What if some patients are more "important" than others? A possible framework for Covid-19 and other emergency care situations.

BACKGROUND: The Covid-19 pandemic caused situations where, in some hospitals, there were more patients in need of urgent treatment in intensive care units (ICU) than were available. In particular, there were not sufficient ventilators or critical care resources for all patients in danger of dying from respiratory failure or other organ failures. DISCUSSION: As the "first come, first served" criterion was not considered adequate, more nuanced and fairer clinical criteria were proposed to assess whom to treat first. One type of patients that has not been considered in the literature so far is that of "important patients", individuals that many people might consider worthy of priority treatment for the contribution they made or might make to society as a whole. In this article, we discuss the moral insights behind the possible treatment of "important patients" and suggest a supererogatory solution of voluntary renunciation/withdrawal. Details of the proposal are explained, and potential objections are addressed.

Vampires 2.0? The ethical quandaries of young blood infusion in the quest for eternal life.

Can transfusions of blood plasma slow down ageing or even rejuvenate people? Recent preclinical studies and experimental tests inspired by the technique known as parabiosis have aroused great media attention, although for now there is no clear evidence of their effectiveness. This line of research and the interest it is triggering testify to the prominent role played by the idea of combating the "natural" ageing process in the scientific and social agenda. While seeking to increase the duration of healthy living time may be considered a duty, it also raises ethical questions about how to pursue this goal. Specifically, therapies and techniques accessible only to a fraction of the population seem destined to exponentially increase social inequality and to produce undesirable consequences. In this article we address the issue precisely in the light of the prospected use of plasma for the rejuvenation of a small elite of people.

Moral and social reasons to acknowledge the use of cognitive enhancers in competitive-selective contexts.

BACKGROUND: Although some of the most radical hypothesis related to the practical implementations of human enhancement have yet to become even close to reality, the use of cognitive enhancers is a very tangible phenomenon occurring with increasing popularity in university campuses as well as in other contexts. It is now well documented that the use of cognitive enhancers is not only increasingly common in Western countries, but also gradually accepted as a normal procedure by the media as well. In fact, its implementation is not unusual in various professional contexts and it has its peak in colleges (where the trend has been characterized as "academic doping"). Even when certain restrictions in the legislation of a country are indeed in place (i.e. through prescriptions requirements), they are without doubts easy to overcome. The legitimacy and appropriateness of such restrictions will not be the focus of our investigation. DISCUSSION: Our concern is instead related to the moral and social reasons to publicly acknowledge the use of cognitive enhancers in competitive-selective contexts. These reasons are linked to a more neutral analysis of contemporary Western society: it is a fact that an increasing number of competitive-selective contexts have a substantial number of contenders using cognitive enhancers. Through the use of five explicative examples, in this paper we want to analyse the problems related to its use. In particular, it will be our aim to show the tension between one of the main argument used by bio-liberals (the use of cognitive enhancers is an eligible procedure that society does not impose on anyone) and the actual implementation of the drugs in competitive, or semi-competitive contexts.

Performance enhancement in the workplace: why and when healthy individuals should disclose their reliance on pharmaceutical cognitive enhancers.

The use of pharmaceuticals cognitive enhancers (PCE) has been stirring growing interest, not only in the scientific domain but also in the popular media, and has probably had some increase recently in academic, professional and military quarters. So this phenomenon is deemed as a normal procedure aimed at improving the performance of an individual as well as the overall standards of an organization. Although the vast majority of countries have some kind of restrictions to reduce the wide non-medical usage of PCE, these can be overcome quite easily. In arguing for our explicit claim that, in many contexts, the use of cognitive enhancers should be disclosed-as a moral and socially relevant duty-we maintain that PCE present typical, or at least not rare, properties. The features are the following: (a) the enhancer has acute and/or chronic effects. In the first case, shortly after taking the drug the performance is significantly better than average; in the second case, there is a growing or lasting effect, which, however, is poised to diminish when one stops taking the drug; (b) those effects are significant (there is a difference in the outcome considered between taking and not taking the drug) and sometimes dramatic; and (c) a third feature, not directly related to enhancers as such, is their varying safety, availability, and legal permissibility, which might either induce people to take them or refrain them from doing so. We will consider the issue of fairness due to "unenhanced" people as well as the potentially dysfunctional social consequences of an undisclosed PCE use.

Family presence during cardiopulmonary resuscitation: who should decide?

Whether to allow the presence of family members during cardiopulmonary resuscitation (CPR) has been a highly contentious topic in recent years. Even though a great deal of evidence and professional guidelines support the option of family presence during resuscitation (FPDR), many healthcare professionals still oppose it. One of the main arguments espoused by the latter is that family members should not be allowed for the sake of the patient's best interests, whether it is to increase his chances of survival, respect his privacy or leave his family with a last positive impression of him. In this paper, we examine the issue of FPDR from the patient's point of view. Since the patient requires CPR, he is invariably unconscious and therefore incompetent. We discuss the Autonomy Principle and the Three-Tiered process for surrogate decision making, as well as the Beneficence Principle and show that these are limited in providing us with an adequate tool for decision making in this particular case. Rather, we rely on a novel principle (or, rather, a novel specification of an existing principle) and a novel integrated model for surrogate decision making. We show that this model is more satisfactory in taking the patient's true wishes under consideration and encourages a joint decision making process by all parties involved.

In defence of male circumcision.

Controversies over the acceptability of male circumcision (MC) are not new to the international bioethical community. I do not expect to add much to the arguments or evidence presented elsewhere, but I want to acknowledge the often-overlooked political element in which the debate is entrenched. In fairness to those sympathetic to the circumcision ban, I will first introduce some supportive arguments to their position. Next, I will show the limits of those critiques, affirming that MC should not be outlawed in any liberal country, but that its permissibility only be evaluated within its medico-ethical dimension without the political charge often associated with the issue.

The Singleton case: enforcing medical treatment to put a person to death.

In October 2003 the Supreme Court of the United States allowed Arkansas officials to force Charles Laverne Singleton, a schizophrenic prisoner convicted of murder, to take drugs that would render him sane enough to be executed. On January 6 2004 he was killed by lethal injection, raising many ethical questions. By reference to the Singleton case, this article will analyse in both moral and legal terms the controversial justifications of the enforced medical treatment of death-row inmates. Starting with a description of the Singleton case, I will highlight the prima facie reasons for which this case is problematic and merits attention. Next, I will consider the justification of punishment in Western society and, in that context, the evolution of the notion of insanity in the assessment of criminal responsibility during the past two centuries, both in the US and the UK. In doing so, I will take into account the moral justification used to enforce treatment, looking at the conflict between the prisoner's right to treatment and his right to refuse medication where not justified by outcomes that can be reasonably expected to be positive for the individual. Finally, in contrast with some retributivist arguments in favour of enforced treatment to enable execution, I will propose a possible alternative, necessary if we are to consistently uphold the notion of autonomy.

When autonomy kills: the case of Sami Mbarka Ben Garci.

Foucault suggested that foreigners and criminals are treated in a particularly unfavourable way by the law. We find arguable support for that proposition in the case of Sami Mbarka Ben Garci. He was a Tunisian Muslim prisoner, charged with rape, held in an Italian prison. He went on a hunger strike, protesting his innocence. He was not force-fed, and was allowed to die. Hunger strikers are commonly force fed. We ask why he was not, and although the reasons in his case are not clear, we suggest that many prisoners perceived as being 'undesirable' (in the sense of being foreigners, or facing particularly serious allegations) are allowed to die (the rhetoric being that their autonomy is being respected), while other prisoners' autonomy would be violated in order to ensure survival. We explore the European and some domestic jurisprudence surrounding force-feeding, and conclude that the law is applied in a worryingly inconsistent way.