Disjunctive Syllogism, that is, the inference from 'not-A or B' and 'A', to 'B' can lead from true premises to a false conclusion if each of the sentences 'A' and 'not-A' is a statement of a partial truth such that affirming one of them amounts to denying the other, without each being the contradictory of the other. Such sentences inevitably occur whenever a situation which for its proper precise description needs the use of expressions such as 'most probably true' and (...) so forth, is described (less precisely) by sentences not containing such expressions. (shrink)

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

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

This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual’s rights over that body can support (...) the moral authority of advance directives. I propose that the predementia individual retains posthumous rights over her body that she acquired through historical embodiment in that body, and further argue that claims grounded in historical embodiment can sometimes override or exclude moral claims grounded in current embodiment. I close by considering how advance directives grounded in historical embodiment might be employed in practice and what they would and would not justify. (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)

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

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

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

We propose a rational method for addressing an important question—who deserves to be an author of a scientific article? We review various contentious issues associated with this question and recommend that the scientific community should view authorship in terms of contributions and responsibilities, rather than credits. We propose a new paradigm that conceptually divides a scientific article into four basic elements: ideas, work, writing, and stewardship. We employ these four fundamental elements to modify the well-known International Committee of Medical Journal (...) Editors (ICMJE) authorship guidelines. The modified ICMJE guidelines are then used as the basis to develop an approach to quantify individual contributions and responsibilities in multi-author articles. The outcome of the approach is an authorship matrix, which can be used to answer several nagging questions related to authorship. (shrink)

Addressing distributive justice issues in health policy—ranging from the allocation of health system funding to the allocation of scarce COVID-19 interventions like intensive care unit beds and vaccines—involves the application of ethical principles. Should a principle of sustainability be among them? I suggest that while the value of temporal neutrality underlying such a principle is compelling, it is already implicit in the more basic principle of equal treatment. Munthe et al imagine sustainability accompanying four other principles: need, prognosis, equal treatment (...) and cost-effectiveness. Some are spelled out, however, in ways that are ambiguous or incomplete. (shrink)

Basic income and basic capital are two common ideas for redesigning distribution. Basic income provides people with a regular income from government. Basic capital provides people with a lump-sum grant. An important part of scholarly debate concentrates on the merits of basic income versus basic capital. This paper claims that these debates are too narrow. First, current debates overlook the way that a chief inspiration for both ideas, Thomas Paine, wanted basic capital and basic income to be complements not substitutes. (...) Second, it is more instructive to compare basic capital or basic income with a wider set of alternatives than with each other. Widening the debates would benefit the discussion of a basic capital or basic income. (shrink)

The separable hidden variables theory (Bhave [1986]) of Aspect's [1982] four single channel polarizers is developed further to consider possible modified Aspect's experiment with four double channel polarizers. It is shown that Aspect's commutator is not a truly stochastic commutator, and that until such a truly stochastic commutator is devised, experiments based on Bell's inequalities (like those of Aspect's) cannot be adequate experimental tests of quantum nonseparability.

A realist separable hidden variables theory in conformity with Einstein's principle of causality is developed in this paper to explain the Einstein-Podolsky-Rosen paradox, and the experimental results (including those in Aspect's four polarizers experiment) obtained so far with a view to test the non-separability of quantum mechanics.

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)

Mental time travel research emphasizes the connection between past and future thinking, whereas autobiographical memory research emphasizes the interrelationship of self and memory. This study explored the relationship between self and memory when thinking about both past and future events. Participants reported events from the near and distant past and future, for themselves, a close friend, or an acquaintance. Past events were rated higher in phenomenological quality than future events, and near self events were rated higher in quality than those (...) about friends. Although future events were more positive than past events, only valence ratings for self and close friend showed a linear increase in positivity from distant past to future. Content analysis showed that this increase in positivity could not be ascribed to choosing events from the cultural life script. These findings provide evidence for the role of personal goals in imagining the future. (shrink)

The social sciences are at a remarkable confluence of events. Advances in computing have made it feasible to analyze data at the scale of the population of the world. How can we combine the depth of inquiry in the social sciences with the scale and robustness of statistics and computer science? Can we decompose complex questions in the social sciences into simpler, more robustly testable hypotheses? We discuss these questions and the role of machine learning in the social sciences.

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...) first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

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

The vital data about the electrical activities of the brain are carried by the electroencephalography signals. The recordings of the electrical activity of brain neurons in a rhythmic and spontaneous manner from the scalp surface are measured by EEG. One of the most important aspects in the field of neuroscience and neural engineering is EEG signal analysis, as it aids significantly in dealing with the commercial applications as well. To uncover the highly useful information for neural classification activities, EEG studies (...) incorporated with machine learning provide good results. In this study, a Fusion Hybrid Model with Singular Value Decomposition Based Estimation of Robust Parameters is proposed for efficient feature extraction of the biosignals and to understand the essential information it has for analyzing the brain functionality. The essential features in terms of parameter components are extracted using the developed hybrid model, and a specialized hybrid swarm technique called Hybrid Differential Particle Artificial Bee algorithm is proposed for feature selection. To make the EEG more practical and to be used in a plethora of applications, the robust classification of these signals is necessary thereby relying less on the trained professionals. Therefore, the classification is done initially using the proposed Zero Inflated Poisson Mixture Regression Model and then it is also classified with a deep learning methodology, and the results are compared with other standard machine learning techniques. This proposed flow of methodology is validated on a few standard Biosignal datasets, and finally, a good classification accuracy of 98.79% is obtained for epileptic dataset and 98.35% is obtained for schizophrenia dataset. (shrink)

Covid-19 has sparked calls for a universal basic income as a way of coping with a demand shock caused by the pandemic. Temporary income payments have been part of the emergency response to the pandemic. This paper questions the effectiveness of temporary payments as a way to raise demand. Some observers claim that vouchers are better targeted at sectors hit hard by Covid-19 as people may have a tendency to save than spend from temporary payments. There may be a stronger (...) case for permanent rather than temporary payments if the aim is to boost demand in the economy. (shrink)

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

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 essay examines the connection between socioeconomic mobility and equality, and argues for two conclusions: (a) Socioeconomic mobility is conceptually distinct from three common species of equality: (1) equality of opportunity, (2) equality of outcome, and (3) relational equality. -/- (b) However, socioeconomic mobility is connected — in different ways — to each species of equality, and, if we value one or more of these species of equality, these connections endow mobility with derivative normative significance.

Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?

In this Correspondence, I argue that given that scarcity has existed both for critical care resources and for vaccines, allocating critical care resources to prioritize the prevention of early COVID-19 deaths (i.e. COVID-19 deaths among younger patients) could valuably counterbalance the disproportionate exclusion of minority patients and those with life shortening disabilities that age-based vaccine allocation produces. -/- Covid-19 deaths early in life have overwhelmingly befallen minorities and people with life-shortening disabilities. Policies preventing early deaths prevent an outcome widely recognized (...) as worse—dying earlier in one’s life rather than later—while counteracting intersecting forms of injustice. Ultimately, prohibiting the use of age as a tiebreaker in critical care allocation, as Brown et al. propose, will worsen disparities and is not mandated by law. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)