Legal briefing: Crisis standards of care and legal protections during disasters and emergencies

This article outlines current safe harbors in the law for healthcare practitioners who work in a disaster setting. It reviews available legal protection in crisis situations with respect to the Emergency Medical Treatment and Labor Act (EMTALA), criminal liability, and licensure.     

A Mixed Methods Approach to Vulnerability and Quality of Life Assessment of Waste Picking in Urban Nigeria

Quality of life (QoL) studies have become acceptable globally as indicators of how well a people are living. They are increasingly being used to identify and design areas of intervention to raise the wellbeing of a population. While studies on livelihoods in the informal waste recycling system of developing country cities have also been on the increase in recent years, assessments of the QoL expectations within the livelihoods framework in the informal waste recycling sector seem surprisingly few. Studies of this nature have also not been undertaken in the context of Nigerian socio-political, cultural and economic environment. Applying qual-dominant mixed methods approach to the livelihood activity of waste picking in the commercial city of Aba in southeastern Nigeria, this paper identifies predominant social indicators relevant to the Aba scavengers, waste pickers?? perceptions and QoL expectations, and potential outcomes of meeting the QoL expectations of waste pickers in the area. It also categorizes pickers?? vulnerabilities into four levels of increasing magnitude. Given that African social dynamics do not always or often find expression, fully or partially, in figures, the paper stresses the need to apply ethnographic and qualitative research methods in assessment of QoL and wellbeing in the informal waste recycling system. It further argues that integrating QoL assessments into public decision-making and social policy in Nigeria will contribute significantly towards meeting some of the Millennium Development Goals (MDGs) while also engendering sustainable urban livelihood outcomes.     

Legal briefing: The unbefriended: making healthcare decisions for patients without surrogates (Part 1)

This issue's "Legal Briefing" column covers recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the "single greatest category of problems" encountered in bioethics consultation. Moreover, the scope of the problem continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia. Unfortunately, most U.S. jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. "Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform". Most providers are "muddling through on an ad hoc basis". Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two define the problem of medical decision making for the unbefriended. The remaining 12 categories describe different solutions to the problem. The first six of these solutions are discussed in this article (Part 1). The last eight solutions will be covered in the Summer 2012 issue of JCE (Part 2). 1. Who are the unbefriended? 2. Risks and problems of the unbefriended. 3. Prevention: advance care planning, diligent searching, and careful capacity assessment. 4. Decision-making mechanisms and standards. 5. Emergency exception to informed consent. 6. Expanded default surrogate lists: close friends. 7. Private guardians. 8. Volunteer guardians. 9. Public guardians. 10. Temporary and emergency guardians. 11. Attending physicians. 12. Other clinicians, individuals, and entities. 13. Institutional committees. 14. External committees.     

Assessment of Socio-Economic Characteristics and Quality of Life Expectations of Rural Communities in Enugu State,Nigeria

This study examined the social, infrastructural and economic conditions prevalent in some rural communities of Enugu State, Nigeria, where recent oil and gas prospecting activities have generated concerns for the environment and quality of rural life. Mixed but complimentary methods of data collection employed include consultations with key stakeholders, focus group discussions, questionnaire survey, field observations, key-informant interviews and secondary sources. Existing socio-economic and infrastructural conditions, citizens’ perceptions of oil and gas activities, and quality of life (QoL) expectations of study communities were documented. Six major units of analysis (or levels of aggregations) with the aid of qualitative and quantitative methodologies were used to describe both empirical and /or secondary data. The study revealed large population sizes and even higher population densities, with the economic base in the study area being agriculture. Findings of the study indicate that despite some negative socio-environmental perceptions, citizens’ receptiveness and attitude towards the projects were patently positive. QoL expectations of the communities were embedded in environmentally responsible, culturally sensitive and socially responsive operation of oil companies. Agents and institutions of social control and well- being were also appraised to highlight their QoL contributions in the area.     

‘The snake and the seraph’ – sexual addiction and religious behaviour

The purpose of this article is to explore the relationship between sexual misconduct and religious vocation. Drawing on clinical and ministerial experience the article suggests that most sexual misconduct among religious officials is a combination of sexual addiction and religious behaviour acting as interconnected responses to narcissistic damage. It goes on to outline a reciprocal inter-locking cyclical pattern of behaviour and suggests a treatment strategy that prioritizes four tasks: psycho-education, group work, family of origin exploration, and facilitating access to the components of a good quality of life.     

Mental rotation of possible and impossible four-cornered toruses

Possible and impossible four-cornered toruses were used as stimuli in a mental rotation paradigm. Rotation rates varied with number of “net changes in depth,” a variable that closely corresponds with ratings of impossibility, rather than with formal distinctions between the possible and the impossible. Rotation rates were also affected by perimeter shapes but not in accord with perimeter complexity as defined by number of vertices. Experiment 2 attempted to separate net changes in depth from figure symmetry and found symmetry to be the more reliable predictor of rotation rates, suggesting that symmetry may underlie the influence of net changes of depth.     

Some variation of the twisted cord illusion and their analyses

Two approaches to the analysis of the twisted cord illusion are discussed. One suggests that the illusion is produced by embedded illusions (e.g., Zollner’s illusion); the other points to nonillusion features such as the lines of the cord strands. A number of novel variations of the illusion are presented, and four experiments using these variations are described in an attempt to discern which of the two approaches was more viable. The implications of these remits for various theories, including a multicomponent theory, are discussed.     

An African Theory of Moral Status: A Relational Alternative to Individualism and Holism

The dominant conceptions of moral status in the English-speaking literature are either holist or individualist, neither of which accounts well for widespread judgments that: animals and humans both have moral status that is of the same kind but different in degree; even a severely mentally incapacitated human being has a greater moral status than an animal with identical internal properties; and a newborn infant has a greater moral status than a mid-to-late stage foetus. Holists accord no moral status to any of these beings, assigning it only to groups to which they belong, while individualists such as welfarists grant an equal moral status to humans and many animals, and Kantians accord no moral status either to animals or severely mentally incapacitated humans. I argue that an underexplored, modal-relational perspective does a better job of accounting for degrees of moral status. According to modal-relationalism, something has moral status insofar as it capable of having a certain causal or intensional connection with another being. I articulate a novel instance of modal-relationalism grounded in salient sub-Saharan moral views, roughly according to which the greater a being's capacity to be part of a communal relationship with us, the greater its moral status. I then demonstrate that this new, African-based theory entails and plausibly explains the above judgments, among others, in a unified way.     

Higher Education,Knowledge for Its Own Sake,and an African Moral Theory

I seek to answer the question of whether publicly funded higher education ought to aim intrinsically to promote certain kinds of “blue-sky” knowledge, knowledge that is unlikely to result in “tangible” or “concrete” social benefits such as health, wealth and liberty. I approach this question in light of an African moral theory, which contrasts with dominant Western philosophies and has not yet been applied to pedagogical issues. According to this communitarian theory, grounded on salient sub-Saharan beliefs and practices, actions are right insofar as they respect relationships in which people both share a way of life, or identify with one another, and care for others’ quality of life, or are in solidarity with each other. I argue that while considerations of identity and solidarity each provide some reason for a state university to pursue blue-sky knowledge as a final end, they do not provide conclusive reason for it to do so. I abstain from drawing any further conclusion about whether this provides reason to reject the Afro-communitarian moral theory or the intuition that blue-sky knowledge is a proper final end of public higher education. I do point out, however, that the dominant Western moral theories on the face of it do no better than the African one at accounting for this intuition.     

Legal briefing: organ donation and allocation

This issue's "Legal Briefing" column covers legal developments pertaining to organ donation and allocation. This topic has been the subject of recent articles in JCE. Organ donation and allocation have also recently been the subjects of significant public policy attention. In the past several months, legislatures and regulatory agencies across the United States and across the world have changed, or considered changing, the methods for procuring and distributing human organs for transplantation. Currently, in the U.S., more than 100,000 persons are waiting for organ transplantation. In China, more than 1.5 million people are waiting. Given the chronic shortage of available organs (especially kidneys and livers) relative to demand, the primary focus of most legal developments has been on increasing the rate of donation. These and related developments are usefully divided into the following 12 topical categories: 1. Revised Uniform Anatomical Gift Act. 2. Presumed Consent and Opt-Out. 3. Mandated Choice. 4. Donation after Cardiac Death. 5. Payment and Compensation. 6. Donation by Prisoners. 7. Donor Registries. 8. Public Education. 9. Other Procurement Initiatives. 10. Lawsuits and Liability. 11. Trafficking and Tourism. 12. Allocation and Distribution.