There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste.In this paper we consider and evaluate a range of ways (...) to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation.We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care.Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives. (shrink)

Images have power - for good or ill. They may challenge us to see things anew and, in widening our experience, profoundly change who we are. The change can be ugly, as with propaganda, or enriching, as with many works of art. Sight and Sensibility explores the impact of images on what we know, how we see, and the moral assessments we make. Dominic Lopes shows how these are part of, not separate from, the aesthetic appeal of images. His book (...) will be essential reading for anyone working in aesthetics and art theory, and for all those intrigued by the power of images to affect our lives. '...tightly focused and carefully argued... an exceptionally interesting contribution to the philosophy of art: it contains subtle, concise, and convincing discussions of a number of difficult concepts and contentious doctrines... lucid and meticulous'. (shrink)

In early 2020, a number of countries developed and published intensive care triage guidelines for the pandemic. Several of those guidelines, especially in the UK, encouraged the explicit assessment...

The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units within many health systems, including the National Health Service in the UK. The (...) experience of Northern Italy—a couple of weeks ahead of the UK, suggests that it will simply not be possible to provide mechanical ventilation to every patient who might need it. When the crunch comes, the unpalatable question facing clinicians is which patient to save. There are some obvious strategies to avoid or reduce the problem—through measures to increase intensive care capacity, and via society-level interventions to reduce the spread of the virus. These are vitally important, but unfortunately they are unlikely to prevent the problem of demand outstripping supply from occurring. What, then, should clinicians do? How should they allocate the scarce resource of intensive care—particularly over the coming weeks as the crisis escalates? There are different values at stake in triage decisions, but at a basic level the key values are those of benefit and …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Establishment Hypothesis:Toward a More Integrated Theology of Holy OrdersDominic CerratoPreliminary ConsiderationsUnderstanding the ProblemThough the Sacrament of Holy Orders is a single sacrament consisting of three degrees, throughout its theological development, much of the focus has been on that of the priesthood. By priesthood I mean the two degrees that are sacerdotal in nature, the episcopate and the presbyterate. Given the growing understanding of the Eucharist in the Tradition, (...) and its intrinsic connection to the priesthood as its exclusive agent, this sacerdotal emphasis was a natural and organic development.1 Nonetheless, while revealing much, this sacerdocentrism, along with the adoption of the cursus honorum,2 had the unintended effect of obscuring the third level of the hierarchy, the diaconate.3 While the diaconate as an ancient order (Acts 6:1–6) would eventually be numbered among the major orders, being ordained non ad sacerdotium sed ad ministerium episcopi4 meant that deacons were not, in the same sense, related to the Eucharist as were priests. Consequently, much of [End Page 1275] what passed for diaconal theology is its liturgical role and charitable work among the poor. As observed by the Benedictine theologian Dom Augustinus Kerkvoorde just prior to the restoration of the diaconate, "there is, as far as we know, no independent theology of the diaconate. The number of authors and works should not delude us. None of them deals with the diaconate exclusively, say, to help deacons correctly understand and exercise their function in the Church."5 He goes on to characterize diaconal theology as fragments strewn throughout the various writings on orders in general, the priesthood, and the sacraments.6As later noted by the 2002 International Theological Commission on the Diaconate, this lack can be clearly observed in both the conciliar and post-conciliar documents on the diaconate. Of these, the commission wrote, "with reference to the pastoral priorities and in what concerns objective doctrinal difficulties, the Council texts show diversity of theological nuances which it is quite hard to harmonize."7 In a similar manner, with regard to the 1983 revision of the Code of Canon Law, the American canonist James Provost commented that there is:still no coherent treatment of the permanent deacons as a "proper and permanent rank in the hierarchy" comparable to the treatment given presbyters and bishops in the code; rather they are treated as exceptions to the norms for presbyters.8As a result, both before and after the Second Vatican Council, theological consideration of Holy Orders focused almost exclusively on the episcopate and presbyterate.9The recognition of a deficient theological development in the diaconate does not mean that there has been no progress over the centuries. There are, as Kerkvoorde observes, fragments throughout the Tradition up to and beyond the Vatican II. Moreover, there are some who have proposed new [End Page 1276] ways of envisioning the diaconate grounded in these very same fragments.10 While these have advanced our understanding of the diaconate as an order, missing is precisely how the three degrees relate to one another and how this unity is grounded.As the Catechism of the Catholic Church (CCC) points out, Holy Orders is a single sacrament consisting of three degrees. If one degree, say the diaconate, is theologically impoverished, then the unity of Holy Orders suffers from this same deficiency. Put another way, the triune nature of this sacrament means that its unity is dependent upon the three degrees and their relationship to one another. Commenting on this dependency, the English Dominican scholar Aidan Nichols observes: "The priesthood cannot be approached in isolation from the episcopate and the diaconate."11 To better illustrate the relationship of the three degrees to the intelligibility of Holy Orders, he goes on to observe:To the ordinary Catholic Christian, the priesthood is the order with which he or she is most familiar, and understandably so.... In this sense, it is the central image of the triptych: yet the central panel cannot be appreciated without those which flank it. We need the whole picture. 12The image of the triptych to describe the unity and diversity of Holy Orders is quite useful. As a work... (shrink)

Accession Number: ATLA0001788471; Hosting Book Page Citation: p 26-43.; Physical Description: diag, table ; Language(s): English; Issued by ATLA: 20130825; Publication Type: Essay.

Controversial cases in medical ethics are, by their very nature, divisive. There are disagreements that revolve around questions of fact or of value. Ethical debate may help in resolving those disagreements. However, sometimes in such cases, there are opposing reasonable views arising from deep-seated differences in ethical values. It is unclear that agreement and consensus will ever be possible. In this paper, we discuss the recent controversial case of Vincent Lambert, a French man, diagnosed with a vegetative state, for whom (...) there were multiple court hearings over a number of years. Both family and health professionals were divided about whether artificial nutrition and hydration should be withdrawn and Lambert allowed to die. We apply a ‘dissensus’ approach to his case and argue that the ethical issue most in need of scrutiny is different from the one that was the focus of attention. (shrink)

What role should legislation or policy play in avoiding the complications of in-vitro fertilization? In this article, we focus on single versus double embryo transfer, and assess three arguments in favour of mandatory single embryo transfer: risks to the mother, risks to resultant children, and costs to society. We highlight significant ethical concerns about each of these. Reproductive autonomy and non-paternalism are strong enough to outweigh the health concerns for the woman. Complications due to non-identity cast doubt on the extent (...) to which children are harmed. Twinning may offer an overall benefit rather than burden to society. Finally, including the future health costs for children in reproductive policy is inconsistent with other decisions. We conclude that mandatory single embryo transfer is not justified and that a number of countries should reconsider their current embryo transfer policy. (shrink)

This issue of the Journal of Medical Ethics features a special symposium on ‘elective ventilation’ . EV ) was originally described in the 1990s by doctors working in Exeter in the UK.1 At that time there was concern about the large shortfall in organs for transplantation. Patients could become organ donors if they were diagnosed as being brain dead, but this only ever occurred in patients on breathing machines in intensive care who developed signs of brainstem failure. Doctors wondered if (...) there were patients dying outside intensive care who, if they were ventilated, could become brain dead and hence eligible to donate their organs. They embarked on a process of identifying patients who were dying who would not normally be taken to intensive care because their prognosis was judged to be too poor, and then ‘electing’ to insert breathing tubes when they stopped breathing.1 With the consent of family members the patients were supported in intensive care until they were diagnosed as having signs of brain death, or until the family and doctors together judged that this was unlikely to occur.1 The Exeter team saw a 50% increase in their numbers of organs for transplantation.Box 1 Definition of elective ventilation Elective ventilation is the provision to a patient of intensive medical treatment with the sole purpose of facilitating organ donation, in the absence of an expected medical benefit.EV was a controversial practice at the time. There were a number of papers written from points of view defending2 ,3 and criticising it.4 A Department of Health guideline in 1994 concluded that EV was not in the best interests of patients and was therefore unlawful5; subsequently, the practice effectively ceased.2 However, debate about EV has not …. (shrink)

Human cooperation is held to be an evolutionary puzzle because people voluntarily engage in costly cooperation, and costly punishment of non-cooperators, even among anonymous strangers they will never meet again. The costs of such cooperation cannot be recovered through kin-selection, reciprocal altruism, indirect reciprocity, or costly signaling. A number of recent authors label this behavior ‘strong reciprocity’, and argue that it is: (a) a newly documented aspect of human nature, (b) adaptive, and (c) evolved by group selection. We argue (...) exactly the opposite; that the phenomenon is: (a) not new, (b) maladaptive, and (c) evolved by individual selection. In our perspective, the apparent puzzle disappears to reveal a biological and evolutionary logic to human cooperation. Group selection may play a role in theory, but it is neither necessary nor sufficient to explain human cooperation. Our alternative solution is simpler, makes fewer assumptions, and is more parsimonious with the empirical data. (shrink)

This issue of the journal includes papers across both analytical and empirical schools within bioethics.In his feature article, ‘The kindest cut? Surgical castration, sex offenders and coercive offers’, John McMillan asks whether surgical castration can be ethically provided as medical treatment for sex offenders . While surgical castration has previously been available in a number of European countries, in recent years it has only been available in the Czech Republic and in Germany. The European Committee for the Prevention of (...) Torture has attacked the Czech and German governments for engaging in degrading treatments. McMillan focuses on the nature of the relationship between psychiatrist and the detainee. Is the option of surgical castration a non-coercive ‘offer’, or is the option of non-castration a coercive threat? For McMillan, the nature of the intent is important, but he argues that the Czech and German approaches to surgical castration are not necessarily coercive, and can be a component of ethically praiseworthy self-transformation.Responding to McMillan, Alan Wertheimer and Franklin Miller focus on the question of coercion . They argue that the offer of castration is only coercive if psychiatrists or the state threaten to violate sex-offenders’ rights, or forego an obligation to the prisoner if he declines castration. On their view, such offers are not coercive, though they note that this does not settle the key ethical questions.Jesper Ryberg and Thomas Petersen, by contrast, argue both that offers can be coercive and that coercive offers could be morally legitimate - where there is a significant societal benefit . They suggest …. (shrink)

I am grateful to the commentators for their deep engagement with the issues raised in my paper. They raise a number of important challenges and questions about the use of frailty i...

Birth asphyxia is the most common single cause of death in term newborn infants. The majority of deaths in developed countries follow decisions to withdraw intensive care. Recent technological advances, particularly the use of magnetic resonance imaging (MRI) of the brain, may affect the process of prognostication and decision-making. There is little existing evidence about how prognosis is determined in newborn infants and how this relates to treatment withdrawal decisions.An exploratory qualitative study was performed using in-depth semi-structured interviews with a (...) sample of ten neonatologists from tertiary intensive care units in the UK. Participants were purposively selected to ensure a range of experience and type of unit. They were asked about the process of prognostication for infants with birth asphyxia and decisions about treatment withdrawal. Interviews were transcribed and thematically analysed.MRI played a significant role in decision-making about life-sustaining treatment for a number of clinicians. Clinicians did not identify particular ethical concerns related to MRI, though wider discussion revealed issues relating to uncertainty around predictions, the timing of prognostication and decision-making, and difficulty in predicting quality of life. (shrink)

One of the most contested areas in relation to literacy has been the teaching of reading. The British National Literacy Strategy (NLS) was intended to foreclose the reading debate by taking a clear position on the teaching of reading and prescribing this for all schools. National policy makers have claimed that the NLS is underpinned by research evidence. The central question that informs this paper is: has the research evidence on the teaching of reading demonstrated that the greater emphasis on (...) phonics evident in the NLS Framework for Teaching is justified? Empirical evidence in a number of key areas is reviewed: seminal work; teaching method evaluations; longitudinal evidence and the DfEE review of research and related evidence. It is concluded that there is a weak link between research and the prescribed phonics teaching in the Framework, and that changes should be made to reflect more accurately the research evidence. (shrink)

The Pythagorean idea that numbers are the key to understanding reality inspired philosophers in late Antiquity (4th and 5th centuries A.D.) to develop theories in physics and metaphysics based on mathematical models. This book draws on some newly discovered evidence, including fragments of Iamblichus's On Pythagoreanism, to examine these early theories and trace their influence on later Neoplatonists (particularly Proclus and Syrianus) and on medieval and early modern philosophy.

This book is addressed to readers new to the Enneads. One of the greatest of ancient philosophers, Plotinus is attracting ever-increasing attention from those interested in ancient philosophy, late Antiquity, and the importance of this period for the Western intellectual tradition. O'Meara presents a brief outline of Plotinus's life, and of the composition of the Enneads, placing Plotinus within the intellectual context of the philosophical schools and religious movements of his time. He then discusses selected Plotinian texts in relation to (...) a number of central philosophical issues to show how Plotinus's thinking on these issues evolved, and to assess the historical importance of his philosophy. (shrink)

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number (...) of ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making. In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices. (shrink)

During the first UK wave of the pandemic, there were two areas of immediate ethical concern for the medical profession. The first was the possibility that life-saving resources could be overwhelmed. Early reports from hospitals in the Italian city of Bergamo suggested that ventilatory support might need rationing and emergency ‘battlefield’ triage was a real possibility.1 In the UK, several professional bodies, including the British Medical Association and the Royal College of Physicians rapidly developed guidance for doctors should triage become (...) a reality.2 The second issue was the acute shortage of personal protective equipment. Where doctors were unable to protect their patients – and themselves – from the risk of COVID-19, ethical challenges emerged. Ordinarily, doctors and patients do not present risks of significant harm to each other. To shift to a position where every patient – and every health professional – could potentially be a threat presented serious clinical and ethical challenges. To treat with inadequate PPE, so options for mitigating harms are radically reduced, deepens the challenges. Among the questions the BMA wrestled with was the extent of doctors’ duties to treat infected or potentially infected patients in the absence of effective PPE. The BMA was clear that despite obligations to treat, medicine is not a self-sacrificing profession: there were limits to the risk doctors could be required to expose themselves to.3 These issues no longer seem so pressing. In the UK at least, there is adequate PPE and with the second steep wave behind us, and significant numbers vaccinated, it is less likely that triage will be required in the UK. But as those concerns have receded so other ethical questions have arisen. Among them is a cluster of issues associated with what might be called COVID-19’s indirect harms. Understandably, in response to …. (shrink)

The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction (...) of immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people’s civil liberties. We make tentative recommendations for the ethical introduction of immunity passports. (shrink)

Pandemic ethics raises unresolved, fundamental, and controversial questions. The defining feature of a pandemic is its scale—the simultaneous threat to millions or even billions of lives. That scale creates and necessitates awful choices since the wellbeing and lives of all cannot be protected. Central to decisions are questions of the value of life, but also core human rights doctrines including the right to health, individual freedom and autonomy. Whether allocating limited supplies of ventilators, novel treatments, and vaccines or making policies (...) that restrict movement and freedom, which values are most important? How should risk and burden be distributed? Should society save the greatest number of lives or accept higher deaths for the sake of other ethical values? These questions touched the lives of billions during the COVID pandemic. However, children who were home-schooled during the coronavirus outbreak will almost certainly face another pandemic in their lifetime – one at least as bad, and potentially much worse than this one. In this volume, bioethicists Dominic Wilkinson and Julian Savulescu have gathered leading philosophers, lawyers, economists, and bioethicists to address the global response to the pandemic, questions of liberty, how to balance competing ethical values and considerations of equality and inequality. The book critically reviews the COVID-19 pandemic to identify key lessons for “Disease X”, the currently unknown but serious global threat that lies ahead. (shrink)

In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds’ availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, (...) Analgesia, Resuscitation, and Intensive Care issued recommendations aimed at supporting physicians in prioritizing patients when the number of critically ill patients overwhelm the capacity of ICUs. One motivating concern for the SIAARTI guidance was that, if no balanced and consistent allocation procedures were applied to prioritize patients, there would be a concrete risk for unfair choices, and that the prevalent “first come, first served” principle would lead to many avoidable deaths. Among the drivers of decision for admission to ICUs, age, comorbidities, and preexisting functional status were included. The recommendations were criticized as ageist and potentially discriminatory against elderly patients. Looking forward to the next steps, the Italian experience can be relevant to other parts of the world that are yet to see a significant surge of COVID-19: the need for transparent triage criteria and commonly shared values give the Italian recommendations even greater legitimacy. (shrink)

As the COVID-19 vaccine roll out continues apace, in the higher-income countries at least, concerns remain about the level of vaccine coverage in some health and social care settings. Although most countries have seen a relatively high uptake of vaccination against COVID-19 among staff, there continue to be some pockets of hesitancy. The risk of outbreaks in settings with potentially very vulnerable patients has led some governments across Europe to consider, or to introduce, measures compelling healthcare staff to be vaccinated. (...) The justifiability of mandating the vaccination of healthcare professionals is a longstanding question but it has come to the fore in recent months following a resurgence of cases of COVID-19 and the prevalence of the more transmissible Delta variant. In deciding whether the introduction of a mandate is appropriate, states have to balance a range of ethical and practical considerations. A voluntary approach, backed up with education, respects healthcare workers’ autonomy to make private healthcare decisions, which is valued highly in liberal democracies. However, healthcare professionals also have an obligation to ensure that they do not present a risk of harm to their patients. Similarly, healthcare providers have a responsibility to take appropriate steps to minimise the risk of infection. Alongside balancing these rights and responsibilities, governments must also consider the potential consequences and risks of enforcing vaccine uptake. For example, there are concerns that a coercive approach could deepen mistrust and resentment among people who are genuinely fearful or hesitant. Moreover, a large number of refusals and the subsequent imposition of sanctions, such as suspension or redeployment, could affect the ability of providers to staff necessary services. In the UK, Wales, Northern Ireland and Scotland have all ruled out the introduction of compulsory vaccination. However, in July, the English Parliament voted through …. (shrink)

The essays in this book discuss a number of the central metaphysical and ethical themes that engaged the minds of Platonist philosophers during late Antiquity and the early Middle Ages. One particular theme is that of the structure of reality, with the associated questions of the relations between soul and body and between intelligible and sensible reality, and the existence of mathematical objects. Other topics relate to evil and beauty, political life and its purpose, the philosophical search for the (...) absolute Good, and how one can speak about this Absolute and have union with it. Going from Plato to Eriugena, the ways in which Platonist philosophers understood and developed these themes are analysed and compared. (shrink)

Historians of modern medicine often divide their subject into two parts, separated by the bacteriological revolution of the late nineteenth century, when medicine supposedly became 'scientific' for the first time. The history of medical geography - to say nothing of other subjects - calls this common view into question. At least in the United States, students of medical geography, arguably the pre-eminent medical science in an age dominated by miasmatic theories of disease, readily adapted to the discovery of germs. And (...) although bacteriology quickly eclipsed medical geography in the world of medicine, place remained an important consideration in treating asthma (and allergies generally) throughout the post-bacteriological period. (shrink)

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

For most of the history of prejudice research, negativity has been treated as its emotional and cognitive signature, a conception that continues to dominate work on the topic. By this definition, prejudice occurs when we dislike or derogate members of other groups. Recent research, however, has highlighted the need for a more nuanced and “inclusive” (Eagly 2004) perspective on the role of intergroup emotions and beliefs in sustaining discrimination. On the one hand, several independent lines of research have shown that (...) unequal intergroup relations are often marked by attitudinal complexity, with positive responses such as affection and admiration mingling with negative responses such as contempt and resentment. Simple antipathy is the exception rather than the rule. On the other hand, there is mounting evidence that nurturing bonds of affection between the advantaged and the disadvantaged sometimes entrenches rather than disrupts wider patterns of discrimination. Notably, prejudice reduction interventions may have ironic effects on the political attitudes of the historically disadvantaged, decreasing their perceptions of injustice and willingness to engage in collective action to transform social inequalities.These developments raise a number of important questions. Has the time come to challenge the assumption that negative evaluations are inevitably the cognitive and affective hallmarks of discrimination? Is the orthodox concept of prejudice in danger of side-tracking, if not obstructing, progress towards social justice in a fuller sense? What are the prospects for reconciling a prejudice reduction model of change, designed to get people to like one another more, with a collective action model of change, designed to ignite struggles to achieve intergroup equality? (shrink)

BackgroundGenome-wide association studies (GWAS) provide a powerful means of identifying genetic variants that play a role in common diseases. Such studies present important ethical challenges. An increasing number of GWAS is taking place in lower income countries and there is a pressing need to identify the particular ethical challenges arising in such contexts. In this paper, we draw upon the experiences of the MalariaGEN Consortium to identify specific ethical issues raised by such research in Africa, Asia and Oceania.DiscussionWe explore (...) ethical issues in three key areas: protecting the interests of research participants, regulation of international collaborative genomics research and protecting the interests of scientists in low income countries. With regard to participants, important challenges are raised about community consultation and consent. Genomics research raises ethical and governance issues about sample export and ownership, about the use of archived samples and about the complexity of reviewing such large international projects. In the context of protecting the interests of researchers in low income countries, we discuss aspects of data sharing and capacity building that need to be considered for sustainable and mutually beneficial collaborations.SummaryMany ethical issues are raised when genomics research is conducted on populations that are characterised by lower average income and literacy levels, such as the populations included in MalariaGEN. It is important that such issues are appropriately addressed in such research. Our experience suggests that the ethical issues in genomics research can best be identified, analysed and addressed where ethics is embedded in the design and implementation of such research projects. (shrink)

BackgroundObtaining informed consent for participation in genomic research in low-income settings presents specific ethical issues requiring attention. These include the challenges that arise when providing information about unfamiliar and technical research methods, the implications of complicated infrastructure and data sharing requirements, and the potential consequences of future research with samples and data. This study investigated researchers’ and participants’ parents’ experiences of a consent process and understandings of a genome-wide association study of malaria involving children aged five and under in Mali. (...) It aimed to inform best practices in recruiting participants into genomic research.MethodsA qualitative rapid ethical assessment was undertaken. Fifty-five semi-structured interviews were conducted with the parents of research participants. An additional nine semi-structured interviews were conducted with senior research scientists, research assistants and with a member of an ethics committee. A focus group with five parents of research participants and direct observations of four consent processes were also conducted. French and translated English transcripts were descriptively and thematically coded using OpenCode software.ResultsParticipants’ parents in the MalariaGEN study had differing understandings of the causes of malaria, the rationale for collecting blood samples, the purposes of the study and the kinds of information the study would generate. Genomic aspects of the research, including the gene/environment interaction underlying susceptibility or resistance to severe malaria, proved particularly challenging to explain and understand.ConclusionsThis study identifies a number of areas to be addressed in the design of consent processes for genomic research, some of which require careful ethical analysis. These include determining how much information should be provided about differing aspects of the research and how best to promote understandings of genomic research. We conclude that it is important to build capacity in the design and conduct of effective and appropriate consent processes for genomic research in low and middle-income settings. Additionally, consideration should be given to the role of review committees and community consultation activities in protecting the interests of participants in genomic research. (shrink)

The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in (...) the future. This so-called ‘non-identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non-identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non-identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non-identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person-affecting intervention over an impersonal intervention. However, their responses did not appear to be strongly influenced by the non-identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non-identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important (...) higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

We would like to thank each of the commentators on our feature article for their thoughtful engagement with our arguments. All the commentaries raise important questions about our proposed justification for natural immunity exemptions to COVID-19 vaccine mandates. Thankfully, for some of the points raised, we can simply signal our agreement. For instance, Reiss is correct to highlight that our article did not address the important US-centric considerations she helpfully raises and fruitfully discusses. We also agree with Williams about the (...) need to provide a clear rationale for mandates, and to obtain different kinds of data in support of possible policies.Unfortunately, we lack the space to engage with every one of the more critical comments raised in this rich set of commentaries; as such, in this response, we shall focus on a discussion of hybrid immunity, which underlies a number of different arguments evident in the commentaries, before concluding with some reflections responding to Lipsitch’s concern about the appropriate standard of proof in this context. (shrink)

We pursue the study of families of functions on the natural numbers, with emphasis here on the bounded families. The situation being more complicated than the unbounded case, we attack the problem by classifying the families according to their bounding and dominating numbers, the traditional scheme for gaps. Many open questions remain.

In graph theory, the concept of domination is essential in a variety of domains. It has broad applications in diverse fields such as coding theory, computer net work models, and school bus routing and facility lo cation problems. If a fuzzy graph fails to obtain acceptable results, neutrosophic sets and neutrosophic graphs can be used to model uncertainty correlated with indeterminate and inconsistent information in arbitrary real-world scenario. In this study, we consider the concept of domination as it relates to (...) single-valued neutrosophic incidence graphs (SVNIGs). Given the importance of domination and its utilization in numerous fields, we propose the application of dominating sets in SVNIG with valid edges. We present some relevant definitions such as those of valid edges, cardinality, and isolated vertices in SVNIG along with some examples. Furthermore, we also show a few significant sets connected to the dominating set in an SVNIG such as independent and irredundant sets. We also investigate a relationship between the concepts of dominating sets and domination numbers as well as irredundant and independence sets in SVNIGs. Finally, a real-life deployment of domination in SVNIGsis investigated in relation to COVID-19 vaccination locations as a practical application. (shrink)

In this paper we introduce a new property of families of functions on the Baire space, called pseudo-dominating, and apply the properties of these families to the study of cardinal characteristics of the continuum. We show that the minimum cardinality of a pseudo-dominating family is min{.

If dominating functions in ω ω are adjoined repeatedly over a model of GCH via a finite-support c.c.c. iteration, then in the resulting generic extension there are no long towers, every well-ordered unbounded family of increasing functions is a scale, and the splitting number s (and hence the distributivity number h) remains at ω 1.

Epistemic decision theory produces arguments with both normative and mathematical premises. I begin by arguing that philosophers should care about whether the mathematical premises (1) are true, (2) are strong, and (3) admit simple proofs. I then discuss a theorem that Briggs and Pettigrew (2020) use as a premise in a novel accuracy-dominance argument for conditionalization. I argue that the theorem and its proof can be improved in a number of ways. First, I present a counterexample that shows that (...) one of the theorem’s claims is false. As a result of this, Briggs and Pettigrew’s argument for conditionalization is unsound. I go on to explore how a sound accuracy-dominance argument for conditionalization might be recovered. In the course of doing this, I prove two new theorems that correct and strengthen the result reported by Briggs and Pettigrew. I show how my results can be combined with various normative premises to produce sound arguments for conditionalization. I also show that my results can be used to support normative conclusions that are stronger than the one that Briggs and Pettigrew’s argument supports. Finally, I show that Briggs and Pettigrew’s proofs can be simplified considerably. (shrink)

According to T. M. Scanlon’s anti-aggregation principle, it is wrong to save a larger number of people from minor harms rather than a smaller number from much more serious harms. This principle is a central part of many influential and anti-utilitarian ethical theories. According to the sequential-dominance principle, one does something wrong if one knowingly performs a sequence of acts whose outcome would be worse for everyone than the outcome of an alternative sequence of acts. The intuitive appeal (...) of the sequential-dominance principle should be obvious; everyone is knowingly made worse off if it is violated. In this paper, I present a number of cases where one is forced to violate either the anti-aggregation principle or the sequential-dominance principle. I show that these principles conflict regardless of whether one accepts a counterfactual or a temporal, worsening view of harm. Moreover, I show that this result holds regardless of how much worse a harm has to be in order to count as a much more serious harm. (shrink)

Decision theorists widely accept a stochastic dominance principle: roughly, if a risky prospect A is at least as probable as another prospect B to result in something at least as good, then A is at least as good as B. Recently, philosophers have applied this principle even in contexts where the values of possible outcomes do not have the structure of the real numbers: this includes cases of incommensurable values and cases of infinite values. But in these contexts the usual (...) formulation of stochastic dominance is wrong. We show this with several counterexamples. Still, the motivating idea behind stochastic dominance is a good one: it is supposed to provide a way of applying dominance reasoning in the stochastic context of probability distributions. We give two new formulations of stochastic dominance that are more faithful to this guiding idea, and prove that they are equivalent. (shrink)

Domination is a structural complexity of chemical molecular graphs. A dominating set in a graphG=V,Eis a subsetS⊆Vsuch that each vertex inV\Sis adjacent to at least one vertex inS. The domination numberγGof a graphGis the minimum size of a dominating set inG. In this paper, computer-aided approaches for obtaining bounds for domination number on torus graphs are here considered, and many new exact values and bounds are obtained.

We continue [21] and study partition numbers of partial orderings which are related to /fin. In particular, we investigate Pf, be the suborder of /fin)ω containing only filtered elements, the Mathias partial order M, and , ω the lattice of partitions of ω, respectively. We show that Solomon's inequality holds for M and that it consistently fails for Pf. We show that the partition number of is C. We also show that consistently the distributivity number of ω is (...) smaller than the distributivity number of /fin. We also investigate partitions of a Polish space into closed sets. We show that such a partition either is countable or has size at least D, where D is the dominating number. We also show that the existence of a dominating family of size 1 does not imply that a Polish space can be partitioned into 1 many closed sets. (shrink)

SummaryMutations in human genes encoding transcription factors are often dominant because one active allele cannot ensure a normal phenotype (haploinsufficiency). In other instances, heterozygous mutations of two genes are required for a phenotype to appear (combined haploinsufficiency). Here, we explore with models (i) the basis of haploinsufficiency and combined haploinsufficiency owing to mutations in transcription activators, and (ii) how the effects of such mutations can be amplified or buffered by subsequent steps in a transcription cascade. We propose that the non‐linear (...) (sigmoidal) response of transcription to the concentration of activators can explain haploinsufficiency. We further show that the sigmoidal character of the output of a cascade increases with the number of steps involved, the settings of which will determine the buffering or enhancement of the effects of a decreased concentration of an upstream activator. This exploration provides insights into the bases of compensatory mutations and on interloci interactions underlying oligogenic inheritance patterns. (shrink)

Some are born to sweet delight,Some are born to endless night.William Blake - Auguries of InnocenceIt goes without saying that severe poverty is a human tragedy. The problem of poverty stemming from inequality has however only recently become one of the most fundamental questions in international ethics. The publication in 1972 of Peter Singer's important article, “Famine, Affluence and Morality” certainly marks an important date in the literature. Even those who don't agree with Singer's utilitarian approach will recognize that he (...) was among the first to articulate the problem of poverty on an international scale in philosophical terms. Since then, a greater number of philosophers have examined the problem of world poverty. Some of their work has been extremely influential. (shrink)

For cardinals we let be the smallest size of a subset B of unbounded in the sense of ; that is, such that there is no function such that has size less than for all . Similarly for , the general dominating number, which is the smallest size of a subset B of such that for every there is an such that the above set has size less than . These cardinals are generalizations of the usual ones for (...) . When all three are the same regular cardinal, the relationships between them have been completely described by Cummings and Shelah. We also consider some variants of the functions, following van Douwen, in particular the version of in which B is required to consist of strictly increasing functions. Some of the main results of this paper are: (1) ; (2) for , always exists; (3) if , then ; (4) . For background see Section 1 of the paper. Several open problems are stated. (shrink)

Let ω be the set of natural numbers. For functions f, g: ω → ω, we say f is dominated by g if f < g for all but finitely many n ∈ ω. We consider the standard “fair coin” probability measure on the space 2ω of in-finite sequences of 0's and 1's. A Turing oracle B is said to be almost everywhere dominating if, for measure 1 many X ∈ 2ω, each function which is Turing computable from X (...) is dominated by some function which is Turing computable from B. Dobrinen and Simpson have shown that the almost everywhere domination property and some of its variant properties are closely related to the reverse mathematics of measure theory. In this paper we exposit some recent results of Kjos-Hanssen, Kjos-Hanssen/Miller/Solomon, and others concerning LR-reducibility and almost everywhere domination. We also prove the following new result: If B is almost everywhere dominating, then B is superhigh, i. e., 0″ is truth-table computable from B ′, the Turing jump of B. (shrink)

In recent studies of primates, the question has been raised whether competitive regimes are species-specific or should rather be considered as sex-specific. To study this problem we use an individual-oriented model called DomWorld in which artificial agents are equipped merely to group and compete. In former studies of this model, dominance style appeared to be strongly influenced by the intensity of aggression: by increasing only this intensity of aggression, a great number of the characteristics of an egalitarian society switched (...) to those of a despotic one. Here, we investigate, using DomWorld, a competitive regime of artificial males and females that differ exclusively in their fighting capacity; males having a higher intensity of aggression and a higher initial capacity of winning, such as may be due to a male-biased sexual dimorphism. Unexpectedly it appears that, in the model, even if the intensity of aggression of males is greater than that of females, their hierarchy is still significantly weaker and thus their society less differentiated and more egalitarian than that of females. The explanation is that, due to the higher initial dominance of males, single events of victory and defeat lead to less differentiation than among females. The greater the sexual difference in initial dominance between the sexes is the more egalitarian the males behave among themselves compared to the behaviour of the females among themselves. These effects are already visible during the initial phases of the hierarchical development. These results resemble findings among primates; in real primates their degree of sexual dimorphism may influence the competitive regime of each sex. (shrink)

In recent studies of primates, the question has been raised whether competitive regimes are species-specific or should rather be considered as sex-specific. To study this problem we use an individual-oriented model called DomWorld in which artificial agents are equipped merely to group and compete. In former studies of this model, dominance style appeared to be strongly influenced by the intensity of aggression: by increasing only this intensity of aggression, a great number of the characteristics of an egalitarian society switched (...) to those of a despotic one. Here, we investigate, using DomWorld, a competitive regime of artificial males and females that differ exclusively in their fighting capacity; males having a higher intensity of aggression and a higher initial capacity of winning, such as may be due to a male-biased sexual dimorphism. Unexpectedly it appears that, in the model, even if the intensity of aggression of males is greater than that of females, their hierarchy is still significantly weaker and thus their society less differentiated and more egalitarian than that of females. The explanation is that, due to the higher initial dominance of males, single events of victory and defeat lead to less differentiation than among females. The greater the sexual difference in initial dominance between the sexes is the more egalitarian the males behave among themselves compared to the behaviour of the females among themselves. These effects are already visible during the initial phases of the hierarchical development. These results resemble findings among primates; in real primates their degree of sexual dimorphism may influence the competitive regime of each sex. (shrink)

English has become the first global language of international com- munication during the last decades. It is dominant in many fields as science, technology, transportation, business and tourism and diplomacy. The European Union with law applicable directly on individuals is officially multilingual. English is, however, preferred in internal communication and in communication with national experts. National laws are closely related with particular states. Related discourse is therefore realized mostly in national language. Legal education and research are thus less anglicized than (...) other university education and research. Nevertheless, increasing importance of international and supranational rules for harmonization and coordination, growing demand for comparison, pres- sure to publish in internationally recognized journals, Europe-wide research projects and rising numbers of exchange of students cause widespread resort to English also at schools of law. Unfortunately, English is language of countries with Anglo-American law which differs significantly from continental law existing in most European and other countries. Therefore, it is difficult to find adequate English words for phenomena of civil law and to stabilize their use in international discourse. (shrink)