Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution

Objectives: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. Design: Multi-method study involving interviews and a physical inspection of clinical areas. Setting: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. Participants: Senior managers and ward based medical and nursing staff. Main outcome measures: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. Results: All trusts required that potassium chloride concentrate be stored in a separate locked cupboard from common injectable diluents (100% compliance). Unauthorised stocks of potassium chloride were found in five clinical areas not authorised by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. Conclusions: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes

Autonomous Weapons Systems and the Moral Equality of Combatants

To many, the idea of autonomous weapons systems (AWS) killing human beings is grotesque. Yet critics have had difficulty explaining why it should make a significant moral difference if a human combatant is killed by an AWS as opposed to being killed by a human combatant. The purpose of this paper is to explore the roots of various deontological concerns with AWS and to consider whether these concerns are distinct from any concerns that also apply to long- distance, human-guided weaponry. We suggest that at least one major driver of the intuitive moral aversion to lethal AWS is that their use disrespects their human targets by violating the martial contract between human combatants. On our understanding of this doctrine, service personnel cede a right not to be directly targeted with lethal violence to other human agents alone. Artificial agents, of which AWS are one example, cannot understand the value of human life. A human combatant cannot transfer his privileges of targeting enemy combatants to a robot. Therefore, the human duty-holder who deploys AWS breaches the martial contract between human combatants and disrespects the targeted combatants. We consider whether this novel deontological objection to AWS forms the foundation of several other popular yet imperfect deontological objections to AWS

Fighting Back: Crime, Self-Defense, and the Right to Carry a Handgun

Ten years ago this month, a controversial "concealed- carry" law went into effect in the state of Florida. In a sharp break from the conventional wisdom of the time, that law allowed adult citizens to carry concealed firearms in public. Many people feared the law would quickly lead to disaster: blood would literally be running in the streets. Now, 10 years later, it is safe to say that those dire predictions were completely unfounded. Indeed, the debate today over concealed-carry laws centers on the extent to which such laws can actually reduce the crime rate.To the shock and dismay of gun control proponents, concealed-carry reform has proven to be wildly popular among state lawmakers. Since Florida launched its experiment with concealed-carry in October 1987, 23 states have enacted similar laws, with positive results.Prior to 1987, almost every state in America either prohibited the carrying of concealed handguns or permitted concealed-carry under a licensing system that granted government officials broad discretionary power over the decision to grant a permit. The key feature of the new concealed-carry laws is that the government must grant the permit as soon as any citizen can satisfy objective licensing criteria.Concealed-carry reform reaffirms the basic idea that citizens have the right to defend themselves against criminal attack. And since criminals can strike almost anywhere at any time, the last thing government ought to be doing is stripping citizens of the most effective means of defending themselves. Carrying a handgun in public may not be for everyone, but it is a right that government ought to respect

The Right to Die

In this thesis, I argue that, with certain procedural safeguards in place, physician‐assisted death (PAD) and euthanasia are morally permissible and should be an option for terminally ill patients. The first chapter introduces the history of PAD and euthanasia in the United States focusing on Oregon and Washington. Chapter two focuses on PAD in The Netherlands. Chapter three reviews philosophical arguments regarding PAD and details certain procedural safeguards such as medical friendships, consultations, and multiple opinions, which help to guarantee the moral acceptability of PAD and euthanasia. These safeguards also contribute to a relationship of beneficence from the physician to her patient. In addition, I will analyze ways in which PAD and euthanasia can be carried out without traveling down the slippery slope toward killing another human beings against their wishes. I also respond to criticisms of the Oregon Law set forth by Kathleen Foley, M.D. and Herbert Hendin, M.D.. In the conclusion, I take stock and I will summarize the ways in which my thesis addresses the most common arguments against PAD and euthanasia