HARMS, OMISSIONS AND MORALS: AN ANALYSIS OF THE NATURE AND RELATIVE STRINGENCY OF THE DUTY TO PREVENT HARM (NEGATIVE, POSITIVE DUTIES).

My aim is to provide the foundation for a theory about the duty to prevent harm by investigating how this duty compares and contrasts with the duty not to cause harm. I begin by addressing the moral significance of the difference between killing (causing harm) and letting die (refraining from preventing harm), arguing that neither of the prevalent and rival views ('killing is inherently worse than letting die', and 'killing and letting die are, other things equal, morally equivalent') is entirely acceptable. By analyzing the notion of a morally significant difference I argue that these views are only contrary. I then develop an alternative view which locates the difference between killing and letting die at the level of the general moral prohibitions against such acts, and is grounded on a difference in the 'strength' or 'type' of reason that can justify violations of those prohibitions in relevantly similar circumstances. This account is summarized into three intermediate principles. To develop these principles into a general theory, I introduce and clarify the distinction between negative and positive duties, arguing that it is independent of the distinction between negative and positive acts. After exploring the grounds for and against recognizing the significance of the former distinction, I conclude that while it is significant, and that negative duties are in some sense stricter than positive duties, the prevalent interpretation of "stricter" and its corresponding moral principle are unacceptable. I then develop an alternative definition and a theory entailing (a) that while causing harm is sometimes morally worse than failing to prevent harm (other things equal), it is not always worse, (b) the cases in which it is worse are cases in which the agent's negative or positive duty conflicts with another morally relevant consideration, and (c) that negative duties are stricter than positive duties in that the former are more difficult to justifiably violate. Finally, I defend this theory as one which captures the strong points of the rival views, while escaping their problems, and thus provides both a resolution to the current debates and the foundation for a complete analysis of the duty to prevent harm

An evaluation of the interference of alamin with chemistry and co-oximetry tests on nine commonly used instruments

The administration of hydroxocobalamin (OHCob), alone or with sodium thiosulfate, is a standard therapy for cyanide poisoning. OHCob is a red chromophore, and its interference with co-oximetric and colorimetric laboratory measurements has been evaluated in a few conflicting reports. The interference of OHCob was investigated in samples spiked with 10 different concentrations of OHCob (0-1500 mg/L). The concentration of 73 different analytes was measured using nine different analysers (ABL 800 Flex, Advia 1800, Advia Centaur Xp, Architect ci8200, Immulite 2500, Konelab 30i, Modular Analytics SWA, Synchron LX 20 and Vitros 5.1). All instruments yielded some results that were affected by OHCob at concentrations equivalent to a single therapeutic dose. Of the 73 different analytes, 64% showed interference on at least one instrument. Of all 187 tests performed, 47% were biased with more than 10%. Interference was generally limited to photometric assays, whereas immunological and ion-selective electrode measurements were unaffected. OHCob present in the blood after treatment for cyanide poisoning interfered with many laboratory assays in an unpredictable way, making some results invalid. Some affected tests are important in the treatment of cyanide poisoning. The interference is not solely due to wavelength, but also to chemical interaction. Without delaying the administration of OHCob, blood should, preferably, be drawn in advance, or, at least, the laboratory should be informed about the OHCob treatment. If the laboratory receives OHCob-containing samples, methods and instruments should be selected to minimize bias, and the manufacturer of the OHCob should recommend relevant precautions to customers in the package insert