In their thoughtful article, Malm and Navin (2020) raise concerns about a potentially unjust generational welfare tradeoff between children and adults when it comes to chicken pox. We share their c...

BackgroundECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO (...) clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations.MethodsAn online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic.ResultsWhen initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%).ConclusionsWe found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic. (shrink)

In their target article, Childress et al provide a detailed analysis of dilemmas arising from disagreement between an ICU team and a competent patient (Mr J) about dis/continuation of extra-corpore...

Many real-world agents recognise that they impose harms by choosing to emit carbon, e.g., by flying. Yet many do so anyway, and then attempt to make things right by offsetting those harms. Such offsetters typically believe that, by offsetting, they change the deontic status of their behaviour, making an otherwise impermissible action permissible. Do they succeed in practice? Some philosophers have argued that they do, since their offsets appear to reverse the adverse effects of their emissions. But we show that (...) they do not. In practice, standard carbon offsetting does not reverse the harms of the original action, nor does it even benefit the same group as was harmed. Standard moral theories hence deny that such offsetting succeeds. Indeed, we show that any moral theory that allows offsetting in this setting faces a dilemma between allowing any wrong to be offset, no matter how grievous, and recognising an implausibly sharp discontinuity between offsettable actions and non-offsettable actions. The most plausible response is to accept that carbon offsetting fails to right our climate wrongs. (shrink)

The title of Outsider Theory is artfully contrived. By the end of the book, it figures as a near tautology, for Jonathan Eburne here contributes to the study of knowledge production a disclosure of high theory’s intimacy with unrespectable systems of ideas. These systems include the outsider science of Velikovsky’s Worlds in Collision, the amalgam of outsider science and the pick’n’mix theology that is Scientology, and gnostic fictions that tease with a key to all mysteries such as The Da Vinci (...) Code. The book’s first origin story, one out of many, is related in its Preface, with Eburne’s purchase of a large library of popular esoterica, “hundreds upon hundreds of titles” found on Craigslist; this library was... (shrink)

A festschrift for Dorothy Edgington, containing contributions from Cleo Condoravdi, Dorothy Edgington, Kit Fine, Alan Hájek, John Hawthorne, Sabine Iatridou, Nick Jones, Rosanna Keefe, Angelika Kratzer, David Over, Daniel Rothschild, Robert Stalnaker, Scott Sturgeon, and Timothy Williamson.

A recent article published in Nursing Ethics, written by Professor Bridgit Dimond, highlighted the topic of noncompliance by patients and attention was drawn to a number of issues relevant to health care professionals. In this response, some specific challenges facing nurses are considered in the light of Professor Dimond’s arguments. In doing so, the notion of compliance as an appropriate concept in modern nursing practice is questioned. The recommendations to emerge include strategies to consider patient response to treatment regimens in (...) the form of adherence to health care advice through negotiated therapy. The claimed benefits of health care recommendations are considered and caution about iatrogenesis is advised. (shrink)

The 2014 Tanner Symposium features a panel of speakers discussing current research in the areas of volition and self-control and the effects of that research for issues of public policy.

A phenomenological hermeneutic study of the lifeworld of critical care nursing was undertaken, from which emerged the concept of ‘focusing’. Focusing is defined as empathizing concern for the critically ill person and his/her family amid the high technology of the intensive care unit. When nurses focus on the patient and the patient's family they are able to empathize with die personal dimensions of caring. The study used a phenomenological hermeneutic approach to describe die nature of the lived experience of clinical (...) nursing practice in a high technology environment. (shrink)

An attempt is made in this paper to analyze the purely formal nature of information-theoretic concepts. The suggestion follows that such concepts, used to supplement the logical and mathematical structure of the language of science, represent an addition to this language of such a sort as to allow the use of a unitary language for the description of phenomena. (The alternative to this approach must be certain multi-linguistic and mutually untranslatable descriptions of related phenomena, as with the various versions of (...) Complementarity). This conception is tested for the specific case of Heisenberg's Uncertainty Principle, in order to show that, with the assumption of a suitable and intuitively satisfactory definition of the quantity of information contained in a measurement, the Heisenberg Principle becomes an informational restriction arising from the formal properties of the symbols of a given language rather than as a "law" of nature. (shrink)

Background In the early stages of the COVID-19 pandemic, many health systems, including those in the UK, developed triage guidelines to manage severe shortages of ventilators. At present, there is an insufficient understanding of how the public views these guidelines, and little evidence on which features of a patient the public believe should and should not be considered in ventilator triage. Methods Two surveys were conducted with representative UK samples. In the first survey, 525 participants were asked in an open-ended (...) format to provide features they thought should and should not be considered in allocating ventilators for COVID-19 patients when not enough ventilators are available. In the second survey, 505 participants were presented with 30 features identified from the first study, and were asked if these features should count in favour of a patient with the feature getting a ventilator, count against the patient, or neither. Statistical tests were conducted to determine if a feature was generally considered by participants as morally relevant and whether its mean was non-neutral. Results In Survey 1, the features of a patient most frequently cited as being morally relevant to determining who would receive access to ventilators were age, general health, prospect of recovery, having dependents, and the severity of COVID symptoms. The features most frequently cited as being morally irrelevant to determining who would receive access to ventilators are race, gender, economic status, religion, social status, age, sexual orientation, and career. In Survey 2, the top three features that participants thought should count in favour of receiving a ventilator were pregnancy, having a chance of dying soon, and having waited for a long time. The top three features that participants thought should count against a patient receiving a ventilator were having committed violent crimes in the past, having unnecessarily engaged in activities with a high risk of COVID-19 infection, and a low chance of survival. Conclusions The public generally agreed with existing UK guidelines that allocate ventilators according to medical benefits and that aim to avoid discrimination based on demographic features such as race and gender. However, many participants expressed potentially non-utilitarian concerns, such as inclining to deprioritise ventilator allocation to those who had a criminal history or who contracted the virus by needlessly engaging in high-risk activities. (shrink)

This article analyses the results of a series of interviews conducted among leading firms in agrofood designed to assess the strategic importance of biotechnologies. Earlier analyses have emphasized either the revolutionary character of these technologies or the ability of oligopoly structure to contain the potential within existing market patterns. Our interviews would suggest that biotechnologies must be situated within the shift to a demand oriented food system. This has led on the on hand to a preoccupation with quality rather than (...) cost-cutting applications. It has also highlighted the inter-connectedness of the different phases of the agrofood system, since the incentive and the capacity to introduce innovations at any one point in the system depends on their acceptability to other actors in the agrofood chain.Biotechnologies have now become integrated into the competitive strategies of the leading actors but they remain ambiguously placed within the emerging “biotechnology” paradigm. The peculiarities of the agrofood system and the limitations of its industrialization have opened the way to strong consumer pressure based on the demand for quality and “natural” food and agriculture. It remains to be seen whether advanced biotechnologies can be assimilated within these priorities. (shrink)

Nurses involved in research are concerned with methodological issues. This paper explores the Cartesian debate that has polarized the discourse on nursing research methodology. It is argued that methodologies exclusively based on objectivism, one pole of the Cartesian debate, or subjectivism, the other, do not provide nurses with adequate research foundations to understand the complexity of the lifeworld of nursing practice. This paper provides nurse researchers with an alternative methodological perspective, Gadamerian hermeneutics, which is in harmony with the clinical world (...) of nursing practice. (shrink)

Mitochondrial replacement techniques have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer and Maternal Spindle Transfer. It examines how questions of identity impact (...) on the ethical evaluation of each technique and argues that there is an important difference between the two. PNT, it is argued, is a form of therapy based on embryo modification while MST is, instead, an instance of selective reproduction. The article's main ethical conclusion is that, in some circumstances, there is a stronger obligation to use PNT than MST. (shrink)