The prelims comprise: Micro‐v. Macro‐Allocation, and a Quandary for Clinical Practice Allocation and Theories of Justice Cost‐Utility Analysis as a Framework for Allocation Accounting for Specific Factors Other than Health‐Related Utility Further Questions and a Concluding Note References Further Reading.

This paper describes the way in which a certain representation of basic scientific knowledge can be coupled with traditional microeconomic analysis to provide an analysis of rational research planning or agenda setting in basic science. Research planning is conceived as a resource allocation decision in which resources are being allocated to activities directed towards the solution of basic scientific problems. A structuralist representation of scientific knowledge is employed to provide a relatively precise characterization of a basic scientific problem.

This paper stems from the current global worsening of the scarcity of resources for healthcare, which will deepen even more in future public emergencies. This justifies strengthening the reflection on the allocation of resources which, in addition to considering technical issues, should also involve ethical concerns. The two plans in which the allocation of resources develops—macro and micro—are then systematized, both requiring the identification of ethical criteria for the respective complex decision-making. Then, we describe how the complexity (...) at the macro level focuses on the joint consideration of the rectitude of the principles, the goodness of the ends, and the integrity—respectively the deontological, teleological, and procedural perspectives; and at the micro level, it focuses in prioritizing people, which can result in the exclusion of some, as happened with the elderly during peaks of COVID-19. The main objective of this article is to show that, in public health emergency situations, in which the daily criteria for prioritizing access to health care are not efficient, it is possible not only to ration the available means but also to rationalize them. We argue that rationing and rationalization are different concepts, entail different consequences, have different ethical foundations, and draw different guidelines for patient care. We apply them to the distribution of intensive care and vaccines to the elderly thus demonstrating the ethically legitimate domain of implementation of each of these two prioritization criteria. We conclude that rationalization respects more strictly the core ethical principles of our common morality. (shrink)

Credit distribution is uneven in the domestic financial market since it is relatively easy for listed companies, mainly state-owned enterprises, to obtain banks’ funds. Unbalanced credit distribution has caused some listed companies to participate in “Borrow to Lend” activities. Based on the traditional “financing priority” theory and credit rationing theory, this paper studies the “Borrow to Lend” shadow banking activities of China’s non-financial listed companies based on the 2007–2018 financial statement data of Chinese-listed companies and discusses the micro-level and (...) macro-level related factors behind this activity. The empirical results show that China’s non-financial listed companies, especially the state-owned enterprises, are participating in obvious “Borrow to Lend” activities. The real economy’s rate of return shows a negative relationship with “Borrow to Lend” activities at the level of individual companies and their industries. This article uses the exogenous growth part of M2 growth to measure monetary policy tightness in terms of macro and credit policies. It uses the ratio of state-owned enterprise loans to total corporate loans as an approximate indicator of the credit distribution structure. The empirical results indicate that state-owned enterprises’ “Borrow to Lend” activities have shifted in the same direction as the tightening of monetary policy after the financial crisis. The proportion of state-owned enterprise loans positively correlates with state-owned enterprises’ “Borrow to Lend” activities. (shrink)

The allocation of healthcare resources takes place at two distinct levels. At the macroeconomic level, policymakers decide on budgets, staffing, cost‐effectiveness thresholds, clinical guidelines and insurance payments; at the microeconomic level, healthcare professionals decide on whom to treat, what the appropriate treatment is, how much time and effort should each patient receive and how urgent the need for care is. At both levels, there is a constant social need for just allocation. Policymakers are mostly guided by abstract principles (...) of justice, thinking in terms of groups of patients, epidemiological data, impersonal statistics and economic costs. On the other hand, healthcare professionals understand the need for justice at a more personal level, as they interact with patients and, in a sense, put theory into practice. Nurses hold a unique position in healthcare systems, as, traditionally, they are closer to patients than other health professionals. This means that they have a firsthand view of the effect that their decisions have on specific patients and, therefore, nurses tend to get more influenced by their personal feelings, values and beliefs at the microeconomic level. This presentation shall examine the gap between abstract macroeconomic and concrete microeconomic health resources allocation decisions, with a particular emphasis on the role of the nurse. (shrink)

Ethische Leitlinien für die klinische Praxis erfreuen sich zunehmender Beliebtheit. Damit klinisch-ethische Leitlinien aber überhaupt erfolgreich wirksam werden können, ist noch Pionierarbeit zu leisten. Solche Leitlinien müssen wissenschaftlich stärker fundiert und ihre praktische Anwendbarkeit muss verbessert werden. In dieser Arbeit werden die ersten Schritte des Projekts METAP zur methodischen Entwicklung und praktischen Implementierung einer Leitlinie für eine patientengerechte Versorgung am Krankenbett beschrieben und zur Diskussion gestellt. Das Projekt orientiert sich methodisch an der Entwicklung medizinischer Leitlinien und generiert damit eine forschungs- (...) und konsensgestützte Leitlinie, die systematischer Evaluation und Modifikation unterliegt und Rechenschaft über ihre wissenschaftliche Fundierung gibt. Zusätzlich zur Leitlinie bietet das Projekt in der Form eines Handbuchs ein Entscheidungsfindungsverfahren an, welches unter anderem deliberative Aspekte unterstützt. Das Handbuch konzentriert sich auf ethische Fragen der Mikroallokation und liefert darüber hinaus Informationen über empirische, ethische und rechtliche Grundlagen für Therapieentscheidungen. Anhand eines Eskalationsmodells können unterschiedliche Instrumente nach Bedarf als ethische Lösungsstrategien eingesetzt werden, von der Kurzfassung im Kitteltaschenformat („Leporello“) mit den wichtigsten Fakten, weiterführenden Texten und Empfehlungen mit normativen und prozeduralen Hinweisen, über stationsinterne Lösungsversuche bis hin zum Ethikkonsil. Klinische Partner sind von Beginn an aktiv in den Entwicklungsprozess eingebunden und verbessern so die Praxistauglichkeit und Akzeptanz sowie die Ausrichtung des Instrumentariums an den tatsächlichen Bedürfnissen. Dieses partnerschaftliche, partizipative Vorgehen scheint eine wichtige Voraussetzung dafür zu sein, dass METAP in der Klinik Fuß fassen konnte. (shrink)

This paper maps the different levels of the problem of healthcare resource allocation — micro, macro and international — with reference to three cases. It is argued that two standard approaches to the issue of distributive justice in healthcare, the QALY (quality-adjusted life year) approach and the social-contract approach developed by Norman Daniels, are fundamentally unsatisfactory for reasons identified by Alasdair MacIntyre. Although the virtue theory articulated by MacIntyre and others has been influential in many areas of healthcare (...) ethics, there seems to have been relatively little discussion of the difference it might make to the problems of resource allocation. The potential of such an approach is explored in the later sections of the paper. Two apparently promising ways of bringing virtue ethics to bear on resource allocation are examined and found wanting to greater or lesser extents. Firstly, Beauchamp and Childress’s account of the virtues as a supplement to their ‘Four Principles’ is found to have little or no substantive contribution to make to this issue. Secondly, the ‘liberal communitarian’ system of resource allocation proposed by Ezekiel Emanuel, while a considerable improvement on the account of Beauchamp and Childress, remains problematic in some respects. An alternative Christian account is developed by identifying significant influences that might shape the ‘political prudence’ which would enable Christian communities to form sound judgments about distributive justice in healthcare. The paper concludes with some remarks about the relationship between this tradition-constituted account and the wider public sphere of policy-making and practice. (shrink)

Public health ethics is a relatively new academic field. Crucially, it is distinguished from traditional medical ethics by its focus on populations rather than individuals. Still, the ethics of public health cannot be perceived completely detached from the ethics of individuals, as populations are made up of individuals. One issue that clearly falls within the intersection of a population- and an individual based perspective on ethics is resource allocation. Resource allocation takes place at various stages within the organisation (...) of healthcare, i.e. at the micro-, meso- and macro level [3]. Resources are almost always limited, with the consequence that some healthcare is prioritised while other care is rationed. In this manner, resource allocation creates winners and losers; those who get the best care available, those who do not receive the best care and those who do not receive care at all. It seems prudent to assume that any adequate public health ethics involved in population-based decision-making will have to address all ethical aspects of resource allocation, all the way from the macrolevel policy-making process to the micro-level implementation where it affects specific and identifiable individuals. More specifically, such an ethics must be able to deal with the ethical tensions arising between population-based concerns framing the policy design process, and individual concerns in the realisation of the resource allocations. In the following, I will identify an inherent ethical tension involved in ‘legitimate resource allocation’, which is related to the challenge of meeting the ethical requirements from a population- and an individual based perspective at the same time. (shrink)

In health care systems where access to resources is limited, priorities must be set. The Canadian health care system relies on physicians as clinical or micro-level gatekeepers to health care access. Several studies have indicated that physicians do not tend to consider distributive justice concerns when making clinical-level resource allocation decisions. This is concerning, given that the normative literature on micro-level rationing has featured justice considerations as a necessary condition for fair decision-making. I will first discuss the (...) basics of bedside rationing and some studies which identify a possible justice “value deficit.” I will then analyze the relevant normative frameworks in the rationing literature to identify if and where decision-making may be falling short. Finally, I will use Beauchamp and Childress’ fifth and sixth editions of Principles of Biomedical Ethics to examine whether justice in micro-level rationing is best conceptualized as a principle or a virtue. (shrink)

How do states build a security apparatus after violent resistance against state rule? This article argues that in early periods of state building two main factors shape the process: the macro-strategic goals of the state and administrative challenges of personnel management. These dynamics are studied in the context of the establishment of police forces in the settler colony of German Southwest Africa, present-day Namibia. The empirical analysis relies on information about the location of police stations and a near full census (...) of police forces, compiled from the German Federal Archives. A mismatch is found between the allocation of police presence and the allocation of police personnel. The first was driven by the strategic value of locations in terms of extractive potential, political importance, and the presence of critical infrastructure, whereas the allocation of individual officers was likely affected by adverse selection, which led to the assignment of low-quality recruits to strategically important locations. (shrink)

Recently, ethical guidelines for clinical practice have gained increased popularity, but in order to become useful they require more pioneer’s work. Clinical-ethical guidelines need to be based on a scientific foundation and their practicability must be improved. We present and put to discussion the initial steps of the METAP Project about the development and practical implementation of a clinical-ethical guideline dedicated to a fair resource-allocation at the bedside. -/- With its methodological orientation, the project represents a guideline which is (...) based on both research and consensus-building, undergoing systematic evaluation and modification. In addition to the guideline, the project comes with a manual (a tool kit) including a procedural instrument for making decisions supporting deliberative aspects. It focuses on issues of micro-allocation; furthermore, it provides empirical, ethical and legal basics for making fair treatment decisions that should help to prevent overtreatment, undertreatment or discrimination in patient care. We propose an Escalation Model with various instruments serving as problem solving strategies that correspond to the respective needs; these instruments include a pocket-summary (“Leporello”) with the most important facts; further reading material; normative and procedural recommendations; ward-specific strategies, and also the option of clinical ethics consultation. -/- Clinical partners have been actively involved in the developmental process from the beginning and contributed to the practical applicability, acceptance and a valid need-orientation of the whole tool kit. This partnership and the participatory approach seem to have helped METAP to gain a foothold in the clinic. (shrink)

The principles of equality and equity, respectively in the Bill of Rights and the white paper on health, provide the moral and legal foundations for future health care for children in South Africa. However, given extreme health care need and scarce resources, the government faces formidable obstacles if it hopes to achieve a just allocation of public health care resources, especially among children in need of highly specialised health care. In this regard, there is a dearth of moral analysis (...) which is practically useful in the South African situation. We offer a set of moral considerations to guide the macro-allocation of highly specialised public health care services among South Africa's children. We also mention moral considerations which should inform micro-allocation. (shrink)

In this paper, I examine the conflicts between autonomy and justice. The problem of justice in healthcare concerns both micro-allocation and macro-allocation. The latter has to do with distributive justice: who should get what healthcare resources at whose expense. The current debate about healthcare reform brings up two competing models of distributive justice from political philosophy. The libertarian theory holds to the ideal of individual responsibility and choice, viewing taxation for the purpose of providing goods to those (...) who cannot afford them as a form of unjustified coercion. The liberal theory holds that society should ensure that all members are provided with basic goods that correct for inequalities that deprive them of human dignity. Even though both theories value individual choice, these theories provide opposing answers to the question of whether taxes should be collected and used for the purpose of ensuring universal access to healthcare. In my paper, I show that neither theory can respect patient choice in healthcare and achieve distributive justice. Libertarians ignore the realities of the healthcare system and why a free market where patients choose and pay for what they want cannot exist. Liberals face the problem that the choices that patients make can lead to over-consumption of healthcare at the expense of other goods important to society. (shrink)

This book provides a survey of the ethical aspects of health care resources distribution. It first distinguishes health from health care in an effort to clear up the ethical landscape. After this, still with the same purpose, it makes a distinction between problems of macro-allocation and micro-allocation. In the rest of the book two questions of macro-allocation are treated in some detail. First, several approaches – in particular: utilitarian, egalitarian, communitarian, and libertarian – to the question (...) whether we have a right to health care are assessed. Second, it is discussed how best, if we have such a right, health care resources are allocated given obvious budget constraints. Here again the major theories discussed are utilitarian, communitarian, and egalitarian. Although it is not the aim of the book to propose a new theory of the ethics of health care resource distribution, the critical approach throughout is broadly egalitarian in spirit. (shrink)

A common difficulty with the application of theories of justice to the allocation of medical resources is the assumption that one perspective is primary, whether that privileged perspective be that of the practitioner, on the one hand, or policy analyst on the other. By a discussion of three theories — those of Ramsey, Childress, and Joseph Fletcher — I attempt to show that these perspectives must be treated as related. As a result, values and ethics expressed in micro- (...) class='Hi'>allocation should be uniform with those of macro-allocation. This point has implications for such issues as substance and procedure in just decision, the role of the political process in medical allocation, and the definition of health and health services. (shrink)

Applying equity to health care is difficult and it is especially challenging when applied to cases that involve urgent military medicine care under resource scarcity. Part of the difficulty centers on the concept of equity itself. It is not clear what the best concept of equity applicable to medical care would be, or that there should be only one, or the same ones, across all levels of military health care. Despite the fact that equity is a key concern in health (...) care, particularly in the age of the COVID-19 pandemic, it may be that there is no single theory of justice that would be most justified for military physicians to use. This paper examines whether a hybrid position of equity might be both theoretically robust and applicable in practice. After briefly introducing the discussion, we outline four major philosophical definitions of equity – (1) Egalitarianism, (2) Prioritarianism, (3) Desertism, and (4) Sufficientism. We then report empirical findings suggesting that a practice-based hybrid concept of equity is used by physicians within the practice of micro-allocation. Our findings will shed lights on ethical justifications and reasoning which should guide medical rules for military and humanitarian health care providers. (shrink)

Die qualitative Interviewstudie analysiert informelle Wissensstrukturen von Pflegenden und Ärzten hinsichtlich der beiden Einflussfaktoren „Alter“ und „Kosten“ auf Therapieentscheide am Lebensende als Grundlage ethischer Meinungsbildung. Als Auswertungsmaterial dienen spontane Aussagen zu „Alter“ und „Kosten“, die nicht im Kontext von Fragestellungen zu Ageism oder Rationierung erhoben wurden. Diese Aussagen wurden einer Inhaltsanalyse unterzogen, und zwar anhand von qualitativen und quantitativen Analyseschritten.Die Studie zeigt, dass der Faktor „Alter“ wesentlich häufiger als Einflussfaktor auf Therapieentscheide am Lebensende genannt wird als der Faktor „Kosten“. Zudem (...) gibt es Hinweise auf mögliche Ungleichbehandlung sowie auf Überversorgung von Patienten am Lebensende. Die Befunde stützen die Annahme, dass Therapieentscheidungen eher auf informellen, nicht-institutionalisierten Prozessen beruhen. Eine stärker explizite Strukturierung des Prozesses zur Therapieentscheidung könnte die Risiken von Ungleichbehandlung und Überversorgung reduzieren und dadurch zu ethisch besser vertretbaren Ergebnisse führen. (shrink)

Despite a revived interest in explaining the evolution of anisogamy in recent years (i.e. different—micro and macrogametes), there remain more questions than answers. The topic is important because it is thought to be the foundation of the theory of gender differences and relations. Twelve of these questions are briefly reviewed here—(1) the distinction between sex and sexual types; (2) the distinction between mating types and anisogamy; (3) the possible role of ecological as well as social evolution in proto-gender differences (...) and relations; (4) the life history strategies involved; (5) whether the relevant social relationships are based on conflict or cooperation; (6) the origin and properties of meiosis; (7) the conformity of theories with sex allocation theory; (8) the relevance of multiple levels of selection; (9) appropriate modelling strategies; (10) the relationship between the kind of gametes produced and secondary sexual characteristics; (11) the relevance to humans; and (12) how realistic the search for a single explanation is. It is concluded that polarized sexuality may be a form of trade. (shrink)

Corporate social responsibility is a tortured concept. We review the current state of the art across a number of academic disciplines, from accounting to management to theology. In a world that is increasingly global and pluralistic, progress in our understanding of CSR must include theorizing around the micro-level processes practicing managers engage in when allocating resources toward social initiatives, as well as refined measurement of the outcomes of those initiatives on stakeholder and shareholder interests. Scholarship must also account for (...) the influence of diverse, and even maladaptive, stakeholders as well as more fully incorporate non-Western philosophical and economic perspectives. Based on this review, we pose five questions that scholars from each of these disciplines should address as the CSR field moves forward. We hope our questions provoke deeper thinking and greater rigor and attention to detail in this important area of business research. (shrink)

This chapter sets forth a general theory of gender stratification. While both biological and ideological variables are taken into account, the emphasis is structural: It is proposed that the major independent variable affecting sexual inequality is each sex's economic power, understood as relative control over the means of production and allocation of surplus. For women, relative economic power is seen as varying-and not always in the same direction-at a variety of micro- and macrolevels, ranging from the household to (...) the state. A series of propositions links the antecedents of women's relative economic power, the interrelationship between economic and other forms of power, and the forms of privilege and opportunity into which each gender can translate its relative power. (shrink)

We present a computational model of multiple-object tracking that makes trial-level predictions about the allocation of visual attention and the effect of this allocation on observers' ability to track multiple objects simultaneously. This model follows the intuition that increased attention to a location increases the spatial resolution of its internal representation. Using a combination of empirical and computational experiments, we demonstrate the existence of a tight coupling between cognitive and perceptual resources in this task: Low-level tracking of objects (...) generates bottom-up predictions of error likelihood, and high-level attention allocation selectively reduces error probabilities in attended locations while increasing it at non-attended locations. Whereas earlier models of multiple-object tracking have predicted the big picture relationship between stimulus complexity and response accuracy, our approach makes accurate predictions of both the macro-scale effect of target number and velocity on tracking difficulty and micro-scale variations in difficulty across individual trials and targets arising from the idiosyncratic within-trial interactions of targets and distractors. (shrink)

Corporations significantly influence the public and political spheres. In light of this corporate power in society, academics have criticized the lack of legitimization (i.e., the legitimacy gap) and highlighted a potential divergence between corporate resource allocation and the needs and preferences of the public (i.e., the social issues gap). To address these problems, democratizing organizations has been proposed as a potential solution. In line with this, the authors argue that an increase in corporate power outside the economic realm should (...) be counterbalanced by more democratic corporate governance (i.e., an internalization of democracy). While important groundwork exists, academic attention to these topics remains limited. The authors provide an overview of the literature linking corporate power and the claim for democratizing organizations, advocate for legitimization, identify research gaps, and develop a research agenda to inspire and guide future research efforts. The paper's findings suggest the importance of conceptual and empirical research on the micro-, meso-, and macro-levels and the cross-level effects, which is needed to advance this incipient research area. Future research must (1) clearly define corporate power and discuss how democratizing organizations can contribute to more legitimate organizational decisions, (2) unveil novel approaches for more democratic corporate governance, and (3) understand the organizational- and individual-level factors necessary for the successful realization of democratic organizations. (shrink)

The negative co‐variation of life‐history traits such as fecundity and lifespan across species suggests the existence of ubiquitous trade‐offs. Mechanistically, trade‐offs result from the need to differentially allocate limited resources to traits like reproduction versus self‐maintenance, with selection favoring the evolution of optimal allocation mechanism. Here I discuss the physiological (endocrine) mechanisms that underlie optimal allocation rules and how such rules evolve. The hormone testosterone may mediate life‐history trade‐offs due to its pleiotropic actions in male vertebrates. Conservation in (...) the actions of testosterone in vertebrates has prompted the ‘evolutionary constraint hypothesis,’ which assumes that testosterone signaling mechanisms and male traits evolve as a unit. This hypothesis implies that the actions of testosterone are similar across sexes and species, and only the levels of circulating testosterone concentrations change during evolution. In contrast, the ‘evolutionary potential hypothesis’ proposes that testosterone signaling mechanisms and male traits evolve independently. In the latter scenario, the linkage between hormone and traits itself can be shaped by selection, leading to variation in trade‐off functions. I will review recent case studies supporting the evolutionary potential hypothesis and suggest micro‐evolutionary experiments to unravel the mechanistic basis of life‐history evolution. BioEssays 29: 133–144, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe is the future of sustainable (...) medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation. (shrink)

Green finance plays a crucial bridge as an intermediary between finance and the environment, facilitating resource allocation. The disclosure of environmental information (EID) is vital for promoting sustainable economic development. This study utilizes panel data covering the period from 2012 to 2019, focusing on Chinese companies listed in high-polluting industries. The findings demonstrate that green finance policies have a significant positive impact on EID, while increased managerial power has a detrimental effect. However, green finance policies can mitigate the negative (...) consequences arising from moral hazard and adverse selection resulting from managerial power. They enhance the quality of EID by restricting long-term loan resources for polluting entities. The heterogeneity test reveals that the effectiveness of green finance policies in promoting EID varies across different regions of China. In non-state-owned companies, green finance policies are more effective in constraining managerial power. The moderating effect of green finance on managerial power is weakened by improvements in internal control. Green financing can offset the adverse impact of managerial power on EID when debt levels are high. Our research plays a crucial role in advancing micro-academic studies in the field of green finance. By strengthening internal controls for corporate managers and promoting EID policies, we provide essential support and guidance to decision-makers. (shrink)

The average annual profits before fees of the $10 billion plus Renaissance Technologies’ hybrid Medallion “Leveraged, High Frequency, Artificial Intelligence ” trading hedge fund between 1988 and 2019 were about 66 percent. Total trading profits during this period were over $100 billion. The fund has never had a losing year. The fund is not open to the general public. First, distinctions among, in more or less historical order, the traditional market-maker trading model, the hedge fund trading model, the artificial intelligence (...) trading model, and the hybrid LHFAI trading model are discussed. Second, the micro components of the LHFAI trading model are explained in the context of Renaissance Technologies’ Medallion Fund. Third, key positive contributions of the model with respect to profitability, low annual volatility, market liquidity, and intellectual property development; negative ethical issues concerning exclusive access, tax fairness, financial transparency, shared responsibility for losses and systemic risk, and short vs. long-term capital allocation are discussed. Potential reforms that retain the positives, reduce the negatives, and that could positively transform the model are discussed. Fourth, potential impacts that the potential reforms might have on the macro LHFAI form of finance capitalism and the larger finance capitalism political-economic system are considered. Fifth, conclusions are offered and discussed. (shrink)

Corporate social responsibility is a tortured concept. We review the current state of the art across a number of academic disciplines, from accounting to management to theology. In a world that is increasingly global and pluralistic, progress in our understanding of CSR must include theorizing around the micro-level processes practicing managers engage in when allocating resources toward social initiatives, as well as refined measurement of the outcomes of those initiatives on stakeholder and shareholder interests. Scholarship must also account for (...) the influence of diverse, and even mal-adaptive, stakeholders as well as more fully incorporate non-Western philosophical and economic perspectives. Based on this review, we pose five questions that scholars from each of these disciplines should address as the CSR field moves forward. We hope our questions provoke deeper thinking and greater rigor and attention to detail in this important area of business research. (shrink)

What is the link between patients' rights to NHS treatment and PCTs' duties to live within their budgets? This was the issue in Rogers v Swindon PCT [2006], in which a patient had been denied trastuzamab (Herceptin®) for early-stage breast cancer. In principle, rationing is lawful and PCTs have to make hard choices about spending priorities, but they may not ignore the interests of needy patients in doing so. Rather, they must balance the 'corporate' interests of the PCT with the (...) 'clinical' interests of individuals. One way of doing so is to adopt an Ethical Framework at the macro-level to guide NHS resource allocation, but to also recognize 'exceptional cases' at the micro-level, even if the treatment is generally considered to be a low priority. This article is primarily concerned with these micro-level cases. Patients and clinicians should know how the balance is struck. Such a system operates in Berkshire, but there is plenty of room for debate about how it should develop. (shrink)

The ability of two Panepinto micro pigs and two Yorkshire pigs (Sus scrofa) to acquire a joystick-operated video-game task was investigated. Subjects were trained to manipulate a joystick that controlled movement of a cursor displayed on a computer monitor. The pigs were required to move the cursor to make contact with three-, two-, or one-walled targets randomly allocated for position on the monitor, and a reward was provided if the cursor collided with a target. The video-task acquisition required conceptual (...) understanding of the task, as well as skilled motor performance. Terminal performance revealed that all pigs were significantly above chance on first attempts to contact one-walled targets (p< 0.05). These results indicate that despite dexterity and visual constraints, pigs have the capacity to acquire a joystick-operated video-game task. Limitations in the joystick methodology suggest that future studies of the cognitive capacities of pigs and other domestic species may benefit from the use of touchscreens or other advanced computer-interfaced technology. (shrink)

With the rise of an innovation agenda in science policy, previous studies have identified a shift in how the state delegates responsibility to funding agencies in order to change the behaviour of the scientific community. This paper contributes to this literature through a micro-level study of how one of Canada’s largest research funding agencies, the Natural Sciences and Engineering Research Council, has changed resource allocation for research over 25 years. Our study foregrounds research funding agencies as key sites (...) for examining the reconfiguration of the relationship between the state and science, as expressed in programmatic and resource allocation decisions. Through analysis of an original dataset compiled from NSERC’s funding and documentary data, we demonstrate the relationship between the introduction of innovation objectives in funding instruments, the adoption of new delegation modes to guide resource allocation, and changes in funding among research fields over time. Our study empirically demonstrates the cumulative effect of programmatic and funding decisions in a major agency, going beyond previous accounts of more general trends at the national level. (shrink)

It is widely acknowledged that resource allocations are taking place at various levels of the health care system. On the macro level, resources are allocated according to societal and political considerations within the system as a whole. On the micro level, it is the health care organization where allocations have to be made. Ethical analyses of this micro level usually deal with decisions of health care professionals since they affect patients directly. Allocation decisions by management are of (...) less interest to the ethical literature, although they define the framework for patient care. In this respect, this concerns not only the use of drugs or infrastructure but also of human resources. Human resource management, therefore, is deeply involved in allocation decisions and, thereby, must shoulder a threefold responsibility: towards the health of the patient, the employees, and the organization. The objective of this article is to analyze the ethics of allocation that derives from this threefold responsibility from the perspective of human resource management in a hospital. For an adequate ethical analysis of allocation in a hospital, human resource management has to be considered, since personnel is the most precious resource to allocate in a hospital. (shrink)

America’s COVID-19 pandemic has both devastated and disparately harmed minority communities. How can the allocation of scarce treatments for COVID-19 and similar public health threats fairly and legally respond to these racial disparities? Some have proposed that members of racial groups who have been especially hard-hit by the pandemic should receive priority for scarce treatments. Others have worried that this prioritization misidentifies racial disparities as reflecting biological differences rather than structural racism, or that it will generate mistrust among groups (...) who have previously been harmed by medical research. Still others complain that such prioritization would be fundamentally unjust. I argue that, to pass muster under current law, policymaking in this area must recognize a crucial distinction: prioritizing minority communities, such as hard-hit neighborhoods, without regard to individual race is typically legal, but prioritizing individuals on the basis of their racial identity faces is likely not. I also explain how prioritization on the basis of Native American status is allowable and legally distinct from prioritization on the basis of individual race. -/- In Part II, I provide a brief overview of current and proposed COVID-19 treatments and identify documented or likely scarcities and disparities in access. In Part III, I argue that randomly allocating scarce medical interventions, as some propose, will not effectively address disparities: it both permits unnecessary deaths and concentrates those deaths among people who are more exposed to infection. In Part IV, I explain why using individual-level racial classifications in allocation is precluded by current Supreme Court precedent. Addressing disparities will require focusing on factors other than race, or potentially considering race at an aggregate rather than individual level. I also argue that policies prioritizing members of Native American tribes can succeed legally even where policies based on race would not. In Part V, I examine two complementary strategies to narrow racial disparities. One would prioritize individuals who live in disadvantaged geographic areas or work in hard-hit occupations, potentially alongside race-sensitive aggregate metrics like neighborhood segregation. These approaches, like the policies school districts adopted after the Supreme Court rejected individualized racial classifications in education, would narrow disparities without classifying individuals by race. The other strategy would address the starkly disparate racial impact of deaths early in life by limiting the use of age-based exclusions from vaccine or treatment access that explicitly deprioritize the prevention of early deaths and so disparately exclude minorities, and by considering policies that prioritize the prevention of early deaths. (shrink)

The adverse effects of the Covid-19 pandemic have exposed the lack of multi-scalar community resilient strategies that catalyze the development of alternative coping mechanisms for future challenges. To address the immediate needs of vulnerable and marginalized groups, especially in times of crisis, as evidenced by the pandemic, micro-networks within communities have mitigated and reduced harm through self-devised ingenuity based on local ways of life. Socio-spatial micro-networks have the potential to empower communities to self-organize, engage, collaborate, co-design, co-build, and (...) connect with other communities to improve their resilience. This paper focuses on the impact of micro-networks of care, participatory action research, community health, solidarity and mutual aid in Nairobi (Kenya), comparing their resilience strategies, pre- and post Covid-19 pandemic era. Through analytical, empirical, and comparative studies, this paper envisions viable ways of augmenting and enhancing self-devised, self-sufficient, and resilient culture in marginalized communities in Africa and worldwide. -/- . (shrink)

Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

Our study considers the governance, ethics and operational challenges associated with the acquisition, manipulation and commodification of ‘big data’ in the financial services sector. To the best of our knowledge, there are no published studies describing empirical research undertaken within companies in this sector to understand how they are responding to such challenges: our field-based research is a significant initial contribution in this respect. We describe the results of a micro-ethnographic study undertaken in a small-to-medium-sized company developing disruptive, technology-related (...) platforms and services in the banking and retail sectors based on big data and associated analytics: these are used to derive commercially valuable insights from personal customer data in exchange for cash back and targeted rewards. The company was found to employ a multi-level innovation governance approach, underpinned by an ethical strategy based on a principle of mutual benefit. Opt-in and informed consent for using data for specific purposes was supported by principles of data minimisation and anonymisation, with unrestricted use of secondary, anonymised and aggregated data to develop insights. Governance, which included contextual data protection legislation, payment-card industry data usage standards and internal corporate controls, presented as bespoke organisational practices relating to data security and privacy. These in total set the governance and ethics frame for big data innovation at the company within which it has had to be both adaptive and responsive under conditions of normative and regulatory uncertainty. (shrink)

In this paper, it will be argued that each time a procedure in a representational system is functioning adequately and automatically, the child steps up to a metaprocedural level and considers the procedure as a unit in its own right. Data will be drawn from microdevelopment in children's creation of external memory devices (i.e., changes in representation of a spatial task during a one hour's session) as well as from macrodevelopment in language acquisition (i.e., changes occurring over age in a (...) study of nominal determiners, pronouns and gender markers). These two aspects of development of representational systems are examined with respect to the spontaneous passage from concrete reference to abstract systems, from idiosyncratic to conventional notations, from redundant to economic marking, from unifunctional to plurifunctional meaningful units. These micro‐ and manodevelopmental changes take place in a spontaneous fashion despite the fact that the child's earlier system is adequate for successfully conveying the information required. A discussion will be made of the way in which children tend to indicate externally, by unifunctional markers, information which was implicit in their earlier use of an adult‐like system. They appear to be striving for the delicate balance between encoding and decoding efforts, ultimately leading to a felicitous representational system. Metaprocedural behavior is hypothesized to act as a control mechanism in the striving for this delicate balance of information content and information processing effort. It also appears to act as a control mechanism for the interprocedural organizotion of what was previously a plethora of juxtaposed, unconnected procedures yielding superficially analogous behavior. The stepping‐up to a metaprocedural level seems to occur each time the child has a handle on his currently functioning, goal‐oriented system. This enables the child to treat the system, or procedures which are part thereof, as units functioning in their own right. Thus there appears to be a deep‐rooted psychological tendency for a representational tool which functions well procedurally to become subsequently a problem‐space per se. (shrink)

This study contributes to the micro-credit literature by addressing the lack of philosophical dialogue concerning the issue of trust between micro-credit NGOs and rural poor women. The study demonstrates that one of the root causes of NGOs’ contested roles in Bangladesh is the norm that they use (i.e., trust) to rationalize their micro-credit activities. I argue that Bangladeshi micro-credit NGOs’ trust in poor village women is not genuine because they resort to group responsibility sustained through aggressive (...) surveillance. I maintain so by drawing on a trust-based theoretical framework that uses various philosophical insights. Drawing on the same conceptual framework, I also contend, somewhat softening the previous claim, that if micro-credit trust is trust at all, it is at most strategic, not generalized. For being strategic, it has many undermining effects on local social solidarity norms, rendering Bangladeshi micro-credit NGOs and strategic trust an odd couple with no moral compass. To bring forth the moral impetus in micro-credit activities, I lay out some recommendations intended for organizations, managers, and policymakers, consistent with normative corporate social responsibility initiatives. However, further studies can be initiated based on this paper, suggesting its importance for future research. (shrink)

COVID‐19 caused an imbalance between medical resources and the number of patients in Türkiye like in many countries. There was not pandemic‐triage system, and this situation led to decision making based on experience, intuition, and judgment of allocation of scarce resources. The research explains the guiding criteria that healthcare professionals used to prioritize the distribution of scarce medical resources during the COVID‐19 pandemic. The criteria preferred by 928 healthcare professionals were evaluated when preventive measures for COVID‐19 were reduced and (...) so the number of cases increased rapidly. The results indicate that Turkish healthcare professionals largely support the utilitarian approach, which focuses on medical benefit in pandemic. The main problem was that some criteria not approved in COVID‐19 triage guidelines were considered important by healthcare professionals. These criteria, which cause discrimination by preventing the provision of fair and equal medical care to patients, are a prominent issue in the study. (shrink)

Micro Credit (MC) programs lend money to poor borrowers using innovative mechanisms such as group lending under joint liability while successfully accounting for the presence of asymmetric information in underdeveloped financial markets. MC programs have achieved what the conventional financial institutions and the government have not been able to: lend to the poor, impressive loan recuperation, and a positive impact in poverty reduction. This article analyzes the performance of ALSOL, an MC program in Chiapas, México, for 2151 participants in (...) urban and rural areas for the time period between July 2000 and July 2001. While loan recuperation is high (95%), administrative costs also remain high. Socially responsible lenders and donors play a key role in providing continuous funding to MC programs and assisting in reducing the level of poverty. (shrink)

In this paper, it will be argued that each time a procedure in a representational system is functioning adequately and automatically, the child steps up to a metaprocedural level and considers the procedure as a unit in its own right. Data will be drawn from microdevelopment in children's creation of external memory devices (i.e., changes in representation of a spatial task during a one hour's session) as well as from macrodevelopment in language acquisition (i.e., changes occurring over age in a (...) study of nominal determiners, pronouns and gender markers). These two aspects of development of representational systems are examined with respect to the spontaneous passage from concrete reference to abstract systems, from idiosyncratic to conventional notations, from redundant to economic marking, from unifunctional to plurifunctional meaningful units. These micro‐ and manodevelopmental changes take place in a spontaneous fashion despite the fact that the child's earlier system is adequate for successfully conveying the information required. A discussion will be made of the way in which children tend to indicate externally, by unifunctional markers, information which was implicit in their earlier use of an adult‐like system. They appear to be striving for the delicate balance between encoding and decoding efforts, ultimately leading to a felicitous representational system. Metaprocedural behavior is hypothesized to act as a control mechanism in the striving for this delicate balance of information content and information processing effort. It also appears to act as a control mechanism for the interprocedural organizotion of what was previously a plethora of juxtaposed, unconnected procedures yielding superficially analogous behavior. The stepping‐up to a metaprocedural level seems to occur each time the child has a handle on his currently functioning, goal‐oriented system. This enables the child to treat the system, or procedures which are part thereof, as units functioning in their own right. Thus there appears to be a deep‐rooted psychological tendency for a representational tool which functions well procedurally to become subsequently a problem‐space per se. (shrink)

is chapter takes a fresh look at micro-macro relations in the social sciences from the point of view of the mechanistic account of explanation. Traditionally, micro- macro issues have been assimilated to the problem of methodological individualism. It is not my intention to resurrect this notoriously unfruitful controversy. On the contrary, the main thrust of this chapter is to show that the cul-de-sac of that debate can be avoided if we give up some of its presuppositions. The debate (...) about methodological individualism is based on assumptions about explanation, and once we change those assumptions, the whole argumenta- tive landscape changes. (shrink)

The COVID-19 pandemic has forced clinicians, policy-makers and the public to wrestle with stark choices about who should receive potentially life-saving interventions such as ventilators, ICU beds and dialysis machines if demand overwhelms capacity. Many allocation schemes face the question of whether to consider age. We offer two underdiscussed arguments for prioritising younger patients in allocation policies, which are grounded in prudence and fairness rather than purely in maximising benefits: prioritising one’s younger self for lifesaving treatments is prudent (...) from an individual perspective, and prioritising younger patients works to narrow health disparities by giving priority to patients at risk of dying earlier in life, who are more likely to be subject to systemic disadvantage. We then identify some confusions in recent arguments against considering age. (shrink)

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, (...) quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....

Let thin properties be properties shared by coincident entities, e.g., a person and her body, and thick properties ones that are not shared. Thick properties entail sortal properties, e.g., being a person, and the associated persistence conditions. On the first account of realization defined here, the realized property and its realizers will belong to the same individual. This restricts the physical realizers of mental properties, which are thick, to thick physical properties. We also need a sense in which mental properties (...) can be realized in thin physical properties shared by a person and her body. Defining this in turn requires defining a sense in which the instantiations of sortal properties and of thick properties are realized in micro‐structural states of affairs. A fourth notion of realization is needed to allow for the possibility of coincident entities that share a sortal property, e.g., coincident persons. (shrink)