Background: There is a growing need to offer appropriate services to persons with mild cognitive impairment and dementia who are faced with depression and anxiety distresses beyond traditional pharmacological treatment. Dance-based interventions as multi-dimensional interventions address persons' physical, emotional, social, and spiritual aspects of well-being. However, no meta-analysis of randomized controlled treatment trials has examined the effectiveness of dance-based interventions on depression and anxiety among persons with MCI and dementia, and the results of RCTs are inconsistent. The study aimed to (...) examine the effectiveness of dance-based interventions on depression and anxiety among persons with MCI and dementia.Methods: A systematic review with meta-analysis was conducted. The inclusion criteria were: population: people of all ages with MCI and dementia; intervention: dance-based interventions; control group: no treatment, usual care, or waiting list group; outcome: depression and anxiety; study design: published or unpublished RCTs. Seven electronic databases were searched from 1970 to March 2021. Grey literature and reference lists from relevant articles were also searched and reviewed. The Cochrane “Risk of Bias” tool was used to assess study quality. RevMan 5.4 was used for meta-analysis and heterogeneity was investigated by subgroup and sensitivity analysis. GRADE was applied to assess the evidence quality of depression and anxiety outcomes.Results: Five randomized controlled trials were identified. Sample sizes ranged from 21 to 204. The risk of bias was low, except for being rated as high or unclear for most included studies in two domains: allocation concealment, blinding participants and personnel. Meta-analysis of depression outcome showed no heterogeneity, indicating that the variation in study outcomes did not influence the interpretation of results. There were significant differences in decreasing depression in favor of dance-based interventions compared with controls [SMD = −0.42, 95% CI, p < 0.0001] with a small effect size ; Compared with the post-intervention data, the follow-up data indicated diminishing effects. Dance-based interventions were more effective in reducing depression for persons with dementia than with those having MCI, and were more effective with the delivery frequency of 1 h twice a week than 35 min 2–3 times a week. Also, one included RCT study showed no significant benefit on anxiety rating scores, which demonstrated small effect sizes at 6 weeks and 12 weeks. GRADE analysis indicated the evidence quality of depression was moderate, and the evidence quality of anxiety was low.Conclusions: Dance-based interventions are beneficial to alleviate depression among persons with MCI and dementia. More trials of high quality, large sample sizes are needed to gain more profound insight into dance-based interventions, such as their effects of alleviating anxiety, and the best approaches to perform dance-based interventions. (shrink)

It is human nature to try to recognize patterns and to make sense of that which we observe. Unfortunately, our intuition is often wrong, and so there is a need to impose some objectivity on the methods by which observations are converted into knowledge. One definition of biostatistics could be precisely this, the rigorous and objective conversion of medical and/or biological observations into knowledge. Both consumers of biostatistical principles and biostatisticians themselves vary in the extent to which they recognize the (...) need to continue the improvement. Some may not recognize the need for (some or all of) the methods that have already been developed; others may accept these as they find them completely sufficient; still others recognize both the value and the shortcomings of these methods, and seek to develop even better methods to ensure that future medical conclusions are less subject to biases than current ones are. (shrink)

This paper argues first that Armstrong is led to see natural resources primarily as objects of consumption. But many natural resources are better seen as objects of enjoyment, where one person’s access to a resource need not prevent others from enjoying equal access, or as objects of production, where granting control of a resource to one person may produce collateral benefits to others. Second, Armstrong’s approach to resource distribution, which requires that everyone must have equal access to welfare, conceals an (...) ambiguity as to whether this means equal opportunity for welfare, or simply equal welfare – the underlying issue being how far individuals should be held responsible for the use they make of the resources they are allocated. Third, when Armstrong attacks arguments that appeal to ‘improvement’ as a basis for claims to natural resources, he treats them as making comparative desert claims: if country A makes a claim to the improved resources on its territory, it must show that their comparative value accurately reflects the productive deserts of its members compared to those of countries B. But in fact, A needs only to make the much weaker claim that its members have done more than others to enhance the value of its resources. Overall, Armstrong’s welfarist approach fails to appreciate the dynamic advantages of allocating resources to those best able to use them productively. (shrink)

“Run-in” and “washout” periods involving the withholding of medication are widely used in drug research trials in pursuit of both patient safety and scientific reliability. Such no-medication periods can be justified ethically provided that they are apparent to patients, who can thereby properly consent to undergoing them. Less widespread, but still common, is the practice of “single blinding” no-medication periods, concealing them from patients by means of placebo. Whilst all placebos involve a measure of concealment, their use is typically (...) justified in drug research trials by their preserving the uncertainty generated by the random allocation of different treatments within a drug trial; and by the researchers openly declaring both the randomisation process and the chances of receiving placebo. In the single blind placebo “run-in” or “washout”, neither of these conditions is met.This paper considers three possible defences of the practice of using single blind placebo “run-ins” or “washouts” and finds them all to fail; the practice appears ethically unjustified. (shrink)

A pandemic may cause a sudden imbalance between available medical resources and medical needs where fundamental care to a patient cannot be delivered. Inability to fulfil a professional commitment to deliver care as needed can lead to distress among caregivers and patients. This distress is sometimes alleviated through mechanisms that hide the facts that care is rationed and not all medical needs are met. We have identified three mechanisms that jeopardise accountable and optimal allocation of resources: (1) hidden value (...) judgements that allow rationing under the disguise of triage or prioritisation, (2) disguised conflict of interest between societal and individual patient’s needs and (3) concealed biases in the application of medical tools. Under these three pitfalls decisions of resource allocation and who gets treated are handled as medical decisions: normative decisions are concealed and perceived as falling with the realm of medical judgement. Value judgements and moral agency are hidden to offer a ‘false sense of medical judgement’, while in fact there are several ethical judgements and biases at stake. The three pitfalls entail hidden normative deliberation and are inappropriate for sustainable healthcare delivery and resource allocation. We believe it is necessary to maintain transparency in decision making under conditions of insufficient resources to maintain trust in professional care givers and secure fair treatment allocation. Recognition of the pitfalls, by applying our recommendations, may help to ensure transparent and accountable distribution of care and contribute to public acceptance of the ethics behind rationing. (shrink)

The purpose of this paper is to provide a normative model for the assessment of the exercise of power by Big Pharma. By drawing on the work of Steven Lukes, it will be argued that while Big Pharma is overtly highly regulated, so that its power is indeed restricted in the interests of patients and the general public, the industry is still able to exercise what Lukes describes as a third dimension of power. This entails concealing the conflicts of interest (...) and grievances that Big Pharma may have with the health care system, physicians and patients, crucially through rhetorical engagements with Patient Advocacy Groups that seek to shape public opinion, and also by marginalising certain groups, excluding them from debates over health care resource allocation. Three issues will be examined: the construction of a conception of the patient as expert patient or consumer; the phenomenon of disease mongering; the suppression or distortion of debates over resource allocation. (shrink)

Objectives—To assess the relationship between the approval of trials by a research ethics committee and the fact that informed consent from participants was obtained, with the quality of study design and methods.Design—Systematic review using a standardised checklist.Main measures—Methodological and ethical issues of all trials published between 1993 and 1995 in the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association and the British Medical Journal were studied. In addition, clinical trials conducted in Spain and published (...) by at least one Spanish author during the same period in any other journal were also included.Results—We studied the published articles of 767 trials and found the following indicators of lower methodological quality to be independent predictors for failure to disclose REC approval or ICP: absence of concealment of allocation, lack of justification for unblinded trials, not using a treatment for the patients in the control group, absent information on statistical methods, not including sample size estimation, not establishing the rules to stop the trial, and omitting the presentation of a baseline comparison of groupsConclusion—Trials of higher methodological and scientific quality were more likely to provide information about their ethical aspects. (shrink)

Rationing health care is not new. As governments world wide struggle to contain the costs of health care, health policy analysts debate how rationing should be done. However, they too often neglect how the mechanisms for funding and allocating health care resources are themselves vehicles for rationing treatment. In the UK, where health care rationing debates currently abound, there has been no formal evaluation of the role of the market in allocating scarce health care resources.The market in health care has (...) increased administration, fragmented services, eroded local accountability, and decreased choice.This fragmentation, and the associated competition between purchasers and providers, means that resource allocation can no longer be monitored and evaluated in a national context. The loss of a population focus has left a vacuum in planning. Services cannot be planned rationally, and so are not able consistently to avoid duplication or to respond cogently to estimates of need.The loss of accountability means that decisions about the allocation of health care resources are no longer open to scrutiny by local people. Increasingly, especially in social and long term care the cost of care is being transferred to the individual. The new mechanisms for resource allocation are distributing resources unfairly: away from the poor, the sick and the elderly.The great myth of the market is that it has enabled decision-making to become explicit. This is not the case. To make health care resource allocation appear rational and acceptable to the public, health authorities have resorted to exercises in consumer consultation, and value laden guidelines where clinical cloaks are used to disguise political decisions on funding. In the UK, until the true role of the internal market is acknowledged, myths and subterfuge will conceal the winners and losers in the new system of rationing health care. (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.

This article addresses conceal and carry laws on higher education campuses as ethical and social dilemmas. The Second Amendment reads, “A well regulated Militia, being necessary to the security of a Free State, the right of the people to keep and bear Arms, shall not be infringed” (U. S. Const. amend. II 1791 ). Proponents for conceal and carry laws on college and university campuses often interpret the Second Amendment as an overarching right to have weapons, regardless of location. Opponents (...) of such legislation argue that allowing guns on campuses would be a mistake and student safety can be addressed in other ways. Throughout the 2010–2011 legislative sessions Arizona and Texas have been on the cusp of passing pro conceal and carry laws which would allow higher education students to carry weapons on campus. Over two decades states have increased access to weapons, while most in the U.S. have sentiments against their neighbors carrying arms (Kranz 2006 ). While the Second Amendment provides the right for individual to carry arms, higher education campuses are regarded as a subset of the population, a space for maturing adults and not a place for concealed weapons. (shrink)

Concealed questions are determiner phrases that are naturally paraphrased as embedded questions (e.g., John knows the capital of Italy ≈ John knows what the capital of Italy is). This paper offers a novel account of the interpretation of concealed questions, which assumes that an entity-denoting expression α may be type-shifted into an expression ?z.P(α), where P is a contextually determined property, and z ranges over a contextually determined domain of individual concepts. Different resolutions of P and the domain of z (...) yield a wide range of concealed question interpretations, some of which were not noted previously. On the other hand, principled constraints on the resolution process prevent overgeneration. (shrink)

Philosophical discussion about citizenship has traditionally focused on the questions of what citizenship is, its relationship to civic virtue and political participation, and whether or not it can be meaningfully exercised at the supra-national level. In recent years, however, philosophers have turned their attention to the legal status attached to citizenship, and have questioned existing principles of citizenship allocation and withdrawal. With regard to the question of who is morally entitled to citizenship, philosophers have argued for principles of citizenship (...) allocation that go beyond birth and lineage, and have focused instead on the value of political attachment and located life plans. These principles have several advantages over existing legal principles, but they suffer from being under-specified, as well as being over and under-inclusive. With regard to loss of citizenship, philosophers have primarily denounced citizenship withdrawal as a form of punishment by appealing to principles of fair and equal treatment. However, theories purporting to show that denationalization is always wrong have trouble explaining why loss of citizenship is so problematic for persons who have committed the most horrendous crimes against their fellow citizens, and who, in so doing, have in effect self-excluded from the political community. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of (...) current practices and could guide governments, professional societies, and physicians in allocation decisions. (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)

The self-concealing of being is a primary preoccupation of Heidegger's later thought, but neither Heidegger nor his interpreters have made clear precisely what it is. In this paper, I identify the self-concealing of being as the concealing of the worlding of the world, which is essential to and simultaneous with that worlding. In order to establish this, I sketch a taxonomy of the various phenomena of concealing and concealment in Heidegger's work by building on Mark Wrathall's four ‘planks’ of (...) unconcealing and concealment. Importantly, I distinguish the procedurally prior concealment that all unconcealing presupposes from the simultaneous concealing that Heidegger frequently confuses it with. This distinction not only allows us to get clear on what it means to say that being conceals itself but also reveals various confusions and obscurities in Heidegger's own thought as well as in that of his readers. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 56-57, September‐October 2021.

Our evaluation of questions and knowledge attributions may vary relative to the way in which the relevant objects are identified. In the first part, the article proposes a theory that represents different methods of trans-world identification and is able to account for their impact on interpretation. In the second part, the same theory is used to account for the meaning of concealed questions. On the proposed account, the interpretation of a concealed question results from the application of a type-shifting operation (...) mapping an individual denoting expression into an identity question interpreted relative to a contextually selected identification method. (shrink)

This paper presents a novel treatment of quantified concealed questions , examining different types of NP predicates and deriving the truth conditions for pair-list and set readings. A generalization is proposed regarding the distribution of the two readings, namely that pair-list readings arise from CQs with relational head nouns, whereas set readings arise from CQs whose head nouns are not relational. It is shown that set readings cannot be derived under the ‘individual concept’ approach, one of the most influential analyses (...) of CQs on the market. The paper offers a solution to this problem. It shows that once we adopt an independently motivated view of traces—according to which traces are copies with descriptive content —nothing else needs to be postulated to derive set readings within an individual-concept-based analysis. Thus, what seemed to be a challenge for this type of analysis turns out to be an argument in its favor. (shrink)

In their first stasimon, the chorus of Euripides’Iphigenia at Aulis(=IA) praises ‘concealed Kypris’ as a marker of virtue for women (568–72):μέγα τι θηρεύειν ἀρετάν,γυναιξὶ μὲν κατὰ Κύ-πριν κρυπτάν, ἐν ἀνδράσι δ᾿ αὖκόσμος ἐνὼν ὁ μυριοπλη-θὴς μείζω πόλιν αὔξει.It is something great to hunt for excellence. For women, it is according to concealed Kypris, and among men in turn manifold order being within makes the city grow greater.

This book presents a novel analysis of concealed-question constructions, reports of a mental attitude in which part of a sentence looks like a nominal complement, but is interpreted as an indirect question. Such constructions are puzzling in that they raise the question of how their meaning derives from their constituent parts. In particular, how a nominal complement, normally used to refer to an entity ends up with a question-like meaning. In this book, Ilaria Frana adopts a theory according to which (...) noun phrases with concealed question meanings are analysed as individual concepts. The traditional individual concept theory is modified and applied to the phenomena discussed in the recent literature and some new problematic data. The end result is a fully compositional account of a wide range of concealed-question constructions. The exploration of concealed questions offered in the book provides insights into both issues in semantic theory, such as the nature of quantification in natural languages and the use of type shifter in the grammar, and issues surrounding the syntax-semantics interface, such as the interpretation of copy traces and the effects on semantic interpretation of different syntactic analyses of relative clauses. The book will interest scholars and graduate students in linguistics, especially those interested in semantics and the syntax-semantics interface, as well as philosophers of language working on the topic of intensionality. (shrink)

The COVID-19 pandemic will likely recede only through development and distribution of an effective vaccine. Although there are many unknowns surrounding COVID-19 vaccine development, vaccine demand will likely outstrip early supply, making prospective planning for vaccine allocation critical for ensuring the ethical distribution of COVID-19 vaccines. Here, we propose three central goals for COVID-19 vaccination campaigns: to reduce morbidity and mortality, to minimise additional economic and societal burdens related to the pandemic and to narrow unjust health inequalities. We evaluate (...) five prioritisation approaches, assess their likely impact on advancing the three goals of vaccine allocation and identify open scientific questions that may alter their outcomes. We argue that no single prioritisation approach will advance all three goals. Instead, we propose a multipronged approach that considers the risk of serious COVID-19 illness, instrumental value and the risk of transmission, and is guided by future research on COVID-19-specific clinical and vaccine characteristics. While we focus this assessment on the USA, our analysis can inform allocation in other contexts. (shrink)

America’s COVID-19 pandemic has both devastated and disparately harmed minority communities. How can the allocation of scarce treatments for COVID-19 and similar public health threats fairly and legally respond to these racial disparities? Some have proposed that members of racial groups who have been especially hard-hit by the pandemic should receive priority for scarce treatments. Others have worried that this prioritization misidentifies racial disparities as reflecting biological differences rather than structural racism, or that it will generate mistrust among groups (...) who have previously been harmed by medical research. Still others complain that such prioritization would be fundamentally unjust. I argue that, to pass muster under current law, policymaking in this area must recognize a crucial distinction: prioritizing minority communities, such as hard-hit neighborhoods, without regard to individual race is typically legal, but prioritizing individuals on the basis of their racial identity faces is likely not. I also explain how prioritization on the basis of Native American status is allowable and legally distinct from prioritization on the basis of individual race. -/- In Part II, I provide a brief overview of current and proposed COVID-19 treatments and identify documented or likely scarcities and disparities in access. In Part III, I argue that randomly allocating scarce medical interventions, as some propose, will not effectively address disparities: it both permits unnecessary deaths and concentrates those deaths among people who are more exposed to infection. In Part IV, I explain why using individual-level racial classifications in allocation is precluded by current Supreme Court precedent. Addressing disparities will require focusing on factors other than race, or potentially considering race at an aggregate rather than individual level. I also argue that policies prioritizing members of Native American tribes can succeed legally even where policies based on race would not. In Part V, I examine two complementary strategies to narrow racial disparities. One would prioritize individuals who live in disadvantaged geographic areas or work in hard-hit occupations, potentially alongside race-sensitive aggregate metrics like neighborhood segregation. These approaches, like the policies school districts adopted after the Supreme Court rejected individualized racial classifications in education, would narrow disparities without classifying individuals by race. The other strategy would address the starkly disparate racial impact of deaths early in life by limiting the use of age-based exclusions from vaccine or treatment access that explicitly deprioritize the prevention of early deaths and so disparately exclude minorities, and by considering policies that prioritize the prevention of early deaths. (shrink)

Feminists have long argued that women who offend are judged by who they are, not what they do, with idealised images of femininity and motherhood used as measures of culpability. The ability to meet the expectations of motherhood and femininity are particularly difficult for women who experience a crisis pregnancy, as evident in cases where women have been convicted of concealment of birth. The offence prohibits the secret disposal of the dead body of a child, to conceal knowledge of (...) its birth. Traditionally used to prosecute women suspected of killing their newborn children, analysis of court transcripts suggests the offence is also used to punish women who fail to meet expectations of motherhood. This paper analyses three contemporary cases in light of the historical origins of the offence, illustrating the legacy of prejudice against ‘deviant’ mothers. Finally, it questions the continued existence of this archaic offence. (shrink)

The valence–space metaphor research area investigates the metaphorical mapping of valenced concepts onto space. Research findings from this area indicate that positive, neutral, and negative concepts are associated with upward, midward, and downward locations, respectively, in the vertical plane. The same research area has also indicated that such concepts seem to have no preferential location on the horizontal plane. The approach–avoidance effect consists in decreasing the distance between positive stimuli and the body and increasing the distance between negative stimuli and (...) the body. Thus, the valence–space metaphor accounts for the mapping of valenced concepts onto the vertical and horizontal planes, and the approach–avoidance effect accounts for the mapping of valenced concepts onto the “depth” plane. By using a cube conceived for the study of allocation of valenced concepts onto 3D space, we show in three studies that positive concepts are placed in upward locations and near the participants’ body, negative concepts are placed in downward locations and far from the participants’ body, and neutral concepts are placed in between these concepts in both planes. (shrink)

Concealment -- Part of eloquence is to hide eloquence -- The concealed ornament -- Art or nature? -- In the garden -- Iki -- Those who cannot dissimulate cannot rule either -- True eloquence mocks eloquence -- Ready-mades.

The novel COVID-19 pandemic has placed medical triage decision-making in the spotlight. As life-saving ventilators become scarce, clinicians are being forced to allocate scarce resources in even the wealthiest countries. The pervasiveness of air travel and high rate of transmission has caused this pandemic to spread swiftly throughout the world. Ethical triage decisions are commonly based on the utilitarian approach of maximising total benefits and life expectancy. We present triage guidelines from Italy, USA and the UK as well as the (...) Jewish ethical prospective on medical triage. The Jewish tradition also recognises the utilitarian approach but there is disagreement between the rabbis whether human discretion has any role in the allocation of scarce resources and triage decision-making. (shrink)

A small set of allocation principles is said to be behind several theories of distributive justice. However, disagreement about the appropriate relationship between these notions remains, so that compromises between principles may generate more agreement. Truncated utilitarianism is a prominent candidate. It demands maximising total wealth subject to a floor level of individual wealth for all people. Based on some well-known distributive notions, we developed a questionnaire setting and confronted student respondents with corresponding allocation problems, where an exogenously (...) given poverty line served as a floor. However, support for allocations resulting from this specific interpretation of truncated utilitarianism remained rather low. This is surprising because the respective solution was close to an equal split of resources, and aspects of efficiency and responsibility were explicitly introduced to promote more general acceptance. We argue that people may either wish to see higher floor levels or are more inequality averse than probably expected. Moreover, high support for an unconditional consideration of the poverty line can be witnessed, even though aspects of responsibility, but not efficiency arguments, display an influence. In general, attitudes with respect to the equality–efficiency trade-off are found to remain heterogeneous, although different equality concerns are prominent. Furthermore, trade-offs are moderated by the responsibility principle. (shrink)

In a much cited phrase in the famous English ‘Child B’ case, Mr Justice Laws intimated that in life and death cases of scarce resources it is not sufficient for health care decision-makers to ‘toll the bell of tight resources’: they must also explain the system of priorities they are using. Although overturned in the Court of Appeal, the important question remains of the extent to which health-care decision-makers have a duty to give reasons for their decisions. In this paper, (...) I examine the philosophical foundations of the legal obligation to give reasons in English law. Why are judges sometimes supportive of the imposition of a duty to give reasons and sometimes not? What is it about the context of life and death health care allocation problems that makes it unsuitable in their view for such a duty; and is this stance justified? What is it to give a reason for a decision? I examine Frederick Schauer’s account of reason-giving in terms of generalisation and commitment and I suggest that it provides an overstated account of what giving a reason commits one to. I go on to examine an idea of judicial creation: that where value judgements are “inexpressible” there is a strong reason not to impose a duty to give reasons on to public bodies. The strongest case for a duty to give reasons is in terms of the value of respect for citizens. I argue that there is nothing in the very nature of reason-giving that ought to preclude the imposition of such a duty in this context, but concede that there is a serious danger of legalism that could result in a hamstringing of health care decision-making. It is up to judges and lawyers to seek to avoid this danger. (shrink)

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)

ABSTRACT This study examined how lifestyle factors and gender affect kidney allocation to transplant patients by 99 British and Singaporean participants. Thirty hypothetical patients were generated from a combination of six factors and randomly paired four times. Participants saw 60 patient pairings and, in each pair, chose which patient would receive treatment priority. A Bradley-Terry model was used to derive coefficients for each factor per participant. A mean factor score was then calculated across all participants for each factor. Participants (...) gave lower priority to patients who drank more, were overweight, smoked more and exercised less. A patient’s diet and gender had no significant effect on allocation. There were no significant cross-cultural differences. There were moderate correlations between participants’ self-reported pre- and post-experiment ordering of decision criteria, and these measures and factor coefficients, suggesting a modest level of decision-making consistency. Between participants, moderate levels of concordance with respect to factor importance were observed for self-reported orderings of factors, and weaker agreement for model-derived coefficients. Very similar results were obtained for both British and Singaporean participants, and the implications of the findings are discussed. (shrink)

Limits to Action: The Allocation of Individual Behavior presents the ideas and methods in the study of how individual organisms allocate their limited time and energy and the consequences of such allocation. The book is a survey of individual resource allocation, emphasizing the relationships of the concepts of utility, reinforcement, and Darwinian fitness. The chapters are arranged beginning with plants and general evolutionary considerations, through animal behavior in nature and laboratory, and ending with human behavior in suburb (...) and institution. Topics discussed include operant conditioning; the principle of diminishing returns; and issues in relation to mating strategies. Biologists, sociologists, economists, and psychologists will find the book interesting. (shrink)

What is Heidegger talking about when he says that being conceals itself? This is the first study to systematically address that question. Katherine Withy analyses texts from across Heidegger's philosophical career and sorts the various phenomena of concealing and concealment that Heideggerdiscusses into a highly-structured taxonomy. The taxonomy clarifies the relationships and differences between such phenomena as lethe, the nothing, earth, excess, the backgrounding of the world, and un-truth, as well as speaking falsely, talking idly, secrets, mysteries, seeming, andinauthentic (...) discovering. But in relating and differentiating these phenomena, the taxonomy shows that none of them is the self-concealing of being.Having established what the self-concealing of being is not, Withy establishes what it is. She argues that being conceals itself in that it shows up to us as lacking the sorts of contrast cases that render entities determinate and intelligible. This novel and powerful interpretation of theself-concealing of being explains why the secondary literature to date has discussed it in vague and metaphorical terms, as well as why Heidegger tends to collapse being's self-concealing into the concealment of lethe. Withy's interpretation is both a clarification of and a corrective to Heidegger'snotoriously difficult and sometimes misleading discussions of being as self-concealing. (shrink)

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....

Interpersonal responsibility is an indigenous Chinese personality construct, which is regarded to have positive social functions. Two studies were designed to explore the relationship among interpersonal responsibility, proposal allocation ratio, and responders’ hostile decisions in an ultimatum game. Study 1 was a scenario study using a hypothetical ultimatum game with a valid sample of 551 high school students. Study 2 was an experimental study which recruited 54 undergraduate students to play the incentivized ultimatum game online. The results of the (...) two studies showed a significantly negative correlation between interpersonal responsibility and responders’ rejection responses only when the proposal allocation ratio was 3:7. In addition, in study 2, interpersonal responsibility had negative effects on responders’ rejection responses under the offer of 3:7, even after controlling for the Big Five personality traits. Taken together, proposal allocation ratio might moderate the effects of interpersonal responsibility on hostile decision-making in the ultimatum game. The social function of interpersonal responsibility might be beyond the Big Five. Keywords: interpersonal responsibility, proposal allocation ratio, hostile decision-making, moderator, ultimatum game, Big Five personality. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

Bioethical debate in Europe is partly a reaction to political endeavors and events. In line with the political goal of a united Europe, a European regulation is being sought for medical research and medical ethics ('Convention on Human Rights and Biomedicine'). A certain degree of ambivalence has come to the fore: whilst it does seem possible to reach a consensus (albeit a merely 'diplomatic' consensus) about complicated bioethical issues at an international level when certain controversial matters are excluded or a (...) certain vagueness maintained, new principles are also required at a national level, for example when the medical profession of one state feels obliged to assume a 'local' stance, such as in the sensitive issue of termination of treatment. The individual contributions to this publication, together with various other current fields of bioethical conflict in Europe - especially Germany - are introduced below against a common background, namely that the original dividing line between the concealed and the revealed has shifted. (shrink)

As vaccines against COVID-19 are scarce, many countries have developed vaccination prioritisation strategies focusing on ethical and epidemiological considerations. However, public acceptance of such strategies should be monitored to ensure successful implementation. In an experiment withN=1379 German participants, we investigated whether the public’s vaccination allocation preferences matched the prioritisation strategy approved by the German government. Results revealed different allocations. While the government had top-prioritised vulnerable people (being of high age or accommodated in nursing homes for the elderly), participants preferred (...) exclusive allocation of the first available vaccines to medical staff and personnel caring for the elderly. Interestingly, allocation preferences did not change when participants were told how many individuals were included in each group. As differences between allocation policies and public preferences can affect trust in the government and threaten the social contract between generations, we discuss possible strategies to align vaccination prioritisations. (shrink)

The question of resource allocation is particularly pertinent to the realisation of socioeconomic rights. Perceptions of the place of resource allocation impact the adjudication of these rights. This article departs from the premise that with the adoption of the Optional Protocol to the International Covenant on Economic, Social and Cultural rights allowing individual communications and the establishment of the African Court on Human and Peoples’ Rights, there will be an increase in resource allocation questions for adjudication. The (...) article interrogates the experience of national courts and examines potential lessons that can be adopted at the international level to overcome the reluctance that supra-national tribunals may have when adjudicating on states obligations to fulfil. (shrink)

It is argued in this paper that a multimodal analysis of turn-taking, one of the core areas of conversation analytic research, is needed and has to integrate gaze as one of the most central resources for allocating turns, and that new technologies are available that can provide a solid and reliable empirical foundation for this analysis. On the basis of eye-tracking data of spontaneous conversations, it is shown that gaze is the most ubiquitous next-speaker-selection technique. It can function alone or (...) enhance other techniques. I also discuss the interrelationship between the strength for sequential projection and the choice of next-speaker-selection techniques by a current speaker. The appropriate consideration of gaze leads to a revision of the turn-taking model in that it reduces the domain of self-selection and expands that of the current-speaker-selects-next sub-rule. It also has consequences for the analysis of “simultaneous starts”. (shrink)

During the twelfth and thirteenth centuries, great new trends of Jewish thought emerged whose widely varied representatives--Kabbalists, philosophers, and astrologers--each claimed that their particular understanding revealed the actual secret of the Torah. They presented their own readings in a coded fashion that has come to be regarded by many as the very essence of esotericism. Concealment and Revelation takes us on a fascinating journey to the depths of the esoteric imagination. Carefully tracing the rise of esotericism and its function (...) in medieval Jewish thought, Moshe Halbertal's richly detailed historical and cultural analysis gradually builds conceptual-philosophical force to culminate in a masterful phenomenological taxonomy of esotericism and its paradoxes. Among the questions addressed: What are the internal justifications that esoteric traditions provide for their own existence, especially in the Jewish world, in which the spread of knowledge was of great importance? How do esoteric teachings coexist with the revealed tradition, and what is the relationship between the various esoteric teachings that compete with that revealed tradition? Halbertal concludes that, through the medium of the concealed, Jewish thinkers integrated into the heart of the Jewish tradition diverse cultural influences such as Aristotelianism, Neoplatonism, and Hermeticisims. And the creation of an added concealed layer, unregulated and open-ended, became the source of the most daring and radical interpretations of the tradition. (shrink)

Application of egalitarian and prioritarian accounts of health resource allocation in low‐income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian (...) argument that, given extreme scarcity of public health resources in low‐income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low‐income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines. (shrink)

Fair resource allocation in humanitarian medicine is gaining in importance and complexity, but remains insufficiently explored. It raises specific issues regarding non-ideal fairness, global solidarity, legitimacy in non-governmental institutions and conflicts of interest. All would benefit from further exploration. We propose that some headway could be made by adapting existing frameworks of procedural fairness for use in humanitarian organizations. Despite the difficulties in applying it to humanitarian medicine, it is possible to partly adapt Daniels and Sabin's ‘Accountability for reasonableness’ (...) to this context. This would require: (1) inclusion of internally explicit decisions and rationales; (2) publicity to donors, local staff, community leaders and governments, as well as frank answers to any beneficiary—or potential beneficiary—who asked for clarification of decisions and their rationale; (3) a consistent reasoning strategy to weigh conflicting views of equity in specific situations; (4) advocacy within the organization as a mechanism for revision and appeals; and (5) internal regulation according to publicly accessible mechanisms. Organizations could generate a common corpus of allocation decisions from which to draw in future similar cases. Importantly, the complexity of these challenges should encourage, rather than hinder, broader discussion on ethical aspects of resource allocation in humanitarian medicine. CiteULike Connotea Del.icio.us What's this? (shrink)

During the twelfth and thirteenth centuries, great new trends of Jewish thought emerged whose widely varied representatives--Kabbalists, philosophers, and astrologers--each claimed that their particular understanding revealed the actual secret of the Torah. They presented their own readings in a coded fashion that has come to be regarded by many as the very essence of esotericism. Concealment and Revelation takes us on a fascinating journey to the depths of the esoteric imagination. Carefully tracing the rise of esotericism and its function (...) in medieval Jewish thought, Moshe Halbertal's richly detailed historical and cultural analysis gradually builds conceptual-philosophical force to culminate in a masterful phenomenological taxonomy of esotericism and its paradoxes. Among the questions addressed: What are the internal justifications that esoteric traditions provide for their own existence, especially in the Jewish world, in which the spread of knowledge was of great importance? How do esoteric teachings coexist with the revealed tradition, and what is the relationship between the various esoteric teachings that compete with that revealed tradition? Halbertal concludes that, through the medium of the concealed, Jewish thinkers integrated into the heart of the Jewish tradition diverse cultural influences such as Aristotelianism, Neoplatonism, and Hermeticisims. And the creation of an added concealed layer, unregulated and open-ended, became the source of the most daring and radical interpretations of the tradition. (shrink)

Cissexist perception involves a prejudicial judgment and an unmediated affective response, such as that of disgust, directed at the gendered aspects of another person. In this paper, I advance a view of how cissexist perception harms disabled people. On this view, there at least two morally problematic aspects of cissexist perception: that it has painful effects, and that it restricts bodily agency. I defend this claim through an analysis of a double bind faced by people subjected to cissexist perception: on (...) the one hand, such individuals are pressured into avoiding certain environments to dodge dangerous predicaments that can arise on behalf of looking different from others; this constitutes unfair exclusion from an environment and under some conditions causes pain. On the other hand, to avoid dangerous predicaments, targets of cissexist perception are pressured into concealing their gender non-conformity to fit into certain environments; concealing frustrates their bodily agency. I conclude with remarks about how trans-affirming artwork may have the capacity to interrupt cissexist perception. (shrink)

Nursing homes' ethics committees play a role in designing policies to assure ethical care. The administrative structure of nursing homes is not as large as that of hospitals. Nursing home staff and administration can respond to medical accidents in a way that treats family unethically and does serious harm to the facility. This paper describes incidents in which nursing homes attempted to conceal accidental deaths. It describes how such incidents are discovered, and the consequences of such efforts, and suggests ways (...) to prevent such incidents.This paper presents a retrospective review of a convenience sample of eight cases in which it was discovered that a nursing home attempted to conceal an accidental death. The effort to conceal an accidental death requires a coordinated effort to: [1] limit dissemination of information about the accident by staff and records, [2] decrease suspicion about the death, and [3] decrease the likelihood that an inquiry, if launched, will succeed. This effort begins as a reflexive, emotional and defensive response to the accident and consolidates as an institutional strategy to conceal both the accident and the concealment. The effort is coordinated by administrators who coerce cooperation from front line staff, alter medical records, and fail to follow reporting procedures. The attempt to conceal a lethal accident adversely affects the facility and the healthcare system. Ethics committees should work with professional organizations and administrator to assure proper management and disclosure of harmful accidents. (shrink)