Ethics in Health Policy for Allergy : A Practical Approach for Decision-Makers

Comme à l’approche d’un tsunami, l’incidence grandissante des allergies affecte maintenant plus de 30% de la population des pays développés. Étant la cause de nombreuses morbidités et un risque significatif de mortalité, les allergies nécessitent des dépenses exorbitantes au système de santé et constituent une des plus importantes sources d’invalidité. Cette thèse a pour but de contribuer à faciliter la prise de décision éclairée dans le développement de politiques en santé en lien avec cette maladie immunitaire chronique en utilisant des principes d’éthique comme outils pour guider le développement de politiques en santé. Le premier chapitre démontre le présent déficit d’analyses des enjeux éthiques en allergologie et démontre de quelle façon les réflexions en éthique peuvent guider le développement de politiques et l’élaboration de stratégies appliquées aux allergies. Les chapitres qui suivront présentent des applications spécifiques des principes d’éthiques ciblant des contextes précis comme des méthodes qui fournissent des outils de réflexion et des cadres théoriques qui peuvent être appliqués par les décideurs pour guider des interventions en santé concernant les allergies et les conditions de co-morbidité reliées. Le second chapitre présente un cadre théorique pour l’évaluation et la priorisation d’interventions en santé publique par la diminution des allergènes présents dans l’environnement basées sur des théories de justice sociale. Les critères entourant les politiques d’évaluation se concentrent sur les enjeux éthiques référant aux populations vulnérables, sur une distribution plus égale des bénéfices pour la santé, et sur le devoir d’éviter la stigmatisation. Le troisième chapitre offre aux administrateurs et au personnel infirmier du réseau scolaire un cadre décisionnel pour guider le développement de politiques efficaces et éthiquement justifiables concernant les allergies alimentaires pour les écoles. Dans ce contexte, les principes de base d’éthique en santé publique et en bioéthique - par exemple, l’empowerment des populations vulnérables dans la prise en charge de leur santé et la protection de la confidentialité du dossier médical - servent d’outils pour évaluer les politiques. Le dernier chapitre emploie les principes de base de recherche en éthique comme méthode pour développer un argumentaire en faveur de la réforme des réglementations entourant la production de médicaments immunothérapeutiques. La nécessité éthique d’éviter les risques de méfait à l’endroit du sujet humain dans la recherche permettra de servir de guide pour structurer de futures politiques en santé publique en égard à la production d’immunothérapeutiques à l’échelle mondiale.

Bioethics in Health Policy Development: A Primer for Decision-Makers

Article

Which Legal Standards Should Apply To Web-logs? The present legal position of Internet journals in the European iuris prudence in the light of the European Parliament Committee’s on Culture and Education report and Polish Supreme Court decision

The article discusses the present status of weblogs and examines whether legal standards applicable to traditional press and media should be applied to that specific forum. The analysis is based on two key documents: the Draft Report on the concentration and pluralism in the media in European Union (2007/2253(INI)) of the European Parliament Committee on Culture and Education presented in March 2008 and a landmark decision of the Polish Supreme Court from July 26, 2007 (IV KK 174/07) in the light of present judicial tendency in other European countries. The first of the mentioned documents calls for the “clarification of the legal status of different categories of weblog authors and publishers as well as disclosure of interests and voluntary labelling of weblogs”. It emphasizes that the “undetermined and unindicated status of authors and publishers of weblogs causes uncertainties regarding impartiality, reliability, source protection, applicability of ethical codes and the assignment of liability in the event of lawsuits”. The position of the European Parliament, expressed in the document, raises serious questions on the limits of freedom of thought and speech on the Internet and on the degree of acceptable state control. A recent Polish Supreme Court decision, which caused quite a stir in the Polish Internet community, seems to head in the very direction recommended by the EP Culture Committee. In a case of two editors of a web journal (“czasopismo internetowe”) called “Szyciepoprzemysku”, available on-line, accused of publishing a journal without the proper registration, the Polish Supreme Court stated that “journals and periodicals do not lose the character of a press release due solely to the fact that they appear in the form of an  Internet transmission”, and that ‘’the publishing of press in an electronic form, available on the Internet, requires  registration”. The decision was most surprising, as prior lower courts decisions declined the possibility to register Internet periodicals. The accused were acquitted in the name of the constitutional principle of the rule of law (art. 7 of the Polish Constitution) and the ensuing obligation to protect the trust of a citizen to the state (a conviction in this case would break the collateral estoppel rule), however the decision quickly awoke media frenzy and raised the fear of a need to register all websites that were regularly updated. The spokesman of the Polish Supreme Court later explained that the sentence of the Court was not intended to cause a mass registration of all Internet “periodicals” and that neither weblogs nor Internet sites, that were regularly updated, needed registration. Such an interpretation of the Polish press law did not appear clear based only on the original text of the judgment and the decision as such still raises serious practical questions. The article aims to examine the status of Internet logs as press and seeks the compromise between the concerns expressed by European authorities and the freedom of thought and speech exercised on the Internet.

Equality of Opportunity in Public Employment : Judicial Perspectives on Backwardness

This thesis is a study of -Equality of Opportunity in Public Employment : Judicial Perspectives on Backwardness. This study is an attempt to evaluate the concept of backwardness and equality of opportunity in employment and to assess the judicial perspectives in relation to them. The study reveals that the recent review petition of the Constitution Bench did not assess the decision of Chakradhar and its import. The study reveals that the Indian judiciary could successfully locate and apply the above principles. It was-Justice Subba Rao's nascent attempt in Devadasan which marked the starting point of such a jurisprudential enquiry. Later Thomas developed the thoughts by a reading new meaning and content to equality provisions of the Constitution which included the elimination of inequalities as the positive content of Articles 14 and 16(1) and elevated reservation provision to the same status of equality principles under the Constitution. Soshit, Vasanth Kumar and Mandal supplemented further to the jurisprudential contents. In this process, the courts were guided by the theories of John Rawls, David Miller, Ronald Dworkin, Max Weber and Roscoe Pound. Thus there was a slow and steady process of transformation of the reservation provision. From an anti-meritarian, unenforceable and enabling provision, it reached a stage of equally relevant and explanatory part of fundamental right to equality. Mandal viewed it as a part of sharing of State power. Though this can be seen by rereading and re-joining thoughts of judges in this regard, the judicial approach lacks coherence and concerted efforts in evolving a jurisprudential basis for protective discrimination. The deliberations of the framers of the Constitution reveals that there was much confusion and indeterminacy with regard to the concept of Backwardness. The study shows that the judiciary has been keeping intact the framers’ expectation of having a reasonable quantum of reservation, preventing the undeserved sections from enjoying the benefit, avoiding its abuse and evolving a new criteria and rejecting the old ones.

Management of Public Road Transport System in Trivandrum City

An efficient passenger road transport system is a boon to any city and an inefficient one its bane. Passenger bus transport operation involves various aspects like passenger convenience, profitability of operation and social, technological and environmental factors. The author’s interest in this area was aroused when he conducted a traffic survey of Trivandrum City in 1979. While some studies on the performance of the Kerala State Road Transport Corporation in specific areas like finance, inventory control etc. have already been made, no study has been made from the operational point of view. The study is also the first one of its kind in dealing with the transportation problems for a second order city like Trivandrum. The objective of this research study is to develop a scientific basis for analysing and understanding the various operational aspects of urban bus transport management like assessing travel demand, depot location, fleet allocation, vehicle scheduling, maintenance etc. The operation of public road transportation in Trivandrum City is analysed on the basis of this theoretical background. The studies made have relevance to any medium sized city in India or even abroad. If not properly managed, deterioration of any public utility system is a natural process and it adversely affects the consumers, the economy and the nation. Making any system more efficient requires careful analysis, judicious decision making and proper implementation. It is hoped that this study will throw some light into the various operational aspects of urban passenger road transport management which can be of some help to make it perform more efficiently

Does uncertainty cause inertia in decision making? An experimental study of the role of regret aversion and indecisiveness

Previous research has shown that often there is clear inertia in individual decision making---that is, a tendency for decision makers to choose a status quo option. I conduct a laboratory experiment to investigate two potential determinants of inertia in uncertain environments: (i) regret aversion and (ii) ambiguity-driven indecisiveness. I use a between-subjects design with varying conditions to identify the effects of these two mechanisms on choice behavior. In each condition, participants choose between two simple real gambles, one of which is the status quo option. I find that inertia is quite large and that both mechanisms are equally important.

An analysis of the management of a public sector project: a systems-based case study

The management of a public sector project is analysed using a model developed from systems theory. Linear responsibility analysis is used to identify the primary and key decision structure of the project and to generate quantitative data regarding differentiation and integration of the operating system, the managing system and the client/project team. The environmental context of the project is identified. Conclusions are drawn regarding the project organization structure's ability to cope with the prevailing environmental conditions. It is found that the complexity of the managing system imposed on the project was unable to achieve this and created serious deficiencies in the outcome of the project.

A design of e-procurement infrastructure model for public service sector

Procurement is one of major business operations in public service sector. The advance of information and communication technology (ICT) pushes this business operation to increase its efficiency and foster collaborations between the organization and its suppliers. This leads to a shift from the traditional procurement transactions to an e-procurement paradigm. Such change impacts on business process, information management and decision making. E-procurement involves various stakeholders who engage in activities based on different social and cultural practices. Therefore, a design of e-procurement system may involve complex situations analysis. This paper describes an approach of using the problem articulation method to support such analysis. This approach is applied to a case study from UAE.

The use of public participation and economic appraisal for public involvement in large-scale hydropower projects: Case study of the Nam Theun 2 Hydropower Project

Gaining public acceptance is one of the main issues with large-scale low-carbon projects such as hydropower development. It has been recommended by the World Commission on Dams that to gain public acceptance, publicinvolvement is necessary in the decision-making process (WCD, 2000). As financially-significant actors in the planning and implementation of large-scale hydropowerprojects in developing country contexts, the paper examines the ways in which publicinvolvement may be influenced by international financial institutions. Using the casestudy of the NamTheun2HydropowerProject in Laos, the paper analyses how publicinvolvement facilitated by the Asian Development Bank had a bearing on procedural and distributional justice. The paper analyses the extent of publicparticipation and the assessment of full social and environmental costs of the project in the Cost-Benefit Analysis conducted during the projectappraisal stage. It is argued that while efforts were made to involve the public, there were several factors that influenced procedural and distributional justice: the late contribution of the Asian Development Bank in the projectappraisal stage; and the issue of non-market values and discount rate to calculate the full social and environmental costs.

Making robust policy decision using global biodiversity indicators

In order to influence global policy effectively, conservation scientists need to be able to provide robust predictions of the impact of alternative policies on biodiversity and measure progress towards goals using reliable indicators. We present a framework for using biodiversity indicators predictively to inform policy choices at a global level. The approach is illustrated with two case studies in which we project forwards the impacts of feasible policies on trends in biodiversity and in relevant indicators. The policies are based on targets agreed at the Convention on Biological Diversity (CBD) meeting in Nagoya in October 2010. The first case study compares protected area policies for African mammals, assessed using the Red List Index; the second example uses the Living Planet Index to assess the impact of a complete halt, versus a reduction, in bottom trawling. In the protected areas example, we find that the indicator can aid in decision-making because it is able to differentiate between the impacts of the different policies. In the bottom trawling example, the indicator exhibits some counter-intuitive behaviour, due to over-representation of some taxonomic and functional groups in the indicator, and contrasting impacts of the policies on different groups caused by trophic interactions. Our results support the need for further research on how to use predictive models and indicators to credibly track trends and inform policy. To be useful and relevant, scientists must make testable predictions about the impact of global policy on biodiversity to ensure that targets such as those set at Nagoya catalyse effective and measurable change.

The experimetrics of public goods: inferring motivations from contributions

In public goods experiments, stochastic choice, censoring and motivational heterogeneity give scope for disagreement over the extent of unselfishness, and whether it is reciprocal or altruistic. We show that these problems can be addressed econometrically, by estimating a finite mixture model to isolate types, incorporating double censoring and a tremble term. Most subjects act selfishly, but a substantial proportion are reciprocal with altruism playing only a marginal role. Isolating reciprocators enables a test of Sugden’s model of voluntary contributions. We estimate that reciprocators display a self-serving bias relative to the model.

For the public without the public

How is the notion of public interest operationalised in the regulatory practices of the International Public Sector Accounting Standards Board (IPSASB)? A fundamental objective in setting international accounting standards for both the private and public sector is to serve the ‘public interest’. Who or what constitutes ‘public interest’ however remains a highly complex and controversial issue. Private sector financial reporting research posits that users (of financial information) are used as a proxy for the ‘public’ and users are further refined to current and potential investors - a small proportion of the public. The debates surrounding public interest are even more contentious in public sector financial reporting which deals with ‘public’ (tax payers’) money. In our study we use Bourdieu’s notion of semi-homogenous fields to show how autonomous and heteronomous pressures from the epistemic community of the accounting profession and political/government interests compete for the right to define the public interest and determine how (by what accounting solutions) this interest is best served. This is a theoretical study grounded in the analysis of empirical data from interviews with the board members of the IPSASB. The main contribution of the paper is to further our understanding of the perceptions of the main decision makers from the ‘inner regulatory circle’ with regards to the problematic construct of public interest. The main findings suggest a paternal and un-reflexive attitude of the board members leading to the conclusion that the public have no real voice in these matters.