The design and analysis of norms is a somewhat neglected topic in AI and Law, but this is not so in other areas of Computer Science. In recent years powerful techniques to model and analyse norms have been developed in the Multi-Agent Systems community, driven both by the practical need to regulate electronic institutions and open agent systems, and by a theoretical interest in mechanism design and normative systems. Agent based techniques often rely heavily on enforcing norms using the software (...) to prevent violation, but I will also discuss the use of sanctions and rewards, and the conditions under which compliance by autonomous agents (including humans) can be expected or encouraged without sanctions or rewards. In the course of the paper a suggested framework for the exploration of these issues is developed. (shrink)

There is a growing interest in how people conceptualise the legal domain for the purpose of legal knowledge systems. In this paper we discuss four such conceptualisations (referred to as ontologies): McCarty's language for legal discourse, Stamper's norma formalism, Valente's functional ontology of law, and the ontology of Van Kralingen and Visser. We present criteria for a comparison of the ontologies and discuss the strengths and weaknesses of the ontologies in relation to these criteria. Moreover, we critically review the criteria.

In this paper I argue that to explain and resolve some kinds of disagreement we need to go beyond what logic alone can provide. In particular, following Perelman, I argue that we need to consider how arguments are ascribed different strengths by different audiences, according to how accepting these arguments promotes values favoured by the audience to which they are addressed. I show how we can extend the standard framework for modelling argumentation systems to allow different audiences to be represented. (...) I also show how this formalism can explain how some disputes can be resolved while in others the parties can only agree to differ. I illustrate this by consideration of a legal example. Finally, I make some suggestions as to where these values come from, and how they can be used to explain differences across jurisdictions, and changes in views over time. (shrink)

How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow’s transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our (...) fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. Following this, we focus on the knowledge, skills, and professional attributes that fellows develop as they co-create effective mentoring relationships. We will not prescribe a single approach to fellowship training; instead, our perspective will, we hope, become a catalyst for further conversation on training and mentoring clinical ethics fellows. (shrink)

This paper describes one way in which a precise reason model of precedent could be developed, based on the general idea that courts are constrained to reach a decision that is consistent with the assessment of the balance of reasons made in relevant earlier decisions. The account provided here has the additional advantage of showing how this reason model can be reconciled with the traditional idea that precedential constraint involves rules, as long as these rules are taken to be defeasible. (...) The account presented is firmly based on a body of work that has emerged in AI and Law. This work is discussed, and there is a particular discussion of approaches based on theory construction, and how that work relates to the model described in this paper. (shrink)

Nurses, like many other professional and semiprofessional groups, have a code of con duct. This raises important philosophical questions about the point of including nursing ethics in nursing education and about the content and methods of such teaching. This paper identifies seven functions that might be fulfilled by professional codes; it discusses the philosophical issues these raise and the implications for teaching professional ethics. It is argued that, far from codes rendering the teaching of ethics unnecessary, they pro vide additional (...) reasons for its inclusion. An enhanced ability to make moral decisions helps to overcome the shortcomings of the codes, enables a profession to be autonomous in the development of its code, enables individuals to be authentic moral agents, and is essential in matters concerning the disciplinary function of the codes. The role of emo tions, feelings and attitudes in ethics also presents philosophical problems that moral edu cation can help to resolve. (shrink)

It is argued that philosophical realism is well suited to serve as a perspective from which to understand nursing, and that it should be considered as an alternative to positivist, interpretivist, hermeneutical and phenomenological approaches. However, existing forms of realism, including theory and entity realism are shown to be faced with serious problems. In response, an alternative form ‘constraint realism’ is outlined, and shown to be apposite for illuminating the rule or convention governed behaviour characteristic of human beings. A brief (...) sketch is offered of its application to the social practice of nursing. (shrink)

Norms provide a valuable mechanism for establishing coherent cooperative behaviour in decentralised systems in which there is no central authority. One of the most influential formulations of norm emergence was proposed by Axelrod :1095–1111, 1986). This paper provides an empirical analysis of aspects of Axelrod’s approach, by exploring some of the key assumptions made in previous evaluations of the model. We explore the dynamics of norm emergence and the occurrence of norm collapse when applying the model over extended durations. It (...) is this phenomenon of norm collapse that can motivate the emergence of a central authority to enforce laws and so preserve the norms, rather than relying on individuals to punish defection. Our findings identify characteristics that significantly influence norm establishment using Axelrod’s formulation, but are likely to be of importance for norm establishment more generally. Moreover, Axelrod’s model suffers from significant limitations in assuming that private strategies of individuals are available to others, and that agents are omniscient in being aware of all norm violations and punishments. Because this is an unreasonable expectation, the approach does not lend itself to modelling real-world systems such as online networks or electronic markets. In response, the paper proposes alternatives to Axelrod’s model, by replacing the evolutionary approach, enabling agents to learn, and by restricting the metapunishment of agents to cases where the original defection is observed, in order to be able to apply the model to real-world domains. This work can also help explain the formation of a “social contract” to legitimate enforcement by a central authority. (shrink)

What is consciousness? What is its importance and how is it to be described? The paper looks at some of the principal theories and their attempts to solve the “hard problem” of how consciousness is produced by nervous tissue, and attempts to close the “explanatory gap” between such (apparently) profoundly different things as subjective awareness and a physical brain. It ends with a tentative suggestion that, despite centuries of philosophical frustration, recent appeals to quantum physics may offer a glimmer of (...) hope. (shrink)

In this paper it is argued that we have three dispositions, each of which is very laudable in itself: a preference for the positive, constructive and creative aspects of human endeavours; a desire to be open‐minded and tolerant concerning ideas and beliefs; and an admiration of profundity. I have suggested that these dispositions can, if exaggerated or employed uncritically, seduce us into intellectual positions that are very dubious. These arguments are applied to some of the debates within the philosophy of (...) nursing. (shrink)

This paper is concerned with the debate in evolutionary epistemology about the nature of the evolutionary process at work in the development of science: whether it is Darwinian or Lamarckian. It is claimed that if we are to make progress through the many arguments that have grown up around this issue, we must return to an examination of the concepts of change and evolution, and examine the basic kinds of mechanism capable of bringing evolution about. This examination results in two (...) kinds of processes being identified, dubbed direct and indirect, and these are claimed to exhaust all possibilities. These ideas are then applied to a selection of the debates within evolutionary epistemology. It is shown that while arguments about the pattern and rate of evolutionary change are necessarily inconclusive, those concerning the origin of novel variations and the mode of inheritance can be resolved by means of the distinctions made here. It is claimed that the process of selection in the evolution of science can also be clarified. The conclusion is that the main process producing the evolution of science is a direct or Lamarckian one although, if realism is correct, an indirect or Darwinian process plays a vital role. (shrink)

This title is a powerful and topical critique of the higher education system in the UK, with relevance for countries with similar systems. The issues discussed focus on the problems facing the principle responsibilites of universities: teaching, learning and research.

Those matters that are judged to be spiritual are seen as especially valuable and important. For this reason it is claimed that nurses need to be able to offer spiritual care when appropriate and, to aid them in this, nurse theorists have discussed the nature of spirituality. In a recent debate John Paley has argued that nurses should adopt a naturalistic stance which would enable them to employ the insights of modern science. Barbara Pesut has criticized this thesis, especially as (...) it is applied to palliative care. This paper re-examines this debate with particular attention to the meaning of 'spirituality' and the justification for accepting spiritual and religious theories. It is argued that when we take into consideration the great diversity among religious and spiritual ideas, the lack of rational means of deciding between them when they conflict, and the practicalities of nursing, we find that a spiritual viewpoint is less useful than a naturalistic one, when offering palliative care. (shrink)

Evolutionary theory has been a very popular topic in recent years and it has been claimed that it can make a major contribution to the advance of several sciences such as medicine, psychology, psychopathology and sociology: even providing them with new paradigms. This paper explores the possibility that nursing could benefit similarly by adopting an evolutionary perspective. After sketching the scientific and philosophical background to the recent developments concerning evolution, and briefly mentioning the chief features of evolutionary theory, the paper (...) discusses whether it makes sense to talk of ‘evolutionary nursing’, and whether there are any benefits in doing so. It uses a comparison with Darwinian medicine and evolutionary psychology. Several problems and objections are considered. The modest conclusion is reached that nurses need to adopt an evolutionary perspective to serve as a guide for some of their research and a source for research hypotheses. They also need to be informed about evolutionary ideas so as to be aware of the developments in the disciplines with which they work, and this understanding will assist them in maintaining vigilance against the misuse of science, religion and politics on behalf of their patients. (shrink)

Efficiency has become of central importance in health care and is seen as wholly laudable. It appears to offer a precise and objective means of evaluating and comparing institutions, practices and individuals, and is a principle that underlies techniques of cost-benefit analysis and other methods of option appraisal. However, there is a need to examine the concept of efficiency and explore the problems of its application within health care. Efficiency is a value laden notion and it cannot be used as (...) a means of making value judgements from purely factual premises. We have to choose the inputs and outputs in our calculations, and what limits to set on their scope. Efficiency calculations may require us to measure what cannot be quantified, and to treat as commensurable what is incommensurable. There are circumstances in which considerations of efficiency are inappropriate or even immoral. (shrink)

This paper is perhaps an impressionistic response to accounts of the extraordinary set-theoretical activity being undertaken by W. Hugh Woodin (mathematician) and colleagues in the present moment, in the context of the mathematical ontology proposed and elaborated by Alain Badiou (philosopher). The argument presented is that the prevailing and sustained incoherence of the mathematical ontology (i.e. set theory) underscores a contemporary deficit of humanity’s symbolic organization which, in turn, yields confusion and conflict in terms of subjective orientation. But a new (...) axiom (conjectured as yet) promises to realize a coherent set theory, i.e. stable, consistent and complete. This remarkable (and completely unexpected) development offers hope for the pursuit of a modern (i.e. non-hierarchical) symbolic, and a consequent resolution of the general subjective disorientation. (shrink)

This letter responds to the article “Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape,” by Anne Drapkin Lyerly, Ruth R. Faden, and Michelle M. Mello, in the May-June 2024 issue of the Hastings Center Report.

Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: ‘Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.’ This (...) thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. (shrink)

The volume presents essays on the philosophical explanation of the relationship between body and soul in antiquity from the Presocratics to Galen. The title of the volume alludes to a phrase found in Plato, Aristotle and Plotinus, referring to aspects of living behaviour involving both body and soul, and is a commonplace in ancient philosophy, dealt with in very different ways by different authors.

Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist (...) appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle. (shrink)

We consider a weak version of Schindler’s remarkable cardinals that may fail to be ${{\rm{\Sigma }}_2}$-reflecting. We show that the ${{\rm{\Sigma }}_2}$-reflecting weakly remarkable cardinals are exactly the remarkable cardinals, and that the existence of a non-${{\rm{\Sigma }}_2}$-reflecting weakly remarkable cardinal has higher consistency strength: it is equiconsistent with the existence of an ω-Erdős cardinal. We give an application involving gVP, the generic Vopěnka principle defined by Bagaria, Gitman, and Schindler. Namely, we show that gVP + “Ord is not ${{\rm{\Delta (...) }}_2}$-Mahlo” and ${\text{gVP}}$ + “there is no proper class of remarkable cardinals” are both equiconsistent with the existence of a proper class of ω-Erdős cardinals, extending results of Bagaria, Gitman, Hamkins, and Schindler. (shrink)

We give a new proof of a theorem of Shelah which states that for every family of labeled trees, if the cardinality κ of the family is much larger (in the sense of large cardinals) than the cardinality λ of the set of labels, more precisely if the partition relation holds, then there is a homomorphism from one labeled tree in the family to another. Our proof uses a characterization of such homomorphisms in terms of games.

Eye-tracking is increasingly studied as a cognitive and biological marker for the early signs of neuropsychological and psychiatric disorders. However, in order to make further progress, a more comprehensive understanding of the age-related effects on eye-tracking is essential. The antisaccade task requires participants to make saccadic eye movements away from a prepotent stimulus. Speculation on the cause of the observed age-related differences in the antisaccade task largely centers around two sources of cognitive dysfunction: inhibitory control (IC) and working memory (WM). (...) The IC account views cognitive slowing and task errors as a direct result of the decline of inhibitory cognitive mechanisms. An alternative theory considers that a deterioration of WM is the cause of these age-related effects on behavior. The current study assessed IC and WM processes underpinning saccadic eye movements in young and older participants. This was achieved with three experimental conditions that systematically varied the extent to which WM and IC were taxed in the antisaccade task: a memory-guided task was used to explore the effect of increasing the WM load; a Go/No-Go task was used to explore the effect of increasing the inhibitory load; a ‘standard’ antisaccade task retained the standard WM and inhibitory loads. Saccadic eye movements were also examined in a control condition: the standard prosaccade task where the load of WM and IC were minimal or absent. Saccade latencies, error rates and the spatial accuracy of saccades of older participants were compared to the same measures in healthy young controls across the conditions. The results revealed that aging is associated with changes in both IC and WM. Increasing the inhibitory load was associated with increased reaction times in the older group, while the increased WM load and the inhibitory load contributed to an increase in the antisaccade errors. These results reveal that aging is associated with changes in both IC and WM. (shrink)

We show that Weak Vopěnka’s Principle, which is the statement that the opposite category of ordinals cannot be fully embedded into the category of graphs, is equivalent to the large cardinal principle Ord is Woodin, which says that for every class [Formula: see text] there is a [Formula: see text]-strong cardinal. Weak Vopěnka’s Principle was already known to imply the existence of a proper class of measurable cardinals. We improve this lower bound to the optimal one by defining structures whose (...) nontrivial homomorphisms can be used as extenders, thereby producing elementary embeddings witnessing [Formula: see text]-strongness of some cardinal. (shrink)

Unethical behavior coordinated and concealed by teams continues to represent a troubling and all-too-frequent occurrence in organizations. Unfortunately, those who are most knowledgeable about this behavior and thereby best suited to report it to authorities—the complicit members themselves—are susceptible to unique pressures that often discourage them from blowing the whistle. Team members rely on their teammates for relational and other beneficial resources, making it more difficult to potentially break those ties by snitching. However, we argue that the pressure to stay (...) silent is alleviated for members who are ostracized by their team members. Drawing on social exchange theory, we theorize that ostracism decreases positive affect and increases negative affect, decreasing individuals’ communion striving motivation and, in turn, increasing the propensity to blow the whistle. In Study 1, we examined the link between ostracism and whistleblowing utilizing a field sample of diverse employees surveyed over time. In Study 2, we built upon Study 1 and conducted a lab study to examine affect and communion striving motivation as serial mediators. Results were generally supportive of our arguments, although we did not find support for the mediating effect of negative affect. (shrink)

Language is the primary technology clinical ethicists use as they offer guidance about norms. Like any other piece of technology, to use the technology well requires attention, intention, skill, and knowledge. Word choice becomes a matter of professional practice. The Brief Report offers clinical ethicists several reasons for rejecting the phrase “aggressive care.” Instead, ethicists should consider replacing “aggressive care” with the adjacent concept of a “recovery-focused path.” The virtues of this neologism include: the opportunity to set aside the emotion (...) of “aggression,” the phrase’s accuracy when capturing the intention of the patient or their representative, and an unappreciated rhetorical force—and transparent logic—that arises when the patient’s recovery is unlikely. (shrink)

We define a generic Vopěnka cardinal to be an inaccessible cardinal \ such that for every first-order language \ of cardinality less than \ and every set \ of \-structures, if \ and every structure in \ has cardinality less than \, then an elementary embedding between two structures in \ exists in some generic extension of V. We investigate connections between generic Vopěnka cardinals in models of ZFC and the number and complexity of \-Suslin sets of reals in models (...) of ZF. In particular, we show that ZFC + is equiconsistent with ZF + \\) where \ is the pointclass of all \-Suslin sets of reals, and also with ZF + \\) + \\) where \ is the least ordinal that is not a surjective image of the reals. (shrink)

This article shares reflections from members of the community of philosophers of education in the United States and Canada who were invited to express their insights in response to the theme ‘Snaps...

Despite the interpersonal nature of family meetings and the frequency in which they occur, the clinical ethics literature is devoid of any rich descriptions of what clinical ethicists should actually be doing during family meetings. Here, we propose a framework for describing and understanding “transitioning” facilitation skills based on a retrospective review of our internal documentation of 100 consecutive cases wherein a clinical ethicist facilitated at least one family meeting. The internal documents were analyzed using qualitative methodologies, i.e., “codes”, to (...) identify emergent themes. We identified four different transitioning strategies clinical ethicists use to reach a meaningful resolution. These transitioning strategies serve as a jumping-off point for additional analyses, future research, evaluating clinical ethics consultation, and overall performance improvement of a consultation service. (shrink)

Every clinical ethics consultant, no matter their own spirituality, will meet patients, families, and healthcare professionals whose spiritualities anchor their moral worldviews. How might ethicists respond to those who rely on spirituality when making medical decisions? And further, should ethicists incorporate their own spiritual commitments into their clinical analyses and recommendations? These questions prompt reflection on foundational issues in the philosophy of medicine, political and moral theory, and methods of proper clinical ethics consultation. Rather than attempting to offer definitive answers (...) to these questions, this essay prompts readers to consider their own answers to these questions. Specifically, it offers a taxonomic analysis of six (6) distinct responses: assessment, delegation, examination, translation, incorporation, and assertion. Furthermore, this essay describes the role of the ethicist’s own spiritual commitments during the responses. Each section also names several strengths and weaknesses that ethicists ought to consider when evaluating the purpose and scope of each response. This paper prompts readers to consider circumstances under which they might promote, critique, or incorporate spiritual worldviews—their own and those of their patients—when offering clinical analyses and recommendations. (shrink)

We give a level-by-level analysis of the Weak Vopěnka Principle for definable classes of relational structures ( $\mathrm {WVP}$ ), in accordance with the complexity of their definition, and we determine the large-cardinal strength of each level. Thus, in particular, we show that $\mathrm {WVP}$ for $\Sigma _2$ -definable classes is equivalent to the existence of a strong cardinal. The main theorem (Theorem 5.11) shows, more generally, that $\mathrm {WVP}$ for $\Sigma _n$ -definable classes is equivalent to the existence of (...) a $\Sigma _n$ -strong cardinal (Definition 5.1). Hence, $\mathrm {WVP}$ is equivalent to the existence of a $\Sigma _n$ -strong cardinal for all $n<\omega $. (shrink)

In 1924 Banach and Tarski demonstrated the existence of a paradoxical decomposition of the 3-ball B, i.e., a piecewise isometry from B onto two copies of B. This article answers a question of de Groot from 1958 by showing that there is a paradoxical decomposition of B in which the pieces move continuously while remaining disjoint to yield two copies of B. More generally, we show that if n ≥ 2, any two bounded sets in.

Scale is a contested concept in human geography fostering debates and contestation that have escalated to the point where some have argued for the term to be expunged from the geographical lexicon. Yet, despite the importance of scale in the geography of religion, the scalar debates in human geography have only rarely penetrated the conceptual base of the sub-discipline. This article addresses the scale debate through a case study of adherents in three churches in West Virginia, USA. The study explores (...) these highly theoretical scalar issues through an empirical analysis of adherents, congregations and denominational leaders. A critical realist framework of emergence is used to demonstrate the value of a stratified, non-reductionist approach to the geography of religion. An emergent geography of religion is considered alongside other forms of religious social analysis such as poststructural ‘crossings and dwellings’ and actor network theory, and the role of critical realism in the broader scale debates in geography is evaluated. (shrink)

For forty years, beginning with the publication of the first modern English translation of the Dialogue Concerning the Two Chief World Systems, Stillman Drake was the most original and productive scholar of Galileo's scientific work of our age. During that time, he published sixteen books on Galileo, including translations of almost all the major writings, and Galileo at Work, the most comprehensive study of Galileo's life and works ever written. His collection Discoveries and Opinions on Galileohas remained in print since (...) its appearance in 1957 and has become the most widely read of all books on Galileo. In addition to his books, Drake published about 130 papers, of which nearly 100 are on Galileo and the rest on related aspects of the history and philosophy of science. This three-volume collection includes eighty of those papers. Drake's papers are an essential supplement to his translations and other books because it was in his papers that he wrote his most detailed technical studies of Galileo's scientific work. There is hardly a subject in Galileo's science that is not considered. Perhaps the most important is the series on mechanics and motion, in which Drake analysed Galileo's manuscript notes recording the experiments by which he discovered and confirmed the law of the acceleration of falling bodies. There are also papers on the notes in which Galileo recorded his discovery of Jupiter's satellites and on other aspects of Galileo's astronomy, including his defence of the Copernican theory. Other papers consider Galileo's life and scientific work in general, exploring what Drake calls the 'scientific personality' of Galileo along with his scientific method and philosophy of science. In addition to the papers on Galileo, there are a number of papers on medieval and early modern science, principally on mechanics, and on the philosophers A.B. Johnson and J.B. Stallo, both of whom influenced Drake's own philosophy of science. (shrink)

We show that the statement “every universally Baire set of reals has the perfect set property” is equiconsistent modulo ZFC with the existence of a cardinal that we call virtually Shelah for supercompactness. These cardinals resemble Shelah cardinals and Shelah-for-supercompactness cardinals but are much weaker: if $0^\sharp $ exists then every Silver indiscernible is VSS in L. We also show that the statement $\operatorname {\mathrm {uB}} = {\boldsymbol {\Delta }}^1_2$, where $\operatorname {\mathrm {uB}}$ is the pointclass of all universally Baire (...) sets of reals, is equiconsistent modulo ZFC with the existence of a $\Sigma _2$ -reflecting VSS cardinal. (shrink)

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits have been shown to benefit from serious games.Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients (...) with gambling disorder. Preliminary results from a pilot sample are also reported.Method: A pilot sample of 26 patients undergoing treatment for GD was recruited. Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate and heart rate variability data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia.Results and Discussion: e-Estesia performed comparatively well for all the explored groups. Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men. (shrink)

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated (...) in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status. (shrink)

Mr. M is an eighty-five-year-old who presented to the hospital with congestive heart failure exacerbation, pneumonia, altered mental status, and sepsis. A physician determines that he lacks capacity, and the team in the intensive care unit looks to the patient's daughter, Celia, as his surrogate decision-maker because she is named as an agent in his medical power of attorney form. While in the ICU, Mr. M suffers acute respiratory distress secondary to pneumonia and thus requires intubation. Celia accepts several life-sustaining (...) interventions, but she sporadically refuses other medically indicated therapies. Although providers explain the importance of the ICU insulin regimen for glucose control, she either refuses the insulin or requests a lower dose. The health care team believes that it is providing substandard care and that Celia's medical decisions are not in the patient's best interests, so they request an ethics consultation. When the clinical ethicist attempts to talk with Celia, she refuses to speak with him, saying flatly, “I am not interested in talking with you.” The clinical ethicist meets with Celia on a couple of occasions, but she consistently refuses to have a conversation with him. He wonders if the patient's surrogate decision-maker can refuse a clinical ethics consultation and is unsure what his next steps should be. (shrink)