RATIONALE, AIMS AND OBJECTIVES: This paper deals with the problem of surgical waiting lists and is aimed, in particular, at comparing two different prioritization approaches: (1) the clinical assessment of treatment urgency aimed at categorizing patients into urgency-related groups (URGs) with a given recommended maximum waiting time for treatment; and (2) the implementation of an original prioritization scoring algorithm aimed at determining the relative priority of each patient in the waiting list and the corresponding order of (...) admission. METHODS: A modelling exercise based on a cohort of 236 patients enrolled on the waiting list of a surgical department in an Italian public university hospital, from 1 January to 30 June 2004, is presented. The comparison is based on a measure called need-adjusted-waiting-days, which allows to take into proper account both urgency and priority. RESULTS: The results show that both methods should be implemented simultaneously for increasing the department's performance in terms of both efficiency--outcome gained from a given amount of resources--and equity--how patients are admitted according to their need. CONCLUSIONS: Waiting list prioritization should not be limited to classifying patients into URGs, but to using a scoring system as well, in order to schedule patient admissions in an explicit and transparent way. (shrink)

ABSTRACT In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting‐list and receives in exchange a postmortal kidney, usually an O‐kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate directly or to participate in a paired kidney exchange because of blood group incompatibility or a positive cross‐match. Each donation within an LDLE (...) program makes an additional organ available for transplantation. But because most of the pairs making use of the program will be A/o incompatible, it will also tend to increase the waiting time for patients with blood group O, who already have the longest waiting time. It has therefore been objected that the program is materially unjust, because it further disadvantages the least advantaged. This objection appeals to John Rawls’ difference principle. However, the context for which Rawls proposed that difference principle, is significantly different from the present one. Applying the principle here amounts to a lop‐sided trade‐off between considerations of need and considerations of overall utility. Considerations of formal justice, however, may lead to a stronger objection to LDLE programs. Such a program means that one O‐patient on the waiting list is exempted from the application of the general criteria used in constructing the list because he has a special bargaining advantage. This objection is spelled out and weighed against the obvious attraction of LDLE in a situation of (extreme) organ scarcity. (shrink)

RATIONALE AND AIMS: Total hip and knee replacements, usually, have long waiting lists. There are several prioritization tools for these kind of patients. A new tool should undergo a standardized validation process. The aim of the present study was to validate a new prioritization tool for primary hip and knee replacements. METHODS: We carried out a prospective study. Consecutive patients placed on the waiting list were eligible for the study. Patients included were mailed a questionnaire which included, (...) among other questions, the seven items of the priority tool and the Western Ontario and McMasters Universities Arthritis Index (WOMAC) specific questionnaire. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the content and construct validity. We used Student's t-test or one-way analysis of variance. Correlational analysis was used to evaluate convergent and discriminate validity. RESULTS: The sample consisted of 838 patients (62.3% were female), with mean age of 70.2 years (SD 8.4). A total of 55.5% patients underwent knee replacement. Given that the tool was elaborated by patients and orthopaedic surgeons, it shows a good content validity. The priority score was statistically different (P < 0.001) among the three urgency categories created. The scores of the three WOMAC dimensions showed differences (P < 0.001) by the three urgency categories created. The correlations between the priority score and WOMAC dimensions were 0.79 (function), 0.69 (pain) and 0.51 (stiffness). The correlations between WOMAC items and items from priority tool were greater (0.47-0.69) between items measuring similar constructs than those measuring different constructs (0.27-0.49). These data are similar in both joints. CONCLUSIONS: Results support the validity of the prioritization tool to be used with patients waiting for hip or knee replacement. (shrink)

It has often been proposed to restrict access to postmortal organs to registered donors, or at least to give them priority on the waiting list. Such proposals are motivated by considerations of fairness: everyone benefits from the existence of a pool of available organs and of an organised system of distributing them and it is unfair that people who are prepared to contribute to this public good are duped by people who are not. This paper spells out this (...) rationale and goes on to discuss the main principled objections that have been brought forward to such proposals. The most fundamental objection is that healthcare resources should be allocated in accordance with need, not with merit. The reply to this objection is that the principle of allocation according to need only holds in cases in which the provision of such resources and the fair distribution of the burdens of contribution are independently secured, as they are in an obligatory insurance system. (shrink)

The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive (...) justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people's relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed. (shrink)

Anna Chavlovski,1 Greg A Knoll,1–3 Timothy Ramsay,4 Swapnil Hiremath,1–3 Deborah L Zimmerman1–31University of Ottawa, 2Ottawa Hospital, 3Kidney Research Centre, Ottawa Hospital Research Institute, 4Ottawa Methods Centre, Ottawa, ON, CanadaBackground: In patients with end-stage renal disease, use of vitamin D and calcium-based phosphate binders have been associated with progression of vascular calcification that might have an impact on renal transplant candidacy. Our objective was to examine management of mineral metabolism in patients wait-listed for renal transplant and to determine the impact on (...) cardiac perfusion imaging.Methods: Data was collected retrospectively on patients wait-listed for a renal transplant, being either active and on hold. Demographic data, medications, serum concentrations of calcium, phosphate, parathyroid hormone, and cardiac perfusion imaging studies were collected from the electronic health record. Chi-square and Student’s t-tests were used to compare active and on-hold patients as appropriate. Logistic regression was used to examine variables associated with worsening cardiac imaging studies.Results: The wait-listed patients were of mean age 56 ± 14 years and had been on dialysis for 1329 ± 867 days. On-hold patients had received a significantly greater total dose of calcium and were more likely to have developed worsening cardiovascular imaging studies. Total doses of calcium and calcitriol were associated with worsening cardiovascular imaging studies.Conclusion: Patients on hold on the renal transplant waiting list received higher total doses of calcium. A higher total dose of calcium and calcitriol was also associated with worsening cardiovascular imaging. Time on dialysis before transplant has been associated with worse post-transplant outcomes, and it is possible that the total calcium and calcitriol dose received contributed to these inferior outcomes.Keywords: dialysis, calcium, cardiac, transplantation. (shrink)

Hospital waiting lists are a feature ofpublicly funded health services that resultswhen demand appears to exceed supply. Whilemuch has been written about hospital waitinglists, little is known about the dynamics ofdiagnostic waiting lists, or more generally whyhospital waiting lists behave in perverse andoften counter-intuitive ways. This paperattempts to address this gap by applying arecent development in critical systems thinkingcalled boundary critique to understand how aparticular ultrasound waiting list was managed.A new waiting list metaphor (...) based on waitinglists as ritual forms is proposed. (shrink)

Organ transplantation has increased worldwide while the number of organ donors have not increased similarly. Consequently, the waiting period for transplant candidates is prolonged. Patient narratives have uncovered physical and psychosocial suffering in the transplantation process. However, relatively few studies have explored patients’ experiences in the actual waiting period. This qualitative study was conducted in Norway and aimed to describe patients’ experiences of being accepted as recipients of a new liver and their waiting following this decision. A (...) sample of 21 patients with end‐stage liver disease, placed on the ordinary waiting list for a liver transplant, were interviewed in the hospital before they went home to wait for a compatible liver. Uncertainty related to life and death was a major issue, both in the waiting period and as a response to being put on the waiting list. Another central issue was their overwhelming lack of energy. Patients inferred a linear relationship between lack of energy, physical limitations and mental distress. Despite major advances in medical treatment, little follow‐up was given during the waiting period and most of the patients seemed resigned to the inevitability of their suffering. This raises issues of health personnel responsibility and a need to heighten awareness about patient suffering during the waiting period. (shrink)

Recently, debate about the distribution of scarce organs for transplantation has focused on whether patients should have the right to place themselves on waiting lists at several transplant centers, thereby gaining an advantage over other potential recipients. This article explores the social and ethical issues raised by multiple listing, contrasting policies adopted at the national level with those implemented in New York State. It concludes by examining the implications of the debate for broader questions about entitlement and access to (...) health care. (shrink)

ABSTRACT In the 1960s, when Dr. Belding Scribner discovered how to accomplish the process of dialysis in a repeated way, he could not imagine that in solving such a problem others as or more difficult would appear. Given the technological progress and the impossibility of assisting all patients through the most modern methods, the medical doctor often finds himself faced with the moral dilemma of choosing which patient in the waiting list will receive the treatment. This same dilemma (...) is amplified in the case of organ transplants. Professionals, students, professors of the juridical and health fields, and the population in general, were interviewed as a means of documenting the moral concepts and opinions surrounding this problem. In the reality in which we find ourselves, it seems to us that deciding who lives, and the responsibility for all the events that culminate in such decisions, is still a subject left open to discussion. (shrink)

ABSTRACT In the 1960s, when Dr. Belding Scribner discovered how to accomplish the process of dialysis in a repeated way, he could not imagine that in solving such a problem others as or more difficult would appear. Given the technological progress and the impossibility of assisting all patients through the most modern methods, the medical doctor often finds himself faced with the moral dilemma of choosing which patient in the waiting list will receive the treatment. This same dilemma (...) is amplified in the case of organ transplants. Professionals, students, professors of the juridical and health fields, and the population in general, were interviewed as a means of documenting the moral concepts and opinions surrounding this problem. In the reality in which we find ourselves, it seems to us that deciding who lives, and the responsibility for all the events that culminate in such decisions, is still a subject left open to discussion. (shrink)

Debates continue to surround the system in the United States for allocating transplantable cadaveric organs, due in large part to the scarcity of such organs in relation to the number of individuals waiting to undergo transplantation. Candidates awaiting transplantation gain access to cadaveric organs by being placed by individual transplant programs on the national list of the Organ Procurement and Transplantation Network, overseen by the United Network for Organ Sharing. In recent years, the UNOS board has visited the (...) issue of multiple listing, that is, allowing one candidate to be registered on the waiting lists of two or more transplant programs, and has continued to permit multiple listing. (shrink)

The renowned occult scholar Arthur Edward Waite left no stone unturned when preparing this meticulously researched volume on the life and works of the French mystic Louis Claude de Saint-Martin. Drawing on contemporary biographies, correspondences, and all the source materials that were available to him at the time, he put together a biography and summary of Saint-MartinÍs work that is still unsurpassed to this day. This edition is presented with modernised typography and a new and expanded index.

This article examines the methodology of a core branch of contemporary political theory or philosophy: “analytic” political theory. After distinguishing political theory from related fields, such as political science, moral philosophy, and legal theory, the article discusses the analysis of political concepts. It then turns to the notions of principles and theories, as distinct from concepts, and reviews the methods of assessing such principles and theories, for the purpose of justifying or criticizing them. Finally, it looks at a recent debate (...) on how abstract and idealized political theory should be, and assesses the significance of disagreement in political theory. The discussion is carried out from an angle inspired by the philosophy of science. (shrink)

Distributed cognition refers to processes which are (i) cognitive and (ii) distributed across multiple agents or devices rather than performed by a single agent. Distributed cognition has attracted interest in several fields ranging from sociology and law to computer science and the philosophy of science. In this paper, I discuss distributed cognition from a social-choice-theoretic perspective. Drawing on models of judgment aggregation, I address two questions. First, how can we model a group of individuals as a distributed cognitive system? Second, (...) can a group acting as a distributed cognitive system be ‘rational’ and ‘track the truth’ in the outputs it produces? I argue that a group’s performance as a distributed cognitive system depends on its ‘aggregation procedure’ – its mechanism for aggregating the group members’ inputs into collective outputs – and I investigate the properties of an aggregation procedure that matter. (shrink)

This article examines the methodology of a core branch of contemporary political theory or philosophy: “analytic” political theory. After distinguishing political theory from related fields, such as political science, moral philosophy, and legal theory, the article discusses the analysis of political concepts. It then turns to the notions of principles and theories, as distinct from concepts, and reviews the methods of assessing such principles and theories, for the purpose of justifying or criticizing them. Finally, it looks at a recent debate (...) on how abstract and idealized political theory should be, and assesses the significance of disagreement in political theory. The discussion is carried out from an angle inspired by the philosophy of science. (shrink)

Unlike some other reproductions of classic texts (1) We have not used OCR(Optical Character Recognition), as this leads to bad quality books with introduced typos. (2) In books where there are images such as portraits, maps, sketches etc We have endeavoured to keep the quality of these images, so they represent accurately the original artefact. Although occasionally there may be certain imperfections with these old texts, we feel they deserve to be made available for future generations to enjoy.

How can the propositional attitudes of several individuals be aggregated into overall collective propositional attitudes? Although there are large bodies of work on the aggregation of various special kinds of propositional attitudes, such as preferences, judgments, probabilities and utilities, the aggregation of propositional attitudes is seldom studied in full generality. In this paper, we seek to contribute to …lling this gap in the literature. We sketch the ingredients of a general theory of propositional attitude aggregation and prove two new theorems. (...) Our …rst theorem simultaneously characterizes some prominent aggregation rules in the cases of probability, judgment and preference aggregation, including linear opinion pooling and Arrovian dictatorships. Our second theorem abstracts even further from the speci…c kinds of attitudes in question and describes the properties of a large class of aggregation rules applicable to a variety of belief-like attitudes. Our approach integrates some previously disconnected areas of investigation. (shrink)

Are companies, churches, and states genuine agents? Or are they just collections of individuals that give a misleading impression of unity? This question is important, since the answer dictates how we should explain the behaviour of these entities and whether we should treat them as responsible and accountable on the model of individual agents. Group Agency offers a new approach to that question and is relevant, therefore, to a range of fields from philosophy to law, politics, and the social sciences. (...) Christian List and Philip Pettit argue that there really are group or corporate agents, over and above the individual agents who compose them, and that a proper approach to the social sciences, law, morality, and politics must take account of this fact. Unlike some earlier defences of group agency, their account is entirely unmysterious in character and, despite not being technically difficult, is grounded in cutting-edge work in social choice theory, economics, and philosophy. (shrink)

It is often argued that higher-level special-science properties cannot be causally efficacious since the lower-level physical properties on which they supervene are doing all the causal work. This claim is usually derived from an exclusion principle stating that if a higher-level property F supervenes on a physical property F* that is causally sufficient for a property G, then F cannot cause G. We employ an account of causation as difference-making to show that the truth or falsity of this principle is (...) a contingent matter and derive necessary and sufficient conditions under which a version of it holds. We argue that one important instance of the principle, far from undermining non-reductive physicalism, actually supports the causal autonomy of certain higher-level properties. (shrink)

Suppose several individuals (e.g., experts on a panel) each assign probabilities to some events. How can these individual probability assignments be aggregated into a single collective probability assignment? This article reviews several proposed solutions to this problem. We focus on three salient proposals: linear pooling (the weighted or unweighted linear averaging of probabilities), geometric pooling (the weighted or unweighted geometric averaging of probabilities), and multiplicative pooling (where probabilities are multiplied rather than averaged). We present axiomatic characterisations of each class of (...) pooling functions (most of them classic, but one new) and argue that linear pooling can be justified procedurally, but not epistemically, while the other two pooling methods can be justified epistemically. The choice between them, in turn, depends on whether the individuals' probability assignments are based on shared information or on private information. We conclude by mentioning a number of other pooling methods. (shrink)

Racism in nursing is multifaceted, ranging from internalized racism and interpersonal racism to institutional and systemic (or structural) elements that perpetuate inequities in the nursing profession. Employing the socio‐ecological model, this study dissects the underlying challenges across various levels and proposes targeted mitigation strategies to foster an inclusive and equitable environment for nursing education. It advances clear, context‐specific mitigation strategies to cultivate inclusivity and equity within nursing education. Effectively addressing racism within this context necessitates a tailored, multistakeholder approach, impacting nursing (...) students, faculty, administration, professional organizations, and licensing and accrediting bodies. This all‐encompassing strategy recognizes that the interplay of interpersonal dynamics, community culture, institutional policies, and broader societal structures intricately shapes individual experiences. Nurses, nurse leaders, educators, organizations, and policymakers can work together to create a more equitable and inclusive nursing profession by targeting each of these levels. This transformational process can yield positive outcomes across various environments where nurses learn, work, and serve people and enable the demographic composition of nurses to better match the populations served. (shrink)