The rule of rescue describes the moral impulse to save identifiable lives in immediate danger at any expense. Think of the extremes taken to rescue a small child who has fallen down a well, a woman pinned beneath the rubble of an earthquake, or a submarine crew trapped on the ocean floor. No effort is deemed too great. Yet should this same moral instinct to rescue, regardless of cost, be applied in the emergency room, the hospital, or the community clinic? (...) -/- In health care, the desire to save lives at any cost must be reconciled with the reality of resource scarcity. As one example, the estimated cost for prophylactic Factor VIII to treat one patient with hemophilia for one year is $300,000. Costs of this magnitude have been accepted by public and private insurers in the developed world, even though, in principle, these sums could provide greater overall health benefit if allocated to pay for the unmet health care needs of many other patients. Looking forward, however, broad application of the rule of rescue will be increasingly untenable. But the moral instinct will remain: the desire to help those weakest among us, especially when their small numbers allow us to see them as unique individuals. What, then, is the ethical framework that can guide coverage and reimbursement decisions for orphan drugs into the future? (shrink)

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of ‘proficiency’ in nurse education—prescribed by the regulator—impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical‐legal challenges posed by sanctioned powers to restrict patients' (...) freedom at the same time as the desire (and obligation) to promote patients' self‐determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain. (shrink)

Humans have a complex and dynamic mating system, and there is evidence that our modern sexual preferences stem from evolutionary pressures. In the current paper we explore male use of a dual mating strategy: simultaneously pursuing both a long-term relationship (pair-bonding) as well as short-term, extra-pair copulations (variety-seeking). The primary constraint on such sexual pursuits is partner preferences, which can limit male behavior and hence cloud inferences about male preferences. The aim of this study was to investigate heterosexual male mating (...) preferences when largely unconstrained by female partner preferences. In service of this goal, female full-service sex workers (N = 6) were surveyed on the traits and behaviors of their male clients (N = 516) and iterative cluster analysis was used to identify male mating typologies. Two clusters emerged: clients seeking a pair-bonding experience and clients seeking a variety experience. Results also suggested that romantically committed men were more likely to seek a variety experience than a relationship experience. We conclude that men desire both pair-bonding and sexual variety, and that their preference for one might be predicted by fulfilment of the other. These findings have implications for relationships, providing insight into motivations for male infidelity. (shrink)