INDUCTIVE RISK AND JUSTICE IN KIDNEY ALLOCATION

How should UNOS deal with the presence of scientific controversies on the risk factors for organ rejection when designing its allocation policies? The answer I defend in this paper is that the more undesirable the consequences of making a mistake in accepting a scientific hypothesis, the higher the degree of confirmation required for its acceptance. I argue that the application of this principle should lead to the rejection of the hypothesis that ‘less than perfect’ Human Leucocyte Antigen (HLA) matches are an important determinant of kidney graft survival. The scientific community has been divided all along on the significance of partial antigen matches. Yet reliance on partial matches has emerged as one of the primary factors leading blacks to spend a much longer time than whites on the waiting list for kidneys, thereby potentially impacting the justice of the kidney allocation policy. My case study illustrates one of the legitimate roles non‐epistemic values can play in science and calls into question the ideal of a value‐free science.     

Rawlsian Justice and Palliative Care

Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable to provide pain relief to those who need it as a supplement to treatment and, without justice‐based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive.     

JUSTIFIED COMMITMENTS? CONSIDERING RESOURCE ALLOCATION AND FAIRNESS IN MÉDECINS SANS FRONTIÈRES‐HOLLAND

Non-governmental aid programs are an important source of health care for many people in the developing world. Despite the central role non-governmental organizations (NGOs) play in the delivery of these vital services, for the most part they either lack formal systems of accountability to their recipients altogether, or have only very weak requirements in this regard. This is because most NGOs are both self-mandating and self-regulating. What is needed in terms of accountability is some means by which all the relevant stakeholders can have their interests represented and considered. An ideally accountable decision-making process for NGOs should identify acceptable justifications and rule out unacceptable ones. Thus, the point of this paper is to evaluate three prominent types of justification given for decisions taken at the Dutch headquarters of Médecins sans Frontières. They are: population health justifications, mandate-based justifications and advocacy-based justifications. The central question at issue is whether these justifications are sufficiently robust to answer the concerns and objections that various stakeholders may have. I am particularly concerned with the legitimacy these justifications have in the eyes of project beneficiaries. I argue that special responsibilities to certain communities can arise out of long-term engagement with them, but that this type of priority needs to be constrained such that it does not exclude other potential beneficiaries to an undesirable extent. Finally, I suggest several new institutional mechanisms that would enhance the overall equity of decisions and so would ultimately contribute to the legitimacy of the organization as a whole.     

The legitimacy of elite gatekeeping

Natasha Warikoo’s study of how students at Harvard, Brown, and Oxford Universities view race and fairness highlights the vast differences between the U.S. and Britain with respect to perceptions of meritocracy by these winners in the competition for places in elite institutions. The strict enforcement of uniform standards for admission is seen as critical and legitimate at Oxford, whereas a more holistic approach in the U.S. – one that sees racial diversity as an important and desirable part of the institution’s culture and identity – is seen as critical to a “diversity bargain”. I question the sources of students’ ideas about race and the diversity bargain, suggesting that they may be rooted more in their pre-college experiences than in their life at university. I also raise questions about whether and how an admissions lottery would work to address some of Warikoo’s concerns.     

Threshold considerations in fair allocation of health resources: justice beyond scarcity

Application of egalitarian and prioritarian accounts of health resource allocation in low-income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, given extreme scarcity of public health resources in low-income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low-income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines.     

Exploring the concept of genetic discrimination

The issue of genetic discrimination has attracted growing attention and has been the focus of a recent major Australian inquiry. It is, however, a complex and loaded notion, open to interpretation. This paper explores the concept of genetic discrimination in both its theoretical and practical dimensions. It examines its conceptual underpinnings, how it is understood, and how this understanding fits within the legal framework of disability discrimination. The paper also examines the phenomenon in practice, including the 'fear factor' and the resulting implications for the development of regulatory policy. The paper argues that we need to be discerning in our interpretation of this term, and differentiate between discriminatory conduct which is legal and illegal. Further, it is argued that a concerted societal response to the 'problem' of genetic discrimination is needed involving targeted legal reforms as well as broader non-legal strategies.     

Performance Evaluation of TCP over Optical Channels and Heterogeneous Networks

Next generation optical networks will soon provide users the capability to request and obtain end-to-end all optical 10 Gbps channels on demand. Individual users will use these channels to exchange large amounts of data and support applications for scientific collaborative work. These new applications, which expect steady transfer rates in the order of Gbps, will very likely use either TCP or a new transport layer protocol as the end-to-end communication protocol. In this paper, we investigate the performance of TCP and newer TCP versions over High Bandwidth Delay Product Channels (HBDPC), such as the on demand optical channels described above. In addition, we investigate the performance of these new TCP versions over wireless networks and according to old issues such as fairness. This is particularly important to make adoption decisions. Using simulations, we show that (1) the window-based mechanism of current TCP implementations is not suitable to achieve high link utilization and (2) congestion control mechanisms, such as the one utilized by TCP Vegas and Westwood are more appropriate and provide better performance. We also show that new TCP proposals, although perform better than current TCP versions, they still perform worse than TCP Vegas. In addition, we found that even though these newer versions improve TCP's performance over their original counterparts in HBDPC, they still have performance problems in wireless networks and present worse fairness problems than their old counterparts. We conclude that all these versions are still based on TCP's AIMD strategy or similar and therefore continue to be fairly blind in the way they increase and decrease their transmission rates. TCP will not be able to utilize the foreseen optical infrastructure adequately and support future applications if not redesigned to scale.     

B chromosomes reveal a female meiotic drive suppression system in Drosophila melanogaster

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