abandoned during the 1960s and 1970s. Greater homogeneity of treatment of public and private sector workers was also subsequently reflected in employment practices in Britain and elsewhere as a product of the «marketization» of public services, a strategy which involved replacing centralized regulation by greater local determination in accordance with «business» needs. (...) More radically, the provision of some public services was removed from the public sector altogether, either by contracting out particular elements of the service or by wholesale privatization, subject to some form of regulatory regime. These changes may appear to render otiose discussion of the case for special treatment of the employment relation in public services. This article expounds the proposition that, on the contrary, public services possess distinctive qualities which necessitate regulation of the employment relationship within those services in areas beyond those covered by the general law, and aims to provide a framework within which the justification for specific additional measures can be assessed. The article also considers the further questions which need to be addressed if the framework it proposes is accepted, including, in particular, the appropriate mechanisms for imposing and enforcing regulation. (shrink)

ABSTRACT There is general agreement that Kant’s thought strongly influenced Heidegger’s. Nevertheless, there is still much work to be done in order to fully appreciate this influence. A central theme to disclose the relation between these authors is the role they give to the transcendental. In this paper I show that Kant’s account of intuition is the focus of Heidegger’s interpretation of Kant in his Die Frage nach dem Ding, since Heidegger interprets Kant’s treatment of intuition as a delimiting of (...) the modern mathematical tendency to determine everything out of pure reason alone. I argue that this interpretation is at the basis of Heidegger’s appropriation of Kant’s synthetic a priori in this work, the aim of which is to take this notion away from the sphere of the objects of mathematical physical science, and place it in the realm of everyday experience. I claim that Heidegger thinks that this move can only be accomplished by removing universality and necessity from Kant’s a priori. Finally, I show that Heidegger’s appropriation of Kant’s synthetic a priori goes together with and illuminates his understanding of transcendence as das Zwischen, ‘the between us and things’. RESUMO É consenso geral que o pensar de Kant influenciou fortemente o pensar de Heidegger. Porém, há ainda muito trabalho a fazer para se conseguir apreciar essa influência plenamente. Um tema crucial para conseguir expor a relação entre esses dois autores é o rol que ambos dão ao transcendental. Neste artigo, vou mostrar que o tratamento que Kant faz da intuição é o foco da interpretação que Heidegger oferece acerca de Kant em sua obra Die Frage nach dem Ding, dado que Heidegger interpreta o jeito como Kant trabalha a intuição como uma delimitação da tendência matemática moderna a determiná- lo tudo pelo só uso da razão pura. Argumento que essa interpretação está na base da apropriação que Heidegger faz do sintético a priori kantiano nesta obra, cujo fim é tirar essa noção fora da esfera dos objetos da ciência físico- matemática e posicioná-la no reino da experiência cotidiana. Sustento que Heidegger pensa que isto só pode ser alcançado ao eliminar a necessidade e a universalidade do a priori kantiano. Finalmente, mostro que a apropriação que Heidegger faz do sintético a priori kantiano vai junto e ilumina sua compreensão da transcendência como o das Zwischen, ‘o entre nós e as coisas’. (shrink)

This report presents a comprehensive set of recommendations for protection of human beings who are trafficked for the purpose of organ removal or are targeted for such trafficking. Developed by an interdisciplinary group of international experts under the auspices of the project Trafficking in Human Beings for the Purpose of Organ Removal, these recommendations are grounded in the view that an individual who parts with an organ for money within an illegal scheme is ipso facto a victim and that the (...) crime of trafficking in human beings for the purpose of organ removal intersects with the crime of trafficking in organs. Consequently, the protection of victims should be a priority for all actors involved in antitrafficking activities: those combating organ-related crimes, such as health organizations and survivor support services, and those combating trafficking in human beings, such as the criminal justice sectors. Taking into account the special characteristics of THBOR, the authors identify 5 key stakeholders in the protection of human beings trafficked for organ removal or targeted for such trafficking: states, law enforcement agencies and judiciary, nongovernmental organizations working in the areas of human rights and antitrafficking, transplant centers and health professionals involved in transplant medicine, and oversight bodies. For each stakeholder, the authors identify key areas of concern and concrete measures to identify and protect the victims of THBOR. The aim of the recommendations is to contribute to the development of a nonlegislative response to THBOR, to promote the exchange of knowledge and best practices in the area of victim protection, and to facilitate the development of a policy-driven action plan for the protection of THBOR victims in the European Union and worldwide. (shrink)

Healthcare user fees present an important barrier for accessing services for the poorest (indigents) in Burkina Faso and selective removal of fees has been incorporated in national healthcare planning. However, establishing fair, effective and sustainable mechanisms for the removal of user fees presents important challenges. A participatory action-research project was conducted in Ouargaye, Burkina Faso, to test mechanisms for identifying those who are indigents, and funding and implementing user fee removal. In this paper, we explore stakeholder perceptions of ethical (...) considerations relating to participation and partnership arising in the action-research. (shrink)

In response to the severe lack of leadership assessment tools in the Chinese context, the Service Leadership Behavior Scale was developed based on the Service Leadership Model proposed by Po Chung, the co-founder of DHL International. Utilizing responses from 4,486 Hong Kong undergraduates, this paper reports the findings of a validation study on the Short-Form Service Leadership Behavior Scale (SLB-SF-65). Previous findings based on exploratory factor analysis revealed a six-factor 48-item solution (SLB-SF-48). With the removal of ten items, confirmatory factor (...) analysis showed that the final 38-item scale (SLB-SF-38) possessed excellent psychometric properties and factorial stability based on multigroup invariance analyses. The SLB-SF-38 also exhibited excellent reliability and convergent validity. Overall speaking, the present study underscored the utility of the SLB-SF-38 as an objective assessment instrument of service leadership behavior in the education, research and personnel training contexts. (shrink)

Background: Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly (...) understood. -/- Methods: 12 facilitators were interviewed from 10 Canadian medical tourism companies. -/- Results: Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry. -/- Conclusion: Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles. (shrink)

For the last thirty years, the nation's mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery rendering them incapable of ensuring the safety, security, and recovery of their clients. The resulting organizational trauma both mirrors and magnifies the trauma-related problems their clients seek relief from. Just as the lives of people exposed to chronic trauma and abuse become organized around the traumatic experience, so too have our social service (...) systems become organized around the recurrent stress of trying to do more under greater pressure: they become crisis-oriented, authoritarian, disempowered, and demoralized, often living in the present moment, haunted by the past, and unable to plan for the future.Complex interactions among traumatized clients, stressed staff, pressured organizations, and a social and economic climate that is often hostile to recovery efforts recreate the very experiences that have proven so toxic to clients in the first place. Healing is possible for these clients if they enter helping, protective environments, yet toxic stress has destroyed the sanctuary that our systems are designed to provide.This thoughtful, impassioned critique of business as usual begins to outline a vision for transforming our mental health and social service systems. Linking trauma theory to organizational function, Destroying Sanctuary provides a framework for creating truly trauma-informed services. The organizational change method that has become known as the Sanctuary Model lays the groundwork for establishing safe havens for individual and organizational recovery. The goals are practical: improve clinical outcomes, increase staff satisfaction and health, increase leadership competence, and develop a technology for creating and sustaining healthier systems. Only in this way can our mental health and social service systems become empowered to make a more effective contribution to the overall health of the nation.Destroying Sanctuary is a stirring call for reform and recovery, required reading for anyone concerned with removing the formidable barriers to mental health and social services, from clinicians and administrators to consumer advocates. (shrink)

Social welfare workers in the protective services field—among them social workers, psychologists, and psychiatrists—are expected to follow the laws of the state in which they practice, but are also bound by their professional code of ethics. Often this does not present a problem, but at times ethical and legal expectations differ. This is particularly problematic where the professionals may be seen as agents of control, reporting possible child abuse, conducting child abuse investigations, inspecting homes, monitoring families, removing children from (...) their homes and the like, often working with or reporting to law enforcement agents where expectations are different and codes of ethics absent. This paper explores the relationship between law and professional ethics, and, in particular, situations in which actions and decisions can be legal yet unethical or ethical but yet illegal. It then analyzes some critical child protective service activities where Child Protective Services (CPS) workers exert significant control over parents and children, and where the legal and ethical requirements may differ. Finally, the paper discusses the problems that CPS professionals face when law and ethics collide, and suggests various steps to resolve some of these conflicts. (shrink)

BackgroundThe Public Health Service Increased Risk designation identified organ donors at increased risk of transmitting hepatitis B, hepatitis C, and human immunodeficiency virus. Despite clear data demonstrating a low absolute risk of disease transmission from these donors, patients are hesitant to consent to receiving organs from these donors. We hypothesize that patients who consent to receiving offers from these donors have decreased time to transplant and decreased waitlist mortality.MethodsWe performed a single-center retrospective review of all-comers waitlisted for liver transplant from (...) 2013 to 2019. The three competing risk events (transplant, death, and removal from transplant list) were analyzed. 1603 patients were included, of which 1244 (77.6%) consented to offers from increased risk donors.ResultsCompared to those who did not consent, those who did had 2.3 times the rate of transplant (SHR 2.29, 95% CI 1.88–2.79, p < 0.0001), with a median time to transplant of 11 months versus 14 months (p < 0.0001), as well as a 44% decrease in the rate of death on the waitlist (SHR 0.56, 95% CI 0.42–0.74, p < 0.0001). All findings remained significant after controlling for the recipient age, race, gender, blood type, and MELD. Of those who did not consent, 63/359 (17.5%) received a transplant, all of which were from standard criteria donors, and of those who did consent, 615/1244 (49.4%) received a transplant, of which 183/615 (29.8%) were from increased risk donors.ConclusionsThe findings of decreased rates of transplantation and increased risk of death on the waiting list by patients who were unwilling to accept risks of viral transmission of 1/300–1/1000 in the worst case scenarios suggests that this consent process may be harmful especially when involving “trigger” words such as HIV. The rigor of the consent process for the use of these organs was recently changed but a broader discussion about informed consent in similar situations is important. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic (...) review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

A methodical study of the primitive cultures of the hunting-gathering peoples which focuses on their social structures and economic relations.

Chapter on The Australian class system previously published as Sociocentre relationship terms and the Australian class system qv. for annotation.

Previous studies of verbal short-term memory indicate that STM for serial order may be linked to language development and developmental language disorder. To clarify whether a domain-general mechanism is impaired in DLD, we studied the relations between age, non-verbal serial STM, and language competence. We hypothesized that non-verbal serial STM differences between groups of children with DLD and typically developing children are linked to their language acquisition differences. Fifty-one children with DLD and sixty-six TD children participated as part of the (...) HelSLI project in this cross-sectional study. The children were 4–6-year-old monolingual native Finnish speakers. They completed several tests of language and cognitive functioning, as well as new game-like tests of visual and auditory non-verbal serial STM. We used regression analyses to examine how serial STM moderates the effect of age on language. A non-verbal composite measure of serial visual and auditory STM moderated cross-sectional development of receptive language in the children with DLD. This moderation was not observed in the TD children. However, we found more rapid cross-sectional development of non-verbal serial STM in the TD children than in the children with DLD. The results suggest that children with DLD may be more likely to have compromised general serial STM processing and that superior non-verbal serial STM may be associated with better language acquisition in children with DLD. (shrink)

New Blackfriars, Volume 103, Issue 1103, Page 159-161, January 2022.

ABSTRACT Global biodiversity declines are increasingly recognized as profound ecological and social crises. In areas subject to colonialization, these declines have advanced in lockstep with settler colonialism and imposition of centralized resource management by settler states. Many have suggested that resurgent Indigenous-led governance systems could help arrest these trends while advancing effective and socially just approaches to environmental interactions that benefit people and places alike. However, how dominant management and conservation approaches might be decolonized (i.e., how their underlying colonial structure (...) might be addressed, transformed, and replaced) is not always clear. Here, we describe a ‘Decolonial Model of Environmental Management and Conservation’ as an alternative paradigm to dominant approaches of conservation and management. The tenets of the model describe characteristics that might be expected of decolonized management, contrasted with those of dominant state-led approaches such as those embedded in the North American Model of Wildlife Conservation. The model does not prescribe how Indigenous governments or communities ought to govern their own territories, but instead offers insights into how external management and conservation agencies and practitioners might support (or stop impeding) Indigenous-led governance. We illustrate the model with a conservation ‘bright spot’: grizzly bear stewardship in the area now referred to as the Great Bear Rainforest in British Columbia, Canada, with a focus on work led by or in collaboration with, and within the territories of, the Haíɫzaqv, Kitasoo/xai’xais, Nuxalk, and Wuikinuxv First Nations. While acknowledging the important context-specific variability among place-based management and conservation applications, we also discuss the model’s broader applicability. (shrink)

This book contains programmatic essays that focus on broad-ranging proposals for re-envisioning a discipline of comparative philosophy of religions. It also contains a number of case studies focussing on the interpretation of particular religio-historical data from comparatively oriented philosophical perspectives.

Logistics services involve a wide range of transport operations between distributors and clients. Currently, the large number of intermediaries are a challenge for this sector, as it makes all the processes more complicated. To face that problem, we propose a system that uses smart contracts to remove intermediaries and speed up logistics activities. Our new model combines smart contracts and a multi-agent system in a single platform to improve the current logistics system by increasing organization, security and getting rid (...) of several human intermediaries to automate its processes, making distribution times significantly faster. Also, with this kind of approach, it is possible to apply penalties to parties that do not comply with the terms of using this platform. (shrink)

This chapter first outlines the three main phases of the development of the single market, together with the impetus and philosophy underpinning it. The idea behind the original European Economic Community (EEC) Treaty was simple: barriers to free movement of goods, persons, services, and capital would be removed through the use of treaty provisions that prohibited obstacles to free movement. One aspects of the single market have been reformed following the crisis, notably financial services. The legislature is increasingly (...) moving towards the use of regulations, rather than directives, to ensure greater uniformity and maximum as opposed to minimum harmonization to remove the possibility of national variation. The chapter then examines some of the challenges facing the single market. The challenges essentially concern questions of competence, sovereignty and effectiveness. There are two main approaches to attaining a common market, namely decentralized model and centralized model. (shrink)

In a recent Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious (...) objection in publicly-funded healthcare systems, at least in the area of abortion and end-of-life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access. (shrink)

The epsilon calculus is a logical formalism developed by David Hilbert in the service of his program in the foundations of mathematics. The epsilon operator is a term-forming operator which replaces quantifiers in ordinary predicate logic. Specifically, in the calculus, a term εx A denotes some x satisfying A(x), if there is one. In Hilbert's Program, the epsilon terms play the role of ideal elements; the aim of Hilbert's finitistic consistency proofs is to give a procedure which removes such terms (...) from a formal proof. The procedures by which this is to be carried out are based on Hilbert's epsilon substitution method. The epsilon calculus, however, has applications in other contexts as well. The first general application of the epsilon calculus was in Hilbert's epsilon theorems, which in turn provide the basis for the first correct proof of Herbrand's theorem. More recently, variants of the epsilon operator have been applied in linguistics and linguistic philosophy to deal with anaphoric pronouns. (shrink)

The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...) and Genomics England.3 A recent review commissioned by the UK’s Department of Health and Social Care (hereafter referred to as the ‘Goldacre Review’) places TREs at the heart of its recommendations around the future of National Health Service (NHS) health data sharing for research, describing them as the ‘clear path forward’ to a health data system in which trust is ‘earned’ through ‘provable, credible steps to protect patient privacy, and by being transparent with everyone about everything that is done with their deepest medical secrets’.4 We argue that rather than building public trust, the TRE model actually reduces the need for trust in the use and sharing of patient health data. This is because trust is importantly connected to vulnerability and uncertainty; an essential part of trusting someone is accepting that one’s trust could be disappointed or betrayed. In attempting to provide assurances or guarantees of data privacy and security, TREs strive to remove this vulnerability, and so remove the need for trust. We do not see this as a problem and are broadly supportive of this kind of data sharing model because of the increased security and oversight it provides. However, having argued that TREs are not actually concerned with trust, we consider the importance of being precise about the words that we use …. (shrink)

ABSTRACT In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice (...) of conscientious objection in publicly‐funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end‐of‐life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access. (shrink)

In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue (...) that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: removing a right to conscientious objection; selecting candidates into relevant medical specialities or general practice who do not have objections; demonopolizing the provision of these services away from the medical profession. (shrink)

False belief tasks have enjoyed a monopoly in the research on children’s development of a theory of mind. They have been granted this status because they promise to deliver an unambiguous assessment of children’s understanding of the representational nature of mental states. Their poor cousins, true belief tasks, have been relegated to occasional service as control tasks. That this is their only role has been due to the universal assumption that correct answers on true belief tasks are inherently ambiguous regarding (...) the level of the child’s understanding of mental states. It has also been due to the universal assumption that nothing in the child’s developing theory of mind would lead to systematically incorrect answers on true belief tasks. We review new findings that 4- and 5-year-olds do err, systematically and profoundly, on the true belief versions of all the extant belief tasks. This reveals an intermediate level of understanding in the development of children’s theory of mind. Researchers have been unaware of this intermediate level because it produces correct answers in false belief tasks. A simple two-task battery—one true belief task and one false belief task—is sufficient to remove the ambiguity from each task. The new findings show that children do not acquire an understanding of beliefs, and hence a representational theory of mind, until after 6 years of age, or 2 years later than most developmental psychologists have concluded. This raises the question of how to interpret other new findings that infants are able to pass false belief tasks. We review these new infant studies, as well as recent studies on chimpanzees, in light of older children’s failure on true belief tasks, and end with some speculation about how all of these new findings might be reconciled. (shrink)

Benefit sharing aims to achieve an equitable exchange between the granting of access to a genetic resource and the provision of compensation. The Convention on Biological Diversity, adopted at the 1992 Earth Summit in Rio de Janeiro, is the only international legal instrument setting out obligations for sharing the benefits derived from the use of biodiversity. The CBD excludes human genetic resources from its scope, however, this article considers whether it should be expanded to include those resources, so as to (...) enable research subjects to claim a share of the benefits to be negotiated on a case-by-case basis. Our conclusion on this question is: 'No, the CBD should not be expanded to include human genetic resources.' There are essential differences between human and non-human genetic resources, and, in the context of research on humans, an essentially fair exchange model is already available between the health care industry and research subjects. Those who contribute to research should receive benefits in the form of accessible new health care products and services, suitable for local health needs and linked to economic prosperity. When this exchange model does not apply, as is often the case in developing countries, individually negotiated benefit sharing agreements between researchers and research subjects should not be used as 'window dressing'. Instead, national governments should focus their finances on the best economic investment they could make; the investment in population health and health research as outlined by the World Health Organization's Commission on Macroeconomics and Health; whilst international barriers to such spending need to be removed. (shrink)

This article uses Marc Lewis’ work as a springboard to discuss the socio-political context of the brain disease model of addiction. The claim that promotion of the BDMA is the only way the general public can be persuaded to withhold blame and punishment from addicts is critically examined. After a discussion of public understandings of the disease concept of addiction, it is pointed out that it is possible to develop a scientific account of addiction which is neither a disease nor (...) a moral model but which the public could understand. Evidence is reviewed to suggest that public acceptance of the disease concept is largely lip-service and that the claim the BDMA removes stigma among the public and professionals is unsupported by evidence. Further, there is good evidence that biogenetic explanations of mental/behavioural disorders in general have been counterproductive in the attempt to ally stigma. A model of addiction as a disorder of choice may attract special problems in public-facing communications and risks being misunderstood. However, ways of presenting this model to the public are suggested that may avoid such risks. Lastly, the claim that the BDMA is the only way of ensuring access to treatment and of maintaining research funding for addiction is disputed and a way in which these benefits can be retained under a disorder-of-choice model proposed. The article concludes by enthusiastically endorsing Lewis’ call for a third stage in the governing image of addiction. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would be the (...) acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

In so far as long-range tele-operated weapons, such as the United States’ Predator and Reaper drones, allow their operators to fight wars in what appears to be complete safety, thousands of kilometres removed from those whom they target and kill, it is unclear whether drone operators either require courage or have the opportunity to develop or exercise it. This chapter investigates the implications of the development of tele-operated warfare for the extent to which courage will remain central to the role (...) of the warrior and for the future culture of the armed services in the age of drone warfare. (shrink)

ABSTRACT Benefit sharing aims to achieve an equitable exchange between the granting of access to a genetic resource and the provision of compensation. The Convention on Biological Diversity (CBD), adopted at the 1992 Earth Summit in Rio de Janeiro, is the only international legal instrument setting out obligations for sharing the benefits derived from the use of biodiversity. The CBD excludes human genetic resources from its scope, however, this article considers whether it should be expanded to include those resources, so (...) as to enable research subjects to claim a share of the benefits to be negotiated on a case‐by‐case basis. Our conclusion on this question is: ‘No, the CBD should not be expanded to include human genetic resources.’ There are essential differences between human and non‐human genetic resources, and, in the context of research on humans, an essentially fair exchange model is already available between the health care industry and research subjects. Those who contribute to research should receive benefits in the form of accessible new health care products and services, suitable for local health needs and linked to economic prosperity (e.g. jobs). When this exchange model does not apply, as is often the case in developing countries, individually negotiated benefit sharing agreements between researchers and research subjects should not be used as ‘window dressing’. Instead, national governments should focus their finances on the best economic investment they could make; the investment in population health and health research as outlined by the World Health Organization’s Commission on Macroeconomics and Health; whilst international barriers to such spending need to be removed. (shrink)

Contributions to COVID-19 vaccination programmes promise valuable collective goods. They can support public and individual health by creating herd immunity and taking the pressure off overwhelmed public health services; support freedom of movement by enabling governments to remove restrictive lockdown policies; and improve economic and social well-being by allowing businesses, schools, and other essential public services to re-open. The vaccinated can contribute to the production of these goods. The unvaccinated, who benefit from, but who do not contribute to (...) these goods can be morally criticised as free-riders. In this paper defends the claim that in the case of COVID-19, the unvaccinated are unfair free-riders. I defend the claim against two objections. First, that they are not unfair free-riders because they lack the subjective attitudes and intentions of free-riders; second, that although the unvaccinated may be free-riders, their free-riding is not unfair. (shrink)

The meaning of sustainability is the subject of intense debate among environmental and resource economists. Perhaps no other issue separates more clearly the traditional economic view from the views of most natural scientists. The debate currently focuses on the substitutability between the economy and the environment or between “natural capital” and “manufactured capital”—a debate captured in terms of weak versus strong sustainability. In this article, we examine the various interpretations of these concepts. We conclude that natural science and economic perspectives (...) on sustainability are inconsistent. The market-based Hartwick-Solow “weak sustainability” approach is far removed from both the ecosystem-based “Holling sustainability” and the “strong sustainability” approach of Daly and others. Each of these sustainability criteria implies a specific valuation approach, and thus an ethical position, to support monetary indicators of sustainability such as a green or sustainable Gross Domestic Product (GDP). The conflict between “weak sustainability” and “strong sustainability” is more evident in the context of centralized than decentralized decision making. In particular, firms selling “services” instead of material goods and regarding the latter as “capital” leads to decisions more or less consistent with either type of sustainability. Finally, we discuss the implications of global sustainability for such open systems as regions and countries. Open systems have not been dealt with systematically for any of the sustainability criteria. (shrink)

What happens at the end of a clinical trial for an investigational neural implant? It may be surprising to learn how difficult it is to answer this question. While new trials are initiated with increasing regularity, relatively little consensus exists on how best to conduct them, and even less on how to ethically end them. The landscape of recent neural implant trials demonstrates wide variability of what happens to research participants after an neural implant trial ends. Some former research participants (...) continue to receive support for their devices (e.g., battery and component replacements, software updates, etc.). Others, when safe, have their neural implants removed through surgical explantation. Still others continue to live with a deactivated neural implant embedded in their body. In the United States, there are no uniform requirements to provide services, of any kind, after an neural implant study ends, and other nations are similarly facing this challenge. The existence of a post-trial gap in an expanding neural implant research ecosystem invites obvious questions: What is owed to neural implant research participants post-trial, and why has providing it been so difficult to accomplish in practice? To take a step forward on this difficult issue, we assembled one group of stakeholders – researchers funded for neuroethics grants by the National Institutes of Health – to explore possible starting points on one topic: ethical guidance for post-trial care of research participants in neural implant trials. Based on shared concerns discussed in the expert workshop the current paper is a call to action. It reports the key areas of convergence from the meeting and highlights important next steps towards developing much needed guidance. (shrink)

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans feel reluctant to the (...) end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

The meaning of sustainability is the subject of intense debate among environmental and resource economists. Perhaps no other issue separates more clearly the traditional economic view from the views of most natural scientists. The debate currently focuses on the substitutability between the economy and the environment or between “natural capital” and “manufactured capital”—a debate captured in terms of weak versus strong sustainability. In this article, we examine the various interpretations of these concepts. We conclude that natural science and economic perspectives (...) on sustainability are inconsistent. The market-based Hartwick-Solow “weak sustainability” approach is far removed from both the ecosystem-based “Holling sustainability” and the “strong sustainability” approach of Daly and others. Each of these sustainability criteria implies a specific valuation approach, and thus an ethical position, to support monetary indicators of sustainability such as a green or sustainable Gross Domestic Product. The conflict between “weak sustainability” and “strong sustainability” is more evident in the context of centralized than decentralized decision making. In particular, firms selling “services” instead of material goods and regarding the latter as “capital” leads to decisions more or less consistent with either type of sustainability. Finally, we discuss the implications of global sustainability for such open systems as regions and countries. Open systems have not been dealt with systematically for any of the sustainability criteria. (shrink)

BackgroundWith the increased use of implanted medical devices follows a large number of explantations. Implants are removed for a wide range of reasons, including manufacturing defects, recovery making the device unnecessary, battery depletion, availability of new and better models, and patients asking for a removal. Explantation gives rise to a wide range of ethical issues, but the discussion of these problems is scattered over many clinical disciplines.MethodsInformation from multiple clinical disciplines was synthesized and analysed in order to provide a comprehensive (...) approach to the ethical issues involved in the explantation of medical implants.ResultsDiscussions and recommendations are offered on pre-implantation information about a possible future explantation, risk–benefit assessments of explantation, elective explantations demanded by the patient, explantation of implants inserted for a clinical trial, patient registers, quality assurance, routines for investigating explanted implants, and demands on manufacturers to prioritize increased service time in battery-driven implants and to market fewer but more thoroughly tested models of implants.ConclusionSpecial emphasis is given to the issue of control or ownership over implants, which underlies many of the ethical problems concerning explantation. It is proposed that just like transplants, implants that fulfil functions normally carried out by biological organs should be counted as supplemented body parts. This means that the patient has a strong and inalienable right to the implant, but upon explantation it loses that status. (shrink)

The article examines one of the many philosophical problems that arise in the discussion on the prospects of unconditional basic income implementation. The author believes that the question of the future of labor should be reviewed in a social-philosophical perspective. The analytical potential of philosophical thinking can be useful in predicting the consequences of implementing the basic income initiative. The article proceeds from the premise that in the 21 st century the idea of basic income application turns from a utopian (...) project into real measures roadmap. The economic well-being provided by the widespread use of technical means makes it possible to seriously plan the transfer of many workers employed in the sector of services and non-material production to basic income. The author points out that first of all it is necessary to assess the consequences of such a measure for the people. Traditionally, capitalist society has been built around a narrative that hard work is well rewarded. The opposition of labor and free time has shaped consumption patterns and life strategies for several generations. In the conclusion, the author suggests to consider whether, by removing such a system-forming element from the social structure, the society itself will be put under threat. It may turn out that an initiative aimed at changing society for the better will actually turn out to become a personal disaster for many people who will not be able to find a use for themselves in the new world, which is already not built around labor. Among other things, the author draws attention that contemporary capitalism, by actualizing the idea of basic income, abolishes the very opportunity of human choice. Virtually all human activity transforms into alienated labor. (shrink)

Though many of us have constructed our lives (or have had them constructed for us) such that it is easy to ignore or forget, human lives are entangled with other animals in many ways. Some interspecies relations would arguably exist in some form or another even under an ideal model of animal ethics. Others have an inescapably non-ideal character – these relationships exist as they do because things have gone wrong. In such circumstances we have reparative duties to animals we (...) have wronged because we have wronged them. Here I draw upon Christine Korsgaard’s “Fellow Creatures” (2018) and other nonideal approaches to animal ethics to critically assess the United States Fish & Wildlife Service practice of killing barred owls to protect endangered spotted owls in the old growth forest of the Pacific Northwest. This is a difficult case to be sure, but one that can benefit from non-ideal moral assessment in terms of interspecies relational repair. I argue for increased spotted owl habitat preservation and forest restoration as an alternative to barred owl removal that better aligns with both nonideal relational animal ethics and stated US Fish & Wildlife Service values. (shrink)

In the United States, the northern spotted owl has declined throughout the Pacific Northwest even though its habitat has been protected under the Endangered Species Act. The main culprit for this decline is the likely human-facilitated invasion of the barred owl. The United States Fish and Wildlife Service conducted an experiment in which they lethally removed the barred owls from selected areas in Washington, Oregon, and California. In those locations, the northern spotted owl populations have stabilized and increased. Some have (...) argued that we should kill the barred owl to protect the northern spotted owl. In this essay, I argue that the competitive displacement of northern spotted owls by the barred owl should not be addressed by killing the later to save the former. The most powerful objection to this conclusion is that we will lose old-growth temperate rainforest without an indicator species like the spotted owl protected under the Endangered Species Act. In response, I argue that we should directly conserve old-growth temperate rainforest independent of the northern spotted owl. In effect, we need legislation and policies that protects endangered ecosystems. (shrink)