Life‐threatening illness is associated with financial burden among families. During this time, care‐related expenses often increase. The concept of financial burden has not fully been explored nor conceptually described in the literature. Our study coalesces the empirical literature on financial burden into a more comprehensive multidimensional theoretical framework to understand financial burden among patients and families dealing with serious illness. Using Jabareen's phased approach for building conceptual frameworks, we synthesized the existing scientific (...) literature (including existing measures of financial burden) to construct an empirically derived model. Definitions of financial burden are overlapping with similarities, but also inconsistencies. Many studies have focused more on objective and operational definitions, than subjective and conceptual aspects. Regarding measures for financial burden, many studies have only used a few items. The financial burden is dependent on the illness trajectories and duration. By considering multidimensionality, we illustrate potential financial burden factors (objective, coping, and subjective). Although anticipation and expectations about future financial issues are important, patients and caregivers generally experience objective aspects of burden, followed by subjective impressions of burden. Coping skills likely reduce subjective burden. Based on the results, we redefine the financial burden among patients with life‐threatening illness and caregivers. (shrink)

In late March 2020 in response to the COVID-19 pandemic, Australia introduced mandatory 14-day supervised quarantine at hotels and other designated facilities for all international arrivals. From July 2020, most states and territories introduced a fixed charge for quarantine of up to $3220 per adult. The introduction of the fee was rationalised on the basis that Australians had been allowed sufficient time to return and there was a need to recover some of the cost associated with administering the program. Drawing (...) on an empirical study of 58 returned Australian citizens and residents quarantined between March 2020 and January 2021, this paper aims to explore how people experienced paying for hotel quarantine, particularly with respect to fairness and relatedly, the principle of reciprocity. Reciprocity requires that the state has an obligation to assist individuals in discharging their duty to comply with public health measures and avoid disproportionate burdens accruing to populations or individuals. Though participants had varying opinions on whether they thought it fair to be charged for their quarantine, for many, the fee constituted a significant burden and source of stress. Given the undertaking of quarantine is primarily for the benefit of the public good, we argue the financial cost imposed on individuals does not meet the demands of reciprocity. It is imperative that future quarantine and isolation arrangements consider seriously the need to minimise burdens of individuals subject to such measures, and that fees do not become a new norm in public health and infectious disease control. (shrink)

Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in (...) America. These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved. (shrink)

The financial toxicity of biotherapeutic treatments is examined. Kymriah, a new gene therapy, has a list price of $475,000 per treatment; Yescarta, from Kite Pharma, costs $373,000 per treatment. Such costs are a significant burden on patients, patients’ families, payers, health care systems, and communities. Studies have shown that financial toxicity—the effect of excessive treatment cost—diminishes patients’ quality of life, compliance, and survival. Some pharmaceutical companies promote outcomes-based pricing and other strategies to offset financial toxicity, but (...) these approaches have not been shown to reduce burdens. Catholic teaching holds that the benefits of treatment should outweigh its burdens, and that burdensome treatments are not obligatory. The financial toxicity of treatments should be included in the ethical assessment of burdens on the patient. (shrink)

Environmental chemicals accumulate in all human bodies and have the potential to affect the health of men and women, adults, and children. This article advances “precautionary consumption”—the effort to mediate personal exposure to environmental chemicals through vigilant consumption—as a new empirical site for understanding the intersections between maternal embodiment and contemporary motherhood as a consumer project. Using in-depth interviews, I explore how a group of 25 mothers employ precautionary consumption to mediate their children’s exposure to chemicals found in food, consumer (...) products, and the home. Most of the mothers in the study situate their children’s chemical “burdens” within their own bodies and undertake the labor of precautionary consumption as part of a larger and commodity-based motherhood project. In actively expanding the sphere of responsible motherhood to include managing children’s body burdens, these mothers navigate multiple and overlapping contexts that hold women accountable for children’s futures and value the agency of the proactive consumer. Yet, as the sphere of responsible mothering expands, women without financial resources, time, and family stability are pushed to the margins of normative motherhood. (shrink)

Critics of state punishment have frequently pointed out that its imposition sometimes involves the infliction of burdens on innocent people: namely, those falsely convicted of crimes and punished. Punishment also creates significant burdens for innocent children and other dependents of those punished (social stigma, financial stress, direct abuse, and so on). But these burdens on innocents have received much less philosophical attention than the burdens created for the falsely convicted. This article examines five lines of argument that might lead (...) one to the conclusion that the burdens punishment creates for the falsely convicted are more morally troubling than the burdens it creates for innocent dependents of those punished. I offer reasons to be sceptical about each of these arguments. I contend that we should regard the burdens state punishment creates for innocent dependents of those punished as no less morally troubling than the burdens it creates for innocent, falsely convicted people. In the article's final section, I discuss some implications of my account. (shrink)

The reliability of clinical practice guidelines has been disputed because guideline panel members are often burdened with financial conflicts of interest. Current recommendations for COI regulation advise not only detailed declaration but also active management of conflicts. To continuously assess COI declaration and management in German guidelines we established the public database LeitlinienWatch. We analyzed all German guidelines at the highest methodological level that included recommendations for pharmacological therapy according to five criteria: declaration and assessment of COI, composition of (...) the guideline development group, independence of the coordinators and lead authors, imposed abstentions because of COI and public external review. Each criterion was assessed using predefined outcome categories. Most guidelines contained a detailed declaration of COI. However, none of the guidelines provided full transparency of COI assessment results. The guideline group was composed of a majority of participants with COI in 55% of the guidelines, no guideline was free of participants with COI. Only 9% of guidelines had coordinators and lead authors without any financial COI. Most guidelines did not provide a rule for abstentions for participants with COI. In 21% of guidelines there was a rule, but abstentions were either not practiced or not documented, whereas in 7% partial abstentions and in 2% complete abstentions were documented. Two thirds of the guideline drafts were not externally reviewed via a public website. COI are usually documented in detail in German guidelines of the highest methodological level. However, considerable improvement is needed regarding active management of COI, including recruitment of independent experts for guideline projects, abstention from voting for participants with COI and external review of the guideline draft. We assume that the publicly available ratings on GuidelineWatch will improve the handling of conflicts of interest in guideline development. (shrink)

The real significance of this book lies in the fact that it tells us more about the everyday life of black South Africans. It delves into the essence of black family life and the secret anguish of family members who often battle to cope. A secret torment for some, a proud responsibility for others, 'black tax' is a daily reality for thousands of black South Africans. In this thought-provoking and moving anthology, a provocative range of voices share their deeply personal (...) stories.With the majority of black South Africans still living in poverty today, many black middle-class households are connected to working-class or jobless homes. Some believe supporting family members is an undeniable part of African culture and question whether it should even be labelled as a kind of tax.Others point to the financial pressure it places on black students and professionals, who, as a consequence, struggle to build their own wealth. Many feel they are taking over what is essentially a government responsibility.The contributions also investigate the historical roots of black tax, the concept of the black family and the black middle class.In giving voice to so many different perspectives, Black Tax hopes to start a dialogue on this widespread social phenomenon. (shrink)

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one (...) ‘buyer’—in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England. (shrink)

Regulation is often applied to business behavior to ensure that the social costs of doing business are included in the cost and pricing structures of the firm. Because the consumer benefits from the transaction that generated the social costs, asking the consumer to bear the burden imposed by the transaction is fair. However, there may be a lack of Justice m the internal and external distribution of the social costs of doing business if consumers are the only party bearing (...) that burden, or if the costs are being shifted to employees or taxpayers when a closer stakeholder is also benefiting from the transaction – the stockowner. A social justice perspective requires that those benefiting from a transaction share in the burdens of it. We propose that a Tobin-like tax on stock transactions might be a just means of achieving greater justice in the distribution of the social cost burden. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the (...) treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

This paper examines the recent rise of initiatives for responsible agricultural investment and provides a preliminary assessment of their likely success in curbing the ecological and social costs associated with the growth in private financial investment in the sector over the past decade. I argue that voluntary responsible investment initiatives for agriculture are likely to face similar weaknesses to those experienced in responsible investment initiatives more generally. These include vague and difficult to enforce guidelines, low participation rates, an uneven (...) business case, and confusion arising from multiple and competing initiatives. In addition, the large diversity of investors and high degree of complexity of financial investments further complicate efforts to discern who bears the burden of responsibility in practice. As a result, there is a strong likelihood that voluntary governance initiatives for responsible agricultural investment will shift discourse more than they will change practice. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the (...) treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

Patients and physicians do not know the cost of medical procedures. Opaque medical billing thus contributes to exorbitant, rising medical costs, burdening the healthcare system and individuals. After criticizing two proposed solutions to the problem of opaque medical billing, I argue that the Centers for Medicare and Medicaid Services should pursue a rule requiring that patients be informed by the physician of a reasonable out-of-pocket expense estimate for non-urgent procedures prior to services rendered.

Numerous high-profile ethics scandals, rising inequality, and the detrimental effects of climate change dramatically underscore the need for business schools to instill a commitment to social purpose in their students. At the same time, the rising financial burden of education, increasing competition in the education space, and overreliance on graduates’ financial success as the accepted metric of quality have reinforced an instrumentalist climate. These conflicting aims between social and financial purpose have created an existential crisis for (...) business education. To resolve this impasse, we draw on the concept of moral self-awareness to offer a system-theoretical strategy for crowding-in a culture of ethics within business schools. We argue that to do so, business schools will need to (1) reframe the purpose of business, (2) reframe the meaning of professional success, and (3) reframe the ethos of business education itself. (shrink)

Black Mountain College is remembered as an artistic utopian alternative to institutional learning. Its faculty and students included some of the most important creative thinkers of the 20th century. Its foundation was built on the philosophy of “learning by doing.” But what made Black Mountain such a dynamic educational environment? Today, the financial burden of higher education places a lasting strain on students that inhibits creative growth. Does the educational structure of the college system impede our learning? Black (...) Mountain was a legendary educational experiment, which offers a model for contemporary art education. (shrink)

This paper looks how health systems can go beyond clinical care to address the social determinants of health and considers why this approach might be particularly relevant for Accountable Care Organizations touted by the Affordable Care Act. ACOs make profits by reducing the medical expenses of patient populations. The leading causes of death in the United States are tobacco use, insufficient physical activity, and an unhealthy diet. These risk factors are linked to increased incidence of a wide range of chronic (...) diseases, the treatment of which places a tremendous financial burden on our health care system. Health care delivery and access are just a small part of the solution to our chronic disease crisis. Increasingly, strategies that address the social determinants of health —“the conditions into which people are born, grow, live, work, and age”— are the ones that hold the most promise. In Massachusetts, Steward Health Care System supports a number of initiatives to address the social determinants of health in its patient population. Steward provides an example of how a hospital system can address the health of its patient population by moving beyond clinical care. The varied initiatives have also resulted in cost savings for the system. (shrink)

In the field of psychology, filial piety is usually defined in terms of traditional Chinese culture-specific family traditions. The problem with this approach is that it tends to emphasize identification of behavioral rules or norms, which limits its potential for application in other cultural contexts. Due to the global trend of population aging, governments are searching for solutions to the accompanying financial burden so greater attention is being focused on the issue of elder care and its relevance to (...) filial practices. We contend that the psychological investigation of filial piety in Chinese societies has progressed to the point that it can now provide a solid structure for research targeting intergenerational relations in other cultures. We describe an indigenous psychology approach that integrated Chinese historical, philosophical, and social trends to construct a model of filial piety in terms of the dual reciprocal and authoritarian filial aspects underlying parent-child relations: the dual filial piety model (DFPM). We use this model to re-conceptualize filial piety from its usual definition as a set of Chinese culture-specific norms to a contextualized personality construct represented by a pair of culturally-sensitive psychological schemas of parent-child interaction. We then describe how the DFPM can provide a framework for research on filial relations on individual, structural, societal, and cross-cultural levels. We conclude with a discussion of how the model may be able to integrate and extend Western research on intergenerational relations and contribute to the issue of elder care beyond Chinese societies. (shrink)

This article offers proposed guidelines intended to protect the public interest in relationship to the advocated social responsibilities of successful entrepreneurs. The author argues that the most effective approach, then, is not preaching about obligations but, rather, establishing financial incentives for doing well by doing good. One example is the U.S. patent system. Another is a redesigned tax system that uses imposts to make socially damaging activities expensive, while reducing the financial burden on virtuous behavior.

The factors that determine the decision-making mechanisms on the regional level are twofold in nature : internal and external.We may distinguish three internal factors: 1° the councils of the regions are composed of members of the national parliament ; 2° on the national level, the regional problem is not dealt with by representatives of the regions ; 3° the conventional system controls the relationship between the executives and the councils of the regions.The external factors may be reduced to five: 1° (...) the regions do not have jurisdiction for their entire territory; 2° the financing of the regions is done via a system that implies no financial responsibility and onesidedly favors the southern regions ; 3° the financial burden of some decisions of the nation is imposed on the regions; 4° the distribution of authority disregards federal practice; 5° conflicts of authority are not resolved by a purely jurisdictional organ.Finally, we stress the contiguous existences·of regions and communities as substructures white the latter are the true components of the Belgian nation. (shrink)

Since autumn 2012, higher education institutions in England have been able to charge undergraduate students up to £9,000 a year in tuition fees. Full-time students are expected to take out loans large enough to cover their tuition fees and living costs for the duration of their studies. They must start repaying these loans if and when their earnings reach £21,000 a year. In this bold and timely pamphlet, Christopher Martin argues that forcing students to borrow is a serious mistake. He (...) contends that higher education is a welfare good on a par with basic schooling and health care. To flourish in liberal democratic societies, citizens must be personally autonomous, and the educational demands of personal autonomy are too heavy to be met by compulsory schooling alone. To lead autonomous lives, adult citizens need ongoing educational support, support that the liberal democratic state has an obligation to provide. Higher education should therefore be a universal entitlement and free at the point of use. The global debate about who should pay for higher education is by no means settled. As England shifted the financial burden from taxpayers to students, Germany moved in the opposite direction: all German universities have offered free tuition since 2014. Christopher Martin's distinctive contribution to the debate is to lay out a principled argument, based on a plausible assessment of the purpose of higher education, for the view that students should not have to pay for their education. His argument is controversial, to be sure, but it represents a serious and considered attempt to set the question of higher education funding on sure normative foundations. (shrink)

Healthcare expenditures account for approximately 9% of GDP in OECD countries and are on an upward trajectory (OECD, 2017). This significant financial burden, combined with an aging global population and increasing demand, emphasizes the imperative for sustained research and innovation to enhance health system efficacy. Key to this transformation are technological advancements, including digital health, which presents novel opportunities for improvement. Emerging digital health technologies, such as virtual consultations, complex imaging procedures, and electronic medical records, are fundamental to (...) modern healthcare infrastructures. However, significant gaps remain in the evaluation and understanding of these innovations, especially for nascent technological areas. This thesis addresses this subject, aiming to delineate how individuals and institutions can bolster their evaluative capabilities, strategic decision-making, and planning for the deployment of emerging digital healthcare technologies. The research methodology amalgamates theoretical exploration, literature scrutiny, and empirical examinations, presenting an integrated perspective that intersects the disciplines of Management & Decision Science, Technology & Innovation, and Health Economics & Outcomes Research. From an applied perspective, this research focuses on developing evidence within the context of pediatric healthcare in Canada — a context notably underrepresented in healthcare management research, despite its disproportionate per capita expenditure. Technologically, the predominant focus is on applications in virtual reality (VR) and three-dimensional (3D) printing and virtualization, though with the aspiration of ensuring the generalizability of results. The current thesis is structured to parallel the progression of the research itself, as three distinct phases; this begins with a comprehensive Background that contextualizes the initial intent, exploring the relationship between technology, innovation, and health outcomes. In this phase, each academic discipline is analyzed to identify base theoretical underpinnings for the research. The second phase of this work includes five empirical studies, each preceded by context-specific literature reviews for the respective technological domain, providing insight into the current state of evidence related to value-based assessment and economic evaluation in that area. Empirical studies included a randomized controlled trial and a cost consequences assessment of VR for pre-procedural preparation for medical imaging. Additionally, novel applications of 3D printing and virtualization are critically analyzed, accompanied by a multi-case study on the implementation of 3D printing in pediatrics, a cost-consequences study of applications for thoracoabdominal surgeries, and an outcomes study on the use of 3D virtualization in medical education during the COVID-19 pandemic. The final phase of this research includes the critical analysis and synthesis of findings into a proposal for a novel value-based assessment and decision-making framework specific to emerging health innovations; this framework integrates insights and resources for clinicians, administrators, and policymakers. The outcomes of this research are skewed toward Knowledge Users, but also aims to advance the theoretical basis for health technology assessment (HTA). (shrink)

It is commonly thought that when democratic states act wrongly, they should bear the costs of the harm they cause. However, since states are collective agents, their financial burdens pass on to their individual citizens. This fact raises important questions about the proper distribution of the state’s collective responsibility for its unjust policies. This article identifies two opposing models for sharing this collective responsibility in democracies: first, in proportion to citizens’ personal association with the unjust policy; second, by giving (...) each citizen an equal share of the costs. Proportional distribution is compatible with the principle of fairness. And yet, both in the literature and in political praxis we find many supporters for the equal sharing of the costs of unjust policies in democracies. How can equal distribution be defended on normative grounds? This article develops a defense that is grounded in citizens’ associative obligations. I argue that, at least in some democracies, one of the intrinsic values of the civic bond revolves around the joint formation and execution of worthy political goals. This social good generates the political associative obligation to accept an equal distribution of the costs of unjust policies. (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)

Despite the worldwide prestige of America's doctoral programs in the humanities, all is not well in this area of higher education and hasn't been for some time. The content of graduate programs has undergone major changes, while high rates of student attrition, long times to degree, and financial burdens prevail. In response, the Andrew W. Mellon Foundation in 1991 launched the Graduate Education Initiative, the largest effort ever undertaken to improve doctoral programs in the humanities and related social sciences. (...) The only book to focus exclusively on the current state of doctoral education in the humanities, Educating Scholars reports on the GEI's success in reducing attrition and times to degree, the positive changes implemented by specific graduate programs, and the many challenges still to be addressed.Over a ten-year period, the Foundation devoted almost eighty-five million dollars through the GEI to provide support for doctoral programs and student aid in fifty-four departments at ten leading universities. The authors examine data that tracked the students in these departments and in control departments, as well as information gathered from a retrospective survey of students. They reveal that completion and attrition rates depend upon financial support, the quality of advising, clarity of program requirements, and each department's expectations regarding the dissertation. The authors consider who earns doctoral degrees, what affects students' chances of finishing their programs, and how successful they are at finding academic jobs.Answering some of the most important questions being raised about American doctoral programs today, Educating Scholars will interest all those concerned about our nation's intellectual future. (shrink)

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy (...) raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden. (shrink)

The U.S. oversight system for genetically engineered organisms was evaluated to develop hypotheses and derive lessons for oversight of other emerging technologies, such as nanotechnology. Evaluation was based upon quantitative expert elicitation, semi-standardized interviews, and historical literature analysis. Through an interdisciplinary policy analysis approach, blending legal, ethical, risk analysis, and policy sciences viewpoints, criteria were used to identify strengths and weaknesses of GEOs oversight and explore correlations among its attributes and outcomes. From the three sources of data, hypotheses and broader (...) conclusions for oversight were developed. Our analysis suggests several lessons for oversight of emerging technologies: the importance of reducing complexity and uncertainty in oversight for minimizing financial burdens on small product developers; consolidating multi-agency jurisdictions to avoid gaps and redundancies in safety reviews; consumer benefits for advancing acceptance of GEO products; rigorous and independent pre- and post-market assessment for environmental safety; early public input and transparency for ensuring public confidence; and the positive role of public input in system development, informed consent, capacity, compliance, incentives, and data requirements and stringency in promoting health and environmental safety outcomes, as well as the equitable distribution of health impacts. Our integrated approach is instructive for more comprehensive analyses of oversight systems, developing hypotheses for how features of oversight systems affect outcomes, and formulating policy options for oversight of future technological products, especially nanotechnology products. (shrink)

The proportion of older people in the total population is increasing in most countries because of advances in medical technology and resulting longer life expectancy. The role that older people play in our communities does not reflect this. Sometimes they are reduced to mere statistics and stereotypes in economic and political discussions on the financial burdens of care for older people. I argue that we need to rebuild inclusive communities in which older people are respected as valuable members. I (...) suggest that this can be done by studying the characteristics of past communities and by learning from the work of environmental ethicists who advocate the preservation of our heritage. Nurses share with them a holistic perspective on complex issues such as ageing. They are therefore in a position to empower older people to play a role in our communities as unique individuals with integrity and wisdom. (shrink)

The proportion of older people in the total population is increasing in most countries because of advances in medical technology and resulting longer life expectancy. The role that older people play in our communities does not reflect this. Sometimes they are reduced to mere statistics and stereotypes in economic and political discussions on the financial burdens of care for older people. I argue that we need to rebuild inclusive communities in which older people are respected as valuable members. I (...) suggest that this can be done by studying the characteristics of past communities and by learning from the work of environmental ethicists who advocate the preservation of our heritage. Nurses share with them a holistic perspective on complex issues such as ageing. They are therefore in a position to empower older people to play a role in our communities as unique individuals with integrity and wisdom. (shrink)

Photo by Alex Guillaume on Unsplash Introduction The problem of climate change raises some important philosophical, existential questions. I propose a radical solution designed to provoke reflection on the role of humans in climate change. To push the theoretical limits of what measures people are willing to accept to combat it, an extreme population control tool is proposed: allowing people to reproduce only if they make a financial commitment guaranteeing a carbon-neutral upbringing. Solving the problem of climate change in (...) the long run by halting the procreation of human beings is controversial. In the absence of human beings and consequent climate change, other animals and plant species would benefit from an atmosphere more conducive to prolonging their existence and even improving their ability to thrive. If someone were to invent something to reverse the effects of climate change and improve animals’ lives, then human beings’ presence would be justified by the invention. Whether the propagation of the human species is beneficial to anyone or anything but human beings themselves is difficult to answer. Perhaps human beings are unfit to tackle this issue, being unable to judge it objectively. Managing Procreation: An alternative to Piecemeal Approaches Measures aimed at reducing greenhouse gases by nudging individuals and corporations may have a positive effect, but if their behavior is not climate neutral, they continue to contribute to climate change. Consequently, as long as the number of people increases, reducing greenhouse gases is at best a mitigation tool. If humans could rely solely on renewable energy, decreasing the population arguably would not be necessary. Significantly reducing the number of people appears to provide a solution to both problems: people who do not exist do not contribute to climate change, and renewable energy could meet the demand of a smaller population. One option is to let only those who produce the problem pay for its solution. One could determine the expected annual emission of greenhouse gases per person, assuming an average life expectancy, and calculate the costs to compensate them by, e.g., installing extra solar panels. Those expected costs could then be paid by the parents of each new person annually over the first eighteen years of that person’s life by dividing the total expected costs by eighteen. There are also practical difficulties. It would be difficult to determine the payment necessary. What should be done if a child has been born whose parents cannot afford to pay? In addition, child benefits could be canceled, contrary to recent incentives for child births instated in Italy,[1] where additional benefits will be made available to pay for childcare, and Hungary,[2] where women with four children or more will be exempted for life from paying income tax. A transition period could exist once the policy has been adopted, since it would be unreasonable to confront those who are already pregnant with costs they could not reasonably have expected. While the analysis is both hypothetical and theoretical, the impracticality is a noteworthy obstacle. There are several practical issues that cannot be addressed here, like the difficulty of calculating the added negative effects of each new individual and the unlikelihood that many citizens will support politicians who propose adopting policies that discourage having children. The upshot of what I have proposed is that climate change can be solved in the long run without financial costs to society as a whole, notwithstanding the transitional measures that would bring costs with them. Managing Procreation to Reduce Suffering Should this be deemed too harsh a stance, it is important to consider the basic issue of whether it is justified to introduce measures to reduce the number of people in an already overpopulated world, especially if climate change leads to additional suffering. One need not agree with Benatar, but his perspective must at least be taken seriously: It is curious that while good people go to great lengths to spare their children from suffering, few of them seem to notice that the one guaranteed way to prevent all the suffering of their children is not to bring those children into existence in the first place.[3] Benatar argues that non-existence is preferable to existence,[4] which raises the question why new people should be created at all. Those who question whether this planet will be habitable for future generations presuppose that such generations will exist. If people are not brought into existence, they may be said to be deprived of what life has to offer, but life must not be presupposed to be something positive. Whether this is the case in fact merits an inquiry of its own. A solution to the problem of climate change despite an increased population does not equate to a positive outcome since it merely means that something negative is removed. After all, solving the problem is not a means to an end, but a means to a means, the latter means being a means to a happy life, which does not automatically ensue from a solution to the problem. Benatar, as an anti-natalist, argues that procreation is morally wrong. His basic idea is that there is an asymmetry between pleasure and pain and that the pleasure that is not experienced by someone because that person does not exist is not something bad whereas the absence of pain that is not experienced – for the same reason – is something good.[5] Accordingly, “The reason why we do not lament our failure to bring somebody into existence is because absent pleasures are not bad.”[6] One may question whether such a perspective suffices to prove that coming into existence is always a harm, but the assertion that coming into existence exposes a new being to potential harm is clear. Objections A drawback of the proposed radical solution, placing the financial impediment on procreation, is that it will not solve climate change in the short run. A significant drop in the number of people may have a positive effect in the long run, but for now the behavior of the people in existence is the problem. Other climate change mitigation policies would necessarily continue. Additionally, there are important practical reasons to continue to procreate. The benefits for the elderly are paid for by the labor force. It is a problem that new generations are created as mere means to benefit older people. Perhaps more troubling, a pyramid scheme is created: by the time those people have themselves become old, a new labor force must have been brought into existence, a process that must presumably continue. If a consideration for people in developing countries to have children is that they cannot provide for themselves at an advanced age, while benefits are either lacking or insufficient, developed countries could collectively fund a pension scheme.[7] This may be low-cost if it is tailored to the living standard in the countries in question and given the life expectancy. Such a pension scheme should be predicated on the countries’ efforts in reducing the birth rate. If the labor force decreases, the economy may suffer. The focus on economic growth is arguably one of the causes of climate change, but if the number of people is reduced, the living standard does not have to be compromised, since the economy can then still grow. If fewer people began to use natural resources and nonrenewable energy at higher per capita rates, then the procreation might not be beneficial to the climate. It would need to be accompanied by regulations on use. One may also object that only wealthy people will be able to afford children. This is correct, but there is no right to have a child one cannot afford. The right to procreate does not entail the right to have as many children as one wants.[8] Yet in many countries, like the United States, it is a fundamental right that is constitutionally protected. There are numerous social, emotional, and even biological reasons why people choose to procreate. These may include the joy of having a family, the hope that children may bring in society, and the intergenerational transference of knowledge. People may have a strong desire to raise children or even a religious duty. If someone procures a sports car that is highly polluting, it would be justifiable to impose a tax in such a case. Many taxes and fines are imposed on corporate polluters. Procreation is significantly different but if the issue is regarded with some distance, then a climate change prevention tax could be appropriate. Some may argue that raising children is expensive already, which nonetheless does not deter people from having children. The tax I propose would be additional and specifically dedicated to carbon neutrality, but it would be difficult to predict whether it would discourage procreation. One last objection may be that for those now dedicated to sustainability for preserving the earth for the sake of future generations, there would be little or no incentive to continue any climate change mitigation efforts at all. If they sense they cannot afford to procreate, they may simply use every natural resource rather than save the earth for animals or for next generations. In a democracy, this problem does not exist if the majority can afford to procreate and agree with legislation on the basis of which such behavior is discouraged or punished. CONCLUSION Prior to their existence, there is no obligation to bequeath the earth to next generations. Such generations will only exist if they are actually created, and there is no obligation to create them. The lack of existence should not be confused with harm. Climate change provides an important reason to stem overpopulation. Ironically, fast rates of procreation may lead to the earth becoming uninhabitable for humans altogether. The radical solution that has been proposed here is an unrealistic scenario. For now, the average global birth rate is just over 18 per thousand people, but there is a need to ensure that the number of people is not greater than the planet can endure. While it is better to prevent problems than to solve them, the interest in procreation and its associated joys, usefulness, and cultural value make mass reduction in the population unlikely. Some countries have smaller average family size than others and can act as models for reducing population in a less radical way. The need to continue efforts to reduce climate change persists. Whether it would curb population growth or not, an additional financial burden applied to neutralizing each person’s offspring’s carbon footprint provides a meaningful thought exercise that could help alleviate the pressure on current climate mitigation strategies. [1] The Local Italy, How Italy’s new ‘Family Act’ aims to increase the plunging birthrate, https://www.thelocal.it/20200612/what-you-need-to-know-about-italys-new-family-act/. [2] BBC, Hungary tries for baby boom with tax breaks and loan forgiveness, https://www.bbc.com/news/world-europe-47192612. [3] David Benatar, Better never to have been, 6. [4] David Benatar, Better never to have been, 44, 58. [5] David Benatar, Better never to have been, 14, 30, 38. [6] David Benatar, Better never to have been, 35. [7] Alastair Leithead, “Can Niger break out of its cycle of poverty?”, https://www.bbc.com/news/world-africa-41018081; Sebastien Malo, “Fewer children, fewer climate risks? Niger ponders a controversial option”, https://www.reuters.com/article/us-niger-climate-change-familyplanning-idUSKBN1WM11E. [8] Sarah Conly, “The Right to Procreation: Merits and Limits,” American Philosophical Quarterly 42, no. 2 : 105-115, 105, 106. (shrink)

Outsourcing of Public-Services - Forms and Limitations Purpose of the article is to show how public services can be outsourced from communities and what legal, organizational or other limitations may have to be taken into account.Methodology used for this article is literature research, analysis and comparison. An in-depth look into the present status of research and literature will be interconnected to the basic research in this matter that has been done from the 1970's to the 1990's.Scientific aim is to show (...) the potential of the process as being important and helpful in creating better community-service and meanwhile relieve the communities from organizational and financial burdens that are more difficult to carry than ever before.Findings are that we have to determine between the different municipal economic activities and the legal basis of these activities. The intervening public-service is a prominent example for the restrictive regulatory system it is set in but also is seen as having a big potential for cooperation and outsourcing by contracting-out. Contrary to that the service-rendering public-service is less regulated and more open to a market approach.There are different spheres for these economic activities to take place. Different reasons for outsourcing depend on the specific sphere a certain task belongs to and can include economic, fiscal and political aspects. Two big groups of tasks are annex-tasks from within the public-service and characteristic public-services. There can be outsourcing by commissioning or by using submissions.With different legal forms of the outsourced entities and the legal limits that are set for every different kind of structure, it is clear that there is no solution that always fits all the needs and that this has to be carefully taken into account.Conclusions are that there is a high potential and big successes when outsourcing is done well planned and as a strategic activity. A number of legal issues and other limitations always has to be respected. (shrink)

Diabetes is epidemic and many people cannot afford insulin, a lifesaving medication, as its price has increased by almost 160 percent in the past five years.1 To help subsidize the cost of insulin, one of the staff members at my hospital would like to give patients copayment coupons provided to her by pharmaceutical companies. I advised my colleague to stop distributing these branded coupons, as they promote particular pharmaceutical companies. This practice is not consistent with the policy on interaction with (...) industry established by the Johns Hopkins Health System. Yet at the same time, I want my patients to be able to afford their insulin so they can treat their diabetes. I truly believe in utilitarianism. Would temporarily subsidizing patients’ insulin make me and my staff better healthcare providers? Would this minimize my patients’ financial burden? Would giving away medications coupons help pharmaceutical companies influence me as a prescriber? This challenge created a personal internal debate and profound moral distress. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion (...) for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

The paper identifies common barriers and challenges to Pre-Exposure Prophylaxis (PrEP) uptake and offers considerations for state and local public health departments to address barriers and retool infrastructure to increase access to PrEP to new users. Authors identify synergistic opportunities with federal agencies and funders to advance PrEP-related HIV prevention efforts, that prioritize strategies and investments to provide PrEP to people who could benefit from the intervention but are unaware of PrEP or struggle to access it. Barriers discussed and examined (...) include financing strategies to reduce financial burden of PrEP medication, expanding PrEP access and outreach beyond clinical settings, and increasing the network and reach of the provider community to serve people we oppress through policy choices and discourses of racial and socioeconomic inferiority. (shrink)

Responsible innovation is an approach to business that can both incur and save costs. Some company leaders are concerned that it is yet another administrative and financial burden on their commercial operations. Others can see its financial advantages, e.g. avoiding the development of products the market will not accept, or reducing costs through sustainability measures. Building on the corporate responsibility and management advice literature, this chapter indicates a number of areas where RI can create a competitive advantage (...) for SMEs. Real life case studies provide examples of reduced costs, reputational gains, employee retention, faster market entry, access to previously unavailable stakeholders, higher acceptability of end products, and higher innovation potential through diverse employees. Success cannot be guaranteed, but the willingness of an SME to innovate in areas that have positive societal impact in addition to profits can bring business benefits. (shrink)

Tournai is a town of intermediate dimensions with a regional vocation ; since a few years it has had to face serious budgetary problems. These are primarily due to a relative absence of resources as opposed to a constant growth of the financial burdens, actually stemming from this regional vocation.Therefore, the intention to start from the existing entity and to create a larger entity which ought to be financially viable, is quite right. In this respect, the governmental merger plan (...) aims at reassembling Tournai - as the core of the mergers - with the neighbouring communes that actually are the town's suburbs, and with the recently created industrial areas. Moreover, merging Tournai with the rural communes serving as abuffer between Tournai and the French border, the new entity will directly touch the "urban community" Lille - a major pole of attraction from the economic and commercial as well as from the cultural point of view.A particular care to keep an equilibrium among rural and urban population accounts for the absorption of several communes that are rather distant and have no direct links with Tournai. Finally, there has been an underlying concern to ensure that in the new entity the christian-democratic and the socialist party would have an almost equal weight and the Walloon Gathering would have a chance to break through ; this seems to explain the fact that Antoing and its peripheral communes, having a socialist majority, have been kept out of the merging operation, one has on the contrary merged several rural communes with a clear christian-democratic tendency, and the government eventually decided to realize a maximum merger which is supposed to electorally favour the Wallon Gathering. (shrink)

The recent global pandemic has led to a shift to online conferences in philosophy. In this paper we argue that online conferences, more than a temporary replacement, should be considered a sustainable alternative to in-person conferences well into the future. We present three arguments for more online conferences, including their reduced impact on the environment, their enhanced accessibility for groups that are minorities in philosophy, and their lower financial burdens, especially important given likely future reductions in university budgets. We (...) also present results from two surveys of participants who attended one large and three small online philosophy conferences this year. We show that participants were in general very satisfied with presentations and discussions at the conferences, and that they reported greater accessibility. This indicates that online conferences can serve as a good alternative to in-person conferences. We also find that networking was less satisfactory in online conferences, indicating a point for improvement and further research. In general, we conclude that philosophers should continue to organize online conferences after the pandemic. We also provide some advice for those wishing to organize online conferences. (shrink)

For much of the last year and a half, the US has appeared on the verge of extensively reforming its financing and provision of health care, guaranteeing universal coverage for basic care and significantly controlling the long-term growth of costs. But it now appears that with a new Republican-led Congress we will at best adopt only selected insurance reforms: guaranteeing portability of insurance between jobs, banning insurers from excluding preexisting conditions from a person's coverage, and perhaps increasing subsidies for the (...) purchase of insurance by low-income families and small businesses. The long struggle throughout this century for a societal sharing of the financial burdens of illness will again have yielded only a small increment. (shrink)

The paper proposes a comparative intercultural approach to the climate change. The author bases on the cases of Chinese Daoism and Norbert Bolz’s philosophy to present his personal general viewpoint. The today greatest challenge is the recovery after the Covid-19 pandemic by getting rid of the financial burden and by introducing individual economical solutions to each country as well as accepting international conventions on the reduction of climate change results. According to the author of the article, the increasing (...) consequences of the climate change liven up international business and indifferent politicians to make positive decisions concerning it. (shrink)

Glioblastoma is a brain tumor condition marked by rapid neurological and clinical demise, resulting in disproportionate disability for those affected. Caring for this group of patients is complex, intense, multidisciplinary in nature, and fraught with the need for expensive treatments, surveillance imaging, physician follow-up, and rehabilitative, psychological, and social support interventions. Few of these patients return to the workforce for any meaningful time frame, and because of the enormity of the financial burden that patients, their caregivers, and society (...) face, utilization reviews become the focus of ethical scrutiny. (shrink)

Significant attention has been given both to the ethics of Controlled Human Infection Model research and the ethics of payment for research participation. However, comparatively little attention has been given to the ethics of paying for participation specifically in CHIM research. Grimwade et al should be commended for thoughtfully addressing this topic and especially for the empirical data collection informing their work, which is too often lacking in discussions of payment for research participation. In what follows I will discuss three (...) relatively subtle factors that, I believe, make a difference to the ethical analysis of paying for research participation and raise what I intend to be constructive questions about the extent to which the survey instrument employed by the authors captures them. The authors focus on payment for risk in CHIM research. They correctly stress that compensating participants for risk is controversial and that “many general guidelines warn against paying for the risk in medical research”. While not all guidance documents share this scepticism,1 compensating for risk raises thorny issues and uncertainty over the topic among IRBs and regulatory bodies is likely to hinder the practice. Part of the difficulty in assessing payment for research risks stems from the way in which subtle variances in background assumptions influence the ethical assessment, which also complicates empirical attempts to measure attitudes on the topic. Most importantly, it is crucial to be precise about background assumptions concerning whether participants are protected from bearing the financial burdens of research risks that eventuate in actual harms. Protective mechanisms …. (shrink)

Current health care standards, in many countries, Australia included, are regrettably poor. Surprisingly, practitioners and treating teams alike in mental health and disability sectors, in particular, make far too many basic care-related mistakes, in addition to the already abundant diagnostic mistakes that cause and amplify great harm. In part, too many practitioners also fail to distinguish adverse effects for what they are and all too often treat adverse effects, instead, as comorbidities. Diagnostic failures are dangerous, the result of which generates (...) and perpetuates harms that are extremely costly in terms of patient welfare, in addition to the financial burden placed on everyone. In this essay, I contend that the authority bestowed upon psychiatry is misplaced. Subsequently, this misplaced authority affects the governing and investigatory institutions reliant and informed by psychiatry. The examination process undertaken in this investigation traces the metaphysics of psychiatric disorders relative to the Diagnostic-Statistical-Manual (DSM) in all its iterations and to the epistemological construction process that serves to underpin the fundamentals of psychiatric practice. There exists a crisis of confidence in psychiatric practice and I urge drastic reform be undertaken to arrest the damage. (shrink)

Understanding why individuals opt out of living donation is crucial to enhancing protections for all living donors and to identify modifiable barriers to donation. We developed an ethical approach to conducting research on individuals who opted out of living kidney donation and applied it in a small-scale qualitative study at one US transplant centre. The seven study participants had varied reasons for opting out, the most prominent of which was concern about the financial burden from lost wages during (...) the postoperative period. Several reported feeling alone during their decision-making process. Although no participants used an alibi, a centre-provided statement of non-eligibility to donate, all believed that centres should offer alibis to help preserve donor autonomy. Given the complexity of participants' decisions and the emotions they experienced before and after deciding not to donate, we suggest approaches for independent living donor advocates to support this population. This study demonstrates that research on individuals who opt out of donation is feasible and yields valuable insight into methods to improve the evaluation experience for potential living donors. (shrink)

Selected as a Financial Times Best Book of 2013Governments today in both Europe and the United States have succeeded in casting government spending as reckless wastefulness that has made the economy worse. In contrast, they have advanced a policy of draconian budget cuts--austerity--to solve the financial crisis. We are told that we have all lived beyond our means and now need to tighten our belts. This view conveniently forgets where all that debt came from. Not from an orgy (...) of government spending, but as the direct result of bailing out, recapitalizing, and adding liquidity to the broken banking system. Through these actions private debt was rechristened as government debt while those responsible for generating it walked away scot free, placing the blame on the state, and the burden on the taxpayer. That burden now takes the form of a global turn to austerity, the policy of reducing domestic wages and prices to restore competitiveness and balance the budget. The problem, according to political economist Mark Blyth, is that austerity is a very dangerous idea. First of all, it doesn't work. As the past four years and countless historical examples from the last 100 years show, while it makes sense for any one state to try and cut its way to growth, it simply cannot work when all states try it simultaneously: all we do is shrink the economy. In the worst case, austerity policies worsened the Great Depression and created the conditions for seizures of power by the forces responsible for the Second World War: the Nazis and the Japanese military establishment. As Blyth amply demonstrates, the arguments for austerity are tenuous and the evidence thin. Rather than expanding growth and opportunity, the repeated revival of this dead economic idea has almost always led to low growth along with increases in wealth and income inequality. Austerity demolishes the conventional wisdom, marshaling an army of facts to demand that we austerity for what it is, and what it costs us. (shrink)

The European Clinical Trials Directive was issued in 2001 and aimed to simplify and harmonise the regulatory framework of clinical trials throughout Europe, thus stimulating European research. However, significant complexity and inconsistency remains due to disparate interpretation by EU member states. Critical care research has been particularly impacted due to variable and often restrictive consenting procedures for incapacitated subjects, with some countries requiring a court-appointed representative, while others recognise consent from family members and occasionally professional representatives. Furthermore, the absence of (...) a waiver of consent threatened to put an end to emergency research in Europe and was met with varied responses. Approval procedures by ethics committees are equally inconsistent, particularly those relating to provision of a single opinion for multi-centre trials. Although evidence is somewhat mixed, this complexity as well as a general increase in administrative and financial burden following the Directive has been shown to cause a reduction in clinical trial activity in Europe, particularly academic trials. We aim to clarify some of these inconsistent procedures, particularly those relating to informed consent of incapacitated subjects, as well as discussing some general weaknesses and possible improvements of the Directive ahead of its planned revision in 2011. (shrink)

In 2007, Massachusetts instituted a universal coverage health plan that requires all citizens to purchase insurance. I argue that there is nothing wrong in principle with the use of an individual mandate to force citizens to secure health insurance. I argue that state neutrality is not tenable on this issue. Then I proceed to show that even if state neutrality were viable, it is not a violation of state neutrality (thought of as neutrality of intent) to force citizens to insure (...) themselves with the primary purpose of securing the normative good of health. I adapt recent work on universal medical coverage to demonstrate that such a mandate is in keeping with several principles of fairness shared in liberal democratic societies. This argument not only applies to the Massachusetts plan but likely to any other health care coverage schemes using individual mandates in the US political context, including recently passed federal health care reform measures. However, even though the Massachusetts plan may provide increased access to health care for many, there are still legitimate worries that it currently places disproportionate financial burdens on the working poor and thus will need refinement. (shrink)