Should the Equality Act 2010 be extended to prohibit appearance discrimination

The UK Equality Act 2010 prohibits direct and indirect discrimination with respect to nine characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. We argue that the best way of understanding the Act is to see it as protecting those who are vulnerable to systematic disadvantage, partly in virtue of being at risk of experiencing discrimination that violates what we call the meritocratic principle. If this is a key principle underpinning the Act, then there is a compelling case for extending the legislation to include the protection of at least one further characteristic, namely, appearance. We consider but reject various difficulties that might be raised with extending the Act in this way, including the objection that those vulnerable to forms of appearance discrimination that violate the meritocratic principle could be adequately protected by treating them as disabled

Editorial

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Can ‘eugenics’ be defended?

In recent years, bioethical discourse around the topic of ‘genetic enhancement’ has become increasingly politicized. We fear that there has been too much focus on the semantic question of whether we should call - or in this case perhaps it would be better to say brand - particular practices and emerging bio-technologies such as CRISPR ‘eugenicist’ or ‘eugenic’, rather than the more philosophically important question of how we should view them from the perspective of ethics and policy. Here, we address the question of whether ‘eugenics’ can be defended and how proponents and critics of enhancement should engage with each othe

A pilot study on the application of the current European guidelines for the management of acute coronary syndrome without elevation of ST segment (NSTEMI) in the Emergency Department setting in the Italian region Lazio.

Background: In 2011 the European Society of Cardiology published the new guidelines for the treatment and management of acute coronary syndrome without elevation of the ST segment (NSTEMI). For the treatment of the syndrome, the use of P2Y12 inhibitors in addition to aspirin was strongly recommended (evidence IA). We studied the application of this recommendation in the setting of the emergency department in the vast and uneven area of the Italian region Lazio, three years after the release of these drugs in Italy. Methods: 121 consecutive patients (65% older than 65 years) affected by NSTEMI were recruited between May and July 2013. During the transition in the emergency department data was collected on patient's symptoms, syndrome severity and type & timing of treatments chosen. Adherence to the guidelines was evaluated considering the number of "good treated" patients: these being the patients that received at least 80% of the main five recommendations on percutaneous coronary intervention (PCI) timing, antiplatelet and anti-coagulant therapy suggested by the European Cardiology Task Force (ESC guidelines, 2011) for the very acute phase of NSTEMI. Results: Patients were treated with: 1) 35% of cases with double antiplatelet therapy and anticoagulation (DAPT+AC), 2) 22% of cases with single antiplatelet and anticoagulation (SAPT+AC), 3) 6% of cases with a single antiplatelet therapy (SAPT), 4) 6% of cases with a double antiplatelet therapy (DAPT) and 5) 24% of cases did not receive any therapy. Data on PCI was available for 95 patients and, of these, only 82% of the patients underwent the procedure. The percentage of "good treated" patients were among of 20-40%, depending on PCI timing – as guidelines suggested – was considered as mandatory (20,5%) or as the extreme time limit (40%). Significant differences were found between patients treated in a central hospital with a hemodynamic laboratory active 24/24hr (HUB) and patients treated in the other hospital (SPOKE). HUBs showed a higher percent of "good treated" patients, a higher percentage of early invasive treated and a better adherence to recommended pharmacological therapy. Conclusions: A significant number of patients did not receive adequate treatment during the emergency department stay. The absence of hemodynamic services increases the risk of inadequate treatment

Ceramics and its dimensions : shaping the future

European ceramics traditions and cultures are facing challenges, many of them linked to the recent development of digital technology that is changing the rules of our everyday life as well as all aspects of trade. The publication shares, shows and discusses the ideas and processes that have evolved during the project Ceramics and its Dimensions and the related sub-project Shaping the Future. The sub-project began with a workshop on the premises of the KAHLA Porcelain factory in Germany gathering together international team of students, teachers and other stakeholders with the aim of exploring the material of ceramics and the associated new technologies. These experiments resulted in diverse new ceramic pieces yet even more important were the shared experiences and ideas that gave birth to new creative processes. The articles of the publication discuss the topics of design, education, 3D printing and food. The publication includes also a catalogue of the works that are on display in a touring exhibition Ceramics and its Dimensions: Shaping the Future. The aim of the publication is to challenge and reposition the role of ceramics and its future

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

How should we tackle financial and prosocial biases against unattractive people?

The fact that attractive people benefit from their good looks is not bad per se. Rather, what is worrisome is the fact that unattractive people are discriminated against, and that such discrimination negatively affects many aspects of their lives. I focus on the moral implications of this discrimination and on the possible measures that could be taken to alleviate it

E' possibile giustificare moralmente l'obiezione di coscienza in campo medico?

Scopo di questa tesi di dottorato è stabilire se l’obiezione di coscienza in ambito medico sia moralmente giustificabile. Esistono essenzialmente tre tipi di rifiuto motivati dall’obiezione di coscienza (1) rifiuto di informare un paziente relativamente alle opzioni terapeutiche come ad esempio l’uso di un contraccettivo di emergenza o l’interruzione volontaria di gravidanza (2) rifiuto di rinviare un paziente che chiede un particolare intervento (o terapia) presso un collega non obiettore (3) rifiuto di svolgere in prima persona una certa attività richiesta dal paziente Per rispondere a questo interrogativo si è svolta un’analisi filosofico-morale dei principali argomenti utilizzati dalla letteratura su questo tema per giustificare o per negare un diritto morale all’obiezione di coscienza degli operatori sanitari. Il diritto degli operatori sanitari all’integrità morale e a non essere complici di attività ritenute immorali dev’essere infatti confrontato con il diritto dei pazienti ad avere un’assistenza sanitaria efficiente, a poter compiere scelte autonome riguardo alla propria salute e ad essere informati relativamente a tutte le opzioni terapeutiche disponibili. Nel corso dell’intero lavoro è stato dimostrato come suddetti diritti dei pazienti sono facilmente e frequentemente violati a causa dell’incidenza dell’obiezione di coscienza in ambito medico. L’analisi condotta nel corso del lavoro di tesi si concentra fondamentalmente su quattro importanti aspetti del problema quali diritto all’integrità morale dell’ operatore sanitario, obblighi professionali, cooperazione al male e laicità dello stato. Alla fine del lavoro di analisi si è giunti alla conclusione che: le obiezioni di tipo (1) e (2) non sono mai moralmente giustificabili perché comportano sempre una violazione dei diritti fondamentali del paziente. Le obiezioni di coscienza di tipo (3) sono moralmente accettabili solo quando non impongono un peso eccessivo al paziente, vale a dire quando il rinvio presso un collega non obiettore è veloce, sicuro e agevole. Tuttavia le condizioni ideali in cui vengono rispettati i criteri minimi di ammissibilità dell’obiezione di coscienza di tipo (3) non si verificano quasi mai nella realtà dei fatti (per ragioni ampiamente spiegate nel corso del lavoro), per cui tali obiezioni risultano in pratica solo raramente accettabili da un punto d vista morale.This dissertation investigates whether conscientious objection in medicine is morally justifiable. I first distinguish between three types of conscientious objection: (1) where health workers refuse to inform a patient about a possible therapeutic option as an emergency contraceptive or a vaccination or an abortion, (2) where health workers refuse to refer a patient who asked for a certain medicine or intervention to a willing colleague and (3) where health workers refuse to personally engage in a certain therapeutic activity. I then consider the most important arguments used to justify or to deny a moral right to conscientious objection among health workers. The rights to moral integrity and to not be an accomplice to activities one considers immoral ground the main arguments used to defend a right to conscientious objection by health workers. On the other hand patients have rights to make autonomous decisions about their own healthcare, to be informed about the therapeutic options available, to have access to legal and safe treatments and to an efficient health care system. These patients' rights are very likely to be violated when many health workers refuse to practice certain activities because of their conscientious objections to them. My analysis focuses on four relevant aspects of this issue : a right to moral integrity, professional duties, cooperation with evil and secularism. I reach the conclusion that conscientious objections of types (1) and (2) are never justifiable, as they always violates a patient’s rights to be informed, to decide autonomously, and to have access to the best therapies. I conclude that conscientious objections of type (3) are justifiable just when they don’t impose an unreasonable burden on the patient, which means, in practice, that making a referral is immediate, safe and easy. However I also show that this is rarely the case, so that conscientious objections of type (3) are rarely morally justifiable