Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Why do people read novels, go to the theater, or listen to beautiful music? Do we seek out aesthetic experiences simply because we enjoy them--or is there another, deeper, reason we spend our leisure time viewing or experiencing works of art? Aesthetics, the first short introduction to the contemporary philosophy of aesthetics, examines not just the nature of the aesthetic experience, but the definition of art, and its moral and intrinsic value in our lives. Anne Sheppard divides her work into (...) two parts: In the first, she summarizes the major theories defining art and beauty; in the second, she explores the nature of aesthetic evaluation and appreciation. As Sheppard explains, there are three main approaches to defining art, all focused on what art objects share. One proposes that all art imitates something in life, another that it expresses something (such as anger or ecstasy), still another suggests that all art has formal qualities. There is also a fourth which offers that all art shares the quality of beauty. In the second part, which concentrates on literary art, Sheppard explores such philosophic topics as critical judgment, meaning and truth in literature, and the relationship between art and morals. She raises such questions as whether there is one correct interpretation of a work of art and whether art has a moral effect on its audience and, citing specific examples, explores the views that have been put forth. A wide-ranging, intriguing book, which assumes no formal knowledge on the part of its readers, Aesthetics opens the door to a greater understanding and appreciation of art. (shrink)

"By combining recent advances in the physical sciences with some of the novel ideas, techniques, and data of modern biology, this book attempts to achieve a new and different kind of evolutionary synthesis. I found it to be challenging, fascinating, infuriating, and provocative, but certainly not dull."--James H, Brown, University of New Mexico "This book is unquestionably mandatory reading not only for every living biologist but for generations of biologists to come."--Jack P. Hailman, Animal Behaviour , review of the first (...) edition "An important contribution to modern evolutionary thinking. It fortifies the place of Evolutionary Theory among the other well-established natural laws."--R.Gessink, TAXON. (shrink)

Offers a comprehensive nonmathematical treatment regarding the design and analysis of experiments, focusing on basic concepts rather than calculation of technical details. Much of the discussion is in terms of examples drawn from numerous fields of applications. Subjects include the justification and practical difficulties of randomization, various factors occurring in factorial experiments, selecting the size of an experiments, different purposes for which observations may be made and much more.

Background. The COVID-19 pandemic necessitated drastic changes to undergraduate medical training at the University of Botswana (UB). To save the academic year when campus was locked down, the Department of Medical Education conducted a needs assessment to determine the readiness for emergency remote teaching (ERT) of the Faculty of Medicine, UB. Objectives. To report on the findings of needs assessment surveys to assess learner and teaching staff preparedness for fair and just ERT, as defined by philosopher John Rawls. Methods. Needs (...) assessment surveys were conducted using Office 365 Forms distributed via WhatsApp, targeting medical students and teaching staff during the 5 undergraduate years. Data were analysed quantitatively and qualitatively. Results. Ninety-two percent (266/289) of students and 73.5% (62/84) of teaching staff responded. Surveys revealed a high penetration of smartphones among students, but poor internet accessibility and affordability in homes. Some teaching staff also reported internet and device insufficiencies. Only WhatsApp was accessible to students and teaching staff. Conclusions. For equitable access to ERT in the future, the surveys revealed infrastructural improvement needs, including wider, stronger, affordable WiFi coverage within Botswana and enhanced digital infrastructures in educational institutions, with increased support for students. (shrink)

One of the arguments against conducting human subject trials in the Third World adopts a distributive justice principle found in a commentary of the CIOM'S Eighth Guideline for international research on human subjects. Critics argue that non-participant members of the community in which the trials are conducted are exploited because sponsoring agencies do not ensure that the products developed have been made reasonably available to these individuals. I argue that the distributive principle's wording is too vague and ambiguous to be (...) used to criticize any trial. Furthermore, the mere fact that an experiment does not fulfill this particular distributive justice principle does not entail that it is unethical. (shrink)

The common consensus on suicide seems to be that even if taking one's life is permissible on some basis, it cannot be morally obligatory. In fact, one argument often used against Utilitarianism is that the principle sometimes requires individuals to sacrifice themselves for the benefit of others, as in the case of healthy individuals who can donate all their life saving organs to those in need of transplants. However, a plausible philosophical case can be built for morally obligatory suicide. First, (...) although not a standard interpretation, it seems clear Kant thought some crimes so morally repugnant that the moral agent should commit suicide rather than performing the former. Using this interpretation, I will strengthen and defend a Kantian argument for morally obligatory suicide in situations of crimina carnis contra naturum. (shrink)

Due to the competitive nature of business as a whole, it is sometimes difficult to develop moral relationships with others. However, though friendships are possible in business, most relationships must be kept on the lower level of business acquaintanceship.

Currently, an emphasis is being placed on the integration of ethical issues into the business curriculum. This paper investigates the viability of using student group interaction to induce an upward movement in the stages of moral development as advanced by Kohlberg. The results of a classroom experiment using graduate business law students suggest that formulating groups that mix stages of moral development can provide a robust environment for upward movement. In addition, the results suggest strategies for formulating effective groups, based (...) upon entry levels as measured by the Defining Issues Test. (shrink)

Much effort and many resources have been expended in enacting smoking bans for private businesses catering to adult-only clientele. Although the arguments in favor of bans leave much to be desired, many people believe that banning smoking in the hospitality industry is justified.What is puzzling is the lack of attention on banning smoking around children in cars, houses, and other private property. After all, if such prohibitions are justified for autonomous adults, then they must be for non-autonomous minors as well. (...) A good case can be made out for banning smoking around children in the best interests of their health. (shrink)

The common consensus on suicide seems to be that even if taking one's life is permissible on some basis, it cannot be morally obligatory. In fact, one argument often used against Utilitarianism is that the principle sometimes requires individuals to sacrifice themselves for the benefit of others, as in the case of healthy individuals who can donate all their life saving organs to those in need of transplants.However, a plausible philosophical case can be built for morally obligatory suicide. First, although (...) not a standard interpretation, it seems clear Kant thought some crimes so morally repugnant that the moral agent should commit suicide rather than performing the former. Using this interpretation, I will strengthen and defend a Kantian argument for morally obligatory suicide in situations of crimina carnis contra naturum. (shrink)

In one study funded by the United States Department of Agriculture, people from North Dakota were interviewed to discover which moral principles they use in evaluating the morality of transgenic organisms and their introduction into markets. It was found that although the moral codes the human subjects employed were very similar, their views on transgenics were vastly different. In this paper, the codes that were used by the respondents are developed, compared to that of the academically composed Belmont Report, and (...) then modified to create the more practical Common Moral Code. At the end, it is shown that the Common Moral Code has inherent inconsistency flaws that might be resolvable, but would require extensive work on the definition of terms and principles. However, the effort is worthwhile, especially if it results in a common moral code that all those involved in the debate are willing to use in negotiating a resolution to their differences. (shrink)