Examining the Potential Exploitation of UNOS Policies

The United Network for Organ Sharing (UNOS) waiting list was designed as a just and equitable system through which the limited number of organs is allocated to the millions of Americans in need of a transplant. People have trusted the system because of the belief that everyone on the list has an equal opportunity to receive an organ and also that allocation is blind to matters of financial standing, celebrity or political power. Recent events have revealed that certain practices and policies have the potential to be exploited. The policies addressed in this paper enable those on the list with the proper resources to gain an advantage over other less fortunate members, creating a system that benefits not the individual most in medical need, but the one with the best resources. These policies are not only unethical but threaten the balance and success of the entire UNOS system. This paper proposes one possible solution, which seeks to balance the concepts of justice and utility.

     

Why we still need a mark of the cognitive

What makes a process a cognitive process? I’m not just asking for a list of cognitive processes, but for what makes an item on that list a cognitive process. Why should it be on the list? This is a question that has been ignored far too long in the domain of research calling itself cognitive science. It is time to give an answer and that is what I propose in this paper. I contrast my answer with others that have been given and defend the need against some claims in the literature that a mark of the cognitive is not needed.     

Left ventricular assist devices: An ethical analysis

United States statistics continue to indicate that the human donor heart pool does not and will not meet the great demand for hearts. For those patients unresponsive to maximal medical therapy (approximately 60,000 patients per year), cardiac transplantation is currently their best hope for increased survival. To address the need for additional end-stage congestive heart failure (CHF) therapy options, three medical device manufacturers have developed implantable left ventricular assist devices (LVAD) which act as a pump for hemodynamic support of the patient’s diseased heart. Although LVADs have been shown to improve patient disease state prior to organ transplantation. LVADs do nothing to increase the pool of human donor hearts, and they negatively impact the United Network for Organ Sharing (UNOS) waiting list by increasing the size of the waiting pool. This paper identifies and explores the ethical challenges presented by the use of LVADs as a bridging technology for heart transplant candidates. Although LVADs raise some ethical concerns, these concerns are outweighed by the proven medical efficacy of these devices. Thus, this technology should continue to be used and further developed. This paper was written by the author while in the Masters degree progrm at Loma Linda University (Dept. of Biomedical and Clinical Ethics), 11234 Anderson Street, Coleman Pavillion, Loma Linda, CA 92354, USA. The author is currently an Ethies Fellow (pre-doctoral) in UCLA’s program in Biomedical and Research Ethics.     

Disability as diversity in Fortune 100 companies

To investigate the inclusion of people with disabilities in the diversity policies of the most successful businesses in the United States, we examined the publicly available workforce and supplier diversity policies of the top 100 companies on Fortune Magazine's 2003 list of the 500 most profitable companies in the nation. The majority of these companies have extensive information about their diversity policies and practices available on their corporate website. The information was used to categorize the policies into those that include people with disabilities, do not define diversity, and enumerate what is meant by diversity (e.g. in terms of race or gender) but do not expressly mention disability. In addition, we looked beyond the diversity policies to information available on corporate websites relating to a variety of diversity initiatives. Findings suggest that the majority of the companies that top the Fortune 500 list have developed and implemented diversity policies. Of these, 42% have diversity policies that include people with disabilities in the definition of a diverse workforce. Furthermore, 47% of companies with workplace diversity policies discuss diversity in a way that neither expressly includes nor excludes people with disabilities. Far fewer (15%) supplier diversity policies include disability in the definition of diversity, but a significant number of companies use criteria that allow a business owner with a disability to benefit from the company's supplier diversity program.     

Gender Issues in US Science and Technology Policy: Equality of What?

Fairness in evaluation processes for women in science and engineering is only one of a set of issues that need to be addressed to reach gender equality. This article uses concepts from Amartya Sen's work on inequality to frame gender issues in science and technology policy. Programs that focus on increasing the number of women in science and engineering careers have not generally addressed a broader set of circumstances that intersect with gender at various economic levels and stages of life. The agendas in research and innovation policies also need to reflect these issues, and fair allocation of resources within both science and technology needs to be on the agenda. Getting women into high-level positions is not enough. Articulating the full research and innovation agendas for women will require broader participatory processes.     

THE BEGINNING OF COMMUNITY: POLITICS IN THE FACE OF DISAGREEMENT

Rawls' requirement that citizens of liberal democracies support only policies which they believe can be justified in 'public reason' depends on a certain ideal for the relationships between citizens. This is a valuable ideal, and thus citizens have reasons to try to achieve it. But it is not always possible to find the common ground that we would need in order to do so, and thus we should reject Rawls' strong claim that we have an obligation to defend our views in public reason. Because I recognize that we have strong reasons to conduct our political enquiry within the guidelines of political liberalism, but deny that we always have an obligation to do so, one might call my view 'permissive political liberalism'.     

Single payers and multiple lists: must everyone get the same coverage in a universal health plan?

In spite of recent political setbacks for the movement toward universal health insurance, considerable support remains for the idea. Among those supporting such plans, most assume that a universal insurance system, especially if it is a single-payer system, would offer a single list of basic covered services. This paper challenges that assumption and argues for the availability of multiple lists of services in a universal insurance system. The claim is made that multiple lists will be both more efficient and more fair. Any single list will fund some services that are quite attractive to some people, but only marginally attractive to others. Thus any single-list plan will fund some services that produce only marginal benefit for the resources used. Moreover, since some people will hold values quite compatible with the single list and others will hold values leading to preferences for unfunded services, some people will get much more benefit from any single list than other people will. Fairness and efficiency require providing an entitlement to universal access to health insurance that could be purchased by typical consumers for a fixed price of perhaps $3500. By permitting everyone to pick their preferred list of services available at that price, each person will efficiently use his or her entitlement while getting more equal opportunity for benefits.     

Perceptual distinctiveness and proactive interference in the primacy effect

When subjects monitor a list of verbal items for one item which is to be selected and remembered, they are more likely to recall the critical item if it is the first member of the list than if it is presented towards the centre of the list. The present experiment examined the possibility that this primacy results from an accumulation of proactive interference from incidentally processed early members of the list which would cause a decrement in the recall of later members. By changing the semantic category of the list members before presentation of the critical item any accumulated interference would have been released, but this procedure produced no weakening of the primacy effect and so the interference theory of primacy was not supported. An alternative explanation of the effect was discussed in which it is assumed that the first member of a series is perceptually distinct from central members.     

Cross-domain interference costs during concurrent verbal and spatial serial memory tasks are asymmetric

Some evidence suggests that memory for serial order is domain-general. Evidence also points to asymmetries in interference between verbal and visual–spatial tasks. We confirm that concurrently remembering verbal and spatial serial lists provokes substantial interference compared with remembering a single list, but we further investigate the impact of this interference throughout the serial position curve, where asymmetries are indeed apparent. A concurrent verbal order memory task affects spatial memory performance throughout the serial positions of the list, but performing a spatial order task affects memory for the verbal serial list only for early list items; in the verbal task only, the final items are unaffected by a concurrent task. Adding suffixes eliminates this asymmetry, resulting in impairment throughout the list for both tasks. These results suggest that domain-general working memory resources may be supplemented with resources specific to the verbal domain, but perhaps not with equivalent spatial resources.     

Cross-domain interference costs during concurrent verbal and spatial serial memory tasks are asymmetric

Some evidence suggests that memory for serial order is domain-general. Evidence also points to asymmetries in interference between verbal and visual-spatial tasks. We confirm that concurrently remembering verbal and spatial serial lists provokes substantial interference compared with remembering a single list, but we further investigate the impact of this interference throughout the serial position curve, where asymmetries are indeed apparent. A concurrent verbal order memory task affects spatial memory performance throughout the serial positions of the list, but performing a spatial order task affects memory for the verbal serial list only for early list items; in the verbal task only, the final items are unaffected by a concurrent task. Adding suffixes eliminates this asymmetry, resulting in impairment throughout the list for both tasks. These results suggest that domain-general working memory resources may be supplemented with resources specific to the verbal domain, but perhaps not with equivalent spatial resources.     

Effect of Object and Task Properties on Bimanual Transport

The use of both hands simultaneously when manipulating objects is fairly commonplace, but it is not known what factors encourage people to use two hands as opposed to one during simple tasks such as transport. In particular, we are interested in three possible transport strategies: unimanual transport, handing off between hands, and symmetric bimanual transport. In this study, we investigate the effect of object size, weight, and starting and ending position (configuration) as well as the need to balance the object on the use of these three strategies in a bowl-moving task. We find that configuration and balance have a strong effect on choice of strategy, and size and weight have a weaker effect. Hand-offs are most often used when the task requires moving an object from left to right and vice versa, while the unimanual strategy was frequently used when passing front to back. The bimanual strategy is only weakly affected by configuration. The need to balance an object causes subjects to favor unimanual and bimanual strategies over the hand-off. In addition, an analysis of transport duration and body rotation suggests that strategy choice may be driven by the desire to minimize body rotation.     

Safeguarding the earth system as a priority for sustainable development and global ethics: the need for an earth system SDG

While the list of 17 Sustainable Development Goals (SDGs) proposed by the United Nations’ Open Working Group (OWG) comprises a catalog of highly important post-2015 development priorities, one of the key issue that has not received the attention it deserves is the need to safeguard the Earth's life-support system. Over the course of the past decades, we have concentrated much more on socioeconomic development rather than on environmental sustainability while putting a number of the Earth's systems at risk, and with it poverty eradication and sustainable development. There is thus a need to put the spotlight on global environmental change and to take account of the insights from the latest Earth system science and its implications for the future of global development and global ethics. The ongoing debate on the post-2015 SDGs offers an important occasion for this endeavor. Going beyond the current proposal of the Open Working Group and building on the planetary boundaries or guard rails framework, the SDGs should contain the goal to safeguard Earth's life-support system.     

The virtues of illusion

Conclusion The moral is plain enough. For purposes of distinguishing an object from surroundings of similar lightness, one needs to have a receptive system that is sensitive to small wavelength differences. For signalreception and identification purposes, one needs to have a receptive system engendering a few basic categories that can ignore minor variations and lump stimuli together into a small number of salient, memorable equivalence classes. With elegant economy, our visual systems does both by drawing on the same neural resources. The system of qualitative classification that this involves need not match any analogous set of structures outside the organism in order to provide real advantages to the animal that uses it. The hues that we human beings see express our system of coding wavelength information rather than some set of properties of reflecting surfaces. But the form of the coding is not just a bit of non-functional adornment freeloading on the serious business of visual information processing. We must see it, rather, as supplying the means by which a rich amount of sensory information can be rapidly and efficiently represented by cognitive machinery of limited capacity [Miller, 1957]. With color, the medium is the message.This is a revised version of Hardin [1990], with permission of SPIE.     

Paying for medical care: a Jewish view

According to Jewish law, there is a clear obligation to try to heal, and this duty devolves upon both the physician and the society. Jewish sources make it clear that health care is not only an individual and familial responsibility, but also a communal one. This social aspect of health care manifests itself in Jewish law in two ways: first, no community is complete until it has the personnel (and, one assumes, the facilities) to provide health care; second, the community must pay for the health care of those who cannot afford it as part of its provision for the poor. The community, in turn, must use its resources wisely, which is the moral basis within the Jewish tradition for some system of managed care. The community must balance its commitment to provide health care with the provision of other services.     

Revelation without presentation: Counterfeit study list yields robust revelation effect

This study explores the revelation effect, a recognition memory phenomenon that occurs when test items (or related items) are specially processed before recognition judgment. These revealed items, whether targets or lures, receive a positive response bias. Although the effect occurs across various conditions, it has not been shown to occur when participants make judgments unrelated to episodic memory. We investigated whether the effect would occur when a recognition decision was nominally one of episodic memory, but when a complete episodic event had not occurred. Specifically, participants listened to noise that allegedly masked a list of words (in fact, no words existed). A revelation effect occurred with this pseudo-subliminal procedure, suggesting that the revelation effect need not rely on stimuli recalled through episodic memory but only a specific event to recall. The effect did not occur when participants simply guessed whether words were on an unheard list or made semantic judgments.     

The Relevance of Social Theory in the Practice of Environmental Management

In this paper I argue that the dominance of certain paradigms and theories on policies can have an influence on the value added by impact assessments. A link exists between paradigms and theories and policies and consequently the practices humans develop to tackle real world problems. I also argue that different types of thinking (contained in paradigms and theories) need to be integrated, at least at the scientific level, to enhance our understanding of social phenomena. This in turn can have a positive influence on policy processes that follow impact assessment recommendations. I am not arguing for the adoption of theoretical positions by practitioners, Instead, I contend that if impact assessments are informed by a variety of paradigms and theories, the policy practitioner might have a better understanding of the issue and the moral choices he or she needs to make. I will highlight the connection between theory and policies with practical examples from the social impact assessment of the De Hoop Dam, which was constructed on the Steelpoort River. I also argue for an integration of different theories to give a deeper understanding of real world problems.     

Are Healthy Eating Policies Consistent with Public Reason?

States are increasingly implementing policies aimed at changing people's dietary habits, such as fat taxes, food bans, and nudges. In this article, we ask whether healthy eating policies are consistent with public reason, the view that state laws and policies should be justified on the basis of reasons that all citizens can accept at some level of idealisation despite their different conceptions of the good. What we intend to explore is an ‘if…, then…’ line of thought: if one is committed to public reason, then may one consistently endorse healthy eating policies? First, we illustrate multiple ways in which contemporary societies are characterised by a reasonable pluralism concerning conceptions of health and values attached to eating practices. Second, we critically assess the implications of three main conceptions of the structure of public reason, i.e. ‘shareability’, ‘intelligibility’ and ‘accessibility’, for the public justifiability of healthy eating policies. We conclude that healthy eating policies are only consistent with public reason under the ‘accessibility’ conception, i.e. if they are based on reasons grounded in shared epistemic and moral evaluative standards, as long as such reasons reflect a reasonable balance of political values and do not overly prioritise or neglect any of these values.     

When Reminiscence is Harmful: The Relationship Between Self-Negative Reminiscence Functions,Need Satisfaction,and Depressive Symptoms Among Elderly People from Cameroon,the Czech Republic,and Germany

Reminiscence has various functions, not all of which are beneficial for well-being. In particular, self-negative reminiscence functions—boredom reduction, bitterness revival, and intimacy maintenance—have been shown to be associated with reduced well-being. The present paper examines the link between self-negative reminiscence functions and depression in three cultural contexts. We hypothesize that both variables are indirectly linked via satisfaction of basic psychological needs: Self-negative reminiscing is associated with an impairment of need satisfaction which in turn relates to enhanced depressive symptoms. This hypothesis is tested in elderlies from Cameroon, the Czech Republic, and Germany. A total of 637 elderly participants reported on self-negative reminiscing, need satisfaction, and depressive symptoms. Analyses indicate that for boredom reduction and bitterness revival an indirect effect on depression via decreased need satisfaction can be established in all cultural contexts. For intimacy maintenance, a different picture emerges in that in the Czech and the German sample, there was a direct effect on depression but not an indirect one via need satisfaction. Yet, among Cameroonian participants an indirect effect was found, demonstrating that intimacy maintenance was related to decreased depression via enhanced need satisfaction. These results suggest that reminiscence functions may have partly universal, partly culture-specific effects on well-being.