This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and (...) other disciplines to provide analysis on a variety of related topics ranging from case studies and first-hand experiences to policy and philosophical analysis. It is of great interest to to academics, practitioners, policy makers and students who are looking for analyses and guidance regarding the fair provision of medical care and the use of medical rules of eligibility under adverse conditions. (shrink)

Occasionally, doctors and health providers have to choose whom they save from death and this is an extremely hard decision to take. Here, I work on what I deem to be a crucial caveat: scarcity of resources should never be used as an alibi for bad, and sometimes wicked, public policies. In other words, if scarcity is somewhat produced or at least induced, it should never serve as a pretext to put the blame or the responsibility on medical (...) doctors, nurses and other people who are at the front of the war against COVID-19. During the COVID-19 pandemic, an ethical question was often raised: if resources are scarce (and they often have been), whom should you prioritize? Should we protect first of all those who are young and can then have a long life before them? Or should we rather prioritize those who have rendered important services to health, or broadly to mankind, and could, therefore, bring other good results to society? This discussion is of course important, but it leaves aside something more fundamental: the fact that resources are not simply scarce, they have been made scarce in the last years by a series of public policies nourished by an economic view that sacrificed social welfare on behalf of neoliberal beliefs. (shrink)

It is often argued, most recently by Samuel Scheffler, that we should reconcile with our mortality as constitutive of our existence: as essential to its temporal structure, to the nature of deliberation, and to our basic motivations and values. Against this reconciliatory strategy, I argue that there is a kind of immortal existence that is coherently conceivable and potentially desirable. First, I argue against the claim that our existence has a temporal structure with a trajectory that necessarily culminates in an (...) ending. This claim is based on two false assumptions: that a life as a whole calls for narrative structure, and that narratives necessarily require closure as temporal endings. Second, I reject the proposal that temporal finitude is constitutive of the basic elements of diachronic agency, including the nature of deliberation and of our values. I argue that only finitude as scarcity of opportunities is constitutive of these elements. Additionally, scarcity might be present in an endless existence. Therefore, it is not incoherent to conceive of a recognizable and potentially desirable immortality that grounds the core features of diachronic agency. Thus, against the reconciliatory strategy, I conclude that we might never fully reconcile with mortality. Although we might embrace our inescapable mortality as essential to a fuller range of features of our existence, we can still justifiably regret our missing on an immortal existence. (shrink)

We defend a scalar theory of the relationship between material scarcity and justice. As scarcity increases beyond a specified threshold, we argue that deontological egalitarian constraints should be gradually relaxed and consequentialist considerations should increasingly determine distributions. We construct this theory by taking a bottom-up approach that is guided by principles of medical triage. Armed with this theory, we consider the range of conditions under which justice applies. We argue that there are compelling reasons for thinking that justice (...) applies under a far broader range of conditions than is standardly supposed, including those that could sensibly be labelled as conditions of extreme rather than moderate scarcity. (shrink)

I argue that, because of scarcity, the right to life cannot imply an obligation on others to save the life of the right-holder, and that collectivising resources for health care not only ensures that resources are used inefficiently and inappropriately but also removes from people the authority to make decisions for themselves about matters of health, life and death.

We study the effect of scarcity on decision making by low income Swedes. We exploit the random assignment of welfare payments to study their borrowing decisions within the pawn and mainstream credit market. We document that higher educated borrowers borrow less frequently and choose lower loan to value ratios when their budget constraints are exogenously tighter. In contrast, low-educated borrowers do not respond to temporary elevated levels of scarcity. This lack of response translates into a significantly higher probability (...) to default and an 11.6% increase in borrowing cost. We show that a difference in access to liquidity and/or buffer stocks cannot explain our results. Instead a framework, where the awareness of self-control problems is positively correlated with education can explain that high-educated consumers choose a lower LTV as a commitment device to increase their likelihood to repay. Analogously, low-educated with less awareness of their future self-control problems, do not tie themselves to the mast and thus ignore the consequences of their credit decisions when focusing on solving acute liquidity problems. Our findings highlight that increased levels of scarcity risk reinforcing the conditions of poverty through overborrowing. (shrink)

The COVID-19 pandemic has created or revealed scarcities in many domains: medical, civic, economic, and ideological. Responses to these are analyzed in the framework of a map of justice and an imperative of openness. The main argument is that whatever the view of justice chosen by public health authorities, they should be able and willing to disclose it to the citizens. Objections are considered and qualifications added, but the general conclusion is that in liberal democracies, truth-telling by those in power, (...) although politically hazardous, would be ethically advisable. (shrink)

The scarcity of women’s writings in antiquity presents an intractable problem for feminists intending to integrate women’s perspectives into the existing philosophical canon. One way to undo the erasure of women is for feminists to look to the east; in China, there is an abundance of well-preserved women’s writings, along with their biographical records, as early as the 6th century BCE. This essay will provide a survey of those women’s records, focusing on the 6th century BCE to the 4th (...) century CE, as a way to reimagine the discipline of Philosophy and its canon. (shrink)

It is often claimed that our knowledge of the evolutionary process adds an extra dimension to the classical problem of natural evil and makes this problem worse. Especially the principle of natural selection is often portrayed as morally inappropriate or “unfitting” for a perfectly good God to use as a means for creating biological complexity. In this article, I argue that this common view is misconceived, and that natural selection is a wholly innocuous principle. The real source of evolutionary evils (...) is the fact that resources in nature are scarce – a fact that was known long before Darwin. The problem of natural and evolutionary evil, therefore, is best construed as a question about why God permits scarcity in nature. I argue that recent research about the interrelation between competition and cooperation in the evolutionary process provides resources for answering this perennial question in a more satisfactory way than could be done before the advent of evolutionary theory. (shrink)

The purpose of this essay is to formulate a sociological critique of the concept of scarcity in mainstream economics by synthesising necessary conceptions in the construction of a theoretical structure with greater explanatory power than the current mainstream articulation. Mainstream economics asserts the universality of scarcity. A critical scrutiny of this assertion is conducted by discussing the empirical phenomenon of global hunger in relation to a theoretical elaboration of the concepts of scarcity and abundance. The historical origins (...) of the scarcity postulate is traced to the work of Carl Menger. The concern of global hunger shows that there is abundance of food goods, but still frustration of human needs occurs. An alternative approach is developed through a theoretical synthesis of Menger, Amartya Sen and critical realism, which asserts an ontologically stratified, differentiated and geo-historically conditioned understanding of scarcity and abundance. It is proposed that this approach is more fruitful than the scarcity postulate in explaining the process and conditions of frustration and satisfaction of human needs. Merely postulating scarcity tends to veil the underlying causes of poverty in general and hunger in particular. Central implications of the new model for socioeconomic analysis are considered. (shrink)

Moral philosophers have often felt the need of a concept which would cover all those cases where we are prevented from achieving our ends through no fault of our own: a criterion for saying when failure is not blameworthy. The deontologists thought we were not to blame for actions done in genuine ignorance of the facts. Kant declared in a famous passage that we were not morally responsible for failures due to the “niggardliness of stepmother nature.” In this article I (...) want to introduce into moral philosophy a new concept for clarifying the failures for which we are not to blame: the notion of scarcity, taken from economic theory. (shrink)

Although women have made important inroads in science and engineering since the early 1970s, their progress in these fields has stalled over the past several years. This study looks at women in science and engineering careers in the 1970s and 1980s, documenting differences in career outcomes between men and women and between women of different races and ethnic backgrounds. The panel presents what is known about the following questions and explores their policy implications: In what sectors are female Ph.D.s employed? (...) What salary disparities exist between men and women in these fields? How is marital status associated with career attainment? Does it help a career to have a postdoctoral appointment? How well are female scientists and engineers represented in management? Within the broader context of education and the labor market, the book provides detailed comparisons between men and women Ph.D.s in a number of measures: financial support for education, academic rank achieved, salary, and others. The study covers engineering; the mathematical, physical, life, and social and behavioral sciences; medical school faculty; and recipients of National Institutes of Health grants. Findings and recommendations in this volume will be of interest to practitioners, faculty, and students in science and engineering as well as education administrators, employers, and researchers in these fields. (shrink)

In the street life of the Mission District in San Francisco, two opposite ways of understanding the female ownership of the body circulate among women who are drug-using sex workers: sexual slavery and women's liberation. This article analyzes how both models obfuscate the manner in which lack and scarcity govern the economy of needs and desires when drug abuse intersects with sex work. Lack and scarcity are shown to pervade not only economic resources but also drug-related gratification, bodily (...) well-being, sexual desire and body commitment during sexual practices. Even though both women and men are involved in this economy, there is an `artificial scarcity' of drug-related gratification for women. Controlling women's ability to close this circuit, men reinstate and reproduce the gender stereotypes that dominate in the street culture. (shrink)

William Ophuls has argued that the sources of and solutions for present scarcity conditions are to be found in Western political philosophy. I clarify various theoretical issues raised by Ophuls’ work and offer conceptual alternatives regarding some of the more basic issues. Specifically, I critique the Lockean and Hobbesian elements in Ophuls’ treatment of the role of liberal democracy, with special attention to abundance assumptions and Lockean individualism. I also argue that he fails to deal adequately with resource distribution (...) in his treatment of resource scarcity, that he improperly removes man from nature, that he misunderstands the relationship of technology and politics, and that he encounters other difficulties in terms of the public/private distinction and in integrating micro and macro issues. Ironically, Ophuls’ admirable attempt to shed light on the critical relationship between scarcity conditions and political philosophy may have created a new and disorienting set of shadows. (shrink)

The scarcity of resources during the COVID‐19 pandemic caused ethical dilemmas in prioritizing patients for treatment. Medical and ethical guidance only emphasizes clinical procedures but does not consider the sociocultural aspect. This study explored the perception of former COVID‐19 patients and their families on the decision‐making process of the patient's selection at a time of scarcity of resources. The result will inform the development of an ethical guide for allocating scarce resources that aligns with Indonesian culture. We conducted (...) qualitative research with in‐depth interviews between May ‐ December 2022 involving sixteen participants from various cities in Indonesia. We transcribed the interviews and analyzed the results using thematic analysis. This study found that doctor's decisions often differed from patient's expectations in allocating scarce resources, and therefore, it should be communicated appropriately. Medical decisions were not sufficiently made ethically, but must also be made communicatively. In Indonesia's strong communal culture, community involvement was essential to distributing limited resources. A better approach to ethical education, including adequate communication skills, is necessary to prepare health professionals for facing unpredictable future pandemics. (shrink)

The article addresses the role of scarcity in negotiating the relationship between intellectual property, particularly from a legal-economic perspective, and property rights, as understood by transaction cost economics, to shed light on the deadlock faced by those suffering from neglected tropical diseases (NTDs). The consistency of the law and economics fundamentals that support the trade on knowledge goods, namely patents on essential medicines, is put under check by Scott Veitch’s scholarship on legal irresponsibility. The damages that emerge from the (...) operations of the intellectual property system are registered in the novel concept of negative public domain, and are due mainly to the lack of access to treatments that end up being unaffordable, or to innovation that leads to new drugs that is not sufficiently incentivised though price signals. The accountability for such damages is taken into consideration by arguing that the disavowal of responsibility is made possible by the negative public domain, which is balanced by the construction of a positive response through the language of rights. As such, responsibility per se is preserved, evading one instantiation of Teubner’s legal paradoxes, but rendered ineffective by design. In other words, even if the harms endured by those affected by the NTDs can be traced back to the operations of the intellectual property system, there is no one to hold accountable. The main goal pursued through the article is to make such an arrangement explicit, by giving centrality to the notion of scarcity and its interplay between legal and economic theory, alongside the novel concept of negative public domain as a site where the actual consequences of irresponsibility lie, to hopefully inform further critique in subsequent works. (shrink)

This paper contains a critique of Habermas' discourse theory of law and democracy from an economic perspective. An example drawn from Klaus Günther's work on discourses of application suggests the failure of discourse ethics to adequately account for the problem of scarcity. This blindpoint is reflected in Habermas' legal theory through the latter's inadequate recognition of the internal connection between markets and law. Discourses of implementation are introduced as a discourse‐relevant procedure to account for the problem of scarcity. (...) Consensus, as defined by Habermas, cannot be the agreement mode applicable to discourses of implementation. (shrink)

Humanitarian social enterprises (HSEs) are facing mounting pressure to incorporate social innovation into their practice. This study thus identifies how HSEs leverage organizational capabilities toward developing social innovation. Specifically, it considers how resource scarcity and operating circumstances affect the capabilities used by HSEs for developing social innovation, using a longitudinal case study approach with qualitative data from 12 hunger-relief HSEs operating in the United States. Based on 59 interviews with 31 managers and directors and related documents, several propositions are (...) posited. The findings suggest that resource availability (i.e., scarcity vs. abundance) leads some HSEs to focus on developing social innovation using their collaborative capabilities, while others leverage their absorptive capacity. Further, HSEs adjust their approach to developing social innovation based on whether they are operating in ordinary circumstances (i.e., before the COVID pandemic) or extraordinary ones (i.e., during the COVID pandemic). Interestingly, the findings suggest that the organizational capabilities used by HSEs are adjusted as these enterprises become more familiar with extraordinary operating circumstances. For example, at the onset of the COVID-19 pandemic, resource-scarce HSEs focused on parallel bricolage to develop social innovation. Subsequently, they focused on selective bricolage. The findings offer novel insights by relating the social innovation of social enterprises to crisis management. (shrink)

As we write, U.S. cities and states with extensive community transmission of Covid‐19 are in harm's way—not only because of the disease itself but also because of prior and current failures to act. During the 2009 influenza pandemic, public health agencies and hospitals developed but never adequately implemented preparedness plans. Focused on efficiency in a competitive market, health systems had few incentives to maintain stockpiles of essential medical equipment. Just‐in‐time economic models resulted in storage of only those supplies needed then. (...) At the same time, global purchasing in search of lower prices reduced the number of U.S. suppliers, with hospitals dependent on foreign companies. There is still a possibility that the pandemic will be manageably bad rather than unmanageably catastrophic in this country. Immediate, powerful, and sustained federal action could make the difference. (shrink)

Practical deliberation consists in thinking about what to do. Such deliberation is deemed rational when it conforms to certain normative requirements. What is often ignored is the role that an agent's context can play in so-called ‘failures’ of rationality. In this paper, I use recent cognitive science research investigating the effects of resource-scarcity on decision-making and cognitive function to argue that context plays an important role in determining which norms should structure an agent's deliberation. This evidence undermines the view (...) that the norms of ‘ideal’ rationality are necessary and universal requirements on deliberation. They are a solution to the problems faced by cognitively limited agents in a context of moderate scarcity. In a context of severe scarcity, the problems faced by cognitively limited agents are different and require deliberation structured by different norms. Agents reason rationally when they use the norms best suited to their context and cognitive capacities. (shrink)

Zur Verringerung der Knappheit an Organen wird die Einführung eines Marktes für menschliche Organe vorgeschlagen. Personen, die ihre Organe verkaufen, und Personen, die ihre Organe lebend spenden, sind medizinisch den gleichen Gefahren ausgesetzt. Der Verkaufserlös bietet für den Abgebenden eine Einkommenssteigerung, die vielfältig genutzt werden kann. Die auf Schwarzmärkten beobachteten negativen Effekte sollen durch eine strikte Überwachung und Regulierung verhindert werden. Der Markt für Organe kann von zwei getrennten Ankaufsorganisationen geprägt werden. Eine Organisation zahlt die Weiterverkaufserlöse der Organe direkt an (...) die Geber aus, eine andere Organisation investiert sie stattdessen in wohltätige Zwecke und gibt so den Gebern die Möglichkeit, ihr Organ aus rein altruistischen Motiven zu spenden. Die Finanzierung des Systems soll durch das öffentliche Gesundheitssystem bzw. die privaten Krankenversicherungen erfolgen. (shrink)

Professor Hall is to be congratulated on his thoughtful analysis of an issue that, as he rightly suggests, “is one of the most important issues that will confront health care tort law throughout the remainder of the century.”’ He argues that malpractice law currently can accommodate considerable latitude both for a conservative streamlining of medical practices in general and for a cost-sensitivity in individual treatment decisions. And he further argues that existing tort principles, such as the locality rule, can comfortably (...) be stretched to embrace still greater room for economics in the medical standard of care. I quite agree.Unfortunately, Hall's arguments do not go nearly far enough, for they are framed around a seriously oversimplified picture of the economic changes that are revolutionizing medicine in the United States. He envisions a fairly uniform, global set of resource constraints that generally pressure physicians to conserve on care—pressures that tort law can then encompass equally globally as it accepts more cost-efficient standards of care. However, neither the changing economics of medicine nor the resulting jurisprudential challenges are anywhere near this generalized. (shrink)

This essay historicizes cultural and psychic economies in the postwar United States under the sign of material scarcity. It situates the proliferation of plastic flowers in domestic space within a context of bureaucratic anxieties surrounding natural resource scarcity, and trends toward ‘outdoor living’ that were an offshoot of the ideology of economic growth. Interrogating repeated, if relatively unexamined, invocations of ‘anxious’ suburban subjects in descriptions of postwar society, the essay suggests that plastic flowers shored up a sense of (...) stability and permanence at a time when nuclear annihilation, Cold War paranoia, and population growth combined to render life uncertain and potentially unsustainable. The essay concludes by reflecting on how legacies of that epoch – and the fiction of permanence offered by plastic flowers – endure in contemporary fantasies of limitless progress. (shrink)

BackgroundLittle is known about the ethical situations which physiotherapists encounter internationally. This lack of knowledge impedes the ability of the profession to prepare and support physiotherapists in all world regions in their ethical practice. The purpose of the study was to answer the following research questions: What types of ethical issues are experienced by physiotherapists internationally? How frequently are ethical issues experienced by physiotherapists internationally? Can the frequency and type of ethical issue experienced by physiotherapists be predicted by sociodemographic, educational (...) or vocational variables?MethodsAn observational study was conducted in English using an online survey from October 2018 to May 2019. Participants were 1212 physiotherapists and physiotherapy students located internationally which represented less than 1% of estimated number of physiotherapists worldwide at that time. The survey questionnaire contained 13 items requesting demographic detail and knowledge of ethical codes and decision-making, and 46 items asking what frequency participants experienced specific ethical issues in four categories: Physiotherapist and patient interaction, Physiotherapist and other health professionals including other physiotherapists, Physiotherapists and the system and Professional and economic ethical situations.ResultsThe two most frequently experienced ethical issues were ‘Scarce resources and time affecting quality of physiotherapy treatment’ and ‘Physiotherapy not accessible to all people in society who need it’. These items were experienced, on average, more often than monthly. Interprofessional practice also presented frequent ethical issues for participants. Ethical issues related to the context of ‘Physiotherapists and the system’ were most frequently experienced for all world regions. Working longer years in physiotherapy and learning about ethics in basic physiotherapy education was associated with participants reporting lower frequencies of ethical issues across all contexts.ConclusionThis study provides the first global profile of ethical issues experienced by physiotherapists. Societal and cultural systems are key influences on physiotherapists’ ethical practice. Physiotherapists globally need support from their work organisations, academic institutions and professional associations, and robust ethical training, to assist them to be active moral agents in their practice. (shrink)

This article makes a contribution to the on-going debates about universalism and cultural relativism from the perspective of sociology. We argue that bioethics has a universal range because it relates to three shared human characteristics,—human vulnerability, institutional precariousness and scarcity of resources. These three components of our argument provide support for a related notion of ‘weak foundationalism’ that emphasizes the universality and interrelatedness of human experience, rather than their cultural differences. After presenting a theoretical position on vulnerability and human (...) rights, we draw on recent criticism of this approach in order to paint a more nuanced picture. We conclude that the dichotomy between universalism and cultural relativism has some conceptual merit, but it also has obvious limitations when we consider the political economy of health and its impact on social inequality. (shrink)

By trying to see how one can use African values to fight against fraud, the paper attempts to bring out the structural dimension of this moral cancer by showing how it is linked to the ethical and economic/business systems where it thrives. I start by making some theoretical remarks about how values are to be placed in each socio‐cultural setting. An analysis of how the free market economy as a system creates conditions where fraud becomes possible then follows. This is (...) contrasted with an analysis of the African worldview and economic system where the starting point is that material and human resources abound, provided they are shared. The paper ends by suggesting ways in which African ethical values can be merged with the dominant economic system. (shrink)

As prototypical incentive with biological meaning, food illustrates the distinction between money as tool and money as drug. However, consistent neuroscience results challenge this view of food as intrinsic value and opposite to drugs of abuse. The scarce availability over evolutionary time of both food and money may explain their similar drug-like non-satiability, suggesting an integrated mechanism for generalized reinforcers. (Published Online April 5 2006).

By trying to see how one can use African values to fight against fraud, the paper attempts to bring out the structural dimension of this moral cancer by showing how it is linked to the ethical and economic/business systems where it thrives. I start by making some theoretical remarks about how values are to be placed in each socio‐cultural setting. An analysis of how the free market economy as a system creates conditions where fraud becomes possible then follows. This is (...) contrasted with an analysis of the African worldview and economic system where the starting point is that material and human resources abound, provided they are shared. The paper ends by suggesting ways in which African ethical values can be merged with the dominant economic system. (shrink)

There is a common view, dating back at least to Hume, that property rights presuppose scarcity. This paper is a critical examination of that thesis. In addition to questioning the thesis, the paper highlights the need to divorce the debate over this thesis from the debate over Intellectual Property (IP) rights (the area where it is most frequently applied). I begin by laying out the thesis’ major line of defense. In brief, the argument is that (1) property rights are (...) legitimate only when necessary, (2) necessary only to avoid injury resulting from one party’s use or possession of a good over others’, and (3) that such injury is possible only where there is scarcity. While I accept (1) (at least for the sake of argument), I argue that each of three prominent theories of the justification of property rights cast doubt on (2) and (3). As it turns out, at the theoretical level, there are a number of different ways of dealing with this conflict. However, I argue, no matter which theoretical path one takes, it turns out that the practical implications of the relationship between property rights and scarcity have been woefully misconstrued. Finally, I recount an independent argument for the thesis under consideration and argue that, whether or not it is successful against IP, it does not extend as an argument against ownership of non-scarce goods in general. This serves to further highlight the need to distinguish arguments for the thesis under consideration from arguments against IP. (shrink)

First published in French in 1979, “The Ambivalence of Scarcity” was a groundbreaking work on mimetic theory. Now expanded upon with new, specially written, and never-before-published conference texts and essays, this revised edition explores René Girard’s philosophy in three sections: economy and economics, mimetic theory, and violence and politics in modern societies. The first section argues that though mimetic theory is in many ways critical of modern economic theory, this criticism can contribute to the enrichment of economic thinking. The (...) second section explores the issues of nonviolence and misrecognition, which have been at the center of many discussions of Girard’s work. The final section proposes mimetic analyses of the violence typical of modern societies, from high school bullying to genocide and terrorist attacks. Politics, Dumouchel argues, is a violent means of protecting us from our own violent tendencies, and it can at times become the source of the very savagery from which it seeks to protect us. The book’s conclusion analyzes the relationship between ethics and economics, opening new avenues of research and inviting further exploration. Dumouchel’s introduction reflects on the importance of René Girard’s work in relation to ongoing research, especially in social sciences and philosophy. (shrink)