This paper examines maternal trade-offs between subsistence/economic activities and caregiving, and it explores the effect of allomaternal investment on maternal time allocation and child care. I examine how nonmaternal investment in two multiple caregiving populations may offset possible risk factors associated with reductions in maternal caregiving. Behavioral observations were conducted on 8- to 12-month-old infants and their caregivers among the Aka tropical forest foragers and Ngandu farmers of Central Africa. Analysis demonstrates that mothers face trade-offs between (...) subsistence/economic activities and infant care. Infants receive less investment when their mothers engage in subsistence/economic activities, indicating a potential risk to those infants. However, results indicate that allomothers target their assistance during times when mothers are engaged in work activities, partially offsetting potential risks associated with the maternal trade-off. The effects of intercultural variability on maternal time allocation and allomaternal investment are also explored as a means of examining the potential impact of their behaviors on infant care. (shrink)

It has recently been reported that some hospitals in the UK have placed a blanket restriction on the provision of maternal request caesarean sections as a result of the COVID-19 pandemic. Pregnancy and birthing services are obviously facing challenges during the current emergency, but we argue that a blanket ban on MRCS is both inappropriate and disproportionate. In this paper, we highlight the importance of MRCS for pregnant people’s health and autonomy in childbirth and argue that this remains crucial (...) during the current emergency. We consider some potential arguments—based on pregnant people’s health and resource allocation—that might be considered justification for the limitation of such services. We demonstrate, however, that these arguments are not as persuasive as they might appear because there is limited evidence to indicate either that provision of MRCS is always dangerous for pregnant people in the circumstances or would be a substantial burden on a hospital’s ability to respond to the pandemic. Furthermore, we argue that even if MRCS was not a service that hospitals are equipped to offer to all pregnant persons who seek it, the current circumstances cannot justify a blanket ban on an important service and due attention must be paid to individual circumstances. (shrink)

Can mammalian mothers adaptively control the sex of their offspring? The influential Trivers-Willard hypothesis proposes that when maternal condition increases the fitness of sons more than that of daughters, the proportion of sons produced should increase with maternal condition. Studies of mammals, however, often fail to support this hypothesis. This article highlights recent advances, including studies on the assumptions of the TWH and physiological mechanisms for sex-ratio manipulation. Particular emphasis is placed on how factors such as paternal quality, (...) maternal reproductive costs and environmental conditions experienced by mothers early in life can mask/alter the expected relationship between maternal condition and offspring sex ratio or lead to apparent support for the TWH. While there is growing evidence that sex ratio around conception may be maternally and paternally manipulated, a challenge for future studies on sex allocation is to integrate how multiple and potentially opposite selective pressures affect offspring sex ratio. The relationship between offspring sex and maternal condition lies at the heart of one of the most controversial hypotheses in evolutionary biology. This review highlights recent findings on the Trivers-Willard hypothesis with particular emphasis on factors which may mask the relationship of interest or falsely demonstrate it. (shrink)

While across the animal kingdom offspring are born smaller than their parents, notable exceptions exist. Several dipteran species belonging to the Hippoboscoidea superfamily can produce offspring larger than themselves. In this essay, the blood‐feeding tsetse is focused on. It is suggested that the extreme reproductive strategy of this fly is enabled by feeding solely on highly nutritious blood, and producing larval offspring that are soft and malleable. This immense reproductive expenditure may have evolved to avoid competition with other biting flies. (...) Tsetse also transmit blood‐borne parasites that cause the fatal diseases called African trypanosomiases. It is discussed how tsetse life history and reproductive strategy profoundly influence the type of vector control interventions used to reduce fly populations. In closing, it is argued that the unusual life history of tsetse warrants their preservation in the areas where human and animal health is not threatened. (shrink)

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies (...) in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution. (shrink)

In angiosperms cytoplasmic DNA is typically passed on maternally through ovules. Genes in the mtDNA may cause male sterility. When male-sterile (female) cytotypes produce more seeds than cosexuals, they pass on more copies of their mtDNA and will co-occur with cosexuals with a neutral cytotype. Cytoplasmic gynodioecy is a well-known phenomenon in angiosperms, both in wild and crop plants. In some conifer families (e.g. Pinaceae) mitochondria are also maternally inherited. However in some other families (e.g. Taxaceae and Cupressaceae) mtDNA is (...) paternally inherited through the pollen. With paternal mtDNA inheritance, male cytotypes that produce more pollen than cosexuals are expected to co-occur with cosexuals. This is uncharted territory. An ESS model shows that the presence of male cytotypes selects for more female allocation in the cosexual, i.e. for sexual specialisation. An allele that switches sex from male to female can then invade. This leads to rapid loss of the neutral cytotype of the cosexual, fixation of the male cytotype and dioecy with 50% males and 50% females. The models suggest that paternal inheritance of mtDNA facilitates the evolution dioecy. Consistent with this hypothesis the Pinaceae are 100% monoecious, while dioecy is common in the Taxaceae family and in the genus Juniperus (Cupressaceae). However, no reliable data are yet available on both mode of inheritance of mtDNA and gender variation of the same species. When cosexuals benefit from reproductive assurance (high selfing rate, low inbreeding depression, low fertilisation) they maintain themselves next to males and females. This predicted pattern with three sex types present in the same population is observed in conifers in nature. (shrink)

This article reviews the effects of malnutrition on early brain development using data generated from animal experiments and human clinical studies. Three related processes, each with their own functional consequences, are implicated in the alteration of brain development. (1) Maternal undernutrition at the start of pregnancy results in reduced transfer of nutrients across the placenta, allowing the conservation of effort for future reproductive episodes. (2) Differential allocation to growing organs by the fetus in response to nutritional stress spares (...) the brain to a large though still limited degree, reflecting the organ’s relative contribution to survival and reproductive success. (3) Prenatal malnutrition disrupts developing neurotransmitter systems, which results in the expression of specific cognitive and affective traits. It is argued that the increasing size and therefore cost of the brain, in conjunction with increasing ecological instability and marginality, reinforced selection for maternally controlled growth suppression of offspring, reallocation of organ growth rates by offspring, and behavioral changes related to development of neurotransmitter systems. (shrink)

The doctrine of double effect (DOE) has its origins in Roman Catholic thought and has been held to have widespread applications in bioethics. Its applications range over issues of maternal-fetal conflict, organ donation and transplant, euthanasia, and resource allocation, among other controversial issues. Recently, Joseph Boyle, the foremost proponent of the DOE over the past few decades, has argued that the DOE is required by the absolutist context of the Catholic tradition, and, further, that anyone who rejects this (...) particular context is not entitled to use the doctrine. In this essay, I will focus exclusively on the intention condition of the DOE and its central distinction, i.e., intention/side effect. I will proceed by considering in turn (1) Boyle's argument that the absolutist moral framework of the Catholic tradition requires the intention/side effect distinction; (2) the ways in which that framework is made vulnerable by this requirement; and (3) just why the DOE should be viable even outside of the Catholic tradition if it turns out that a feature of (l) is correct and the challenges of (2) can be met. (shrink)

In this paper I use measures of childhood growth to assess from both an evolutionary theoretical and an applied public health perspective the impact of polygyny on maternal-child welfare among the Datoga pastoralists of Tanzania. I report that the growth and body composition of children varies in such a way as to suggest that polygyny is not generally beneficial to women in terms of offspring quality. Cross-sectional analysis of covariance by maternal marriage status revealed that children of first (...) and second wives in polygynous marriages grow relatively poorly, that this is correlated with maternal physical status, and that the pattern is not modified by household wealth. I discuss how the dynamics of sexual conflicts operating during the formation and maintenance of marriages may be important factors in the etiology of poor child growth in this population, leading to complex patterns of variation in anthropometric indicators of both women and children. The theoretical conclusion is that improved evolutionary models of polygyny should be designed to examine the potential for adaptive tradeoffs between the currencies of offspring quality and quantity for all types of parents in a polygynous population. The practical conclusion is that a better understanding of the relationships between marriage practices and health outcomes would assist in the development of culturally appropriate health and nutrition interventions. (shrink)

Kant's contribution to modern Protestant theology is as unmistakable as it is controversial. The authors of this volume are investigating a new perspective on the work of theology and the effects of Kant's philosophy of religion concentrated on biblical hermeneutics and dogmatic theology.

Cet article a pour objectif de montrer l’importance de la réception de la théologie politique de J.B. Metz auprès de certains théologiens soucieux de la dimension politique de la foi chrétienne. L’étude présente les réactions immédiates au projet théologique de Metz pour ensuite se focaliser sur des théologiens contemporains. Premièrement, on trouve J. Milbank, qui apprécie la pensée de Metz en la confrontant à son programme de Radical Orthodoxy. Deuxièmement, on rencontre H.-J. Gagey et J.-L. Souletie, qui évaluent la force (...) politique de la théologie de Metz. Enfin, on découvre la façon dont L. Boeve reprend de façon personnelle certains aspects de la pensée du théologien allemand. Pour terminer, l’article propose une réflexion synthétique et critique sur cette réception, avec le souci de montrer la pertinence de la théologie politique de Metz et sa capacité à stimuler la réflexion sur le rapport foi et société. (shrink)

In den Publikationen der Synthetischen Biologie und in Darstellungen dieser neuen Biotechnologie finden sich häufig Begriffe des Herstellens, Konstruierens, Erschaffens und Kreierens. Im folgenden Beitrag wird dieses Begriffsfeld auf der Basis von technikphilosophischen und kunsttheoretischen Ansätzen systematisiert. Es wird erstens untersucht, inwiefern sich die verschiedenen Forschungsrichtungen in der Synthetischen Biologie mit diesem Begriffsinstrumentarium angemessen beschreiben lassen; zweitens wird analysiert, welche ethischen Fragestellungen mit den unterschiedlichen Begriffen des Herstellens und Erschaffens im Fall der Synthetischen Biologie verbunden sind.

We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. (...) We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose. (shrink)

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine (...) and life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

The concept of distributed moral responsibility (DMR) has a long history. When it is understood as being entirely reducible to the sum of (some) human, individual and already morally loaded actions, then the allocation of DMR, and hence of praise and reward or blame and punishment, may be pragmatically difficult, but not conceptually problematic. However, in distributed environments, it is increasingly possible that a network of agents, some human, some artificial (e.g. a program) and some hybrid (e.g. a group (...) of people working as a team thanks to a software platform), may cause distributed moral actions (DMAs). These are morally good or evil (i.e. morally loaded) actions caused by local interactions that are in themselves neither good nor evil (morally neutral). In this article, I analyse DMRs that are due to DMAs, and argue in favour of the allocation, by default and overridably, of full moral responsibility (faultless responsibility) to all the nodes/agents in the network causally relevant for bringing about the DMA in question, independently of intentionality. The mechanism proposed is inspired by, and adapts, three concepts: back propagation from network theory, strict liability from jurisprudence and common knowledge from epistemic logic. (shrink)

The urgent drive for vaccine development in the midst of the current COVID-19 pandemic has prompted public and private organisations to invest heavily in research and development of a COVID-19 vaccine. Organisations globally have affirmed the commitment of fair global access, but the means by which a successful vaccine can be mass produced and equitably distributed remains notably unanswered. Barriers for low-income countries include the inability to afford vaccines as well as inadequate resources to vaccinate, barriers that are exacerbated during (...) a pandemic. Fair distribution of a pandemic vaccine is unlikely without a solid ethical framework for allocation. This piece analyses four allocation paradigms: ability to develop or purchase; reciprocity; ability to implement; and distributive justice, and synthesises their ethical considerations to develop an allocation model to fit the COVID-19 pandemic. (shrink)

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it helps (...) to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources. (shrink)

ABSTRACTOrganization and management researchers praise the value of care in the workplace. However, they overlook the conflict between caring for work and for coworkers, which resonates with the dilemma of care allocation highlighted by ethicists of care. Through an in-depth qualitative study of two organizations, we examine how this dilemma is confronted in everyday organizational life. We draw on the concept of boundary work to explain how employees negotiate the boundary of their caring responsibilities in ways that grants or (...) denies care to coworkers. We argue that the possibility of an ethics of care for coworkers requires boundary work that suspends the separation of personal and professional selves and constitutes the worker as a whole person. We contribute to research on care in organizations by showing how care for coworkers may be enabled or undermined by maintaining or suppressing the care allocation dilemma. (shrink)

This article argues that values that apply to health care allocation entail the possibility of “spectrum arguments,” and that it is plausible that they often fail to determine a best alternative. In order to deal with this problem, a two-step process is suggested. First, we should identify the Strongly Uncovered Set that excludes all alternatives that are worse than some alternatives and not better in any relevant dimension from the set of eligible alternatives. Because the remaining set of alternatives (...) often contain more than one element, we need some complementary method of selecting a unique alternative. In order to address this issue, I suggest that we must invoke caps on the values that are used to evaluate alternatives, and that these caps must be grounded in collective commitments. (shrink)

Early in the COVID-19 pandemic there was widespread concern that healthcare systems would be overwhelmed, and specifically, that there would be insufficient critical care capacity in terms of beds, ventilators or staff to care for patients. In the UK, this was avoided by a threefold approach involving widespread, rapid expansion of critical care capacity, reduction of healthcare demand from non-COVID-19 sources by temporarily pausing much of normal healthcare delivery, and by governmental and societal responses that reduced demand through national lockdown. (...) Despite high-level documents designed to help manage limited critical care capacity, none provided sufficient operational direction to enable use at the bedside in situations requiring triage. We present and describe the development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity. The document combines a wide variety of factors known to impact on outcome from critical illness, integrated with broad-based clinical judgement to enable structured, explicit, transparent decision-making founded on robust ethical principles. It aims to improve communication and allocate resources fairly, while avoiding triage decisions based on a single disease, comorbidity, patient age or degree of frailty. It is designed to support and document decision-making. The document has not been needed to date, nor adopted as hospital policy. However, as the pandemic evolves, the resumption of necessary non-COVID-19 healthcare and economic activity mean capacity issues and the potential need for triage may yet return. The document is presented as a starting point for stakeholder feedback and discussion. (shrink)

Background: Some members of the general public feel that patients who cause their own organ failure through smoking, alcohol use, or drug use should not receive equal priority for scarce transplantable organs. This may reflect a belief that these patients (1) cause their own illness, (2) have poor transplant prognoses or, (3) are simply unworthy. We explore the role that social acceptability, personal responsibility, and prognosis play in people's judgments about transplant allocation. Methods: By random allocation, we presented (...) 283 prospective jurors in Philadelphia county with one of five questionnaire versions. In all questionnaires, subjects were asked to distribute transplantable hearts between patients with and without a history of three controversial behaviors (eating high fat diets against doctors’ advice, cigarette smoking, or intravenous drug use). Across the five questionnaire versions, we varied the relative prognosis of the transplant candidates and whether their behavior caused their primary organ Results: Subjects were significantly less willing to distribute organs to intravenous drug users than to cigarette smokers or people eating high fat diets (p le; 0.0005), even when intravenous drug users had better transplant outcomes than other patients. Subjects’ allocation decisions were influenced by transplant prognosis, but not by whether the behavior in question was causally responsible for the patients’ organ failure. Conclusion: People's unwillingness to give scarce transplantable organs to patients with controversial behaviors cannot be explained totally on the basis of those behaviors either causing their primary organ failure or making them have worse transplant prognoses. Instead, many people believe that such patients are simply less worthy of scarce transplantable organs. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 42-47, September‐October 2021.

The most popular uniting theme in feminist peace literature grounds women's peace work in mothering. I argue if maternal arguments do not address the variety of relationships different races and classes of mothers have to institutional violence and/or the military, then the resulting peace politics can only draw incomplete conclusions about the relationships between maternal work/thinking and peace. To illustrate this I compare two models of mothering: Sara Ruddick's decription of "maternal practice" and Patricia Hill Collins's account (...) of racial-ethnic women's "motherwork.". (shrink)

The debate about justice and health care has occurred largely at a remove from the institutions it concerns; it has been about our most general moral principles, and about what things we value. This debate has foundered. But if the debate is turned in another direction, toward some moral principles that are widely accepted within those institutions, and toward principles that have to do with control over allocation decisions rather than with actually how to make those decisions, agreement may (...) be nearer at hand. (shrink)

BackgroundThe coronavirus 2019 pandemic placed unprecedented pressures on healthcare services and magnified ethical dilemmas related to how resources should be allocated. These resources include, among others, personal protective equipment, personnel, life-saving equipment, and vaccines. Decision-makers have therefore sought ethical decision-making tools so that resources are distributed both swiftly and equitably. To support the development of such a decision-making tool, a systematic review of the literature on relevant ethical values and principles was undertaken. The aim of this review was to identify (...) ethical values and principles in the literature which relate to the equitable allocation of resources in response to an acute public health threat, such as a pandemic.MethodsA rapid systematic review was conducted using MEDLINE, EMBASE, Google Scholar, LitCOVID and relevant reference lists. The time period of the search was January 2000 to 6th April 2020, and the search was restricted to human studies. January 2000 was selected as a start date as the aim was to capture ethical values and principles within acute public health threat situations. No restrictions were made with regard to language. Ethical values and principles were extracted and examined thematically.ResultsA total of 1,618 articles were identified. After screening and application of eligibility criteria, 169 papers were included in the thematic synthesis. The most commonly mentioned ethical values and principles were: Equity, reciprocity, transparency, justice, duty to care, liberty, utility, stewardship, trust and proportionality. In some cases, ethical principles were conflicting, for example, Protection of the Public from Harm and Liberty.ConclusionsAllocation of resources in response to acute public health threats is challenging and must be simultaneously guided by many ethical principles and values. Ethical decision-making strategies and the prioritisation of different principles and values needs to be discussed with the public in order to prepare for future public health threats. An evidence-based tool to guide decision-makers in making difficult decisions is required. The equitable allocation of resources in response to an acute public health threat is challenging, and many ethical principles may be applied simultaneously. An evidence-based tool to support difficult decisions would be helpful to guide decision-makers. (shrink)

Christian Munthe, David Fumagalli and Erik Malmqvist argue that well-known healthcare resource allocation principles, such as need, prognosis, equal treatment and cost-effectiveness, should be supplemented with a principle of sustainability.1 Employing such a principle would entail that the allocation of healthcare resources should take into account whether a specific allocation causes negative dynamics, which would limit the amount of resources available in the future. As examples of allocation decisions, which may have such negative dynamics, they mention (...) those who cause a lack of vaccines, anti-bioethics resistance and drug shortages. Thus, the overall thought is that we can spend and allocate healthcare resources in a certain way at t1, which means that we will have fewer resources available at a later point, t2. The authors argue that we should include a principle of sustainability to justify allocations, which avoids or diminishes the negative dynamics. The authors argue that existing principles cannot sufficiently include proper regard for how our current decisions affect future allocation decisions and, therefore, the people who need healthcare resources in the future. I am sympathetic to the developed argument and believe that the authors are correct that negative dynamics provide reasons to take our ability to meet future health needs …. (shrink)

A new word has recently entered the British medical vocabulary. What it stands for is neither a disease nor a cure. At least, it is not a cure for a disease in the medical sense. But it could, perhaps, be thought of as an intended cure for a medicosociological disease: namely that of haphazard or otherwise ethically inappropriate allocation of scarce medical resources. What I have in mind is the term ‘QALY’, which is an acronym standing for quality adjusted (...) life year. Just what this means and what it is intended to do I shall explain in due course. Let me first, however, set the scene. (shrink)