Suchergebnisse

Across the world, in countries with permissive or restrictive existing legislation, debates about Euthanasia and Assisted Suicide (EAS) continue to grip politicians, ethicists, physicians and the wider public. Early debates about EAS focused on whether it could ever be ethical for a physician to actively cause the death of a patient. However, most contemporary writers, including most of the contributors to this special double issue of the JME appear to accept that such actions could, in some circumstances, be ethical. Current debate is mostly focused instead on which actions are permissible, when they are permissible, and what safeguards are necessary to protect the vulnerable.

In the mid 21st century, humans finally established a small community on Mars. The Martian colony grew slowly over its first 50 years. There were substantial technical challenges to living in the artificial biospheres. Early colonists had to accept significant restrictions because of the harshness of the environment, and the limited shared physical space. However, by 2116, the community was starting to relax its initial strictures. There was a growing community of young, native Martians. Technology was more robust. Some of the initial strict rules were being reconsidered and debated in the Martian parliament. One question, tabled for late 2116, was whether it should be permissible to grow tobacco. Smoking had not been an option for the initial colonists. Only non-smokers were allowed to travel because of the dangers of fire during the long journey from Earth and in the first generation of domes. But now the atmospheric regulators were stable enough to cope with combustion of plant matter, while the community had sophisticated mechanisms to prevent dangerous fires. Should Martians be allowed to smoke?

Variable tuition fees and bursaries, funded by higher education institutions, were introduced in England to promote student choice and provider competition, while bursaries would off-set higher fees and safeguard access. Both have been central to government reforms of undergraduate student funding since 2004. This article assesses student perceptions of the impact of bursaries on their higher education decisions and choices, and considers the implications for the 2012/13 National Scholarship Programme. It concludes that most students do not think their choices are affected by bursaries, although those who are cost-conscious, expect to receive higher bursaries, especially of £1,000 or more, and attend Russell Group universities are more likely to think bursaries are influential and important. The reconfiguration of institutional aid from 2012/13 may overcome some perceived barriers to the effectiveness of financial support, but is likely to exacerbate others, and create new impediments and inequalities.

Intro -- Contents -- Prologue -- Chapter One: Ice in August: Life in the Time It Never Rained-in Three Parts, 1935-1953 -- Chapter Two: Rider through the Storm: In Four Parts, 1950-1966 -- Chapter Three: Order before Law -- Chapter Four: The Ghost and the Great Bear Hunt, 1967 -- Chapter Five: The Reconquest of Aztlan: An Angel on My Ass, 1972 -- Chapter Six: The Things I Carried (With Apologies to Tim O'Brien) 1966-1993 -- Chapter Seven: For Love and Horses: The Manhunt for the "See More Kid" 1967 -- Chapter Eight: Earth, Fire, Water, and Blood: I: (Ockham's Razor and the Devil's Swing): The Colorado Canyon Shootings, 1988 -- Chapter Nine: Earth, Fire, Water, and Blood: II: (Ockham's Razor and the Devil's Swing): The Colorado Canyon Shootings, 1988 -- Chapter Ten: My Heroes Have Always Been Rangers: The Captain, 1969 -- Chapter Eleven: A Goat and a Guitar: The Story of a Texas Country Music Star, 1969-2004 -- Chapter Twelve: Just Folks: Me and the Mujahedin: (The Seven Tribes and a Crowd of One) 1987 -- Chapter Thirteen: My Heroes Have Always Been Rangers: Just a Ranger, 1987 -- Chapter Fourteen: Desperadoes and Dumbasses, 1966-1993 -- Chapter Fifteen: With Friends Like These: La Puerta and the Damage Done, 1990 -- Chapter Sixteen: Moving Pictures, 1986-2004 -- Chapter Seventeen: A Slow, Cold Rain: 1990-This Very Day -- Chapter Eighteen: Saddle My Pony, Boys . . . A Farewell to Arms, 1993 -- Chapter Nineteen: El Último Grito: For a Hundred More: (With a Nod to Hemingway's Death in the Afternoon) 2005 -- Appendix One: In Black and White: Career Statistics -- Appendix Two: Letter from the Reverend -- Acknowledgments -- Index.

The UK government has put Lateral Flow Antigen Tests (LFATs) at the forefront of its strategy to scale up testing in the coronavirus pandemic. However, evidence from a pilot trial using an LFAT to identify asymptomatic infections in the community suggests that the test missed over half of the positive cases in the tested population. This raises the question of whether it can it be ethical to use an inaccurate test to guide public health measures. We begin by explicating different dimensions of test accuracy (sensitivity, specificity, and predictive value), and why they matter morally, before highlighting key data from the Liverpool pilot. We argue that the poor sensitivity of the LFAT in this pilot suggests that there are important limitations to what we can expect these tests to achieve. A test with low sensitivity will provide false negative results, and in doing so generate the risk of false assurance and its attendant moral costs. However, we also suggest that the deployment of an insensitive but specific test could identify many asymptomatic carriers of the virus who are currently being missed under existing arrangements. Having outlined ways in which the costs of false reassurance could potentially be mitigated, we conclude that the use of an insensitive LFAT in mass testing may be ethical if (i) it is used predominantly to identify positive cases (ii) it is a cost-effective method of achieving that goal and (iii) if other public health tools can effectively prevent widespread false reassurance.

In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds' availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) issued recommendations aimed at supporting physicians in prioritizing patients when the number of critically ill patients overwhelm the capacity of ICUs. One motivating concern for the SIAARTI guidance was that, if no balanced and consistent allocation procedures were applied to prioritize patients, there would be a concrete risk for unfair choices, and that the prevalent "first come, first served" principle would lead to many avoidable deaths. Among the drivers of decision for admission to ICUs, age, comorbidities, and preexisting functional status were included. The recommendations were criticized as ageist and potentially discriminatory against elderly patients. Looking forward to the next steps, the Italian experience can be relevant to other parts of the world that are yet to see a significant surge of COVID-19: the need for transparent triage criteria and commonly shared values give the Italian recommendations even greater legitimacy.

What role should legislation or policy play in avoiding the complications of in-vitro fertilization? In this article, we focus on single versus double embryo transfer, and assess three arguments in favour of mandatory single embryo transfer: risks to the mother, risks to resultant children, and costs to society. We highlight significant ethical concerns about each of these. Reproductive autonomy and non-paternalism are strong enough to outweigh the health concerns for the woman. Complications due to non-identity cast doubt on the extent to which children are harmed. Twinning may offer an overall benefit rather than burden to society. Finally, including the future health costs for children (not yet born) in reproductive policy is inconsistent with other decisions. We conclude that mandatory single embryo transfer is not justified and that a number of countries should reconsider their current embryo transfer policy.

In response to the COVID-19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre-existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID-19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives.