Search

Sometimes, offering someone beneficial care is likely to thwart the similar or more serious medical needs of more people. For example, when acute shortage is strongly predicted to persist, providing the long period on scarce intensive care that a certain COVID‐19 patient needs is sometimes projected to block several future COVID‐19 patients from receiving the shorter periods on intensive care that they will need. Expected utility is typically higher if the former is denied intensive care. A tempting initial account of such cases is that consequentialism supports denying care to that patient and nonconsequentialism supports providing that care. This paper argues that the consequentialist case is more complicated than it may initially seem and that nonconsequentialism sides more readily with denial of the beneficial treatment. It also shows that when denying it would directly enhance public health by a lot, either ethical approach would normally recommend denying it. Practical implications are discussed, including how to address conscientious objection to this shared recommendation. [ABSTRACT FROM AUTHOR]

In many countries, the COVID‐19 pandemic varied starkly between different racial and ethnic groups. Before vaccines were approved, some considered assigning priority access to worse‐hit racial groups. That debate can inform rationing in future pandemics and in some of the many areas outside COVID‐19 that admit of racial health disparities. However, concerns were raised that "race‐responsive" prioritizations would be ruled unlawful for allegedly constituting wrongful discrimination. This legal argument relies on an understanding of discrimination law as demanding color‐blindness. We argue that a, color‐blind understanding of discrimination would be hostile only to one of two rationales for prioritizing the relevant racial minorities in settings of racial health disparities. We also propose a method for incorporating appropriate race‐responsive concerns that is in many ways ethically and legally superior to ones suggested thus far. That method turns artificial intelligence, thanks precisely to its artificial and "black box" nature (features that underlie recent concerns about artificial intelligence's discriminatory potential), into an instrument of social justice. [ABSTRACT FROM AUTHOR]

Governments and non-governmental organisations are increasingly adopting a 'zero-suicide' goal, but what such a goal precisely involves is unclear. Ostensibly it strongly prioritises the prevention and elimination of all suicide. We argue that, so understood, a societal goal of zero suicide risks contravening several ethical principles. In terms of beneficence and non-maleficence, a 'zero-suicide' goal risks being inefficient and may burden or harm many people. Autonomy-wise, a blanket ban on all suicide is excessive. As regards social justice, zero suicide risks focusing on the symptoms of social malaise instead of the structures causing it. With respect to transparency, a 'zero' goal that cannot be met makes these authorities look detached and risks frustration, distrust and, worse, stigmatisation of suicide and of mental health conditions. Instead, we propose a middle path for suicide prevention, founded on harm reduction, 'soft group paternalism' and efforts directed at increased quality of life for disadvantaged groups. Although soft group paternalism respects autonomy, this approach permits coercive interferences in certain circumstances. We hope that the justificatory framework tying together these largely familiar elements is novel and sensible. [ABSTRACT FROM AUTHOR]

Problem District hospitals in Nepal struggle to provide essential services such as caesarean sections. Approach Retention of health workers is critical to the delivery of long-term, quality health-care services. To promote retention and enhance performance in rural public hospitals, the Government of Nepal and the Nick Simons Institute progressively implemented a rural staff support programme in remote hospitals. After competitive selection for a compulsory-service scholarship and training, family practice doctors who could do basic surgery, orthopaedics and obstetrics were hired under a binding three-year contract in each participating hospital. Comfortable living quarters and an Internet connection were provided for the resident doctors; in- service training for all staff and capacity development for each hospital's management committee were provided. Local setting Nepal's mountainous landscape, poverty and inequitable rural/urban distribution of health workers pose barriers to adequate health care. Relevant changes Between 2011 and 2015 family practice doctors were maintained in all seven programme hospitals. All hospitals became providers of comprehensive emergency obstetric care and served more patients. Compared with hospitals not within the programme, deliveries increased significantly (203% versus 71% increase, respectively; P=0.002).The programme recently expanded to 14 hospitals. Lessons learnt A package of human resource supports can improve the retention of doctors and the use of remote hospitals. Factors contributing to the success of this programme were compulsory-service scholarship, central personnel management, performance-based incentives and the provision of comfortable living quarters. Probleme Les hopitaux de district du Nepal ont du mal a fournir des services essentiels tels que des cesariennes. Approche Le maintien des professionnels de sante s'avere crucial pour pouvoir fournir des services medicaux de qualite sur le long terme. Afin d'ameliorer ce maintien ainsi que les performances des hopitaux publics situes en zone rurale, le gouvernement nepalais et le Nick Simons Institute ont progressivement mis en place un programme de soutien du personnel dans les hopitaux recules. Apres une selectlon par concours pour beneficier d'une formation et d'une bourse conditlonnee a un service obligatoire, des medecins generalistes pouvant realiser des actes basiques dans le domalne chirurgical, prthopedique et obstetrique ont ete recrutes dans chaque hopital participant au titre d'un contrat de trois ans. Un logement confortable et une connexion Internet ont ete fournis aux medecins residents; dans chaque hopital, l'ensemble du personnel a beneficie d'une formation continue et le comite de gestion d'un renforcement des competences. Environnement local Le relief montagneux du Nepal, la pauvrete et la repartition inequitable des professionnels de sante entre milieu rural / urbain sont autant d'obstacles a l'offre de soins adequats. Changements significatifs Entre 2011 et 2015, les medecins generalistes sont restes dans l'ensemble des sept hopitaux du programme. Tous ces hopitaux ont pu delivrer des soins obstetricaux d'urgence et prendre en charge davantage de patients. Compares a des hopitaux ne faisant pas partie du programme, les soins dispenses ont considerablement augmente (augmentation de 203% contre 71%, respectivement; P=0,002). Le programme a recemment ete etendu a 14 hopitaux. Lecons tirees Des dlspositifs de soutien des ressources humaines peuvent ameliorer le maintien des medecins et le recours aux hopitaux situes dans des zones reculees. Les facteurs qui ont contribue a la reussite de ce programme sont la bourse conditionnee a un service obligatoire, la gestion centralisee du personnel, les primes au rendement et la mise a disposition de logements confortables. Situacion Los hospitales de distrito en Nepal tienen dificultades para proporcionar servicios basicos como cesareas. Enfoque La retencion del personal sanitario es indispensable para suministrar servicios medicos de calidad a largo plazo. Para promover la retencion y mejorar el rendimiento en los hospitales publicos rurales, el Gobierno de Nepal y el Instituto Nick Simons aplicaron de forma progresiva un programa de apoyo al personal rural en hospitales remotos. Tras una seleccion competitiva para una beca de servicio obligatorio y formacion, se contrato en cada hospital participante a medicos de familia que pudieran llevar a cabo una cirugia basica, ortopedias y obstetricia con un contrato vinculante de tres anos. Se proporciono una comoda residencia y conexion a internet a los medicos residentes y tambien formacion en el servido para todo el personal y desarrollo de capacidades para el comite de gestion de cada hospital. Marco regional En Nepal, el paisaje montanoso, la pobreza y la injusta distribucion del personal sanitario entre las zonas rurales y urbanas obstaculizan una adecuada atencion sanitaria. Cambios importantes Entre 2011 y 2015 se mantuvieron medicos de familia en los siete hospitales del programa. Todos los hospitales se volvieron proveedores de atencion obstetrica de emergencia integral y atendieron a mas pacientes. En comparacion con otros hospitales que no se encontraban en el programa, el numero de partos aumento significativamente (aumento del 203% frente al 71 %, respectivamente; P = 0,002). Recientemente, el programa se extendio hasta los 14 hospitales. Lecciones aprendidas Un paquete de apoyo a los recursos humanos puede mejorar la retencion de medicos y el uso de hospitales remotos. Los factores que contribuyeron al exito de este programa fueron la beca de servicio obligatorio, la gerencia central de recursos, los incentivos basados en el rendimiento y la provision de una residencia comoda., Introduction In remote areas, an absence of doctors and nurses leads to poor health outcomes for local populations. (1) To increase access to health-care workers, the World Health Organization recommends [...]

Distributive theories evaluate distributions of goods based on candidate recipients' characteristics, e.g. how well off candidates are, how deserving they are, and whether they fare below sufficiency. But such characteristics vary across possible worlds, so distributive theories may differ in terms of the world which for them settles candidates' characteristics. This paper examines how distributive theories differ in terms of whether candidate recipients' relevant characteristics are grounded in the possible world that would take place if the distributor does not intervene (call it the "input" world) or if they are grounded in each possible world that the distributor can bring about through different decisions (call each an "output" world). We illustrate the importance of this distinction in relation to one distributive theory, prioritarianism. As we show, both input and output versions of prioritarianism are plausible interpretations of the literature, and there are good reasons to take input prioritarianism seriously. Ultimately, however, we argue that input prioritarianism should be rejected. [ABSTRACT FROM AUTHOR]