Disability might be relevant to decisions about life support in intensive care in several ways. It might affect the chance of treatment being successful, or a patient’s life expectancy with treatment. It may affect whether treatment is in a patient’s best interests. However, even if treatment would be of overall benefit it may be unaffordable and consequently unable to be provided. In this paper we will draw on the example of neonatal intensive care, and ask whether or when it is (...) justified to ration life-saving treatment on the basis of disability. We argue that predicted disability is relevant both indirectly and directly to rationing decisions. (shrink)

Algorithmic discrimination has rapidly become a topic of intense public and academic interest. This article explores three issues raised by algorithmic discrimination: 1) the distinction between direct and indirect discrimination, 2) the notion of disadvantageous treatment, and 3) the moral badness of discriminatory automated decision-making. It argues that some conventional distinctions between direct and indirect discrimination appear not to apply to algorithmic discrimination, that algorithmic discrimination may often be discrimination between groups, as opposed (...) to against groups, and that it is not necessarily the case that morally bad algorithmic discrimination gives us reason to not use automated decision-making. For each of the three issues, the article explores implications for algorithmic discrimination, suggests some alternative answers, and clarifies how we may want to think of discrimination more broadly in light of lessons drawn from the context of algorithmic discrimination. (shrink)

Terror and its cognates have come to signify the darkest excesses of contemporary and 20th-century political life. These include aggressive claims to purity; murderous manifestations of programmatic and religious self-certainty; paranoid and devastating responses to threats to national security; and more generally, an intensity of instrumental forms of thinking and acting that give to individuals, groups, and states a broad warrant for deploying violence as a means to their purposefulness. Hannah Arendt reflected deeply on the implications of such high-minded (...) and bellicose purposefulness. This chapter focuses on how Arendt also associated terror with something utterly commonplace, whose reach and provenance extended well beyond the 20th century—namely, in the political attempt to address ubiquitous social questions. (shrink)

Prenatal diagnosis utilizes invasive procedures such as amniocentesis, chorionic villus sampling, cord blood sampling and pre-implantation genetic diagnosis. These techniques can diagnose serious foetal illnesses and this therefore provides valuable information to couples, helping them to prepare for the birth of an affected child. It also affords women the freedom to decide whether to terminate a pregnancy. The selective termination of foetuses with serious disabilities does not represent disability discrimination because women and parents are actually rejecting the disability, rather (...) than the foetus itself More significantly, the choice to abort a foetus with a serious illness or disability is an intensely private and personal exercise that does not and cannot be reflective of a wider public morality. Exactly the same can be said of the choice to selectively abort foetuses based solely on their sex. The private choice of women in this respect does not amount to the social devaluation of women. Firstly, it is an erroneous assumption that women in Australia prefer male babies. Secondly, even if there is a preference for male babies, banning prenatal sex selection would be treating just one of many symptoms of sexism, rather than curing the primary causes. The moral right of all women to reproductive freedom is an embodiment of their equal value in society. (shrink)

Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care medicine (...) and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian, concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency. (shrink)

Purpose This study aims to explore whether face recognition technology – as it is intensely used by state and local police departments and law enforcement agencies – is racism free or, on the contrary, is affected by racial biases and/or racist prejudices, thus reinforcing overall racial discrimination. Design/methodology/approach The study investigates the causal pathways through which face recognition technology may reinforce the racial disproportion in enforcement; it also inquires whether it further discriminates black people by making them experience more (...) racial discrimination and self-identify more decisively as black – two conditions that are shown to be harmful in various respects. Findings This study shows that face recognition technology, as it is produced, implemented and used in Western societies, reinforces existing racial disparities in stop, investigation, arrest and incarceration rates because of racist prejudices and even contributes to strengthen the unhealthy effects of racism on historically disadvantaged racial groups, like black people. Practical implications The findings hope to make law enforcement agencies and software companies aware that they must take adequate action against the racially discriminative effects of the use of face recognition technology. Social implications This study highlights that no implementation of an allegedly racism-free biometric technology is safe from the risk of racially discriminating, simply because each implementation leans against our society, which is affected by racism in many persisting ways. Originality/value While the ethical survey of biometric technologies is traditionally framed in the discourse of universal rights, this study explores an issue that has not been deeply scrutinized so far, that is, how face recognition technology differently affects distinct racial groups and how it contributes to racial discrimination. (shrink)

Health care providers are expected both to relieve pain and to provide anticipatory guidance regarding how much a procedure is going to hurt. Fulfilling those expectations is complicated by the cognitive modulation of pain perception. Warning people to expect pain or setting expectations for pain relief not only influences their subjective experience, but it also alters how nociceptive stimuli are processed throughout the sensory and discriminative pathways in the brain. In light of this, I reconsider the characterization of placebo analgesia (...) as pharmacologically inert and the use of it as deceptive. I show that placebo analgesia exploits the same physical mechanisms as proven analgesics and argue that it should be utilized to relieve pain. Additionally, I describe factors to help identify situations in which clinicians have the obligation to disclose the potential for pain coupled with ways of mitigating the risk of high-intensity pain by setting positive expectations. (shrink)

In "Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?," Wilkinson (2021) argues that the use of frailty scores in ICU triage does not necessarily involve discrimination on the basis of disability. In support of this argument, he claims, “it is not the disability per se that the score is measuring – rather it is the underlying physiological and physical vulnerability." While we appreciate the attention Wilkinson explicitly pays to disability in this piece, we find (...) the distinction between disability and underlying vulnerability untenable both theoretically and practically. In this peer commentary, we begin with a brief overview of research in philosophy of disability concerning the meaning of the concept itself. We argue that this research demonstrates that many forms of disability do not involve underlying vulnerabilities, and, furthermore, that Wilkinson equivocates between "disability" understood as a medical category vs. "disability" understood as a feature of lived experience. We reject Wilkinson’s distinction on these grounds and offer further considerations to avoid disability discrimination in emergency and crisis standards of care contexts. (shrink)

To cause pain, it is not enough to deliver a dose of noxious stimulation. Pain requires the interaction of sensory processing, emotion, and cognition. In this paper, I focus on the role of cognition in the felt intensity of pain. I provide evidence for the cognitive modulation of pain. In particular, I show that attention and expectation can influence the experience of pain intensity. I also consider the mechanisms that underlie the cognitive effects on pain. I show that (...) all the proposed mechanisms of pain modulation affirm the view that cognition impacts the sensory and discriminative aspects of pain. I conclude that pain perception is a cognitively penetrated phenomenon. (shrink)

This research aims to examine access to medical treatment during the COVID-19 pandemic for people living with disabilities. During the COVID-19 pandemic, the practical and ethical problems of allocating limited medical resources such as intensive care unit beds and ventilators became critical. Although different countries have proposed different guidelines to manage this emergency, these proposed criteria do not sufficiently consider people living with disabilities. People living with disabilities are therefore at a higher risk of exclusion from medical treatments as physicians (...) tend to assume they have poor quality of life, whereas access to medical treatment should be based on several parameters, including clinical data and prognosis. However, the COVID-19 pandemic shifts the medical paradigm from person-centred medicine to community-centred medicine, challenging the main ethical theories. We reviewed the main guidelines and recommendations for resources allocation and examined their position toward persons with disabilities. Based on our findings, we propose criteria for not discriminating against people with disabilities in allocating resources. The shift from person-centred to community-centred medicine offers opportunities but also risks sacrificing the most vulnerable people. The principle of reasonable accommodation must always be considered to guarantee the rights of persons with disabilities. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

The aim of this study was to assess the opinions and role of intensive care unit (ICU) nurses regarding the distribution of ICU beds. We conducted this research among 30% of the attendees at two ICU congresses in Turkey. A self-administered questionnaire was used, which included 13 cases and allocation criteria. Of the total (136 nurses), 53.7% participated in admission/discharge decisions. The most important criterion was quality of life as viewed by the physician; the least important was the patient’s social (...) status. According to the findings, the nurses thought that medical benefit and avoiding discrimination were important. On the other hand their ignorance of patients’ autonomous preferences arouses suspicions about these nurses’ role in advocating for patients’ rights. For this reason, nurses’ role in allocation decisions should be clearly described and should also be the basis on which intensive care nurses’ duties in allocation decisions should be determined. (shrink)

This questionnaire-based observational study was conducted in July 2020 with the aim of understanding the ethical and social issues faced by health care providers (HCPs) registered with the Japanese Society of Intensive Care Medicine in intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic. There were 200 questionnaire respondents, and we analyzed the responses of 189 members who had been involved in COVID-19 treatment in ICUs. The ethical and social issues that HCPs recognized during the pandemic were difficulties in (...) the decision-making process with patients’ families, limitations of life-sustaining treatment, lack of palliative care, and inadequate mental support for patients’ families and HCPs. Regarding decision-making on issues of clinical ethics during the pandemic, more than half of the respondents thought they had failed to provide sufficient palliative care to patients and responded that they experienced moral distress. The free-text responses on moral distress revealed issues such as unusual treatment and care, restricted visits, challenging situations for HCPs, and psychological burden. Additionally, 38.1% of respondents experienced episodes of social prejudice or discrimination and 4.7% experienced a shortage of medical resources. Our study result shows that the moral distress of HCPs was caused by difficulties in patient-centered decision-making and insufficient medical care to patients and their families. These were caused mainly by a lack of communication due to the stronger implementation of infection control measures. We believe that it is important to address ethical and social issues during a pandemic in order to provide appropriate medical care and prevent burnout among HCPs. (shrink)

In this paper, we bring into focus the level of thought or content in the elucidation of disagreement. We set out the view that disagreement at this level involves a specific form of noncotenability, namely, noncotenability as captured by sense or intension as opposed to reference. We present the challenge that nourishes the alternative referential view and suggest, through examples, that (i) only intensional disagreement is apt to adequately accommodate basic rationality constraints on disagreement, and (ii) it can meet the (...) aforementioned challenge insofar as we discriminate between noncotenability affecting one's concepts, intensionally conceived, and noncotenability affecting merely one's particular understanding of those concepts. We conclude that intensional disagreement is our best choice for an account of disagreement at the level of thought. (shrink)

Definition of the problem The article asks whether vaccination status could become relevant if it is unavoidable to prioritize between patients in intensive care units during a pandemic. The aim is to analyze different approaches and arguments in favor of and against the inclusion of vaccination status. Arguments The following arguments are assessed: First, it has been argued that it is unnecessary to open this discussion. Second, one could make the point that public debates about touchy subjects should be avoided. (...) A third, frequently expressed opinion claims that physicians must never discriminate between vaccinated and unvaccinated patients, either because this is in conflict with human rights or because this is incompatible with the general principle that patients’ prior conduct does not matter. Fourth, behavioral economists argue that intensive care medicine should take vaccination status into account with the goal to improve the overall numbers of vaccinations. A fifth line of thinking argues that it is more just to take vaccination into account. Conclusion The author concludes that the omission to get a necessary and recommended vaccination may be taken into account if patients’ prospects to survive are similar. She points out that lotteries would be worse. (shrink)