In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue (...) in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. (shrink)

In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

Mutagenesis makes it possible to examine the effect of amino acid replacements on the folding and stability of proteins. The evaluation of kinetic and equilibrium folding data using reaction coordinate diagrams allows one to determine the roles that single amino acids play in the folding mechanism.

Govind Chandra Pande, b. 1923, Indian philosopher and historian; contributed articles.

Using historical data from the Utah Population Database, this analysis finds significant, consistent, but small adverse mortality effects for mothers after age 50 who had mostly sons. Examination of age-dependent effects indicates that this association increases with mother’s age. Additionally, mothers who had mostly daughters faced mortality risks that increased with age. Offspring sex composition did not have a significant effect on paternal mortality. Interaction analyses were conducted to examine the effect of offspring sex composition with regard to historical period, (...) residential location, socioeconomic status, and childhood survival. No other interactions were found to be statistically significant. Having mostly boys remained detrimental to maternal mortality regardless of childhood survival. (shrink)

The metaphorical nature of biological language is examined and the use of metaphors for providing the linguistic context in which similarities and differences are made is described. Certain pervasive metaphors which are characterised by systemic properties are noted, and in order to provide some focus to the study, systemic metaphors associated with machine, text and organism are discussed. Other systemic metaphors such as society and circuit are also reported. Some details concerning interrelations between automaton and organism are presented in the (...) light of the previous discussion.An approach towards the analysis of biosystem metaphors is outlined which relates part-whole, organisational level and systemic metaphors in a single model. Examples are provided throughout the discussion and mainly come from computing. The potential for metaphorical transfers between these domains is considered. (shrink)

This paper presents a minimal formulation of nonrelativistic quantum mechanics, by which is meant a formulation which describes the theory in a succinct, self-contained, clear, unambiguous and of course correct manner. The bulk of the presentation is the so-called “microscopic theory”, applicable to any closed system S of arbitrary size N, using concepts referring to S alone, without resort to external apparatus or external agents. An example of a similar minimal microscopic theory is the standard formulation of classical mechanics, which (...) serves as the template for a minimal quantum theory. The only substantive assumption required is the replacement of the classical Euclidean phase space by Hilbert space in the quantum case, with the attendant all-important phenomenon of quantum incompatibility. Two fundamental theorems of Hilbert space, the Kochen–Specker–Bell theorem and Gleason’s theorem, then lead inevitably to the well-known Born probability rule. For both classical and quantum mechanics, questions of physical implementation and experimental verification of the predictions of the theories are the domain of the macroscopic theory, which is argued to be a special case or application of the more general microscopic theory. (shrink)

Chalmers (2018) maintains that even if we understood every physical process in the brain we could still wonder why these processes give rise to conscious experience. The meta-problem is the challenge of explaining why we think this 'hard problem' exists. This response to the target paper endorses illusionist accounts of three 'problem intuitions' about consciousness: duality, presentation, and revelation. Subject–object duality is explained in terms of a clash between two compelling but contradictory convictions about consciousness. Phenomenal presence is understood in (...) relation to the configurational features of sensory experiences. And intuitions of revelation are explained as due to an unfounded belief in introspective ontological access. These illusionist analyses are used to bolster the case for physicalist realism rather than to support 'strong' illusionism. In addition to addressing the meta-problem they suggest a promising approach to the hard problem as wel. (shrink)

Praise for the First Edition: '... a unique and lively business ethics text... fresh and delightful... Sekhar's witty use of stories and cases will engage and enlighten business people in India and the rest of the world' - Joanne B Ciulla, The Journal of Business Ethics 'Richly international in scope and contributes to global concern' - Newsltter IIAS Leiden University 'This book makes an important contribution through its holisitc and balanced approach to the issue... Each chapter has a fair number (...) of relevant cases - many of which are good living examples one can learn from' - Business Standard This Second Edition of Sekhar's highly acclaimed book on business ethics has been revised keeping the student reader in mind. This unique text discusses the way ethical conflicts are handled in reality. The author argues that ethical education should be designed to produce balanced, pleasant and effective managers with the power of insight. Only then will they have the courage to create and use ethically desirable means to sustain organizations in an ambience of liberalism and democratic choice. (shrink)

Healthcare package decisions are complex. Different judgements about effectiveness, cost-effectiveness and disease burden influence the decision-making process. Moreover, different concepts of justice generate different ideas about fair distribution of healthcare resources. This paper presents a decision model that is used in medical school in order to familiarise medical students with the different concepts of justice and the ethical dimension of making concrete choices. The model is based on the four-stage decision model developed in the Netherlands by the Dunning Committee and (...) the discussion that followed its presentation in 1991. Having to deal with 10 medical services, students working with the model learn to discern and integrate four different ideas of distributive justice that are integrated in a flow chart: libertarian, communitarian, egalitarian and utilitarian. (shrink)