Background Prioritization decision-making arises when nurses encounter intricate situations that demand ethically challenging judgments about care. This phenomenon has rarely been studied in nursing homes. Prioritization decision-making may lead to instances where individuals in social and healthcare may not receive all services they need. Making prioritization decisions and awareness of their consequences can increase nurses’ workload. Aim To describe prioritization decision-making regarding unfinished nursing care in nursing homes. Research design A qualitative descriptive study conducted through individual theme interviews. Participants were (...) recruited through social media. The data was analyzed using inductive content analysis. Participants and research context Nurses ( n = 23) working in nursing homes for the elderly people in Finland. Data were collected between June 2022 and February 2023. Ethical considerations Finnish legislation does not mandate an ethical review or research permits, as the participants took part as private individuals. [ask authors to make reference here to informed consent process and anonymity] Findings Nurses stated that the need for prioritization decision-making arises from challenges associated with nurses’ engagement with person-centered care, the culture of the work community, the burden due to workload and challenges associated with the leadership. Prioritization decision-making was based on the interests of residents, striving for an efficient workflow and nurse’s personal interests. Nurses did not receive support for decision-making regarding unfinished care, and protocols for prioritization had not been established in their work communities. Prioritization decision-making and unfinished care were concealed and left unspoken. Conclusion Nursing leaders should address this hidden phenomenon, making it visible through discussions with nurses and by involving them in the development of protocols. The findings can be utilized for developing new approaches to support nurses and reduce their workload and for enhancing the quality and person-centeredness of nursing care in nursing homes. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in 2015 across publicly (...) funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

Studies of how scientists select research problems suggest the process involves weighing a number of factors, including funding availability, likelihood of success versus failure, and perceived publishability of likely results, among others. In some fields, a strong personal interest in conducting science to bring about particular social and environmental outcomes plays an important role. Conservation biologists are frequently motivated by a desire that their research will contribute to improved conservation outcomes, which introduces a pair of challenging questions for managers of (...) science and scholars of policies governing science: 1) How do scientists integrate that goal into their processes of research priority evaluation, and 2) How can managers and funders of science utilize that knowledge in designing and administering funding programs? I use Q method to uncover four distinct schools of thought amongst researchers and knowledge-users about the merits of possible research priorities for coral reefs; one of the axes along which these schools of thought differ is in their interpretation of how science can and should interact with policy. The results reveal that perceived severity of reef stressors plays a role for some participants. Disciplinary training does not appear to be a major influence on research priority evaluation, but individual participants indicated professional expediency does prevent some researchers from pursuing or advocating that others pursue topics outside of that disciplinary specialty. Influences on and processes in research prioritization uncovered in this study have the potential to lead to counter-productive disciplinary path dependencies. From these results and building on outside literature, I conclude that better coordination and communication about research priorities across disciplines and with broader stakeholders – including knowledge users – could improve the research enterprise’s ability to contribute to meaningful societal and conservation goals. These findings are relevant to researchers and research administrators across disciplines that seek to conduct or fund science that is useful in addressing specific goals. (shrink)

Emotions can be insensitive to certain attributes of a situation: Fear of flying is not always reduced by remembering air crash probabilities. A large body of evidence shows that information on probabilities, large numerical counts, and intentions is frequently disregarded in the elicitation and regulation of emotions. To date, no existing theory comprehensively accounts for the features that tend to be overlooked by emotion. In this paper, I call attention to the common denominator of such features: they do not contribute (...) to the iconic representation of events. For instance, the exceedingly low probability of a plane crash does not affect its imagistic representation (i.e., the iconic representation of the event is silent about the event’s probability). This paper introduces the Iconic Prioritization Hypothesis, positing that the prioritization of input in the iconic format by emotions can explain the neglect of information that is representationally silent in this format. Delving into the causes of this format prioritization, I argue that emotion might favour iconicity as it is the format of immediate information about our surroundings (perception) and of stored first-hand evidence (episodic memory). Lastly, the hypothesis's compatibility with philosophical theories of emotion causation and its implications for experimental research are examined. (shrink)

Prioritization in public health has long been contentious, which necessitates ethical discussions. Despite efforts to develop frameworks that address these considerations, universally accepted models remain elusive, leaving decision-makers to manage independently. This study explores the previously underexplored topic of ethical principles guiding prioritization within different domains of health promotion and prevention at a local level. Interviews with decision-makers (n = 21) from Danish municipalities were analyzed thematically to uncover ethical dimensions of local prioritization of public health services. The study showed (...) that when confronted with resource constraints, decision-makers tended to prioritize preventive services for patients, often at the expense of broader health promotional initiatives. This decision appears rooted in ethical principles of assisting individuals who are deemed to be in the most immediate need. Analyzed against principles of justice and the broader literature on prioritization, the results reflect a prioritization common in the hospital sector: the principle of need. This contrasts with broader societal discussions of public health that are often based on principles of maximization of health benefits and equity. The study highlights the importance of weighing diverse ethical principles when prioritizing among and within initiatives and of considering the purpose of different domains of prevention and health promotion. (shrink)

The amount allocated to publicly funded health care for 2005/06 in New Zealand, a small country of some four million people, is $NZ 9.68 billion, or 6.2% of GDP, an increase from the 5.7% of GDP in 2000/01. The Minister of Finance has recently signalled that spending in health and education has outpaced economic growth, and that the present rate of growth in health spending, which has grown at about 7% a year over the last decade, is unsustainable. Despite these (...) big funding increases in recent years, the perception of New Zealanders is that the extra spending has made little difference, at least to hospital services and to people’s ability to access treatment. In surveys, health emerges as a leading concern for New Zealanders. Their concern is apparently less about the quality of services, than about their ability to access treatment - whether they will be able to access timely health care when they or their family members need it. (shrink)

_This article discusses some of the normative bases for the recent (2020) Norwegian policy prioritizing LGBTIQ+ refugees in refugee admissions. It argues that, when properly interpreted, this policy is compatible with the UNHCR vulnerability selection criteria but is not independently supported by it. Combined with some of the broader moral principles guiding refugee admissions – including both state-based and refugee-based reasons in refugee resettlement – the article provides qualified support for the Norwegian policy of LGBTIQ+ refugee prioritization. Drawing from some (...) of the specifics of LGBTIQ+ refugee resettlement and integration, the article nevertheless points to certain limitations of such a policy in so far as refugees’ own agency is concerned. The article emphasizes the need to listen to refugees’ own voices in the selection and resettlement processes, including cases where the default position of LGBTIQ+ prioritization may be overridden by LGBTIQ+ persons’ own interests in being resettled elsewhere__._ _Keywords_: LGBTIQ+, Norwegian refugee policy, priority setting, refugee selection, LGBTIQ+ integration. (shrink)

In times of ongoing resource shortages, appropriate evaluation criteria are crucial for the ethical prioritization of medical care. While the use of scoring models as tools for prioritization is widespread, they are barely discussed in the medical-ethical discourse in the context of the COVID-19 pandemic. During this time, the challenge of providing care for patients in need has promoted consequentialist reasoning. In this light, we advocate for the integration of time- and context-sensitive scoring (TCsS) models in prioritization policies that foster (...) treatment opportunities for patients with subacute and chronic conditions. We argue, first, that TCsSs enable a more efficient use of resources, reducing avoidable harm to patients by preventing arbitrary postponement of necessary but nonurgent interventions. Second, we contend that on an interrelational level, TCsSs render decision-making pathways more transparent, which promotes the information requirement of patient autonomy and raises confidence in the resulting prioritization decision. Third, we claim that TCsS contributes to distributive justice by reallocating available resources to the benefit of elective patients. We conclude that TCsSs promote anticipatory measures that extend the timeframe for responsible action into the future. This strengthens patients' ability to exercise their right to healthcare—primarily during times of crisis, but ultimately in the longer term too. (shrink)

During a pandemic, demand for intensive care often exceeds availability. Experts agree that allocation should maximize benefits and must not be based on whether patients could have taken preventive measures. However, intensive care units are often overburdened by individuals with severe COVID-19 who have chosen not to be vaccinated to prevent the disease. This article reports an experiment that investigated the German public's prioritization preferences during the fourth wave of the coronavirus pandemic. In a series of scenarios, participants were asked (...) to decide on ICU admission for patients who differed in terms of health condition, expected treatment benefits, and vaccination status. The results reveal an in-group bias, as vaccinated individuals preferred to allocate more resources to the vaccinated than to the unvaccinated. Participants also favored admitting a heart attack patient rather than a COVID-19 patient with the same likelihood of benefiting from ICU admission, indicating a preference for maintaining regular ICU services rather than treating those with severe COVID-19. Finally, participants were more likely to admit a patient to intensive care when this meant withholding rather than withdrawing care from another patient. The results indicate that lay prioritizations violate established allocation principles, presaging potential conflicts between those in need of intensive care and those who provide and allocate it. It is therefore recommended that allocation principles should be explained to enhance public understanding. Additionally, vaccination rates should be increased to relieve ICUs and reduce the need for such triage decisions. (shrink)

We distinguish the set of explicit beliefs of a reasoner, his "belief base", from the beliefs that are merely implicit. Syntax-based belief change governed by the structure of the belief base and the ranking ("prioritization") of its elements is reconstructed with the help of an epistemic entrenchment relation in the style of Gärdenfors and Makinson. Though priorities are essentially different from entrenchments, distinguished relations of epistemic entrenchment may be obtained from prioritized belief bases by a number of different constructions. An (...) approximate reconstruction of syntax-based belief change is possible, which can be strengthened to a strict identity in some important special cases. A competitive interpretation and a minimal change interpretation of the basic idea of entrenchment are discussed. It is argued that entrenchment essentially involves multiple belief changes, i.e., changes by sets of sentences. (shrink)

The term "stakeholder engagement" has gained increasing prominence over the last few years. This prominence is fueled by a range of issues such as an increased dissatisfaction with business's focus on stockholder/shareholder interests and the demands for greater transparency from business following major business scandals. A perceived response to this issue in South Africa has been the inclusion of guidelines on stakeholder engagement in the King II Report on Corporate Governance. Despite this growing interest, there has not been clarity on (...) how companies engage with their stakeholders and specifically with how they identify and prioritize their stakeholders. The study sought to establish the reporting practices of South African business in relation to stakeholder identification and prioritization through a content analysis of their annual reports. The findings are discussed and recommendations on the two aspects of stakeholder engagement presented. (shrink)

Dans le contexte actuel de longs délais d’attente pour accéder aux services de réadaptation, la grande majorité des établissements utilisent la priorisation des demandes de référence pour aider à gérer les listes d’attente. Les pratiques de priorisation varient grandement d’un milieu à l’autre et il y a peu de consensus sur la meilleure façon de prioriser les demandes de référence. Cet article décrit les processus de priorisation de services en physiothérapie au Québec et leurs implications potentielles en termes d’équité dans (...) l’accès aux services. Il s’agit d’une analyse secondaire d’une enquête menée en 2015 auprès des cliniques externes en physiothérapie (n=98 ; la proportion de participation était de 99 %) dans les hôpitaux publics du Québec. Dans de nombreux milieux, les personnes ayant une condition orthopédique aigüe étaient priorisées, tandis que les conditions chroniques recevaient une priorité moindre. Nous avons comptabilisé 72 combinaisons différentes de critères de priorisation utilisées dans les cliniques externes de physiothérapie. Nous avons également observé une variabilité dans le type de personnel impliqué dans le processus de priorisation, le nombre de niveaux de priorité utilisés pour classer les demandes de référence et la source d’information utilisée pour établir la priorisation. Ces résultats mettent en lumière des enjeux potentiels concernant l’équité dans l’accès aux services de physiothérapie : la priorisation des personnes atteintes de conditions aigües au détriment de celles atteintes de conditions chroniques, l’absence de consensus sur un processus de priorisation équitable et la nécessité d’évaluer adéquatement les besoins de traitement des patients. De futures recherches et interventions sur les critères et les processus de priorisation sont nécessaires pour assurer un accès équitable aux services de physiothérapie, en particulier dans le secteur public. (shrink)

Rationing is the allocation of a good under conditions of scarcity, which necessarily implies that some who want and could be benefitted by that good will not receive it. One reflection of our ambivalence towards health care rationing is reflected in our resistance to having it distributed in a market like most other goods—most Americans reject ability to pay as the basis for distributing health care. They do not view health care as just another commodity to be distributed by markets. (...) Despite this widespread view, we are the only developed country without some form of universal health insurance, and so for the 46 million Americans without health insurance their access to health care often does depend on their ability to pay for it. Rationing largely remains a topic that the public, their elected leaders, and many health care professionals prefer to avoid. Ever-growing costs of health care will increasingly force the practice and issue of health care resource prioritization and rationing into the open for public, professional, and political attention. This paper explores some of the features of those practices and issues that make them especially ethically and politically difficult. Those issues will not be easily resolved, but avoiding them will not avoid the need or reality of rationing, it will only mean that it will go on covertly and unexamined. That will lead neither to better or more legitimate prioritization and rationing decisions. (shrink)

The allocation of critical care resources and triaging patients garnered a great deal of attention during the COVID-19 pandemic, but there is a paucity of guidance regarding the ethical aspects of resource allocation and patient prioritization in ‘normal’ circumstances for Canadian healthcare systems. One context where allocation and prioritization decisions are required are surgical waitlists, which have been globally exacerbated due to the COVID-19 pandemic. In this paper, we detail the process used to develop an ethics framework to support prioritization (...) for elective surgery at The Hospital for Sick Children, Toronto, a tertiary pediatric hospital. Our goal was to provide guidance for the more value-laden aspects of prioritization, particularly when clinical urgency alone is insufficient to dictate priority. With this goal in mind, we worked to capture familial, relational, and equity considerations. As part of our institution’s concerted efforts to ethically and effectively address our surgical backlog, an ethics working group was formed comprising clinicians from surgery, anesthesiology, intensive care, a hospital bioethicist, a parent advisor, and an academic bioethics researcher. A reflective equilibrium process was used to develop an ethics framework. To this end, the same methodology was used to create a support for patient prioritization that identifies clinically and morally relevant factors for prioritization among medically similar surgical cases, with a substantive goal being to identify and redress health inequities in surgical prioritization, inasmuch as this is possible. While further steps are needed to validate several aspects of the framework, our research suggests that an ethics framework grounded in the practical realities of hospital operations provides consistency, transparency, and needed support for decisions that are often left to individual clinicians, as well as an opportunity to reflect upon the presence of health inequities in all domains of healthcare delivery. (shrink)

RATIONALE AND AIMS: Total hip and knee replacements, usually, have long waiting lists. There are several prioritization tools for these kind of patients. A new tool should undergo a standardized validation process. The aim of the present study was to validate a new prioritization tool for primary hip and knee replacements. METHODS: We carried out a prospective study. Consecutive patients placed on the waiting list were eligible for the study. Patients included were mailed a questionnaire which included, among other questions, (...) the seven items of the priority tool and the Western Ontario and McMasters Universities Arthritis Index (WOMAC) specific questionnaire. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the content and construct validity. We used Student's t-test or one-way analysis of variance. Correlational analysis was used to evaluate convergent and discriminate validity. RESULTS: The sample consisted of 838 patients (62.3% were female), with mean age of 70.2 years (SD 8.4). A total of 55.5% patients underwent knee replacement. Given that the tool was elaborated by patients and orthopaedic surgeons, it shows a good content validity. The priority score was statistically different (P < 0.001) among the three urgency categories created. The scores of the three WOMAC dimensions showed differences (P < 0.001) by the three urgency categories created. The correlations between the priority score and WOMAC dimensions were 0.79 (function), 0.69 (pain) and 0.51 (stiffness). The correlations between WOMAC items and items from priority tool were greater (0.47-0.69) between items measuring similar constructs than those measuring different constructs (0.27-0.49). These data are similar in both joints. CONCLUSIONS: Results support the validity of the prioritization tool to be used with patients waiting for hip or knee replacement. (shrink)

In 1990 the landmark Americans with Disabilities Act (ADA) became federal law with the express purpose to “establish a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities."l The act includes separate titles prohibiting discrimination on the basis of disability in employment, public services, transportation and public accommodations. Since it prohibits discrimination on the basis of disability in both public and private services and programs, in health care “it applies to programs provided by the government, (...) benefits provided by employers, and services pro- ”2 vided by physicians.Moreover, the ADA defines disability broadly to include “any.. (shrink)

The Danish healthcare system must meet the need for easy and equal access to healthcare for every citizen. However, investigations have shown unfair prioritization of cancer patients and unfair prioritization of resources for expensive medicines over care. What is needed are principles for proper prioritization. This article investigates whether American ethicists Tom Beauchamp and James Childress’s principle of justice may be helpful as a conceptual framework for reflections on prioritization of expensive biological therapies in the Danish healthcare system. We present (...) an empirical study exploring the principles for prioritizing new expensive biological therapies. This study includes qualitative interviews with key Danish stakeholders experienced in antibody therapy and prioritizing resources for expensive medicines. Beauchamp and Childress’s model only covers government-funded primary and acute healthcare. Based on the interviews, this study indicates that to be helpful in a Danish context this model should include equal access for citizens to government-funded primary and acute healthcare, costly medicine, and other scarce treatments. We conclude that slightly modified, Beauchamp and Childress’s principle of justice might be useful as a conceptual framework for reflections on the prioritization of expensive biological therapies in the Danish healthcare system. (shrink)

Regression testing is applied whenever a code changes, ensuring that the modifications fixed the fault and no other faults are introduced. Due to a large number of test cases to be run, test case prioritization is one of the strategies that allows to run the test cases with the highest fault rate first. The aim of the paper is to present an optimized test case prioritization method inspired by ant colony optimization, test case prioritization–ANT. The criteria used by the optimization (...) algorithm are the number of faults not covered yet by the selected test cases and the sum of severity of the faults. The cost, i.e. time execution, for test cases is considered in the computation of the pheromone deposited on the graph’s edges. The average percentage of fault detected metric, as best selection criterion, is used to uncover maximum faults with the highest severity, and reducing the regression testing time. Several experiments are considered, detailed and discussed, comparing various algorithm parameter’s alternatives. A benchmark project is also used to validate the proposed approach. The obtained results are encouraging, being a cornerstone for new perspectives to be considered. (shrink)

The recent Ebola virus disease outbreak in Western African countries has raised questions regarding the feasibility of adopting conventional trial designs such as randomized controlled trials for conducting experimental trials in the midst of a fatal epidemic. In the context of Ebola ça Suffit trial conducted in Guinea for testing the efficacy and effectiveness of rVSV–ZEBOV, a candidate vaccine, I argue that the trial design and the methodologies adopted for the trial have been rightly chosen for their ethical appropriateness and (...) social utilities rather than only epistemic advantages. In this paper, I propose and defend the view that in varying scientific research contexts, it is entirely legitimate that non-epistemic values may be prioritized over epistemic considerations. Two vital methodological choices scientists should make while designing a clinical trial are: the choice of appropriate control group and the choice of appropriate randomization. Given this background, I show that the choice of delayed vaccination arm as the control group over placebo control group and the choice of cluster randomization over individually controlled randomization for conducting Ebola ça Suffit trial are perfect instances of such a scenario where addressing social and ethical issues have been justifiably prioritized over epistemic values so that the research in a specific scientific context could be conducted in a socially relevant manner. (shrink)

Developing a way to address troublesome issues in areas such as urban planning is a chal-lenging undertaking. It includes making decisions that involve humans, nonhumans, future generations, and historical and cultural artifacts. All of these groups deserve consideration, but not equally. Figuring out how to approach this topic involves overcoming the problem of moral prioritization. The structure of weak anthropocentrism can help with this problem, suggesting that future research on the environmental aspects of metropolitan regions should make use of its (...) applicability. Despite its strengths, weak anthropocentrism must be expanded to address complicated urban issues. A multitiered weak-anthropocentric measure, a “complex moral assessment,” is needed to address these concerns. (shrink)

Political talk shows, in their various forms, are among the most eagerly presented programs by contemporary media outlets, as they are considered one of the most effective means of conveying the media message to the audience. It is well-known that political movement issues have a significant impact on the lives of Iraqi citizens in various aspects—political, economic, social, and cultural, among others. Consequently, these issues have become a priority for media outlets in general and talk shows in particular, as they (...) seek to find specific solutions to the discussed issues and achieve specific agendas and objectives through the talk show. Given the importance of the topic, the researcher in this study aimed to understand the role of political talk shows in shaping and constructing the audience's agenda regarding political movement issues in Iraq. This study is classified as a descriptive study, and the researcher employed the survey method to collect information and data from the respondents. A questionnaire was used to gather data, and it was administered to a purposive, multi-stage sample consisting of 294 respondents from the audience in Baghdad Province. (shrink)

The rapid development of vaccines against COVID‐19 represents a huge achievement, and offers hope of ending the global pandemic. At least three COVID‐19 vaccines have been approved or are about to be approved for distribution in many countries. However, with very limited initial availability, only a minority of the population will be able to receive vaccines this winter. Urgent decisions will have to be made about who should receive priority for access. Current policy in the UK appears to take the (...) view that those who are most vulnerable to COVID‐19 should get the vaccine first. While this is intuitively attractive, we argue that there are other possible values and criteria that need to be considered. These include both intrinsic and instrumental values. The former are numbers of lives saved, years of life saved, quality of the lives saved, quality‐adjusted life‐years (QALYs), and possibly others including age. Instrumental values include protecting healthcare systems and other broader societal interests, which might require prioritizing key worker status and having dependants. The challenge from an ethical point of view is to strike the right balance among these values. It also depends on effectiveness of different vaccines on different population groups and on modelling around cost‐effectiveness of different strategies. It is a mistake to simply assume that prioritizing the most vulnerable is the best strategy. Although that could end up being the best approach, whether it is or not requires careful ethical and empirical analysis. (shrink)

: Calls for ethics education for members of hospital ethics committees presume that the effects and benefits of such education are well-established. This is not the case. A review of the literature reveals that studies consistently have failed to uncover any significant effect of ethics education on the moral reasoning, moral competency, and/or moral development of medical professionals. The present paper discusses this negative result and describes the author's national study of the value priorities of members of hospital ethics committees. (...) This study discovered correlations between moral decision making and factors like age and type of institution where the committee operates. The results of this study also resemble those of previous studies in finding no correlation between ethics education and moral decision making. The author concludes that there is a need for more research on the effects of nonmoral personal, societal, and institutional factors on the moral reasoning of members of hospital ethics committees. Further, in the absence of any firm empirical basis, calls for ethics education for medical professionals and ethics committee members should be rethought. (shrink)

In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a (...) generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels. (shrink)

During a pandemic, demand for intensive care often exceeds availability. Experts agree that allocation should maximize benefits and must not be based on whether patients could have taken preventive measures. However, intensive care units (ICUs) are often overburdened by individuals with severe COVID-19 who have chosen not to be vaccinated to prevent the disease. This article reports an experiment that investigated the German public's prioritization preferences during the fourth wave of the coronavirus pandemic ( N = 1014). In a series (...) of scenarios, participants were asked to decide on ICU admission for patients who differed in terms of health condition, expected treatment benefits, and vaccination status. The results reveal an in-group bias, as vaccinated individuals preferred to allocate more resources to the vaccinated than to the unvaccinated. Participants also favored admitting a heart attack patient rather than a COVID-19 patient with the same likelihood of benefiting from ICU admission, indicating a preference for maintaining regular ICU services rather than treating those with severe COVID-19. Finally, participants were more likely to admit a patient to intensive care when this meant withholding rather than withdrawing care from another patient. The results indicate that lay prioritizations violate established allocation principles, presaging potential conflicts between those in need of intensive care and those who provide and allocate it. It is therefore recommended that allocation principles should be explained to enhance public understanding. Additionally, vaccination rates should be increased to relieve ICUs and reduce the need for such triage decisions. (shrink)

This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, additional issues remain. One (...) is how to determine who has worse health, and whether the worse off are those with the worse overall health or those with the most serious medical condition now in need of treatment. Another issue is whether only individuals’ present health, or instead their lifetime health, including past and expected future health, is relevant. (shrink)

This article examines some of the ethical challenges of prioritizing intensive care resources during the Covid-19 pandemic by comparing the Italian and United States contexts. After presenting an overview to the clinical, ethical, and public debates in Italy, the article will discuss the development of triage allocation protocols in United States hospitals. Resource allocation criteria underwent increased scrutiny and critique in both countries, which resulted in modified professional and expert guidance regarding healthcare ethics during times of emergency and resource scarcity.

The purpose of this article is to examine stakeholder identification and prioritization by managers using the power, legitimacy, and urgency framework of Mitchell et al. (Academy of Management Review 22, 853–886; 1997). We use a multi-method, comparative case study of two large-scale sporting event organizing committees, with a particular focus on interviews with managers at three hierarchical levels. We support the positive relationship between number of stakeholder attributes and perceived stakeholder salience. Managers’ hierarchical level and role have direct and moderating (...) effects on stakeholder identification and perceived salience. We also found that most stakeholders were definitive, dominant, or dormant types – the other five types were rare. Power has the most important effect on salience, followed by urgency and legitimacy. Based on our case study, we offer several ways to advance the theory of stakeholder identification and salience. (shrink)

Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is (...) needed to share resources equally between high-cost and low-cost treatment; higher inequality aversion is needed to favor treatment rather than prevention, and the highest inequality aversion is needed to favor sharing treatment between urban and rural regions rather than urban provision of treatment. This type of ethical sensitivity analysis may clarify the ethics of health policy choice. (shrink)

In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions regarding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of responsibility in allocating scarce healthcare resources. A large proportion of doctors in both countries supported including responsibility for illness in (...) prioritization decisions. This finding was more prominent in zero‐sum scenarios where allocation to one patient means that another patient is denied treatment. There was most support for incorporating prospective responsibility (through patient contracts), and low support for integrating responsibility into co‐payments (i.e. through requiring responsible patients to pay part of the costs of treatment). Finally, some behaviours were considered more appropriate grounds for deprioritization (smoking, alcohol, drug use)—potentially because of the certainty of impact and direct link to ill health. In zero‐sum situations, prognosis also influenced prioritization (but did not outweigh responsibility). Ethical implications are discussed. We argue that the role that responsibility constructs appear to play in doctors' decisions indicates a needs for more nuanced—and clear—policy. Such policy should account for the distinctions we draw between responsibility‐sensitive and prognostic justifications for deprioritization. (shrink)

Discrimination is an important real-life issue that affects many individuals and groups. It is also a fruitful field of study that intersects several disciplines and methods. This Special Section brings together papers on discrimination and prioritization in healthcare from leading scholars in bioethics and closely related fields.

In the face of the most recent developments in digital and visual art, the Internet, the latest frontiers and currents, the new languages and technologies, Souriau’s schema does not work, but his reflections on the aesthetic notions of instauration and skeuopoetics do, and they pertain both to classical painting and to future perspectives. In fact, we note strong connections with research that the philosopher had had conducted on feelings, relations, forms, and processes, in terms of synaesthesia and structural correspondences. On (...) the basis of his thinking, we can still argue the importance of these concepts and these relations as they relate to physical and phenomenal existence, to materiality and transcendence: a conceptual and imaginative universal that is considered to be eternal. Art is seen as the producer of things capable of performing actions that are purely physical. He makes this claim because these actions expressly and intentionally create things whose existence is their sole purpose. (shrink)

The dominant methodology in health policy for prioritizing and rationing health care resources is cost-effectiveness analysis, typically using quality adjusted life years (QALYs) or disability adjusted life years (DALYs) to measure health outcomes. The construction of these measures involves a number of moral or value choices, including: How should states of health and disability be evaluated, and whose preferences (e.g., the disabled or non-disabled) should be used? How should these evaluations reflect that prioritization will involve tradeoffs between health benefits for (...) different persons or groups? Do all QALYs count equally, no matter what age at which they are received? Should discount rates be applied to health benefits? I will show the nature of the moral issues at stake in answering these questions, and briefly argue how they should be answered. (shrink)

Vaccine scarcity and availability distinguish two central ethics questions raised by the Covid-19 pandemic. First, in situations of scarcity, which groups of persons should receive priority? Second, in situations where safe and effective vaccines are available, what circumstances and reasons can support mandatory vaccination? Regarding the first question, normative approaches converge in prioritizing most-vulnerable groups. Though there is room for prudential judgement regarding which groups are most vulnerable, the human dignity principle is most relevant for prioritization consideration of both medical (...) and non-medical issues. The second question concerning mandates is distinct from considerations about persons’ individual moral duty to receive vaccines judged reasonably safe and critical for individual and public health. While there is consensus regarding the potential normative support for mandated vaccination, the paternalistic government intervention of vaccine mandates requires a high bar of demonstrated vaccine safety and public health risk. We discuss stronger and weaker forms of paternalism to deal with the Covid-19 pandemic from an “integrative” approach that integrates leading normative approaches. We argue against a population-wide compulsory vaccination and support prudential measures to 1) protect vulnerable groups; 2) focus upon incentivizing vaccine participation; 3) maintain maximum-possible individual freedoms, and 4) allow schools, organizations, and enterprises to implement vaccine requirements in local contexts. (shrink)

In their article, Bruno and Arora (2018) conclude that if deceased donor uterus transplantation has equivalent outcomes and the supply of deceased donors is sufficient, then living uterus donation...

One of the grounds on which profit maximization has been morally condemned is the claim that businessmen are led by the logic of profit maximization to prioritize profit above all other values, including human life. Thus, while business critics claim that they object to profit maximization, what, at least some of them, in fact object to is profit prioritization. Drawing upon Ayn Rand's distinction between the intrinsic and objective theories of value, this article unpackages profit maximization and profit prioritization, arguing (...) that businessmen can maximize profit without having to prioritize profit above all other values. (shrink)

The term "stakeholder engagement" has gained increasing prominence over the last few years. This prominence is fueled by a range of issues such as an increased dissatisfaction with business's focus on stockholder/shareholder interests and the demands for greater transparency from business following major business scandals. A perceived response to this issue in South Africa has been the inclusion of guidelines on stakeholder engagement in the King II Report on Corporate Governance. Despite this growing interest, there has not been clarity on (...) how companies engage with their stakeholders and specifically with how they identify and prioritize their stakeholders. The study sought to establish the reporting practices of South African business in relation to stakeholder identification and prioritization through a content analysis of their annual reports. The findings are discussed and recommendations on the two aspects of stakeholder engagement presented. (shrink)

The aim of this study was to describe the reasoning of people aged 60 years and over about prioritization in health care with regard to age and willingness to pay. Healthy people (n = 300) and people receiving continuous care and services (n = 146) who were between 60 and 101 years old were interviewed about their views on prioritization in health care. The transcribed interviews were analysed using manifest and latent qualitative content analysis. The participants' reasoning on prioritization embraced (...) eight categories: feeling secure and confident in the health care system; being old means low priority; prioritization causes worries; using underhand means in order to be prioritized; prioritization as a necessity; being averse to anyone having precedence over others; having doubts about the distribution of resources; and buying treatment requires wealth. (shrink)