The study aims to identify the efficiency of the university education performance from the perspective of postgraduate and undergraduate students in international and Palestinian universities. The analytical descriptive approach was used for this purpose and the questionnaire was used as a main tool for data collection. The study community consists of: post graduate students, (23850) graduate students and (146355) undergraduate students. The sample of the study was 378 graduate students and 383 undergraduate students. The random stratified sample was used. The (...) Statistical Package of Social Sciences (SPSS) was also used for data analysis. The study reached a number of results, the most important of which are: The level of efficiency of educational performance in Palestinian and international universities from the point of view of postgraduate and undergraduate students was high. And that there are significant differences between the average views of the sample of the study on the efficiency of educational performance in Palestinian and international universities attributed to the University and to the benefit of international universities. The study concluded many recommendations, the most important of which is the necessity of continuing to develop e-learning strategies that affect the efficiency of educational performance and research commensurate with the university's position in the local and international community, which puts it on the best classification between local and international universities through e-learning. (shrink)

Background Although methods proposed for the conduct of ethics consultation tend to be viewed as competing approaches, they may in fact function in a complementary manner. Methods We describe the experience of ethics consultation in two ethics committees at the University Hospitals of Geneva, Switzerland. Results Both committees provide case consultation by a multi-disciplinary team of committee members, but with different processes. These differences in process do not necessarily lead to differences in outcome. Discussion Different methods of ethics consultation are (...) not mutually exclusive, and can co-exist within the same institution. The practical application of one method of ethics consultation can lead to substantial variations in process between different groups of consultants. Conclusion Despite the importance of clarifying theoretical groundings, and consultation and deliberation processes, in ethics consultation, choosing between different processes may not be pressing. To assist these choices, exploration of the practical strengths and weaknesses of different methods will be necessary to assist clinical ethicists, and clinical ethics committees, in acquiring a flexible and evidence-based set of approaches to their work. (shrink)

This paper proposes a new category of linguistic harm: that of illocutionary frustration. I argue against Jennifer Hornsby and Rae Langton’s notion of illocutionary silencing by challenging their claim that silencing occurs when there is a lack of uptake of the speaker’s illocutionary act. I look at two scenarios that their view treats differently and argue that these scenarios warrant the same kind of analysis; Hornsby and Langton’s notion of silencing can’t capture the purported difference they want it to capture. (...) I propose that we should look instead to standing to explain the phenomenon that illocutionary silencing intends to explain. I explicate the role of standing in terms of illocutionary frustration, then consider street harassment as an example of a linguistic interaction that is best explained by my proposed view. (shrink)

Thought: A Journal of Philosophy, Volume 10, Issue 3, Page 218-225, September 2021.

Generic claims like ‘women stay home and raise children’ and ‘boys don’t cry’ are normative generics: generic claims that express a norm. The truth conditions of normative generics are even harder to account for than those for more descriptive generics like ‘ducks lay eggs.’ Until recently, such generics were treated as deviant and thus not accounted for in standard accounts of generics. But recent work on the semantics and pragmatics of normative generics has changed that. In light of this recent (...) work, I propose that a speech act analysis of normative generics as instructions will shed light on normative generics. I end by discussing the ways in which this might allow us to use generics to counter harmful speech. (shrink)

The study aimed to identify E- Learning strategies and their relation to the efficiency of research performance in foreign and Palestinian universities (University of Ottawa, Munster, Suez Canal, Al-Azhar, Islamic, Al-Aqsa). The analytical descriptive approach was used for this purpose, and relying on the questionnaire as a main tool for data collection. The study society is from the senior management, where the number of senior management in the universities in question is 206. The random stratified sample was selected and (SPSS) (...) was used for statistical data analysis. The study found a significant relationship between E- Learning strategies and the efficiency of research performance in universities. It also reached the participation of senior management in the research that develops the university performance in the Palestinian universities. The senior management indicated that they do not care to follow the policies of implementing the development of scientific research. While the senior management in foreign universities indicated that they are interested in following up the policies of implementing the development of scientific research. The study also showed that senior management in Palestinian universities does not care about providing the appropriate budget for E- Learning. The study recommended that the senior management of Palestinian universities should provide an E- Learning budget and encourage employees to continue using E- Learning strategies. The administration in the Palestinian universities should adopt and support outstanding research, and the need to encourage interest in the implementation of policies for the development of scientific research. (shrink)

Social scripts, like A gives a compliment, B says ‘thank you’, pervade and shape natural language discourse and social interactions. Scripts usually promote cooperation between conversational participants, but not always. For example, if A pays B a ‘compliment’ like ‘nice legs’, A puts B in a double bind of either abiding by the compliment script by saying ‘thank you’ and being humiliated, or breaking the script and risking escalation. In this paper, I take a philosophical lens to the notion of (...) a social script. I give a theoretical overview of what it would mean to disrupt a social script and explain why and when it is prudential to do so. Then I give several examples of disruptions of social scripts. This essay makes four key contributions to the philosophical literature on social scripts: (1) it introduces a new distinction between interpersonal and structural scripts; (2) it illuminates how interpersonal social scripts can be pernicious by creating a double bind; (3) it analyzes what it is to disrupt a social script; and (4) in doing so, it challenges the orthodoxy about the relationship between cooperation and disruption in political action. (shrink)

Is it harmful to make generic claims about social groups? Those who say yes cite the reinforcement of oppressive stereotypes and cognitive bias. Those who say no cite the potential of generics to do good, rather than harm, by taking advantage of the same mechanisms that perpetuate the harms. This paper analyzes generic utterances in the context of social justice efforts to weigh in on the debate about whether and how generic utterances contribute to stereotypes and oppression. We need to (...) first pay more attention to what it means to utter generics in social justice contexts. Doing so will allow us to distinguish those generic utterances that are helpful for social justice projects from those that might impede their progress. I argue that there is an important pragmatic sense in which generics can be undermined: especially generics used in service of social justice claims. I then offer an epistemic thesis for why some generics are more susceptible to being undermined by counter-examples than others. I conclude that if we are interested in using generics in the service of social justice, then there is reason to restrict the contexts in which we utter generics. In doing so, I challenge the conventional wisdom that generics are resistant to counterexamples. (shrink)

The primary purpose of this study was to explore the indirect effect of intrinsic religiosity and extrinsic religiosity on ethical intention through ethical judgment. A review of the literature shows the need for more research at the intersection of religiosity and ethics, especially in non-Western, highly religious contexts. This research, therefore, addresses the research question: Do intrinsic religiosity and extrinsic religiosity indirectly impact ethical intention through influencing the ethical judgment of management professionals? Data were gathered from members of the Management (...) Association of Pakistan through a questionnaire. Pearson correlation results show the overall trend between the constructs of interest. Multiple regression results show that both intrinsic religiosity and extrinsic religiosity are significant positive predictors of ethical judgment. Ethical judgment was also found to be a significant, positive predictor of ethical intention. The main contribution of the study is evidence that ethical judgment acts as a mediator between religiosity (whether intrinsic or extrinsic) and ethical intention in a non-Western highly religious context. This research also found that intrinsic religiosity impacts ethical intention directly as well as indirectly through ethical judgment, but extrinsic religiosity influences ethical intention only through its effect on ethical judgment. We discuss our results along with practical and research implications, and limitations of this research are highlighted to guide future research. (shrink)

This study attempts to show the role of translation in giving meaning to conflicts whether by reproducing the dominant political beliefs of a particular media society or by resisting counter-ideologies that come from foreign sources of information. It utilizes Critical Discourse Analysis as an effective method for the analysis of power relations behind news reporting. The research uses a corpus from international media and their equivalent texts into Arabic between 2013 and 2017. The data covers events on conflicts in Syria, (...) Iraq, Bahrain and Yemen, each article reporting issues about conflict and its impact on arenas of struggle. Through this case study of transediting, I will explore how textual analysis can unravel power relations and hegemonic orders of discourse. The study shows that translation is a site of conflict and has much to say about reasons for conflict and the complex relationship between language and power. The proposed tools of analysis in this study are based on functional language analysis and will show how language structuring, in particular transitivity analysis, articulates the logic created by the media outlet regarding reasons for conflict. The case study concludes that different media structure the current wars in the Middle East in different chains of causal dependence that can impact the reading positions of the readers. (shrink)

Despite broad agreement that the vulnerable have a claim to special protection, defining vulnerable persons or populations has proved more difficult than we would like. This is a theoretical as well as a practical problem, as it hinders both convincing justifications for this claim and the practical application of required protections. In this paper, I review consent-based, harm-based, and comprehensive definitions of vulnerability in healthcare and research with human subjects. Although current definitions are subject to critique, their underlying assumptions may (...) be complementary. I propose that we should define vulnerability in research and healthcare as an identifiably increased likelihood of incurring additional or greater wrong. In order to identify the vulnerable, as well as the type of protection that they need, this definition requires that we start from the sorts of wrongs likely to occur and from identifiable increments in the likelihood, or to the likely degree, that these wrongs will occur. It is limited but appropriately so, as it only applies to special protection, not to any protection to which we have a valid claim. Using this definition would clarify that the normative force of claims for special protection does not rest with vulnerability itself, but with pre-existing claims when these are more likely to be denied. Such a clarification could help those who carry responsibility for the protection of vulnerable populations, such as Institutional Review Boards, to define the sort of protection required in a more targeted and effective manner. (shrink)

Generic statements are commonly expressed using the bare plural – ‘tigers are striped’ – or the indefinite singular – ‘a tiger is striped’. Notoriously, some generics can be expressed using the bare plural locution, but not the indefinite singular; bare plural generics and indefinite singular generics pattern differently. I explore this phenomenon as it applies to normative generic statements: expressions like boys don’t cry, women are kind and nurturing, children are seen and not heard – that convey something over and (...) above (and even distinct from) the descriptive reading. I argue that we should look to a metalinguistic theory of generics to understand indefinite singular normative generics. That is, a normative indefinite singular generic is a proposal about what to include in the extension of the generic term. This theory explains why it is more often than not that felicitous indefinite singular generics are about social kind terms. I argue that this explains a crucial way in which language shapes the social world. When we say things like (2), we propose definitions and uses for the word ‘boy’. Such proposals and their consequences actually impact the behavior of the groups they pick out, as well as the attitudes of others towards those groups. (shrink)

ABSTRACT Uncertainty as to how we should articulate empirical data and normative reasoning seems to underlie most difficulties regarding the ‘empirical turn’ in bioethics. This article examines three different ways in which we could understand ‘empirical turn’. Using real facts in normative reasoning is trivial and would not represent a ‘turn’. Becoming an empirical discipline through a shift to the social and neurosciences would be a turn away from normative thinking, which we should not take. Conducting empirical research to inform (...) normative reasoning is the usual meaning given to the term ‘empirical turn’. In this sense, however, the turn is incomplete. Bioethics has imported methodological tools from empirical disciplines, but too often it has not imported the standards to which researchers in these disciplines are held. Integrating empirical and normative approaches also represents true added difficulties. Addressing these issues from the standpoint of debates on the fact‐value distinction can cloud very real methodological concerns by displacing the debate to a level of abstraction where they need not be apparent. Ideally, empirical research in bioethics should meet standards for empirical and normative validity similar to those used in the source disciplines for these methods, and articulate these aspects clearly and appropriately. More modestly, criteria to ensure that none of these standards are completely left aside would improve the quality of empirical bioethics research and partly clear the air of critiques addressing its theoretical justification, when its rigour in the particularly difficult context of interdisciplinarity is what should be at stake. (shrink)

In Switzerland, people can be granted access to assisted suicide on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person’s conduct is not selfishly motivated. No restrictions relating to the ground of suffering are mentioned in the act. Existential suffering as a reason for wanting to die, however, gives raise to controversial issues. Moreover, existential suffering lacks definition and no consensus exists on how to evaluate (...) and manage it. This study explores the perspectives of care professionals and volunteers from a “right-to-die organization” on existential suffering as a motive for assisted suicide requests. A qualitative study based on face-to-face interviews was conducted with twenty-six participants: palliative care and primary care providers as well as EXIT right-to-die organization volunteers. Elements from the grounded theory approach were used. The twenty-six participants described existential suffering in a multiplicity of individual ways. In total, sixty-three stories were recounted. Their representations were grouped into eight categories: physical decline and its consequences, loneliness, fear of the future, life is over, loss of social significance, loss of hope for a better future, being a financial burden and loss of pleasurable activities. According to all participants, suffering coming from the loss of self-identity was always linked to physical decline, as if one’s image completely defined someone’s identity. Society’s perception of old people and vulnerable people were also often questioned. Another interesting point was that only four stories referring to a “pure” existential suffering were found. This suffering was related to a feeling that life has come to an end, without identification of any other related restriction or suffering. Existential suffering is multifaceted. Legislators and right-to-die organisations have to address the question of what make a AS acceptable. The plurality of existential suffering implies the need of a very personalized care. A better understanding of what it is made of could provide a “toolbox” to people concerned by these requests, helping them to explore it in order to offer suffering people a wider range of alternatives. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were (...) examined to identify further eligible studies. Forty two articles were identified as eligible. Seventeen used an implicit measure, to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed. (shrink)

Cet article explore les oronymes, noms propres désignant une partie du relief, comme une sous-catégorie du toponyme au sein des noms propres. En dehors de la linguistique historique et de l’onomastique, les travaux en linguistique ont encore consacré peu d’ouvrages au toponyme. Cette sous-catégorie du nom propre est elle-même hétérogène, et la présente étude est consacrée spécifiquement aux oronymes. Après une explication des spécificités de l’oronyme liées à ses caractéristiques formelles et à l’instabilité de son référent dans un espace géophysique (...) continu, nous explorons la manière dont ce type de nom propre émerge. Nous appelons toponymation le parcours qui débute avec la proposition d’un nom propre de relief jusqu’à sa stabilisation dans le langage et sur les cartes. Ce parcours long et complexe montrera les nombreuses hésitations, les erreurs et les doublons. Il permettra de définir les conditions nécessaires à la nomination du relief. (shrink)

This dissertation explores the life and work of a philosophy of education and multicultural education teacher, through the use of narrative inquiry. As a Palestinian/Lebanese Canadian researcher, teacher, mother, activist and writer, I present the journey of freeing myself from colonial grand narratives through the construction of my personal, practical knowledge and values, while providing an answer to the question: “What does it mean to be situated on the boundary between the English West and the Middle Eastern Arab world?” I (...) demonstrate how the Orientalist tradition, as defined by Edward Said, served to confuse, frustrate, and alienate me as an embodied person situated within a web of historical, ethnic, linguistic, social, and cultural tensions. I describe how, having been educated in an English missionary school in the context of a Palestinian culture of dispossession and Diaspora, this education served to paradoxically both estrange and enrich me. I demonstrate how narrative inquiry, modeled after Clandinin and Connelly, has enabled me to understand and communicate who I really am as an educator in the multiple social contexts I have known. Through story-ing my epistemology, I illustrate how the Canon in philosophy and the grand meta-narratives underpinning it served to oppress and alienate me over the years. I emphasize that education is not value-neutral. My autobiographical writing in this dissertation explores how the constructs of ethnicity, gender, religion, culture, language, and class serve to shape thinking and values. [...]. (shrink)

Higher education institutions in the Arabian Gulf region today, which have mushroomed and proliferated in the past ten to fifteen years, have been constructing themselves along models of Western universities at the levels of governance, programs, and structure. At the outset of the twenty-first century, universities have globally experienced a drastic shift in their governance from ‘republics of scholars’ to stakeholder organizations. In this paper, we discuss and deconstruct some of the consequences of that drastic shift, paramount among which is (...) the downsizing and neglect of some sciences/fields. We discuss some of the major problems that the Market Model of the University is facing in the West through a literature review. We also explore the academic view on some problems and challenges facing University governance today in the globe at large and specifically in the Arabian Gulf Region. We believe that universities in this region in their present state face the serious challenge of generating indigenous knowledge that fulfills the needs of citizens within this region, knowledge that draws upon the culture, history, and geography of the area and responds to the specific needs of citizens in this area. (shrink)

Background Implicit biases are present in the general population and among professionals in various domains, where they can lead to discrimination. Many interventions are used to reduce implicit bias. However, uncertainties remain as to their effectiveness. -/- Methods We conducted a systematic review by searching ERIC, PUBMED and PSYCHINFO for peer-reviewed studies conducted on adults between May 2005 and April 2015, testing interventions designed to reduce implicit bias, with results measured using the Implicit Association Test (IAT) or sufficiently similar methods. (...) -/- Results 30 articles were identified as eligible. Some techniques, such as engaging with others’ perspective, appear unfruitful, at least in short term implicit bias reduction, while other techniques, such as exposure to counterstereotypical exemplars, are more promising. Robust data is lacking for many of these interventions. -/- Conclusions Caution is thus advised when it comes to programs aiming at reducing biases. This does not weaken the case for implementing widespread structural and institutional changes that are multiply justified. (shrink)

North American writer Joan Didion’s eloquent testimonial speaks to the significance of storytelling in our lives. Personal storiesmake our lives meaningful. Part of this is because our stories, wittingly or not, become the means through which we fashion our identities for listeners. Or, as scholars from many disciplines have argued, identity and selfhoodare narrative accomplishments. In this formulation, an individual constructs a sense of self by telling stories or “personal narratives,” which describe “the evolution of an individual life over time (...) and in social context” (Maynes et al. in Telling stories: the use of personal narratives in the social sciences and in history. Cornell University Press, Ithaca, 2008, 2). While personal narratives contain unique autobiographical elements, the logics of storytelling and the values and beliefs of a particular time and place also influence the kinds of stories people tell. As feminist historian Mary Jo Maynes and her coauthors argue: “The stories that people tell about their lives are never simply individual, but are told in historically specific times and settings and draw on the rules and models in circulation that govern how story elements link together in narrative logics” (2008, 2). Put another way, even the most idiosyncratic story is always in some way social: what narrators decide to tell is often guided by the expectations of audiences (real or imagined); the conventions of various genres (such as life history or autobiography); as well as the broader cultural narratives located in particular historical times and places. In this light, personal narratives at once provide evidence of a storyteller’s viewpoint and experiences as well as the social and cultural milieu in which they live. (shrink)

A DIGNIDADE DA PESSOA HUMANA E SEUS SUBPRINCÍPIOS.

In this paper we discuss the interaction between science policies (and particularly in the area of scientific research) and higher education policies in Gulf and Mediterranean Arab countries. Our analysis reveals a discrepancy between the two sub-regions with respect to integration in the global market, cooperation in scientific research and international mobility of students. The paper discusses the implications of the analysis of reform policies and higher education restructuring.

In Switzerland, people can be granted access to assisted suicide on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person...

Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference (...) to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness. (shrink)

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified by Wenar. After (...) outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

"Le religieux est-il un objet de recherche comme les autres? Exige-t-il une certaine sensibilité de la part du chercheur ou de la chercheuse? Issus de disciplines diverses, les auteurs et auteures se prononcent sur les distinctions et les convergences entraînées par la mise en tension de la neutralité et de l'engagement dans l'étude du religieux. Comprise superficiellement, cette opposition peut paraître factice : l'engagement n'est pas nécessairement religieux, car la vérité comprend aussi un engagement, et la neutralité n'est pas nécessairement (...) objective, car il y a des neutralités engagées. Qui prend au sérieux cette question n'a pas d'autres choix que d'éviter les dichotomies simplistes et d'aborder de front ce qui unit et différencie plus fondamentalement les relations entre savoir et croire. En posant la relation « neutralité ou engagement » sous forme interrogative, cet ouvrage souhaite traiter des enjeux liés au positionnement épistémologique des chercheurs et des chercheuses ainsi que de la responsabilité scientifique envers le religieux."--Page 4 de la couverture. (shrink)

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified by Wenar. After (...) outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

Which inequalities in longevity and health among individuals, groups, and nations are unfair? And what priority should health policy attach to narrowing them? These essays by philosophers, economists, epidemiologists, and physicians attempt to determine how health inequalities should be conceptualized, measured, ranked, and evaluated.

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)

One of the most striking findings of the study by Foglia and colleagues (2009) was that clinicians and managers were most concerned with limited resources while ethics committee chairpersons focuse...

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included (...) severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

Continued confinement of those most vulnerable to COVID-19—e.g., the elderly, those with chronic diseases and other risk factors—is presented as an uncontroversial measure when planning exit strategies from lockdown measures. Policies for deconfinement assume that these persons will remain confined even when others will not. This, however, could last quite a long time, and for some this could mean that they will remain in confinement for the rest of their lives.In a policy brief on ethical, legal, and social issues of (...) transition strategies, the Swiss national COVID-19 science task force stated that:Specific interventions should target the risks associated with isolation... (shrink)

Next SectionAccess to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ’locally relevant medical training’—teaching primarily locally endemic diseases and practice (...) in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. (shrink)

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of (...) care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits. (shrink)

As highlighted by Pavarini et al., researchers in the field of bioethics have to remain critical and reflexive on the methodology and on the tools they use for their research purpose because...