The argument from transfer

Utilitarian arguments on bioethical issues regarding human reproduction typically start with the view that it is wrong, other things being equal, not to procreate when this would have resulted in an additional being with a life worth living. The paper takes this view for granted and examines the common utilitarian claim that overpopulation and destitution in the world mean that, in practice, this obligation to procreate, other things being equal, often turn into a (categorical) obligation not to procreate. A version of this argument is defended— a version called the argument from transfer — according to which, rather than having additional children and care for them in order to make them happy, many people in the West ought to abstain from procreation and take care of destitute children already existing. The reasoning leading up to this conclusion raises some philosophical questions, seldom discussed in connection with bioethics, which indicate that the argument from transfer, although supporting the claim above, cannot neutralise the obligation to create mare happy people as easib as assumed by utilitarians. It is argued that the argument from transfer may place many people facing the choice of procreation in a peculiar moral dilemma.     

The Imagined Child: Ambiguity and Agency in Australian Intercountry Adoption

The adoption by Australian couples of children from ‘overseas’ involves claborate processes of bureaucratic assessment, approval and ‘parent education’. This paper explores adults' notions of ‘child’(ren) from ‘overseas’, which help shape and constitute such social processes, not only with couples seeking to adopt, but also with those cultural brokers who assess, regulate and ‘educate’ couples pursuing adoption, such as social workers and psychologists. The ways in which the adoptive ‘child’ is imagined and anticipated by counsellors and would‐be parents alike are explored through ethnographic data from South Australia. However, the proclivities of prospective adoptive parents to imagine their child‐to‐be are attenuated by certain social knowledge in relation to countries of origin. This leads to an exploration of ambiguities and tensions between the intercountry adoptive child as a tabula rasa and as a culturally and historically constituted person. The significance of ambiguities and contradictions for the child's agency and identities is highlighted, within the context of certain social policies around adoption. The chronological age of the child at the time of ‘allocation’ to its adoptive parents is considered as constituting a cultural fulcrum, upon which the identity and situational significance of the ‘origins’ of the child are deemed to subsequently turn.     

The claim from adoption

In this article several justifications of what I call 'the claim from adoption' are examined. The claim from adoption is that, instead of expending resources on bringing new children into the world using reproductive technology and then caring for these children, we ought to devote these resources to the adoption and care of existing destitute children.
Arguments trading on the idea that resources should be directed to adoption instead of assisted reproduction because already existing people can benefit from such a use of resources whereas we cannot benefit individuals by bringing them into existence are rejected. It is then argued that a utilitarian argument proposed by Christian Munthe that supports the claim from adoption in some situations should be rejected because the support it offers does not extend to certain situations in which it seems morally obvious that resources should be expended on adoption rather than assisted reproduction. A version of the Priority View improves upon Munthe's utilitarianism by supporting the claim from adoption in the cases in which Munthe's argument failed. Some allegedly counterintuitive implications of the Priority View are then discussed, and it is concluded that the Priority View is more plausible than utilitarianism.
n a concluding section on policy issues it is argued that, even though the claim from adoption can be justified in a variety of situations, it does not follow that, in these situations, governments should direct resources away from assisted reproduction and towards adoption.     

A QUESTION OF JUSTICE: ASSESSING NURSE MIGRATION FROM A PHILOSOPHICAL PERSPECTIVE

The intensified nurse migration leads to severe problems for the health care systems in many developing countries. Using the Philippines as an example, this paper will address the question of global nurse migration from a philosophical perspective. John Rawls' liberal and Michael Walzer's communitarian theory of justice will be examined in view of the ethical problem of nurse migration. In line with Rawls' A Theory of Justice, nurse migration undermines the ability of the people in developing countries to make use of their basic rights and liberties. Walzer's communitarian assessment of nurse migration, on the other hand, will stress the shared ‘thin’ morality, as well as the shared history between the ‘donating’ and receiving countries. This paper argues that the commonality of a shared history and common values implies the moral obligation to ensure a fairer distribution of nurses.     

ARE PATIENTS’ DECISIONS TO REFUSE TREATMENT BINDING ON HEALTH CARE PROFESSIONALS?

When patients refuse to receive medical treatment, the consequences of honouring their decisions can be tragic. This is no less true of patients who autonomously decide to refuse treatment. I distinguish three possible implications of these autonomous decisions. According to the Permissibility Claim, such a decision implies that it is permissible for the patient who has made the autonomous decision to forego medical treatment. According to the Anti-Paternalism Claim, it follows that health-care professionals are not morally permitted to treat that patient. According to the Binding Claim it follows that these decisions are binding on health-care professionals. My focus is the last claim. After arguing that it is importantly different from each of the first two claims, I give two arguments to show that it is false. One argument against the Binding Claim draws a comparison with cases in which patients autonomously choose perilous positive treatments. The other argument appeals to considered judgments about cases in which disincentives are used to deter patients from refusing sound treatments.     

Antibiotic resistance as a tragedy of the commons: An ethical argument for a tax on antibiotic use in humans

To the extent that antibiotic resistance (ABR) is accelerated by antibiotic consumption and that it represents a serious public health emergency, it is imperative to drastically reduce antibiotic consumption, particularly in high‐income countries. I present the problem of ABR as an instance of the collective action problem known as ‘tragedy of the commons’. I propose that there is a strong ethical justification for taxing certain uses of antibiotics, namely when antibiotics are required to treat minor and self‐limiting infections, such as respiratory tract infections, in otherwise healthy individuals. Taxation would allow a reduction in consumption (given certain behavioural economics assumptions) and/or ensure that individuals internalize or compensate for their contribution to the erosion of the common good of antibiotic effectiveness. I suggest that revenue from the tax could be used to fund conservation and innovation strategies. Taxation might be a coercive policy, especially for certain individuals, but the ethical case for coercive policies is very strong when the good to be preserved is important enough and when they force individuals to do something they have a moral obligation to do anyway. I argue that, in the case of mild and self‐limiting infections, individuals have a moral duty of easy rescue and a moral duty of fairness to make their contribution to the preservation of the common good of antibiotic effectiveness by foregoing antibiotics. I also suggest that taxing antibiotics in such cases is an all things considered ethically justified policy even if it would introduce inequalities in access to healthcare.     

First generation decline: downward mobility among refugees and immigrants

Although immigration researchers, like other social scientists who study mobility, usually look only at upward mobility, immigrants and refugees often suffer from downward mobility. This is particularly true of new arrivals who were professionals in their country of origin and now work as technicians, although newcomers of lower status may experience it as well. For some immigrants and refugees, downward mobility is temporary; others may suffer from it all their lives and even pass the pain on to their children.

This paper discusses the various impacts of downward mobility, the ways immigrants and refugees cope with them successfully or not, and the consequences of their class and status decline for their children. The paper can be read as a follow up to my earlier articles in Ethnic and Racial Studies, ‘Second Generation Decline’, (1992) and ‘Acculturation, Assimilation and Mobility’ (2007).     

The ethics of efficacy in North India's goonda raj (rule of toughs)

This study of goondas (gangsters or toughs) in North Indian politics comes by way of a comment on intellectual method in the anthropology of moralities. More especially, it offers critical remarks on the recent adoption of ‘virtue’ as the cardinal moral co‐ordinate of human life. Drawing on field research conducted across northern India, we show that when people celebrate goondas as leaders, they do so not because they see in them virtuous men, but because they think them capable of ‘getting things done’. This ethics of efficacy is neither merely instrumental nor is it but another variant of virtue ethics. It presents, instead, an altogether different moral teleology orientated towards effective action rather than excellent character. While challenging the self‐centred bent of the late anthropology of ethics, we also make preliminary remarks on the contrast between ‘moral’ and ‘practical’ judgement, and the limits of ‘the moral’ as such.     

Propensity of white women in the United States to adopt children

Demographically, adoption is a relatively rare event. In 1982, only 2.3 per cent (or about 650,000) of ever-married white women aged 15 to 44 had adopted one or more children. Adoption is an important and very relevant means of family formation for many women, particularly those for whom biological childbearing is difficult or impossible. Although there is a modest literature on adoption behavior, we have very little information about women who have shown a propensity to adopt children. How should the phenomenon of adoption propensity be conceptualized? How many women are there in the United States with such a propensity? How different is this number from the number of women who eventually adopt children? What are the characteristics of women with a propensity to adopt? The objectives of this paper are (1) to estimate the numbers of U.S. women at three different points in time (1973, 1976, and 1982) who have a propensity to adopt, according to various socioeconomic and demographic characteristics; and (2) to compare via log-linear analysis the major characteristics of these women with women who have not shown such a propensity.     

Nocturnal Activity of Caged Resident and Migrant Silvereyes (Zosteropidae: Aves)

Night-activity patterns of individually-caged grey-breasted silvereyes Zosterops lateralis of resident and migrant status were investigated. True migratory restlessness or ‘Zugunruhe’ was exhibited by some individuals, but there was also considerable ‘noise’ in the data caused by cageing and neighbouring disturbance. In general, ‘Zugunruhe’ took place from about 2 h before, to about 4 h after ‘sunrise’, and both the daily timing and annual duration of Zugunruhe were consistent with the migration pattern observed in the field. A total of 42 % of resident birds from Tasmania, 77 % of migrant birds from Tasmania and 90 % of migrant birds from the mainland were considered to have exhibited true ‘Zugunruhe’, while none of the resident birds from Brisbane were considered to have displayed it. A few individuals spontaneously developed ‘Zugunruhe’ in the absence of other birds, but many birds (both residents and migrants) displayed no elevated night unrest when placed in a room on their own, although displaying unrest when placed among birds exhibiting ‘Zugunruhe’. The migration of the silvereye probably has a genetic basis, but whether an individual migrates or not is also influenced by social factors which differ in magnitude between individuals.     

Serologic prevalence of antibodies to Helicobacter pylori in internationally adopted children

Background. Helicobacter pylori (H. pylori) infection has been linked to gastritis, diarrhea, peptic ulcers, failure‐to‐thrive, anemia, as well as predisposition to gastric malignancies. Because many internationally adopted children have diarrhea, failure‐to‐thrive, and anemia on arrival to the US, we determined the prevalence of HP antibodies among these children. Methods. Serum samples from 226 unselected children from 18 countries who were evaluated in the International Adoption Clinic at New England Medical Center were tested for antibodies to H. pylori. The results of serologic screening were analyzed in relation to age at adoption, site of residence prior to adoption, weight and height, and the presence or absence of anemia, diarrhea, or intestinal parasites. Results. 31% of internationally adopted children had antibodies to H. pylori. The presence of H. pylori‐antibodies was associated with residence in an orphanage (vs. foster care) prior to adoption, older age at adoption, and coinfection with intestinal parasites. No direct effects on height or weight were identified; no associations with diarrhea or anemia were found. Conclusions. Internationally adopted children have a high incidence of exposure to H. pylori, as diagnosed serologically. Residence in an orphanage (compared with foster care), older age at adoption, and coinfection with intestinal parasites were more common among children seropositive for anti‐H. pylori antibodies.     

PALLIATIVE CARE, PUBLIC HEALTH AND JUSTICE: SETTING PRIORITIES IN RESOURCE POOR COUNTRIES

Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care , we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries.     

Accelerating introduction of new vaccines: barriers to introduction and lessons learned from the recent Haemophilus influenzae type B vaccine experience

Adoption of new vaccines in developing countries is critical to reducing child mortality and meeting Millennium Development Goal 4. However, such introduction has historically suffered from significant delays that can be attributed to various factors including (i) lack of recognition of the value of a vaccine, (ii) factors related to weak health systems, and (iii) policy considerations. Recently, the Global Alliance for Vaccines and Immunization (GAVI) supported efforts to accelerate the introduction of Haemophilus influenzae type b (Hib) vaccines in developing countries, which resulted in a significant surge in vaccine adoption by these countries. The experience with Hib vaccines, as well as similar efforts by GAVI to support the introduction of new pneumococcal and rotavirus vaccines, provides a strategy for new vaccine adoption that is reviewed in this paper, providing a useful model to help accelerate the uptake of other life-saving vaccines. This strategy addresses barriers for vaccine adoption by focusing on three major areas: (i) communications to increase awareness about the various factors needed for evidence-based decisions that meet a country's health goals; (ii) research activities to answer key questions that support vaccine introduction and long-term programme sustainability; and (iii) coordination with the various stakeholders at global, regional and country levels to ensure successful programme implementation.     

Crop Management for Soil Carbon Sequestration

Reducing emissions of greenhouse gases (GHG) from agriculture is related to increasing and protecting soil organic matter (SOM) concentration. Agricultural soils can be a significant sink for atmospheric carbon (C) through increase of the SOM concentration. The natural ecosystems such as forests or prairies, where C gains are in equilibrium with losses, lose a large fraction of the antecedent C pool upon conversion to agricultural ecosystems. Adoption of recommended management practices (RMPs) can enhance the soil organic carbon (SOC) pool to fill the large C sink capacity on the world's agricultural soils. This article collates, reviews, and synthesizes the available information on SOC sequestration by RMPs, with specific references to crop rotations and tillage practices, cover crops, ley farming and agroforestry, use of manure and biosolids, N fertilization, and precision farming and irrigation. There is a strong interaction among RMPs with regards to their effect on SOC concentration and soil quality. The new equilibrium SOC level may be achieved over 25 to 50 years. While RMPs are being adapted in developed economies, there is an urgent need to encourage their adoption in developing countries. In addition to enhancing SOC concentration, adoption of RMPs also increases agronomic yield. Thus, key to enhancing soil quality and achieving food security lies in managing agricultural ecosystems using ecological principles which lead to enhancement of SOC pool and sustainable management of soil and water resources.     

Adoption and Kinship in Oceania

The frequency and form of adoption practices in Oceania recently have been cited as evidence that human behavior is inconsistent with predictions derived from sociobiological theory (Sahlins 1976). Ethnographic data reviewed here, however, suggest otherwise. In Oceania kinship is an important factor in the selection and treatment of adopted children as adoption occurs almost exclusively among close relatives. Natal children often ally against their adopted siblings over the division of their common parents' estate while adoptive parents themselves frequently apportion their land unequally among their natal and adopted children. These patterns and other data are consistent with predictions generated by a socio biological model of adoptive decisions. The model illustrates how kinship facilitates adoption as a means of modifying extreme family sizes, and how asymmetries in the degrees of relatedness between parents and their adopted and natal children provide the basis of differential treatment of them. Adoption in Oceania provides an example of a clearly cultural behavior which is consistent with socio biological predictions, and suggests that both culture and biology are relevant to an understanding of human behavior . [sociobiology, kinship, adoption, Oceania]     

Magic,semantics, and Putnam’s vat brains

In this paper we offer an exegesis of Hilary Putnam’s classic argument against the brain-in-a-vat hypothesis offered in his Reason, truth and history (1981). In it, Putnam argues that we cannot be brains in a vat because the semantics of the situation make it incoherent for anyone to wonder whether they are a brain in a vat. Putnam’s argument is that in order for ‘I am a brain in a vat’ to be true, the person uttering it would have to be able to refer successfully to those things: the vat, and the envatted brain. Putnam thinks that reference can’t be secured without relevant kinds of causal relations, which, if envatted, the brain would lack, and so, it fails to be able to meaningfully utter ‘I am a brain in a vat’. We consider the implications of Putnam’s arguments for Cartesian scepticism and suggest that there may yet be some ways out of Putnam’s arguments for the traditional sceptic. In conclusion, we discuss the role of Putnam’s arguments against the brain in a vat hypothesis in his larger defense of his own internal realism against metaphysical realism.     

The ethics of biobanking: Assessing the right to control problem for broad consent

The biobank consent debate is one with deeply held convictions on both the ‘broad’ and ‘specific’ side with little sign of resolution. Recently, Thomas Ploug and Soren Holm have developed an alternative to both specific and broad consent: a meta‐consent framework. The aim here is to consider whether meta‐consent provides a ‘solution’ to the biobank consent debate. We clarify what ‘meta‐consent’ actually is (arguing that the label is a misnomer and ‘consent à la carte’ is more accurate). We identify problems with Ploug and Holm's arguments, and some challenges for meta‐consent. We focus on whether there is any ethical obligation to provide consent à la carte. There may seem to be so, especially if we draw upon an unclear appeal to the ethical significance of ‘respect for autonomy’. Similarly, there might seem to be an intuitive inference from the fact that ethically legitimate research requires informed consent to the conclusion that it thereby requires consent à la carte. It is shown that this line of inference is mistaken.     

Sharing the Knowledge: Sharing Aggregate Genomic Findings with Research Participants in Developing Countries

Returning research results to participants is recognised as an obligation that researchers should always try to fulfil. But can we ascribe the same obligation to researchers who conduct genomics research producing only aggregated findings? And what about genomics research conducted in developing countries? This paper considers Beskow's et al. argument that aggregated findings should also be returned to research participants. This recommendation is examined in the context of genomics research conducted in developing countries. The risks and benefits of attempting such an exercise are identified, and suggestions on ways to avoid some of the challenges are proposed. I argue that disseminating the findings of genomic research to participating communities should be seen as sharing knowledge rather than returning results. Calling the dissemination of aggregate, population level information returning results can be confusing and misleading as participants might expect to receive individual level information. Talking about sharing knowledge is a more appropriate way of expressing and communicating the outcome of population genomic research. Considering the knowledge produced by genomics research a worthwhile output that should be shared with the participants and approaching the exercise as a ‘sharing of knowledge’, could help mitigate the risks of unrealistic expectations and misunderstanding of findings, whilst promoting trusting and long lasting relationships with the participating communities.     

GENETIC ENGINEERING TO AVOID GENETIC NEGLECT: FROM CHANCE TO RESPONSIBILITY

Currently our assessment of whether someone is a good parent depends on the environmental inputs (or lack of such inputs) they give their children. But new genetic intervention technologies, to which we may soon have access, mean that how good a parent is will depend also on the genetic inputs they give their children. Each new piece of available technology threatens to open up another way that we can neglect our children. Our obligations to our children and our susceptibilities to corresponding legal and moral sanctions may be about to explosively increase. In this paper I argue that we should treat conventional neglect and ‘genetic neglect’– failing to use genetic intervention technologies to prevent serious diseases and disabilities – morally consistently. I conclude that in a range of cases parents will have a moral obligation to use genetic treatments to prevent serious disabilities in their children. My particular focus is on prenatal interventions and their impact of the bodily integrity of expectant mothers. I conclude that although bodily integrity constrains moral obligations, it is outweighed in a range of cases.     

Exploring scale-up,spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care

Background

Adoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts. An instrumental case study will track the adoption and adaptation, or not, of a locally developed innovation about dysphagia as a patient safety issue. The case study will examine a conceptual framework with a continuum of spread comprising hierarchical control or ‘making it happen’, participatory adaptation or ‘help it happen’, and facilitated evolution or ‘let it happen’.

Methods

This case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored.

Discussion

Researching spread and sustainability presents methodological and practical challenges. These include fidelity, adaptation latitude, time, and organisational changes. An instrumental case study will allow these confounding factors to be tracked over time and in place. The case study is underpinned by, and will test a conceptual framework about spread, to explore theoretical generalizability.