We study the allocation of cadaveric donor kidneys for transplantation based merely on waiting time. This simple allocation rule turns out to possess very attractive ethical and medical properties. Current allocation rules, on the other hand, violate some basic requirements of distributive justice. Perhaps for fear of exacerbating these problems, these rules also fail to consider criteria such as sex, age and race although certain combinations of these criteria are known to affect graft survival rates. We demonstrate (...) that allocation by waiting time automatically protects disadvantaged patient types and puts them in a near to optimal position. The inclusion of sex, age and race will therefore not lead to morally unacceptable allocations. This allows individual patients to improve the expected survival time of their graft relative to the status quo without being penalized by the allocation rule. Moreover, decisions ab out when to start compromising on expected graft survival rates in favour of shorter waiting times are made locally by patients and their medical advisers rather than by a centralized protocol. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics and the Allocation of Organs for TransplantationJames F. Childress (bio)A quarter of a century ago, in my second year of teaching at the University of Virginia, I began to explore the emerging field of biomedical ethics through a seminar on “Artificial and Transplanted Organs,” which included both faculty and students from law, medicine, and the humanities. My paper for the seminar was entitled “Who Shall Live When (...) Not All Can Live?” This experience drew me into biomedical ethics, because of the complex mix of ethical, legal, and medical issues and the fruitfulness of interdisciplinary and interprofessional dialogue.Several of the major problems confronting that seminar have persisted, often in altered form. In the area of organ transplantation, two significant issues continue to require society’s attention: (1) how can the organ supply be increased, and (2) how should the available organs be allocated? I want to make a few points about ethical criteria in the allocation of donated organs, as a way to indicate some directions for organ allocation policies in the twenty-first century. I will focus on the second question because I believe that a tremendous and ever-widening gap will persist between the need for transplantable organs and the supply of human cadaveric organs.Community Ownership of Donated Organs and Public ParticipationSince the mid-1980s, the operative conception of the ownership of donated organs has shifted, with major implications for the procedures used to formulate policies for organ allocation. As vice-chair of the federal Task Force on Organ Transplantation in the mid-1980s, I did not immediately realize that debates about allocation policies often reflected different conceptions of the ownership of donated organs. More specifically, organ allocation policies largely presupposed that donated organs belonged to, or were under the dispositional authority of, transplant surgeons, with only limited public accountability. However, the Task Force (1986) held that donated organs belong to the community, and that transplant professionals are only trustees and stewards of those organs for the [End Page 397] community’s welfare. This conception of ownership implies that the public should participate in setting the criteria for organ allocation.According to Jeffrey Prottas (1994), another member of the Task Force, these shifts represent the “socialization” of organ transplantation. Although professional dominance, through knowledge and power, continues in the United Network for Organ Sharing (UNOS)—the national organ procurement and transplantation network that was established in the late 1980s—that dominance is now more circumscribed and accountable, particularly because UNOS, in developing any allocation policy, has to respond “to public criticisms with public answers.” Not only is organ allocation policy now in the public domain—and thus a matter of public ethics rather than medical ethics—the terms of the debate have changed, as Prottas further notes, so that equity must be considered along with efficiency.Balancing Several Ethical Principles or ValuesThe main ethical criteria for organ allocation express principles that are prominent in the major competing theories of justice, particularly libertarian, egalitarian, utilitarian, and communitarian theories. The principles of liberty, equality, utility, and community all play important roles, and organ allocation policies often seek to balance these competing principles, which frequently are specified or circumscribed—for instance, utility is specified as medical utility. Just or equitable policies are found in the process of balancing.UNOS (1994) attempts to develop an equitable organ allocation system in light of a “set of basic principles” and “specific measurable objectives” that have been derived from these principles. It uses the metaphor of “balance” for its efforts to relate these different principles and objectives. For instance, it holds that balancing requires that “equal consideration” be given to both medical utility and to justice, so that neither can be ranked a priori over the other. However, it may not be possible to “give equal weight to [both] medical utility and justice” (UNOS 1994, p. 123) because trade-offs appear to be unavoidable in many policies and are consistent with the metaphor of balancing.Medical Utility and EqualityMedical utility—maximizing the welfare of patients suffering from end-stage organ failure—includes, at a minimum, attention to the factors that influence both graft and patient survival, as well... (shrink)

Speciesism, difference of treatment based on an appeal to species membership, is often likened to racism and sexism, and condemned on those grounds. Some philosophers, however, reject this argument by analogy and instead forward an argument for speciesism based on a postulated right of species to compete for survival. This paper attacks this strong form of speciesism by showing that the underlying concept of ‘species’ is incoherent in the context of morality, and that strong speciesism has unacceptable corollaries.

How should UNOS deal with the presence of scientific controversies on the risk factors for organ rejection when designing its allocation policies? The answer I defend in this paper is that the more undesirable the consequences of making a mistake in accepting a scientific hypothesis, the higher the degree of confirmation required for its acceptance. I argue that the application of this principle should lead to the rejection of the hypothesis that ‘less than perfect’ Human Leucocyte Antigen (HLA) matches (...) are an important determinant of kidney graft survival. The scientific community has been divided all along on the significance of partial antigen matches. Yet reliance on partial matches has emerged as one of the primary factors leading blacks to spend a much longer time than whites on the waiting list for kidneys, thereby potentially impacting the justice of the kidney allocation policy. My case study illustrates one of the legitimate roles non-epistemic values can play in science and calls into question the ideal of a value-free science. (shrink)

Speciesism, difference of treatment based on an appeal to species membership, is often likened to racism and sexism, and condemned on those grounds. Some philosophers, however, reject this argument by analogy and instead forward an argument for speciesism based on a postulated right of species to compete for survival. This paper attacks this strong form of speciesism by showing that the underlying concept of ‘species’ is incoherent in the context of morality, and that strong speciesism has unacceptable corollaries.

In The Myth of Ownership, Liam Murphy and Thomas Nagel argue that achieving fairness in taxation is principally a matter of distributive justice. Distributive justice can be understood as being concerned with what is owed to people as a matter of justice. For Nagel and Murphy, fairness in tax schemes is subsumed to the question of distributive justice: fairly allocated tax liabilities are just those that are compatible with the preferred theory of distributive justice. Subsuming assessments of tax fairness to (...) distributive justice, however, overlooks the following possibility: that the question of how we ought to divvy up tax liabilities, and the burdens associated with running a society more generally, requires different, non-distributive considerations of justice. These are considerations of justice that aren’t essentially about distributive justice at all. I argue here that the division of burdens in a society is specifically a matter of contributive justice. Contributive justice is concerned with what people owe as a matter of justice, rather than what is owed to them. It makes the division of burdens itself evaluative salient in assessments of fairness. Even a comprehensive specification of distributive justice leaves indeterminate how the burdens of running a society should be fairly divided up. Each of the chapters in this dissertation develops one part of an account of contributive justice. I first make conceptual space for an account of contributive justice. By taking Murphy and Nagel’s lead, and working within the post-distribution, a distinctive need for principles of justice in contribution can be shown. Murphy and Nagel decline to introduce non-distributive principles for guiding the provision of post-distributive public goods. Instead, they favor efficiency in determining the provision of post-distributive of public goods. I show that contributive justice is genuinely distinct from both efficiency and distributive justice. I also identify one respect in which principles of contributive justice should bear: that of determining the financing and delivery and civic cultural public goods. I then argue that a principle of contribution in accordance with ability (a principle of “ability-to-pay”, or “ability-to-contribute”, for short) stands out as a candidate principle of contributive justice. The version of ability-to-pay that I defend is, in particular, a deontic principle of ability-to-pay. I show that a deontic principle of ability-to-pay is more closely allied with a view of society as a cooperative enterprise than utilitarian versions of ability-to-pay. An account of ability to contribute is developed by grafting a notion of opportunity cost onto Amartya Sen’s capability theory. Lastly, I incorporate contributive justice in an account of contributive legitimacy. Contributive legitimacy gives us a set of conditions under which the state’s use of coercive force to extract tax contributions is legitimate, and hence justified. Drawing on empirical evidence from the development and fiscal sociology literature, I show that contributive legitimacy in a state’s tax extraction practices is essential to rule of law, and the avoidance of kleptocratic authoritarianism. Contributive legitimacy supplements our understanding of conventional notions of political legitimacy and helps us identify possible failures of political legitimacy. These are failures that might be overlooked were we to focus solely on distribution. (shrink)

Amit Sharma, Rajesh Ramanathan, Marc Posner, Robert A Fisher Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA: Pediatric kidney transplantation is the preferred treatment for children with end-stage renal disease. The most common indications for transplantation in children are renal developmental anomalies, obstructive uropathy, and focal segmental glomerulosclerosis. Living donor kidney transplants are often performed pre-emptively and offer excellent graft function. Policy changes in deceased-donor kidney allocation have increased the proportion of such transplants in pediatric recipients. Adequate pretransplant (...) workup along with evaluation of urologic abnormalities is imperative in achieving good outcomes. Overall, patient and graft outcomes after kidney transplantation have improved, with five-year deceased donor and living donor graft survivals of 78.8% and 84.3%, respectively. Improvements in induction and maintenance immunosuppression have contributed to the gradual improvement in outcomes. Unique challenges in pediatric recipients include increased graft thrombosis, adverse growth, and abnormal development relating to immunosuppression, increased rejection due to nonadherence, increased susceptibility to opportunistic infections, and post-transplant malignancy. This review focuses on the current practices and outcomes in pediatric kidney transplantation in North America. We discuss the indications for transplantation, the evaluation process, some key surgical and immunologic considerations, and the common risk factors for graft dysfunction. Keywords: pediatric kidney transplantation, end-stage renal disease, dialysis, organ donors, immunosuppression. (shrink)

A grafted frame is a new kind of frame which combines a modal frame and some relevance frames. A grafted model consists of a grafted frame and a truth-value assignment. In this paper, the grafted frame and the grafted model are constructed and used to show the completeness of S1. The implications of S1-completeness are discussed. A grafted frame does not combine two kinds of frames simply by putting relations defined in the components together. That is, the resulting grafted frame (...) is not in the form of $\langle W, R, R'\rangle$ , or more generally, in the form of $\langle W, R, R', R'',...\rangle$ , which consists of a non-empty set with several relations defined on it. Rather, it resembles the construction of fibering proposed by D. M. Gabbay and M. Finger (see [4] and [3]). On a grafted frame, some modal worlds, which belong to the initial modal frame, are attached by some relevance frames. However, these two semantics have important differences. Consider the combined semantics involving semantics of relevance logic and modal logic. A fibred model and a grafted model proposed in this paper differ in the following respects. First, a fibred model is constructed from a class of modal models and a class of relevance models. A grafted model consists of a grafted frame and a truth-value assignment, where the grafted frame is constructed from a modal frame and some relevance frames, and the assignment is a union of a modal truth-value assignment V M and some relevance truth-value assignments V R . V M (V R ) defined in this paper is not the same as the assignment contained in a modal (relevance) model. Second, in a fibred model each relevance world is associated (or fibred) with a modal model and each modal world with a relevance model. To be the grafted frame on which a grafted model is based, it is enough to have some modal worlds attached by some relevance frames. Moreover, no relevance world is associated with a modal frame in the grafted frame. Third, fibred models are intended to provide an appropriate semantics to combined logics. Grafted frames and grafted models are inspired to characterize S1, which, containing only one modality □, is not a combined logic. It is shown in this paper that S1 is sort of a meta-logic of the intersection of S0.4 and F, where S0.4, a new system proposed in this paper, is in turn a meta-logic of the relevance logic. (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.

A grafted frame is a new kind of frame which combines a modal frame and some relevance frames. A grafted model consists of a grafted frame and a truth-value assignment. In this paper, the grafted frame and the grafted model are constructed and used to show the completeness of S1. The implications of S1-completeness are discussed. A grafted frame does not combine two kinds of frames simply by putting relations defined in the components together. That is, the resulting grafted frame (...) is not in the form of $\langle W, R, R'\rangle$, or more generally, in the form of $\langle W, R, R', R'',...\rangle$, which consists of a non-empty set with several relations defined on it. Rather, it resembles the construction of fibering proposed by D. M. Gabbay and M. Finger. On a grafted frame, some modal worlds, which belong to the initial modal frame, are attached by some relevance frames. However, these two semantics have important differences. Consider the combined semantics involving semantics of relevance logic and modal logic. A fibred model and a grafted model proposed in this paper differ in the following respects. First, a fibred model is constructed from a class of modal models and a class of relevance models. A grafted model consists of a grafted frame and a truth-value assignment, where the grafted frame is constructed from a modal frame and some relevance frames, and the assignment is a union of a modal truth-value assignment V$_M$ and some relevance truth-value assignments V$_R$. V$_M$ defined in this paper is not the same as the assignment contained in a modal model. Second, in a fibred model each relevance world is associated with a modal model and each modal world with a relevance model. To be the grafted frame on which a grafted model is based, it is enough to have some modal worlds attached by some relevance frames. Moreover, no relevance world is associated with a modal frame in the grafted frame. Third, fibred models are intended to provide an appropriate semantics to combined logics. Grafted frames and grafted models are inspired to characterize S1, which, containing only one modality $\square$, is not a combined logic. It is shown in this paper that S1 is sort of a meta-logic of the intersection of S0.4 and F, where S0.4, a new system proposed in this paper, is in turn a meta-logic of the relevance logic. (shrink)

Grafting: do we ever do anything other than that? And are we ever free from vegetal influences when we engage in its operations? For the philosopher Michael Marder, our reflections on vegetal life have a fundamental importance in how we can reflect on our own conceptions of ethics, politics, and philosophy in general. Taking as his starting point the simple vegetal conception of grafting, Marder guides the reader through his concise and numerous reflections on what could be described as a (...) vegetal philosophy. Grafts are transplants either of a shoot inserted into the trunk of another tree or, surgically, of skin (among other living tissues). They are delicate operations intended to preserve, improve, and modify both the grafted materials and the body that receives them. To graft is to create unlikely encounters, hybrid mixes, and novel surfaces. Moving across disciplinary lines, Grafts combines the lessons of plant science with the history of philosophy, semiotics, literary compositions, and political theory. Co-authoring some of the texts with other philosophers, plant scientists and artists, Marder allows their insights to be grafted onto his own, and vice versa. Weighing in on contemporary debates such as the ethics of biotechnology, dietary practices or political organization, Marder inserts an unmistakable vegetal perspective into topics of discussion where it normally wouldnt be found. Transferring the living tissue of his own texts into another context, he helps them live better, more fully, than otherwise. (shrink)

BackgroundMany procedures currently require the use of bone grafts to replace or recover bone volume that has been resorbed. However, the patient’s opinion and preferences must be taken into account before implementing any treatment. Researchers have focused primarily on assessing the effectiveness of bone grafts rather than on patients' perceptions. Thus, the aim of this study was to explore patients' opinions regarding the different types of bone grafts used in dental treatments.MethodsOne hundred patients were randomly chosen participated (...) in the study. A standardized survey of 10 questions was used to investigate their opinions regarding the different types of bone grafts used in dental treatments. Descriptive statistics were calculated for the different variables, and absolute frequencies and percentages were used as summary measures. A value of p <0.05 was selected as the threshold for statistical significance.ResultsThe highest rate of refusal was observed for allografts and xenografts. The grafts with the lowest rates of refusal were autologous grafts and alloplastics. No significant differences were found between the various types of bone grafts in the sociodemographic variables or the refusal/acceptance variable. Similarly, no significant relations were observed between a specific religious affiliation and the acceptance/refusal rates of the various types of graft.ConclusionsAllografts and xenografts elicited the highest refusal rates among the surveyed patients, and autologous bone and alloplastics were the most accepted bone grafts. Moreover, no differences were found in the sociodemographic variables or religious affiliations in terms of the acceptance/refusal rates of the different bone grafts. (shrink)

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

Over the past two decades, research on neural transplantation in animal models of neurodegeneration has provided provocative in sights into the therapeutic use of grafted tissue for various neurological diseases. Although great strides have been made and functional benefits gained in these animal models, much information is still needed with regard to transplantation in human patients. Several factors are unique to human disease, for example, age of the recipient, duration of disease, and drug interaction with grafted cells; these need to (...) be explored before grafting can be considered a safe and effective therapeutic tool. (shrink)

This monograph is a critical assessment of the foundations of microeconomic theory, rationality, welfare resource allocation and capital reproduction. It examines the various concepts of rationality that have been constructed by 20th-century economists.

The transplantation of cholinergic neurons into the hippocampal formation has been well characterized. We describe our studies on the effects of cholinergic transplants in the retrosplenial cortex. These transplants were capable of ameliorating spatial navigation deficits in rats with septohippocampal lesions. In addition, we provide evidence for the modulation of transplanted neurons by the host brain.

The Latin translation of Sextus Empiricus’ ‘Outlines of Pyrrhonism’, published by Henri Estienne in 1562, are amongst the most influential texts in the history of scepticism. And yet, we still lack a complete and detailed study of their reception in modern times. Through investigation of the emblem on the frontispiece of the book, this paper argues that Estienne’s motivations for the publication should be interpreted as essentially anti-dogmatic and humanistic in nature. -/- .

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, (...) quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

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

We investigate the semantics of the logical systems obtained by introducing the modalities and into the family of substructural implication logics (including relevant, linear and intuitionistic implication). Then, in the spirit of the LDS (Labelled Deductive Systems) methodology, we "import" this semantics into the classical proof system KE. This leads to the formulation of a uniform labelled refutation system for the new logics which is a natural extension of a system for substructural implication developed by the first two authors in (...) a previous paper. (shrink)

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

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

The use of neural transplantation to alleviate cognitive deficits is still in its infancy. We have an inadequate understanding of the deficits induced by different types of brain damage and their homologies in animal models against which to assess graft-induced recovery, and of the ways in which graft growth and function are influenced by factors within the host brain and the environment in which the host is operating. Further, use of fetal tissue may only be a transitory phase in the (...) search for appropriate donor sources. Nevertheless, findings from our laboratory and elsewhere have made a prima facie case for successful cognitive reconstruction by graft methods. (shrink)

Grafting embryonic brain tissue into the brain of patients with visual field loss due to cerebral lesions may become a method to restore visual function. This method is not without risk, however, and will only be considered in cases of complete blindness after bilateral occipital lesions, when other, risk-free neuropsychological methods fail.

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

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)

It is well established that neural grafts can exert functional effects on the host animal by a multiplicity of different mechanisms – by diffuse release of trophic molecules, neurohormones, and deficient neurotransmitters, as well as by growth and reformation of neural circuits. Our challenge is to understand how these different mechanisms complement each other.

In the Eurotransplant region transplantable kidneys from cadaveric donors are allocated according to the Wujciak-Opelz algorithm. This paper shows that the algorithm as it stands fulfils certain normative standards of a more formal nature while violating others. In view of these insights, it is explored how the algorithm could perhaps be improved. Even if issues of substantial rather than formal adequacy need to be addressed separately, analyses as presented in this paper can prepare the ground for a discussion of substantive (...) normative issues. In any event, axiomatic accounts can tell us something about what we are in fact doing when using a procedure like the Wujciak-Opelz algorithm. (shrink)

Transpersonal agroecology (TPAE) is a theory, derived from the collective leanings of various important thinkers and practitioners in the field of alternative agriculture over the last century, which sees the mindset of the farmer to be just as important as his or her agricultural practices. However, these accumulated intuitions do not provide a coherent metaphysics within which to practice TPAE. Process metaphysics provides such a coherent framework for TPAE and for sustainable agriculture.

In 1866, six Inuits were taken to the United States for the purpose of serving as specimens to American scientists at the Natural History Museum. Shortly after their arrival in New York, four of them had died. One of the survivors returned to the Arctic, while the sixth, Minik, now alone, fought to make possible the return of the remains of his dead companions to their village. Since the latter were being exhibited, as was then often the case (and happens (...) even today in many museums), in order to offer visitors examples of the Inuk people, Minik protested in vain. In 1909 he returned to Greenland when the scientists denied that the remains of his friends still existed. Several years later, still pursuing the issue, he went back to the United States to take up the fight against the bureaucracy for the repatriation of the bodies. He died in the United States in 1918. It was only in 1993 that he won out and that the remains of the four were returned to the Arctic homeland. (shrink)

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens (...) in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties. (shrink)

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

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

The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in (...) health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times. (shrink)

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

This study aimed to determine if people would use social usefulness as a criterion when allocating a kidney to potential recipients. Participants ranked hypothetical patients in order of priority to receive the kidney, using only information on the patients’ volunteering record, intelligence, emotional intelligence, and attractiveness. The results showed that volunteers were prioritized over nonvolunteers, highly intelligent patients over those with average intelligence, patients with high emotional intelligence over those with average emotional intelligence, and good-looking patients over average-looking patients. There (...) was little evidence of personal favoritism. Implications and limitations are discussed. (shrink)

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

When discussing the allocation of medical resources, it is common to distinguish between macroallocation and microallocation. The former refers to an entire system of healthcare; it determines who gets access to what healthcare and on the basis of what criteria.

Robustness may increase the degree to which the robust result is indirectly confirmed if it is shown to depend on confirmed rather than disconfirmed assumptions. Although increasing the weight with which existing evidence indirectly confirms it in such a case, robustness may also be irrelevant for confirmation, or may even disconfirm. Whether or not it confirms depends on the available data and on what other results have already been established.

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

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

Resource Allocation Mechanisms derives the general welfare properties of systems in which individuals are motivated by self-interest. Satisfactory outcomes will emerge only if individual incentives are harnessed by means of a communication and payoff process, or mechanism, involving every agent. Professor Campbell employs a formal and abstract model of a mechanism that brings into prominence the criteria by which the performance of an economy is to be judged. The mechanism approach is used to prove some fundamental theorems about the (...) possibility of designing an economic system satisfying the criteria. It also establishes a way of thinking about economic issues that is becoming increasingly useful in special branches of economics, such as industrial organization and public finance. This book can be viewed as two different texts: one constitutes an introduction to the theory of mechanism design and the other is a treatment of welfare economics with conventional emphasis on Pareto optimality as well as providing substantial material on incentives, uncertainty, and existence of equilibrium. (shrink)

This chapter contains sections titled: The Conceptual Geography Some Teleological Approaches to Distributing Health Care Hypothetical Contractor Theory Libertarian Approaches: Autonomy by Default Conclusion.

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