Construction of the eukaryotic ribosome is a complex process in which a nascent ribosomal RNA (rRNA) emerging from RNA Polymerase I hierarchically folds into a native three‐dimensional structure. Modular assembly of individual RNA domains through interactions with ribosomal proteins and a myriad of assembly factors permit efficient disentanglement of the error‐prone RNA folding process. Following these dynamic events, long‐range tertiary interactions are orchestrated to compact rRNA. A combination of genetic, biochemical, and structural studies is now providing clues into how a (...) nascent rRNA is transformed into a functional ribosome with high precision. With this essay, we aim to draw attention to the poorly understood process of establishing correct RNA tertiary contacts during ribosome formation. (shrink)

Social media companies commonly design their platforms in a way that renders them addictive. Some governments have declared internet addiction a major public health concern, and the World Health Organization has characterized excessive internet use as a growing problem. Our article shows why scholars, policy makers, and the managers of social media companies should treat social media addiction as a serious moral problem. While the benefits of social media are not negligible, we argue that social media addiction raises unique ethical (...) concerns not raised by other, more familiar addictive products, such as alcohol and cigarettes. In particular, we argue that addicting users to social media is impermissible because it unjustifiably harms users in a way that is both demeaning and objectionably exploitative. Importantly, the attention-economy business model of social media companies strongly incentivizes them to perpetrate this wrongdoing. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in all three subjects combined (...) comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

Progress in psychological science can be limited by a number of factors, not least of which are the starting assumptions of scientists themselves. We believe that some influential accounts of autism rest on a questionable assumption that many of its behavioral characteristics indicate a lack of social interest – an assumption that is flatly contradicted by the testimony of many autistic people themselves. In this article, we challenge this assumption by describing alternative explanations for four such behaviors: low levels of (...) eye contact, infrequent pointing, motor stereotypies, and echolalia. The assumption that autistic people's unusual behaviors indicate diminished social motivation has had profound and often negative effects on the ways they are studied and treated. We argue that understanding and supporting autistic individuals will require interrogating this assumption, taking autistic testimony seriously, considering alternative explanations for unusual behaviors, and investigating unconventional – even idiosyncratic – ways in which autistic individuals may express their social interest. These steps are crucial, we believe, for creating a more accurate, humane, and useful science of autism. (shrink)

Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the (...) overall impact of health policy. This chapter considers what weight health policy should give to its “spill-over effects,” namely non-health and indirect benefits. (shrink)

Autistic children do not consistently show conventional signs of social engagement, which some have interpreted to mean that they are not interested in connecting with other people. If someone does not act like they are interested in connecting with you, it may make it difficult to feel connected to them. And yet, some parents report feeling strongly connected to their autistic children. We conducted phenomenological interviews with 13 mothers to understand how they experienced connection with their 5- to 14-year-old nonspeaking (...) autistic children. Mothers of nonspeaking autistic children represent a unique group in which to study connection because their children both may not seem interested in connecting with them and have limited ability to communicate effectively using speech, a common way people connect with each other. The mothers in this study interpreted a range of child behaviors—some unconventional, but many conventional—as signs that their children were interested in connecting with them, (re)framed child behaviors that could undermine connection as caused by factors unrelated to the relationship, and expressed several convictions that may help build and sustain connection in the face of uncertainty about the meaning of their children’s behavior. Even though their autistic children may not consistently act in conventional socially oriented ways, these mothers reported perceiving their children’s behavior as embedded within an emotionally reciprocal relationship. (shrink)

Brands are widely regarded as a constellation of shared associations surrounding a company and its offerings. On the traditional view of brands, these associations are regarded as perceptions and attitudes in consumers’ minds in relation to a company. We argue that this traditional framing of brands faces an explanatory problem: the inability to satisfactorily explain why certain branding activism initiatives elicit the moralized reactive attitudes that are paradigmatic responses to wrongdoing. In this paper, we argue for a reframing of brands (...) that calls for viewing brands as a series of normatively binding expectations that are ethically akin to promises. Our promissory framing of brands avoids the explanatory problem, illuminates a number of ethical requirements on branding, and reconceptualizes the role of brand managers. (shrink)

This article proposes a novel strategy, one that draws on insights from antidiscrimination law, for addressing a persistent challenge in medical ethics and the philosophy of disability: whether health systems can consider quality of life without unjustly discriminating against individuals with disabilities. It argues that rather than uniformly considering or ignoring quality of life, health systems should take a more nuanced approach. Under the article's proposal, health systems should treat cases where quality of life suffers because of disability-focused exclusion or (...) injustice differently from cases where lower quality of life results from laws of nature, resource scarcity, or appropriate tradeoffs. Decisionmakers should ignore quality-of-life losses that result from injustice or exclusion when ignoring them would improve the prospects of individuals with disabilities; in contrast, they should consider quality-of-life losses that are unavoidable or stem from resource scarcity or permissible tradeoffs. On this proposal, while health systems should not amplify existing injustice against individuals with disabilities, they are not required to altogether ignore the potential effects of disability on quality of life. (shrink)

We've outsourced too much of our thinking. How do we get it back? At the height of the 2014 Ebola epidemic, a man who had recently returned from West Africa with a fever and severe abdominal pain entered a hospital in Dallas--and was sent home. Even after healthcare workers learned their patient had come from Liberia, ground zero of the Ebola hot zone, not one of those treating him considered the deadly virus as a possible cause of his condition. Shortly (...) after the man died, one of the nurses who had treated him sought clearance from the Centers for Disease Control to board a commercial flight. She reported a fever of 99.5 degrees, but because the protocol restricted travel at 100.4 degrees or higher, she was cleared. She was later confirmed to be infected with Ebola. A public health disaster akin to the one depicted in the movie Contagion was averted, but only by sheer luck. How could this happen? As Harvard lecturer and global trend watcher Vikram Mansharamani shows in this eye-opening and perspective-shifting book, our complex, data-flooded world has made us ever more reliant on experts, protocols, and technology. We've stopped thinking for ourselves. (Have you ever followed your GPS device to a deserted parking lot?) With stark and compelling examples drawn from business, sports, and everyday life, the author illustrates how in a very real sense we have outsourced too much of our thinking, relinquishing our autonomy. Of course, experts, protocols, and computer-based systems are essential to helping us make informed decisions. What we need is a new approach for integrating these information sources more effectively, harnessing the value they provide without undermining our own autonomy. The author provides principles and techniques for doing just that, empowering readers with a more critical and nuanced approach to making decisions. Think for Yourself is an indispensable guide for those looking to restore self-reliant thinking in a data-driven and technology-dependent yet overwhelmingly uncertain world. (shrink)

When an employee’s off-duty conduct generates mass social media outrage, managers commonly respond by firing the employee. This, I argue, can be a mistake. The thesis I defend is the following: the fact that a firing would occur in a mass social media outrage context brought about by the employee’s off-duty conduct generates a strong ethical reason weighing against the act. In particular, it contributes to the firing constituting an inappropriate act of blame. Scholars who caution against firing an employee (...) for off-duty conduct have thus far focused primarily on due process related issues or legal concerns pertaining to free speech, lifestyle discrimination, and employment at-will. However, these concerns amount to only a partial, and contingent, diagnosis of what is at issue. I argue that even when due process considerations are met, firings in these contexts can be unjustified. Moreover, even if a business is not concerned with the unethical conduct per se, but is rather strictly concerned with PR, the argument I advance nevertheless provides one important ethical reason that counts against firings in mass social media outrage contexts. Given that managers are often under significant pressure to respond swiftly in cases where an employee is at the center of mass social media outrage, it is especially important that scholars begin to clarify the normative issues. This article builds on the burgeoning philosophical literature on the ethics of blame and provides a novel account of a distinctive ethical concern that arises with firings in mass social media outrage contexts. (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.

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)

Initial vaccine allocations for the coronavirus disease 2019 (COVID-19) will be limited. It is crucial to assess the ethical values associated with different methods of allocation, as well as important scientific and practical questions. This Viewpoint identifies three ethical values, benefiting people and limiting harm; prioritizing disadvantaged populations; and equal concern for all. It then explains why these values support prioritizing three groups: health care workers; other essential workers and people in high-transmission settings; and people with medical vulnerabilities associated with (...) poorer COVID-19 outcomes. In contrast, two other groups, people over 65 without medical vulnerabilities and participants in clinical research, present more complex ethical questions. This prioritization also encompasses valuing direct benefits to vaccinated individuals, indirect benefits to individuals protected from spread of infection, and indirect health and socioeconomic benefits to those protected from harm as health system and societal functioning improve. Vaccine allocation that recognizes important ethical values and avoids arbitrariness, waste, and corruption can ensure that the distribution of a COVID-19 vaccine is both fair and perceived as fair. (shrink)

Certifications of immunity are sometimes called “immunity passports” but are better conceptualized as immunity-based licenses. Such policies raise important questions about fairness, stigma, and counterproductive incentives but could also further individual freedom and improve public health. Immunity licenses should not be evaluated against a baseline of normalcy, ie, uninfected free movement. Rather, they should be compared to the alternatives of enforcing strict public health restrictions for many months or permitting activities that could spread infection, both of which exacerbate inequalities and (...) impose serious burdens. This Viewpoint presents a framework for analyzing the ethics of immunity licenses. (shrink)

Employment-at-will (EAW) is the legal presumption that employers and employees may terminate an employment relationship for any or no reason. Defenders of EAW have argued that it promotes autonomy and efficiency. Critics have argued that it allows for the domination, subordination, and arbitrary treatment of employees. We intervene in this debate by arguing that the case for EAW is contextual in a way that existing business ethics scholarship has not considered. In particular, we argue that the justifiability of EAW for (...) a given jurisdiction depends on existing complementarities among the institutions that constitute the jurisdiction’s political economy. Notably, our view takes seriously the ethical concerns EAW critics have raised by showing how these concerns can be mitigated through public policy measures that do not require eliminating EAW. (shrink)

In one of his earliest dialogues, the Soliloquia, Augustine identifies the liberal arts (disciplinae) with truth (veritas), and employs this somewhat puzzling identification as a premise in his infamous proof of the immortality of the soul (Sol. 2.24). In this paper, I examine Augustine’s argument for this peculiar identification. Augustine maintains both (1) that the constituent propositions of the liberal arts are true, and (2) that the liberal art of dialectic (disciplina disputandi) is the “truth through which all disciplines are (...) true” (Sol. 2.21). I argue that Augustine identifies the liberal arts with truth because (1) the constituent propositions of the liberal arts are learned, and (2) dialectic’s structure is essential to the liberal arts. I further suggest that the subject matter of each liberal art reflects a distinct segment of intelligible reality, that is, the realm of the intelligible Forms. (shrink)

In this short response to Kerstein and Bognar, we clarify three aspects of the complete lives system, which we propose as a system of allocating scarce medical interventions. We argue that the complete lives system provides meaningful guidance even though it does not provide an algorithm. We also defend the investment modification to the complete lives system, which prioritizes adolescents and older children over younger children; argue that sickest-first allocation remains flawed when scarcity is absolute and ongoing; and argue that (...) Kerstein and Bognar are mistaken to base their allocation principles on differences in personhood. (shrink)

Underdetermination of theory choice claims that empirical evidence fails to provide sufficient grounds for choosing a theory over its rivals. We explore the epistemological and methodological significance of this thesis by utilising a classificatory scheme to situate three arguments that purport to establish its plausibility. Proponents of these three arguments, W.V.O Quine, John Earman, and Kyle Stanford, use different premises to arrive at the conclusion that theory choice is empirically underdetermined and their classification along the proposed schema brings out the (...) variety in underdetermination arguments and the historical trajectory of the thesis. Although the epistemological significance of underdetermination—it is seen as undermining the doctrine of scientific realism—is widely discussed in the literature, Quine understood the acceptance of the thesis as interrogating the attitude one is justified in adopting towards rival theories. We argue that sticking with one’s own theory in the face of underdetermination leads to a distinct type of disagreement, which we present as the methodological significance of underdetermination. The examination of the methodological significance of underdetermination allows us to propose weak underdetermination as a philosophically interesting variant of underdetermination. (shrink)

Proceedings of the National Seminar on "Dharmaśāstra and Human Rights" held at University of Pune during 22-24 March 2010.

Papers presented at the National Seminar on 'Indian Hermeneutics : Theory and Application', held at Centre of Advanced Study in Sanskrit, University of Pune during 11-13 January 2011.

NEMO means Network Mobility which is the extension of Mipv6 and it is invented for accessing internet for the group of people when they are travelling in Vehicle as Network group. During handoff while exchanging Binding Updates between the Mobile Network Node, Correspondent Node and Home Agent, many security threats are present during those messages exchange. It may prone to several standard malicious attacks on the BU and Binding Acknowledgement. An efficient end-to-end security method is required to protect the BU (...) Exchange between MNN, HA and CN. In this paper, a secure architecture is proposed to provide authentication and confidentiality at each level of communication using a 3-Party Key Exchange called 3-PKE-NEMO with the help of Bilinear Pairing Theorem. Handoff delay is reduced without compromising security strength. The whole experimentation of this proposed work is carried out using NS2 simulation tool and authentication proof is given using BAN logic between all the nodes in NEMO. The proposed security architecture is compared with related existing solutions and found to be more secure. (shrink)

Consistent and well-designed frameworks for ethical oversight enable socially valuable research while forestalling harmful or poorly designed studies. I suggest some alterations that might strengthen the valuable checklist Rattani & Hyder propose for the ethical review of health policy and systems research (HPSR), or prompt future work in the area.

-/- This chapter evaluates the ethical issues that using cost-effectiveness considerations to set animal health priorities might present, and its conclusions are cautiously optimistic. While using cost-effectiveness calculations in animal health is not without ethical pitfalls, these calculations offer a pathway toward more rigorous priority-setting efforts that allow money spent on animal well-being to do more good. Although assessing quality of life for animals may be more challenging than in humans, implementing prioritization based on cost-effectiveness is less ethically fraught.

This correspondence piece responds to commentaries on the authors' survey of U.S. bioethicists. The authors address two key questions: the definition of a bioethicist and how bioethics should evolve. They identify four distinct roles bioethicists occupy: researchers, pedagogues, consultants, and advocates/activists. The article examines various aspects of inclusiveness in bioethics - demographic, viewpoint, methodological, and topical - while acknowledging inherent tensions and trade-offs between them. For example, including religiously or geographically diverse voices may conflict with other inclusivity goals. The authors (...) argue that while demographic inclusiveness is crucial, other forms of inclusiveness require careful consideration of trade-offs and empirical research to assess their impacts. They emphasize the need for systematic research on bioethicists' beliefs and reasoning, particularly regarding complex issues like disability and racial health disparities. The piece concludes by calling for continued dialogue and better funding for empirical research on ethical perspectives across different groups. (shrink)

Why do organizations conduct job interviews? The traditional view of interviewing holds that interviews are conducted, despite their steep costs, to predict a candidate’s future performance and fit. This view faces a twofold threat: the behavioral and algorithmic threats. Specifically, an overwhelming body of behavioral research suggests that we are bad at predicting performance and fit; furthermore, algorithms are already better than us at making these predictions in various domains. If the traditional view captures the whole story, then interviews seem (...) to be a costly, archaic human resources procedure sustained by managerial overconfidence. However, building on T. M. Scanlon’s work, we offer the value of choice theory of interviewing and argue that interviews can be vindicated once we recognize that they generate commonly overlooked kinds of noninstrumental value. On our view, interviews should thus not be entirely replaced by algorithms, however sophisticated algorithms ultimately become at predicting performance and fit. (shrink)

This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to drop their (...) financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care. -/- . (shrink)

In this paper, we argue that if a set of plausible conditions obtain, then driving a standard vehicle rather than riding in an autonomous vehicle (AV) will become analogous to driving drunk rather than driving sober, and therefore impermissible. In addition, we argue that a ban on the production, sale, and purchase of new standard vehicles would also become justified. We make this case in part by highlighting that the central reasons typically offered in support of state-mandated vaccination will also (...) support mandating AV use. Finally, we discuss some of the implications of our argument for the obligations of vehicle-producing firms. (shrink)

Ethical workplace climate has been extensively researched in the for-profit context but neglected in nonprofits. Perhaps because nonprofits promote shared values, engage with people, and implement development interventions creating public good, they are considered implicitly ethical. This assumption has been questioned in recent studies. We attempted to develop a psychometrically valid scale measuring ethical workplace climate following a sequential research design to fill this gap. We interviewed 74 employees from 30 nonprofit organizations using the critical incident technique to generate statements (...) on ethical workplace climate. The statements generated were categorized with expert judges' help, followed by a survey of 507 nonprofit employees across India. The exploratory factor analysis (EFA) and subsequent confirmatory factor analysis (CFA) resulted in a 43-item scale, further reduced to 26 items using stepwise regression. Results of subsequent application of EFA and CFA confirmed a four-factor solution: self-interest, collegiality, internal legitimacy, and stewardship. A follow-up study of 243 members of nonprofit organizations confirmed the hypothesized relationships that ethical work climate has a significant effect on affective commitment and job engagement. Finally, we discussed our findings along theoretical contributions, implications, limitations, and future direction. (shrink)

fusion theory challenges efforts to see theory as inhibiting by presenting an approach that is innovative, eclectic, and subtle in order to draw out competing and constellating ideas and opinions. This collected volume of essays examines fusion theory and demonstrates how the theory can be applied to the reading of various works of Indian English novelists.

In response to the 32 commentaries, we clarify and extend two of the central arguments in our target article: Social motivation is a dynamic, emergent process, not a static characteristic of individuals, and autistic perspectives are essential to the study of autistic social motivation. We elaborate on how taking these two arguments seriously can contribute to a more accurate, humane, and useful science of autism.

In response to the significant increase of judgment and judgmentalism in contemporary film and television, 'A Critique of Judgment in Film and Television' investigates the evolving connections between the aesthetics and ethics of judgment. The volume ultimately contemplates whether we should, and can, do without judgment, questions that are just the beginning of a much-needed re-examination. The individual contributions of the collection all work towards a very specific focus on judgment that is unprecedented in its transdisciplinary composition and contemporary relevance. (...) By exploring examples of entertainment that aim to instigate judgment, 'A Critique of Judgment in Film and Television' advances the as yet underdeveloped area of research into television and philosophy. (shrink)

Recent disputes over whether older people should pay more for health insurance, or receive lower priority for transplantable organs, highlight broader disagreements regarding the legality of using age-based criteria in health care. These debates will likely intensify given the changing age structure of the American population and the turmoil surrounding the financing of American health care. This Article provides a comprehensive examination of the legality and normative desirability of age-based criteria. I defend a distributive justice approach to age-based criteria and (...) contrast it with two prevailing theoretical approaches to age-based criteria, nondiscrimination and discretion. I propose a detailed normative framework for the use of age-based criteria in health care, the lifetime justice approach, that considers the future life patients can gain from treatment and the past years of life they already have experienced. -/- This paper is available by open access from the Boston College Law School Digital Commons. (shrink)

We argue that the ethical case for instituting vaccine benefit programs is justified by 2 widely recognized values: (1) reducing overall harm from COVID-19 and (2) protecting disadvantaged individuals. We then explain why they do not coerce, exploit, wrongfully distort decision-making, corrupt vaccination's moral significance, wrong those who have already been vaccinated, or destroy willingness to become vaccinated. However, their cost impacts and their effects on public perception of vaccines should be evaluated.

On the life and philosophy of Śaṅkarācārya.

In this commentary, I critique three aspects of Emily Walsh's proposal to reduce the moral and legal weight of advance directives: (1) the ambiguity of its initial thesis, (2) its views about the ethics and legality of clinical practice, and (3) its interpretation and application of Ronald Dworkin’s account of advance directives and L.A. Paul's view on transformative experience. I also consider what Walsh’s proposal would mean for people facing the prospect of dementia. I conclude that our reasons to honor (...) many advance directives survive the move to a transformative experience framework. (shrink)

We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...) daily lives (e.g., home ventilation) present to acute care hospitals, their personal ventilators should not be reallocated to other patients. Fifth, designate triage officers to assess patients individually on the basis of objective medical evidence, not stereotypes or assumptions. Sixth, include disability rights advocates in policy development and dissemination. (shrink)

Although consumers increasingly claim to demand ethical products and state that they are willing to reward firms that are ethical, studies have highlighted that there is a significant gap between consumers’ explicit attitudes toward ethical products and their actual purchase behavior. This has major implications for firm policies revolving around business ethics. This research contributes to the understanding of the attitude–behavior gap in ethical consumption that literature has identified but not explored much. We utilize the model of dual attitudes as (...) a basis for the arguments presented in the paper and test them. We suggest that the gap in ethical consumerism exists because individuals have implicit as well as explicit attitudes, which are impacted differentially by stimuli and elicit dissimilar behavioral responses and thus have different implications for business ethics policies. Two longitudinal studies are conducted to better understand the impact of an individual’s dual attitudes on preferences and choice. Our findings support the presence of dual attitudes in consumers. Explicit attitudes are found to be easily influenced by the nature of the stimuli. On the other hand, implicit attitudes are relatively unaffected by the nature of the stimuli present and remain relatively constant. Based on the findings, implicit attitudes guide behavior and determine an individual’s preferences. Even though explicit attitudes react to the stimuli presented, our findings suggest they have no impact on the choice of consumers. These findings improve the understanding of ethical consumption, provide a reason as to why the attitude–behavior gap exists, provide a foundation for future researchers and help firms better understand the impact of perceived business on creating a behavioral shift in ethical consumption. (shrink)

In this Commentary, I propose an ethical framework for ethical discussions around the allocation of scarce resources in COVID-19 response. The framework incorporates four principles: beneficence (benefiting people by saving lives or years of life), equality, remedying disadvantage, and recognizing past conduct. I then discuss how the framework interacts with ethical constraints against using people as a mere means and against causing death. The commentary closes by criticizing the equation of deontological ethics with random or first-come, first-served allocation and of (...) allocation that aims to save more lives or years of life with utilitarianism.. (shrink)

We provide evidence on the effects of criminal/corrupt politicians on firm performance and investments in their constituencies. Using a regression discontinuity approach, we focus on close parliamentary elections in India to establish a causal link between election of criminal-politicians and firms’ stock-market performance and investment decisions. Election of criminal-politicians leads to lower election-period and project-announcement stock-market returns for private-sector firms with economic ties to the district. There is a significant decline in total investment and employment by private-sector firms in criminal-politician (...) districts. Interestingly, decline in private-sector investment is largely offset by a roughly equivalent increase in investment by state-owned firms. (shrink)

Recognizing that offers of payment to research participants can serve various purposes—reimbursement, compensation, and incentive—helps uncover differences between participants that can justify differential payment of participants within the same study. Participants with different study-related expenses will need different amounts of reimbursement to be restored to their pre-participation financial baseline. Differential compensation can be acceptable when some research participants commit more time or assume greater burdens than others, or if inter-site differences affect the value of compensation. Finally, it may be permissible (...) to offer differential incentive payments if necessary to advance a study’s goals. We encourage investigators and Institutional Review Boards to think not only about whether to offer payment, in what amounts, and for what purpose, but also to consider whether differential payment can help promote the scientific and ethical goals of clinical research. (shrink)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between death (...) or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

In 2017, Americans spent over $3.4 trillion-nearly 18% of gross domestic poduct-on health care. This spending is unevenly distributed: Almost a quarter is spent on the costliest 1% of patients, and almost half on the costliest 5%. Most of these patients soon return to a lower percentile, but many continue to incur health care costs in the top percentiles year after year. This Article focuses on the challenges that persistently expensive patients present for health law and policy, and how fairly (...) dividing their medical costs among payers illuminates fundamental normative choices about the design and reform of health insurance. In doing so, this Article draws on bioethical and health policy analyses of the fair distribution of medical costs, and examines how legal doctrine shapes health systems' options for responding to expensive patients. Part I of this Article discusses two real-world examples of expensive patients and the debate surrounding them, including the case of an Iowa teenager with hemophilia whose treatments cost more than $10 million per year. Part II then examines the normative question of how the costs of treating expensive patients' medical conditions should be shared and identifies three different dimensions of sharing: (1) scope, from narrow (plan members only) to broad (all of society); (2) boundedness, whether there are limits on the costs others can be asked to bear; and (3) progressivity, whether wealthier individuals are asked to bear more costs (similar to progressivity in tax). Part III then considers how health care reform choices could advance or hamper the adoption of broad, bounded, progressive sharing, with a focus on recent state-level reinsurance programs that legal scholarship has not yet analyzed in depth. -/- This Article contributes to the literature on health care reform in three interlocking ways. First, it develops a novel proposal for fairly sharing the cost of expensive patients' care that could usefully inform state- and federal-level policy discussions. Second, it provides a normative, rather than purely political or economic, analysis of existing and proposed options for sharing expensive patients' costs. Third, it bridges the disconnected literature on reinsurance, limit setting, and health care financing, identifying how proposals in these different areas intersect. (shrink)