This article was championed in view of the notion of (perceived) economic rationalisation which seem to be the foremost of patients' care in the NHS as opposed to addressing distress to their existing well-being, while in a state of being tormented with agonising news of prolonged ill health. Serious consideration is given to addressing the need to rationalise resources in ensuring the long standing history of the NHS' free health care is critically addressed, but not in a way that destroys (...) confidence on the ability of professionals to manifest ethical prudence in their acts of judgments about whether patients' care is to be imminent or prolonged on a waiting list. There is certainly serious impacts to be comprehended with in situations of economic rationality through services provided by the NHS, but it is believed that tangible outcomes about definitive care for patients should be addressed collaboratively. (shrink)

The aim of this commentary is to discuss the axiology of the cost–benefit approach assumed by Travis Rieder (2017) to analyze medical decision making in the case of extremely preterm infants.

Discussion of the worldwide corporate development of biotechnologies is sometimes diverted through the introduction of images of heroic medical intervention, exemplified by the statement, I would do anything to save my daughter. Such heroic images seem to justify virtually any deployment of resources and nearly any health or environmental risk. But it is instructive for future public discussions to examine the use of such images, and to note that those advocating a prominent role for biotechnologies in an expanding global economy (...) welcome such diversionary patterns. Our responsibility to do our own thinking is beset by conditions that may lead us astray. In a time burdened by profound worry—crushing inequalities among the world's peoples, an ecological crisis, and threat of nuclear war—it is tempting to avert our eyes when we are faced with grave new dangers. Moreover, in our increasingly visual culture, images have come to function as a facsimile of and substitute for real thinking. If we are to have significant discussions about the potential of biotechnology, we must not only be wary of promises of economic growth but must also be mindful of sources of diversion and the appeals of image-thinking. We should strive to become more critical of our own ways of thinking, thus opening the discussion to a fuller consideration of what needs to be saved. (shrink)

The debate over environmental, health, and safety regulation has reached a new crescendo in the 104th Congress. So impassioned is the debate on occasion, and so high the feelings, that even the tools of regulatory analysis have become part of the combat.To some, the term cost-benefit analysis, for example, is virtually a swearword, a nefarious tool used by big business to undermine regulations aimed at benefiting the people at large. To others, it is the mechanism for achieving more effective (...) regulation at less cost.This new book on the subject of reforming regulation is aimed at increasing the light and turning down the heat. It consists of an introduction and nine chapters written by scientists, public policy analysts, and economists on various aspects of regulation and regulatory analysis.The book advances the latest knowledge and evidence on risk analysis, cost-benefit analysis, and related techniques for improving regulation--all based on experience and data accumulated over the quarter century since regulation in the areas of environment, health, and safety became a major player on the governmental stage. The strengths and limitations of those analytical tools are an important part of the portrait that is painted, but a common thesis is that, properly used, the tools can be helpful in getting better regulatory results. (shrink)

The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost‐effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used (...) to save a greater number of other lives. This argument has not yet been advanced in debates over expanded procurement and could buttress existing concerns about expanded procurement. To support this argument, I review existing empirical data on the cost‐effectiveness of transplantation and compare them to data on interventions for other illnesses. These data should motivate utilitarians and others whose primary goal is maximizing population‐wide health benefits to doubt the merits of expanding organ procurement. I then consider two major objections: one makes the case that transplant candidates have a special claim to medical resources, and the other challenges the use of cost‐effectiveness to set priorities. I argue that there is no reason to conclude that transplant candidates’ medical interests should receive special priority, and that giving some consideration to cost‐effectiveness in priority setting requires neither sweeping changes to overall health priorities nor the adoption of any specific, controversial metric for assessing cost‐effectiveness. Before searching for more organs, we should first ensure the provision of cost‐effective care. (shrink)

The foundation of the Australian colonial project lies within an ‘originary violence’, in which the state retains a vested interest in maintaining the founding order of things. Inequalities and iniquities are maintained for the purpose of sustaining the life and continuity of the state. The Australian state, founder of a violent order is called upon by the international community to conform and uphold ‘human rights’, but what does this call to conformity require, particularly when the call comes from states which (...) are also founded upon colonial violence? This article argumes that very little is required beyond the masquerade that ‘equality’ for Aboriginal peoples is an on-going project of the state. So for what purpose does the masquerade continue? (shrink)

The foundation of the Australian colonial project lies within an ‘originary violence’, in which the state retains a vested interest in maintaining the founding order of things. Inequalities and iniquities are maintained for the purpose of sustaining the life and continuity of the state. The Australian state, founder of a violent order is called upon by the international community to conform and uphold ‘human rights’, but what does this call to conformity require, particularly when the call comes from states which (...) are also founded upon colonial violence? This article argumes that very little is required beyond the masquerade that ‘equality’ for Aboriginal peoples is an on-going project of the state. So for what purpose does the masquerade continue? (shrink)

Much thought has been devoted to how metaethical disagreement between moral realism and expressivism can be saved once minimalism starts creeping. Very little thought has been given to how creeping minimalism affects error-theories’ disagreement with their metaethical competitors. The reason for this omission, I suspect, is found in the belief that whilst locating distinctive moral realist and expressivist positions within a minimalist landscape poses a severe challenge, no such difficulties are encountered when differentiating error-theories from moral realism and expressivism. In (...) the first part of this paper, I show that this belief is mistaken: Insofar as moral realists and error-theorists are still taken to disagree, creeping minimalism renders their disagreement moral, but makes these positions metaethically indistinguishable. In the second part of the paper, I present a modified inferentialist solution to the problem of creeping minimalism which seeks to put error-theories back on the metaethical map. Yet, this too comes at a cost, in that it significantly modifies our interpretation of error-theories. Whichever way we turn, then, creeping minimalism not only forces us to re-phrase metaethical positions in a way that is compatible with minimalism, but also requires us to change our very understanding of these positions. (shrink)

This paper conducts a cost–benefit analysis of Australia’s Covid-19 lockdown strategy relative to pursuit of a mitigation strategy in March 2020. The estimated additional deaths from a mitigation strategy are 11,500 to 40,000, implying a Cost per Quality Adjusted Life Year saved by locking down of at least 11 times the generally employed figure of $100,000 for health interventions in Australia. The lockdowns do not then seem to have been justified by reference to the standard benchmark. Consideration of (...) the information available to the Australian government in March 2020 yields a similar ratio and therefore the same conclusion that lockdown was not warranted. If Australia experiences a new outbreak, and cannot contain it without resort to a nationwide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign, lessons learned since March 2020, and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020. This would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people. (shrink)

When do you have to sacrifice life and limb, time and money, to prevent harm to others? When must you save more people rather than fewer? These questions might arise in emergencies involving strangers drowning or trapped in burning buildings, but they also arise in our everyday lives, in which we confront opportunities to donate time or money to help distant strangers in need of food, shelter, or medical care. With the resources available, we can provide more help--or less. -/- (...) In The Rules of Rescue, Theron Pummer argues that we are often morally required to engage in effective altruism, directing altruistic efforts in ways that help the most. Even when the personal sacrifice involved makes it morally permissible not to help at all, he contends, it often remains wrong to provide less help rather than more. Using carefully crafted examples, he defends the view that helping distant strangers is more morally akin to rescuing nearby strangers than most of us realize. The ubiquity of opportunities to help distant strangers threatens to make morality extremely demanding, and Pummer argues that it is only thanks to adequate permissions grounded in considerations of cost and autonomy that we may pursue our own plans and projects. He ultimately concludes that many of us are required to provide no less help over our lives than we would have done if we were effective altruists. (shrink)

In view of the fact that vigorously promoting recycling has become a viable means to promote sustainable development, it is important to better understand the impact of recycling efforts on subsequent resource saving behavior. This research empirically examines the effects of recycling efforts on subsequent resource saving by analyzing the survey data of 356 college students in China. The recycling efforts, environmental self-identity and feeling of pride were measured using existing scales while saving behaviors and recycling (...) class='Hi'>cost were measured by developing new scales. Partial least squares structural equation modeling was performed to test the structural relationships among recycling efforts, environmental self-identity, feeling of pride, and saving behaviors. Further, the moderation role of recycling cost was tested. The results showed that saving behaviors could be classified into two types based on their costliness; recycling efforts have a positive effect on costless saving behaviors, while having a negative effect on costly saving behaviors; both the positive and negative effect of recycling efforts on resource saving is mediated by pride feeling and environmental self-identity; and recycling cost negatively moderates the effects of recycling efforts on pride feeling. We discuss the theoretical and managerial implications of the findings. (shrink)

If the resources used to wage wars could be spent elsewhere and save more lives, does this mean that wars are unjustified? This article considers this question, which has been largely overlooked by Just War Theorists and pacifists. It focuses on whether the opportunity costs of war lead to a form of pacifism, which it calls ‘Opportunity Costs Pacifism’. The article argues that Opportunity Costs Pacifism is, at the more ideal level, compelling. It suggests that the only plausible response to (...) Opportunity Costs Pacifism applies in highly nonideal circumstances. This has major implications for Just War Theory and pacifism since it is only at the highly nonideal level that war can be justified. (shrink)

A first-person account of some victims of the virus, the author puts faces and circumstances to the tragedy of the Covid-19 pandemic. Told from a chaplain’s point of view, these narratives will take the reader beyond the numbers and ask questions like: What is the cost of keeping families separated at the end of life, and, if patient/family centered care is so central to healthcare these days, why was it immediately discarded? Is potentially saving human lives worth the (...) risk of damaging them beyond repair? (shrink)

Rationale, aims and objectives This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline. Methods Study participants were recruited over a 12 month period and randomized into (...) two groups: one receiving proactive public health nursing and one which did not. Results At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of $240 000 (Canadian) of costs averted within 1 year for every 100 parents. Conclusions In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance. (shrink)

Faced with endlessly repeated opportunities to save drowning children, most people think morality intuitively permits us to indulge in at least some goods that are not nearly as important as a child’s life. Some philosophers argue that this intuition gives us an important (though defeasible) reason to think we may sometimes permissibly refuse to save a life even when we can do so at insignificant cost. I argue that recent psychological experiments should make us wary of this claim.

By describing societal value judgements in health care in numerical terms one may in theory increase the precision of guidelines for priority setting and allow decision makers to judge more accurately the degree to which different health care programs provide societal value for money. However, valuing health programs in terms of QALYs disregards salient societal concerns for fairness in resource allocation. A different kind of numerical valuation of medical interventions, that incorporates concerns for fairness, is described. The usefulness to decision (...) makers of such numerical information remains to be tested. (shrink)

AimTo examine the relative cost-effectiveness of predictive genetic tests for familial breast and ovarian cancer provided by Genetic Services of Western Australia.MethodsThe relative cost-effectiveness was assessed using a decision analytic model.ResultsThe cost and outcomes of genetic testing was compared in first-degree relatives of known BRCA1/2 mutation-carriers who have a 50% risk of carrying the mutated gene (intervention group) to individuals with the same a priori risk but who do not undergo a genetic test (control subjects).Since genetic testing (...) enables the restriction of intensive surveillance to individuals with an identified BRCA1/2 gene mutation, net savings in the period observed (age 25-70) were $980-$1008 per woman in the ovarian intervention group and $1681-$1795 per woman in the breast intervention group, and delayed the onset of breast cancer (6mths BRCA1, 3mths BRCA2).Compared to control subjects undergoing population surveillance, it was estimated the onset of breast cancer could be delayed at a total net cost of $3055 (5.1yrs) to $3389 (3.2yrs) for women in the breast intervention group with BRCA1/2 mutations. Since population surveillance is not currently recommended for ovarian cancer, control subjects undergoing no surveillance were compared with the intervention group. The onset of ovarian cancer was delayed at a net cost of $1630 (3.5yrs) to $2509 (1.2years) for women with BRCA1/2 mutations.ConclusionsTesting allows targeted high-level surveillance for gene mutation carriers, which ensures the cost-effective use of resources and reduces cancer-related morbidity if clinical recommendations for intervention are adopted. (shrink)

Suppose that each of the following four conditions obtains: 1. You can save either a greater or a lesser number of innocent people from (equally) serious harm. 2. You can do so at trivial cost to yourself. 3. If you act to save, then the harm you prevent is harm that would not have been prevented if you had done nothing. 4. All other things are equal. A skeptic about saving the greater number rejects the common-sensical claim that (...) you have a duty to save the greater number in such circumstances. (shrink)

I discuss Gheaus's (2013) argument against the claim that the requirements of justice are not constrained by feasibility concerns. I show that the general strategy exemplified by this argument is not only dialectically puzzling, but also imposes a heavy cost on theories of justice -- puzzling because it simply sidesteps a presupposition of any plausible formulation of the so-called "feasibility requirement"; costly because it it deprives justice of its normative implications for action. I also show that Gheaus's attempt to (...) recover this normative force presupposes an epistemic dimension to the feasibility requirement that most proponents of that requirement would reject. (shrink)

ABSTRACT This paper considers what should be done about offers of organs for transplant that come with racist strings attached. Saving lives or improving their quality seem powerful reasons to accept the offer. Fairness, justice, and rejecting racism seem like powerful reasons against. This paper argues that conditional allocation should occur when it would provide access to organs for at least one person without costing others their access to organs. The bulk of the paper concentrates on defending this claim (...) against these objections: (i) that the good that might come about through conditional allocation does so through wrongful complicity in the racist's wrongdoing; (ii) that conditional allocation symbolizes support for racism; and (iii) that conditional allocation is unjust or unfair and is, for that reason, impermissible. The final section, on conditional allocation as a policy, considers the speculative possibility that conditional allocation would reduce access to organs for some, but it argues that, even then, conditional allocation could be justified. (shrink)

This chapter assesses John Gray’s modus vivendi-based justification for liberalism. I argue that his approach is preferable to the more orthodox deontological or teleological justificatory strategies, at least because of the way it can deal with the problem of diversity. But then I show how that is not good news for liberalism, for grounding liberal political authority in a modus vivendi undermines liberalism’s aspiration to occupy a privileged normative position vis-à-vis other kinds of regimes. So modus vivendi can save liberalism (...) from moralism, but at cost many liberals will not be prepared to pay. (shrink)

This paper defends the Limited Use View of our duties to save. The Limited Use View holds that the duty to save is a duty to treat oneself, and perhaps one’s resources, as a means for preventing harm to others. But the duty to treat oneself as a means for the sake of others is limited. One need not treat oneself as a means when doing so is either very costly, or conflicts with one’s more stringent duties to others. This (...) provides an agent-neutral account of the duty to save. When the cost of saving passes a certain threshold, one is permitted to fail to save, and it is impermissible for others to force one to save, if doing so will force one to incur an equal or greater cost. I argue that the Limited Use View is to be preferred to agent-relative accounts of the duty to save, which hold that the limit on our duty to save is grounded in an agent-relative prerogative to weight our own interests (and those of special others) more heavily than other people’s interests. (shrink)

The spectrum argument purports to show that the better-than relation is not transitive, and consequently that orthodox value theory is built on dubious foundations. The argument works by constructing a sequence of increasingly less painful but more drawn-out experiences, such that each experience in the spectrum is worse than the previous one, yet the final experience is better than the experience with which the spectrum began. Hence the betterness relation admits cycles, threatening either transitivity or asymmetry of the relation. This (...) paper examines recent attempts to block the spectrum argument, using the idea that it is a mistake to affirm that every experience in the spectrum is worse than its predecessor: an alternative hypothesis is that adjacent experiences may be incommensurable in value, or that due to vagueness in the underlying concepts, it is indeterminate which is better. While these attempts formally succeed as responses to the spectrum argument, they have additional, as yet unacknowledged costs that are significant. In order to effectively block the argument in its most typical form, in which the first element is radically inferior to the last, it is necessary to suppose that the incommensurability is particularly acute: what might be called radical incommensurability. We explain these costs, and draw some general lessons about the plausibility of the available options for those who wish to save orthodox axiology from the spectrum argument. (shrink)

Due to the societal dissemination of digital technology, people are increasingly experiencing environmental topics through digital media channels such as social networks. Several researchers therefore have proposed these channels as a possibility to strengthen sustainable development based on their cost-efficient nature. But while prior studies have investigated isolated factors for understanding environmental social media behavior, there is still scarce understanding of the relevant underlying motivational factors and possible connections with more traditional environmental behaviors. Therefore, the present study applied the (...) established socio-psychological model of goal-directed behavior (MGB) and compared the desires for liking as a fundamental form of digital social media behavior with the desires for two traditional environmental behaviors (money donation and volunteering) in a cross-sectional research design. Within the biodiversity conservation case of the Andean bear (Tremarctos ornatus) in Ecuador, we compared the antecedents for the desires for the corresponding environmental behaviors (RQ1) as well as their connections between each other (RQ2). Within a sample of 407 Ecuadorian students (Mage = 20.94 years, SD = 2.25, 61.2 % female), we found the marginal effect of perceived behavioral control on the desires for liking on social media as the main difference concerning the antecedents of the behaviors because money donation and volunteering largely depended on personal resources such as time or money. Furthermore, gender emerged as the second main difference between the behaviors due to it only being predictive for the liking motivation. Enjoyment was the only variable that coherently predicted all three behaviors. Finally, desires for liking on social media predicted both other behaviors in robust regression analyses, but were only predictive for volunteering in corresponding path models. The results illustrate how cost-efficient digital environmental behaviors such as liking may be suitable for sparking low-level environmental action, which may entail more pronounced forms of environmental activism, at least when they involve feasible personal costs. Overall, the findings are in line with prior research regarding the less demanding nature of liking, but further elaborate on the importance of gender for digital environmental behavior and correlates between digital and classical environmental behaviors. (shrink)

Organ transplantation saves lives, yet thousands die through lack of organs. What lies behind our failure to donate? Janet Radcliffe Richards casts a sharp critical eye on the moral arguments, forcing us to confront the logic and implications of our own position. A book for everyone concerned with clear thinking on moral issues.

Every year thousands of computers deemed obsolete by companies upgrading to newer models are kept out of landfills by organizations like World Computer Exchange 1 which recycle them to schools in developing countries. It is possible to set up at a very low cost, clusters of recycled PCs, using Linux software to substantially reduce the cost of establishing school‐based community Internet centers. In the case of such an implementation in Goa, India by a WCE partner‐NGO the key to (...) its success has been collaboration between the NGO and the private sector to encourage the growth of local Linux support skills and with the government sector ‐ the Goa State Education Department ‐ to ensure the acceptance of Linux in the curriculum, and the provision of teacher training. The Goa Schools Computers project 2 project provides an example of how low initial costs of infrastructure and linkages between different stakeholders can result in cost savings of up to 60% over a conventional community Internet center thereby increasing their chances for financial viability. (shrink)

The essays in this issue of The Journal of Medicine and Philosophy explore an innovative voucher program for encouraging kidney donation. Discussions cluster around a number of central moral and political/theoretical themes: What are the direct and indirect health care costs and benefits of such a voucher system in human organs? Do vouchers lead to more effective and efficient organ procurement and allocation or contribute to greater inequalities and inefficiencies in the transplantation system? Do vouchers contribute to the inappropriate commodification (...) of human body parts? Is there a significant moral difference between such a voucher system and a market in human organs for transplantation? This paper argues that while kidney vouchers constitute a step in the right direction, fuller utilization of market-based incentives, including, but not limited to, barter exchanges, would save more lives and further reduce human suffering. (shrink)

To achieve lower medical spending with as little reduction as possible in good outcomes, practitioners and policy makers alike have been experimenting with the use of practice guidelines. These guidelines both recommend certain types of therapies and proscribe others in the treatment of patients with particular conditions. This paper explores the question of whether guidelines which do reduce total resource costs of medical care to a population will be feasible and produce “acceptable” results. The definition of acceptable is part of (...) the policy problem, so it will be left open for a while, but the question of which outcomes match with which levels of resource cost will form the positive basis for the normative judgment of “acceptability.”. (shrink)

To achieve lower medical spending with as little reduction as possible in good outcomes, practitioners and policy makers alike have been experimenting with the use of practice guidelines. These guidelines both recommend certain types of therapies and proscribe others in the treatment of patients with particular conditions. This paper explores the question of whether guidelines which do reduce total resource costs of medical care to a population will be feasible and produce “acceptable” results. The definition of acceptable is part of (...) the policy problem, so it will be left open for a while, but the question of which outcomes match with which levels of resource cost will form the positive basis for the normative judgment of “acceptability.”. (shrink)

A landmark work of environmental philosophy that seeks to transform the debate about climate change. As the icecaps melt and the sea levels rise around the globe—threatening human existence as we know it—climate change has become one of the most urgent and controversial issues of our time. For most people, however, trying to understand the science, politics, and arguments on either side can be dizzying, leading to frustrating and unproductive debates. Now, in this groundbreaking new work, two of our most (...) renowned thinkers present the realities of global warming in the most human of terms—everyday conversation—showing us how to convince even the most stubborn of skeptics as to why we need to act now. Indeed, through compelling Socratic dialogues, Philip Kitcher and Evelyn Fox Keller tackle some of the thorniest questions facing mankind today: Is climate change real? Is climate change as urgent as the “scientists” make it out to be? How much of our current way of life should we sacrifice to help out a generation that won’t even be born for another hundred years? Who would pay for the enormous costs of making the planet "green?" What sort of global political arrangement would be needed for serious action? These crucial questions play out through familiar circumstances, from an older husband and wife considering whether they should reduce their carbon footprint, to a first date that evolves into a passionate discussion about whether one person can actually make a difference, to a breakfast that becomes an examination over whether or not global warming is really happening. Entertaining, widely accessible, and thoroughly original, the result promises to inspire dialogue in many places, while also giving us a line of reasoning that explodes the so-far impenetrable barriers of obfuscation that have surrounded the discussion. While the Paris Agreement was an historic achievement that brought solutions within the realm of possibility, The Seasons Alter is a watershed book that will show us how to make those possibilities a reality. (shrink)

This article explores how agreements to preferentially save can ground an exception to the duty to minimize harm when saving. A rescuer preferentially saves if she knowingly fails to minimize harm among prospective victims, even though minimizing harm would not have imposed greater costs on the rescuer herself. Allowing rescuers to act on agreements to preferentially save is justified by the reasons we have to respect the agreements that agents form as a means of pursuing their own ends.

Living in cities has numerous comparative advantages than living in the countryside or in small villages and towns, most notably better access to education, services and jobs. However, it is also associated with a roughly twofold increase in some mental disorders rate incidence compared with living in rural areas. Economic assessments reported a forecasted loss of more than 19 trillion dollars in global GDP between 2011 and 2030 and of around 7 trillion for the year 2030 alone when measured by (...) the human capital method. If we exclude self-selection processes and make the hypothesis to be able to level down the mental illness rate incidence in urban areas to these of the rural by better urban-societal planning, around € 1.2 trillion could be saved yearly worldwide. Even a reduction of only 20% in urban mental illness rate would save around 250 billion dollars yearly. (shrink)

Many activities of doctors in the acute hospital sector do not improve patient outcome because they are inappropriate. Curtailing interventions that are unnecessary (because the patient is not bad enough) or are unsuccessful (because the condition is too advanced) could both save resources and improve care. Rational rationing depends on knowledge about the expected benefits of various technologies when used in different clinical circumstances.

Yes, relative to the status quo. But the role of health policy experts is not to say what policies we personally favor, but rather to make policy consequences clear to the public. Once we tell the public that such a policy would not much harm the health of the non-low-income, then it is up to them to decide if they want to use the savings to subsidize low-income coverage.

This study employs the Porter hypothesis framework to test the moderating role of production cost in the relationship between resource-efficiency actions and financial performance for German small and medium-sized enterprises (SMEs). For this purpose, we employ the 2012, 2018, and 2021 Flash Eurobarometer surveys to analyze how consistently SMEs adopt resource-efficiency actions, and the impact of these actions on their performance and costs. We also conduct a generalized method of moments regression analysis (GMM). Among the seven resource-efficiency actions proposed, (...) saving water had a significant positive (negative) influence on financial performance in 2012, 2021, and (2018). Saving energy and using renewable energy had a positive and significant (insignificant) effect on financial performance in 2018, 2021, and (2012). Finally, selling scrap material to other companies had a positive and significant impact in all years. Furthermore, increased production costs negatively moderate the relationship between eco-efficiency action scores and financial performance. The results indicate that the “strong” version of the Porter hypothesis is not supported: It only holds when the implementation of eco-efficiency actions reduces production costs and increases financial performance. (shrink)

During the “age of austerity” the UK government has progressively limited free health services for “overseas visitors” on the grounds of fairness and frugality. This is despite the fact that the cost of the additional bureaucracy required by the new system and the public health consequences are expected to exceed the sums saved. In this article I explore the interaction between the discourses of austerity and xenophobia as they relate to migrants’ access to healthcare. By examining the available data (...) and adjudicating various moral arguments, I cast doubt on the claim that the current charging regulations are cost-effective and fair. I instead contend that if the UK is concerned with running a health service that is economically-sustainable and morally-defensible, it is critical that migrants are welcomed, both as staff and as patients. I conclude by arguing that xenophobia has precipitated changes to the health service which do not qualify as “austerity” in the way that is claimed, but rather deliberately produce a “hostile environment” for migrants, despite this very likely generating economic losses. (shrink)

The issues of climate change and environmental degradation elicit diverse responses. This paper explores how an understanding of human moral psychology might be used to motivate conservation efforts. Moral concerns for the environment can relate to issues of harm or impurity . Aversions to harm are linked to concern for current or future generations, non-human animals, and anthropomorphized aspects of the environment. Concerns for purity are linked to viewing the environment as imbued with sacred value and therefore worthy of being (...) protected at all costs. While both harm-based and purity-based framings of environmental issues can sometimes backfire, we argue that making these moral concerns salient can nevertheless bring about moral responses to environmental issues. In sum, scientists' emerging knowledge about the moral mind can be used to facilitate the sustainable conservation of the planet. (shrink)

The rising cost of the opioid antagonist and overdose reversal agent naloxone is an urgent public health problem. The recent and dramatic price increase of Evzio, a naloxone auto-injector produced by Kaléo, shows how pharmaceutical manufacturers entering the naloxone marketplace rely on market exclusivity guaranteed by the patent system to charge prices at what the market can bear, which can restrict access to life-saving medication. We argue that 28 U.S.C. § 1498, a section of the federal code that (...) allows the government to use patent-protected products for its own purposes in exchange for reasonable compensation, could be used to procure generic naloxone auto-injectors, or at least bring Kaléo to the negotiating table. Precedent exists for the use of § 1498 to procure pharmaceuticals, and it could give meaning to the federal government's recent declaration of a public health emergency around the opioid epidemic, discourage new market entrants from charging exorbitant prices, and yield important public health benefits. (shrink)

This article examines the question of whether private obstetric care in South Africa can be saved in view of the escalation in medical and legal costs brought about by a dramatic increase in medical negligence litigation. This question is assessed with reference to applicable medical and legal approaches. The crux of the matter is essentially a question of affordability. From a medical perspective, it seems that the English system as well as American perspectives may be well suited to the SA (...) situation. Legal approaches are assessed in the context of the applicable medicolegal framework in SA, the present nature of damages and compensation with reference to obstetric negligence liability, as well as alternative options to the present system based on fault. It is argued, depending on constitutional considerations, that a system of damages caps for noneconomic damages seems to be the most appropriate and legally less invasive system in conjunction with the establishment of a state excess insurance fund. (shrink)

Kidney markets are prohibited in principle because they are assumed to undermine the seller’s dignity. Considering the trade-off between saving more lives by introducing regulated kidney markets and preserving the seller’s dignity, we argue that it is advisable to demand that citizens restrain their own moral judgements and not interfere with the judgements of those who are willing to sell a kidney. We also argue that it is advisable not only to limit the political implications of the moral argument (...) of dignity concerns toward a market-based solution but also to re-evaluate the dignity argument itself. First, if the dignity argument is to be given normative force, it must also consider the dignity violation of the potential transplant recipient. Second, there seems to be no compelling notion of dignity that demonstrates why it is morally permissible to donate but not to sell a kidney. (shrink)

A travers une phénoménologie où l'art éclaire le réel, à travers son choix des auteurs et des oeuvres qu'il a commentés, le philosophe Henri Maldiney (1912-2013) a proposé un décentrement du regard et du savoir propres à renouveler l'étude du paysage. Il part d'une question trompeusement simple : sommes-nous "devant" ou "dedans" le paysage? Comment s'approche le paysage? Comment se fait-il image? Ce recueil présente une pensée complexe de manière accessible à tous les spécialistes et les passionnés de littérature et (...) d'études visuelles. Exemples littéraires, picturaux et photographiques, témoignent de la fécondité d'une pensée fondée sur l'aisthèsis, la présence et le rythme."--Page 4 of cover. (shrink)

Brad Hooker argues that the cost of inculcating in everyone the prevent disaster rule places a limit on its demandingness. My aim in this article is show that this is not true of existential risk reduction. However, this does not spell trouble for the reason that removing persistent global harms significantly improves our long-run chances of survival. We can expect things to get better, not worse, for our population.

In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have (...) demonstrated many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features. (shrink)

Pre-natal-diagnosis technologies allow parents to discover whether their child is likely to suffer from serious disability. One argument for state funding of access to such technologies is that doing so would be “cost-effective”, in the sense that the expected financial costs of such a programme would be outweighed by expected “benefits”, stemming from the births of fewer children with serious disabilities. This argument is extremely controversial. This paper argues that the argument may not be as unacceptable as is often (...) assumed. In doing so, it sets out a more general framework for assessing the relevance of efficiency calculations to policy-making. The final section also investigates the relationship between the paper’s arguments and claims about parental responsibility for child-bearing and rearing, with reference to Scanlon’s work on “substantive responsibility”. (shrink)