BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured interviews (...) were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

Alan Kahan’s productive professional career has been devoted primarily to translating and writing about European liberals. A partial list would include: Aristocratic Liberalism: The Social and Poli...

“On the Subject Matter of Phenomenological Psychopathology” provides a framework for the phenomenological study of mental disorders. The framework relies on a distinction between (ontological) existentials and (ontic) modes. Existentials are the categorial structures of human existence, such as intentionality, temporality, selfhood, and affective situatedness. Modes are the particular, concrete phenomena that belong to these categorial structures, with each existential having its own set of modes. In the first section, we articulate this distinction by drawing primarily on the work of (...) Martin Heidegger—especially his study of the ontological structure of affective situatedness (Befindlichkeit) and its particular, ontic modes, which he calls moods (Stimmungen). In the second section, we draw on a study of grief to demonstrate how this framework can be used when conducting phenomenological interviews and analyses. In the concluding section, we explain how this framework can be guide phenomenological studies across a broad range of existential structures. (shrink)

In recent years, society has come to recognize that the work performed by scientists, like that of journalists and politicians, may be influenced by the interests they serve. As a result, scientists' research is increasingly contested as a source of reliable knowledge. Such has been the case in issues concerning the climate debate, for example, where research results are at times perceived to comfortably fit in with the viewpoints of interested parties outside science. In medicine, governmental as well as commercial (...) organizations influence the public health research agenda (McGarity and Wagner 2008). Also, studies sponsored by pharmaceutical companies, for example, often yield biased, favorable results for .. (shrink)

This article examines Constant's analysis of character during the French Revolution. During the late-1790s, Constant declared himself a “democrat”, but he worried that the Revolution was reinforcing character traits in France that would undermine stable liberal politics. He was especially concerned that the “revolutionary torrent” [his phrase] had unleashed violent passions that led to fanaticism, rebelliousness, and the search for vengeance. And, he was disturbed to see that, at the other extreme, the chaos of revolutionary violence had led others to (...) resignation, isolation, and a focus on narrow self-interest. In his search for a path between vengeance and fatigue, he encouraged sentiments like self-respect, compassion, and enthusiasm. (shrink)

David Wootton has written an engaging book about the emergence of the theory that all human action is self-interested and that believes societies should be structured in ways that satisfy our “insa...

Raymond Aron is best known for his intellectual sparring with Jean-Paul Sartre and for his stature as the pre-eminent Cold War liberal in France. He is credited with establishing an aut...

Revolutionary Thought after the Paris Commune, 1871–1885 by Julia Nicholls is an ambitious book about the thought of the revolutionary Left in France during the fifteen years after the defeat of th...

Structuralism and dependency theories emerged when the World Wars and the Great Depression revealed to Latin American thinkers the peculiar vulnerabilities of their national economies. These theori...

Friedrich Hayek (1899–1992) remains a controversial figure, applauded by those who support the late-twentieth-century turn to neoliberalism and criticized by those who see him as the poster-boy of...