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Background: Prehospital and early in‐hospital use of low titer group O whole blood (LTOWB) for life‐threatening bleeding has been independently associated with improved survival compared to component therapy. However, when RhD‐positive blood products are administered to RhD‐negative females of childbearing potential (FCP), there is a small future risk of hemolytic disease of the fetus and newborn (HDFN). This raises important ethical questions that must be explored in order to justify the use of RhD‐positive blood products, including LTOWB, both in clinical practice and research. Methods: This essay explores the ethical challenges related to RhD‐positive blood product administration to RhD‐negative or RhD‐unknown FCPs as a first‐line resuscitation fluid in the trauma setting. These ethical issues include: issues related to decision‐making, ethical analysis based on the doctrine of double effect (DDE), and attendant obligations incurred by hospitals that administer RhD‐positive blood to FCPs. Results: Ethical analysis through the use of the DDE demonstrates that utilization of RhD‐positive blood products, including LTOWB, in the early resuscitation of FCPs is an ethically appropriate approach. By accepting the risk of HDFN, hospitals generate obligations to promote blood donation, evaluate for alloimmunization and counsel patients on the future risk of HDFN, and maintain an understanding of the ethical rationale for RhD‐positive blood transfusion. [ABSTRACT FROM AUTHOR]

Electric vehicles are one of the key measures to decarbonize the transportation industry. However, insufficient charging infrastructure hinders the process of vehicle electrification. The government implements investment and operation subsidies for charging infrastructure to overcome this problem. The different effects of different subsidy models on the decisions of infrastructure operators have not been fully discussed in the literature. In addition, the existing literature also lacks attention to consumer preferences for charging convenience and price sensitivity. Therefore, to fill this gap, this study develops four optimization models under the four scenarios of no subsidy (Model N), investment subsidy (Model I), operation subsidy (Model O), and compound subsidy (Model B) to examine and compare the effect of government subsidy. At the same time, consumer preferences are taken into account. The effects of policy, market, cost, and time factors on price, demand, and profit are discussed. Our general equilibrium analysis yields three important findings. First, the government subsidy for charging infrastructure is important and necessary. The government subsidy has a double effect. Differently, the investment subsidy has a direct effect only on the supply side, and the operation subsidy has a direct effect on both the supply and demand side. Thus, the operation subsidy would be a better choice than the investment subsidy. Second, increasing the construction level of charging infrastructure has a strong incentive effect on charging demand and can effectively inhibit refueling demand, while charging demand is less sensitive to changes in charging prices. Third, measures such as reducing the charging cost, increasing the refueling cost, and shortening the time gap are all favorable for promoting the charging infrastructure. This study not only extends the research on charging infrastructure policies from a theoretical perspective but also provides a reference for government policy adjustments. The government should provide appropriate policies according to the development status of different markets. [ABSTRACT FROM AUTHOR]

One of the reliable methods to make more use of energy production sources, is to use power generation units that use a fuel source, and by utilizing any wasted energy, bring the temperature of the exhaust gases closer to the ambient temperature. The use of waste energy of exhaust gases increases the efficiency and improves the performance of the system. The purpose of this paper is to make optimal use of gas turbine exhaust gases and use them to produce cooling in absorption chillers. And then analyze the thermodynamic and exergy performance of a triple hybrid system to generate electrical, heating and cooling energy. In this research, a hybrid cycle of a gas turbine and a fuel cell is considered as the primary actuator, and two single-effect and double-effect absorption chillers are considered as the secondary actuator. To perform this research, two proposed hybrid systems with their peripherals have been analyzed from a thermodynamic point. To have high accuracy results, in addition to thermodynamic analysis, the thermal and the electrochemical analysis has also been performed in order to the importance of the fuel cell in the hybrid system in this component. In the following, the effect of compressor pressure ratio, turbine inlet temperature, evaporator inlet water temperature, cooling tower inlet temperature and generator inlet temperature on energy and exergy efficiency, as well as exergy destruction rate in the system has been checked with the parametric study of the mentioned hybrid system. The results show that the increase in compressor pressure ratio causes the increase of electrical efficiency and exergy efficiency and the decrease of exergy destruction rate of the system. Also, if a double-effect absorption chiller is used instead of a single-effect absorption chiller, the energy efficiency and exergy will increase by 8% and 2%, respectively, and the exergy destruction rate will decrease by 5.4%. [ABSTRACT FROM AUTHOR]

Abstract In 1989, Thomas Donaldson requested the California courts to allow physicians to hasten his death. Donaldson had been diagnosed with brain cancer, and he desired to die in order to cryonically preserve his brain, so as to stop its further deterioration. This case elicits an important question: is this a case of euthanasia? In this article, we examine the traditional criteria of death, and contrast it with the information-theoretic criterion. If this criterion is accepted, we posit that Donaldson’s case would have been cryocide, but not euthanasia. We then examine if cryocide is an ethically feasible alternative to euthanasia. To do so, we rely on the ethical doctrine of double effect.

• Thermodynamic analysis of absorption cooling-assisted CO 2 systems. • Performance enhancement over simple CO 2 system is analysed. • Simple CO 2 system with IHX coupled with DEDHVARS performs better at high T gc. • Enhanced COP and exergy efficiency. Studies have shown appreciable improvements in system performance by subcooling the working fluid in transcritical CO 2 refrigeration systems. The use of a dedicated vapour absorption refrigeration system (VARS) for subcooling the high side working fluid downstream of the heat rejection device is proved to be a viable option. The heat available in the discharged gas downstream of the compressor in the transcritical CO 2 system is used to drive a LiBr-H 2 O VARS. This study examines the performance of an absorption cooling-assisted transcritical CO 2 system. Three different configurations of the absorption system are considered, namely, single effect (SE), series double effect (DE), and series double effect with dual heat input (DEDH). The performance analysis is carried out for gas cooler exit temperatures (T gc) ranging from 30 to 50 °C and evaporation temperatures ranging from -10 to 5 °C. The average COP improvement of the CO 2 system is found to be 29 and 27% using SE and DEDH systems respectively. [ABSTRACT FROM AUTHOR]

In this work, an experiment-based study of a double-effect, single-slope active solar still (SSASS) is presented. The system comprises an upper and a lower basin incorporated with a paraffin wax acting as a phase change material (PCM). The use of phase change materials is very important due to their high storage density and the isothermal nature of the storage process. Paraffin wax was selected based on its attractive thermo-physical properties. The thermal behaviours of the system during the diurnal and nocturnal phases in both compartments were explored. Experimental results showed that the upper basin's yield contributed more to the overall distillate production over a 24-hour cycle while that of the lower basin predominated the diurnal production. Though the PCM served as an energy source during the nocturnal phase, it did not translate to significant improvement in the yield of the lower basin. The heat retention ability of the lower glazing retarded the condensation of the humid air in the lower compartment during the off-sunshine period. Thus, the nocturnal yield of the system was largely driven by the improved temperature difference between the upper saline water and the upper glazing, as well as the stored thermal energy in the saline water mass before sunset. The system achieved a maximum yield of 2,450 ml/day and a yield rate of 232.5 ml/h. A maximum monthly average yield of 1,787 ml/day was realized in May and a minimum of 692 ml/day in July. Nocturnal distillate production accounted for an average of 55% of the total distillate recovered from the still daily. The system achieved an efficiency range of 12.20 - 32.21%. The cost of freshwater production from the system is estimated at 0.0508 $/L with a payback period of 267 days. Thus, this system is economically viable and suitable particularly, for low-income earners. [ABSTRACT FROM AUTHOR]

Is offering hazard pay ethically permissible when the pay premium is the only reason that a dangerous job is accepted? Robert C. Hughes argues that it is not. Central to his argument is the claim that in such cases, workers intend the foreseeable risks of harm as a means to the pay premium. Herein I question the plausibility of this claim and then develop a conception of the concept of means sufficient to make it plausible. By so doing, I provide support for Hughes's stringent position. [ABSTRACT FROM AUTHOR]

Business actors often act in ways that may harm other parties. While the law aims to restrict harmful behavior and to provide remedies, legal systems do not anticipate all contingencies and legal regulations are not always well-enforced. This article argues that the logic of double effect (LDE), which has been developed and deployed in other areas of practical ethics, can be useful in helping business actors decide whether or not to pursue potentially harmful activities in commonplace business activity. The article illustrates how LDE helps to explain the exploitative nature of payday lending, the distinction between permissible and impermissible forms of market competition, and the potential wrong of imposing risk of harm on others. The article also addresses foundational debates about LDE itself. We offer the article as an illustration of the sort of "midlevel" theorizing that can address directly the needs of practitioners. [ABSTRACT FROM AUTHOR]

This paper presents the effects of water thickness and glazing slope on the performance of a double-effect solar still. The effect of the air gap between the water interface and the glazing was also considered. Energy balance equations were developed for the different components of the system. The development of the equations was made considering the thermal resistances offered by the humid-air media in both chambers of the double-effect still. Numerical computation was conducted for a typical day in Owerri. The results obtained were compared with data from a previous experimental study. The water temperatures in the upper and lower basins increased with a reduction in thickness. However, the yield profile did not follow a similar trend to that of the temperature. This was attributed to the influence of the upper water on the lower-glazing temperature. The temperatures of the still components initially reduced with a deviation from the latitude angle (La) and later increased with an increase in glazing slope. The diurnal yield of the system attained a maximum value of 3.04 kg/m2 at an optimum angle of La+15∘ Increasing the glazing slope from La to La+15∘ improved the distillate yield by 47.9%.

The introduction of absorption refrigeration technology addressed several significant concerns in the domain of energy crisis, rising cost of fossil fuel, and ecological challenges arising due to the excess use of traditional compression refrigeration systems. ARS (absorption refrigeration system) is gaining popularity as a result of benefits such as the use of low-grade heat sources and environmentally acceptable low-cost working fluid pairs. However, two significant hurdles to commercial success for this technology are the often too big size of the refrigeration system and the poor performance of the system. Numerous studies have been conducted in an attempt to discover methods for improving the COP (coefficient of performance) of ARS in order to get these systems more competitive in comparison to the conventional compression refrigeration systems. The goal of this article is to perform a review of the literature on different methods used to enhance the COP of ARSs based on cycle layout modification and working pair selection as they are the promising solutions for the enhancement of the performance of ARSs. The futuristic aspect of this technology includes the introduction of new working pairs with no corrosion to the system components, including nanoparticles to increase heat transfer rate while reducing the cost of the system. Heat recovery methods should be introduced and the efficient design of various components especially the generator and absorber are to be addressed. This technology could be combined with other refrigeration technologies while utilizing the waste heat to further improve the efficiency of ARSs. [ABSTRACT FROM AUTHOR]

In 1989, Thomas Donaldson requested the California courts to allow physicians to hasten his death. Donaldson had been diagnosed with brain cancer, and he desired to die in order to cryonically preserve his brain, so as to stop its further deterioration. This case elicits an important question: is this a case of euthanasia? In this article, we examine the traditional criteria of death, and contrast it with the information-theoretic criterion. If this criterion is accepted, we posit that Donaldson's case would have been cryocide, but not euthanasia. We then examine if cryocide is an ethically feasible alternative to euthanasia. To do so, we rely on the ethical doctrine of double effect. [ABSTRACT FROM AUTHOR]

This essay defends the asymmetry between the badness of spontaneous and induced abortions in order to explain why anti-abortionists prioritize stopping induced abortions over preventing spontaneous abortions. Specifically, it argues (1) the distinction between killing and letting-die is of more limited use in explaining the asymmetry than has sometimes been presumed, and (2) that accounting for intentions in moral agency does not render performances morally inert. Instead, anti-abortionists adopt a pluralist, nonreductive account of moral analysis which is situated against a backdrop that sees the limits of our ability to control the process of fertility as themselves valuable. Although this view is complex, the paper concludes by arguing that it has the advantage of explaining features of the anti-abortion outlook that have sometimes been overlooked. First, it accounts for why the pre-Roe regime of abortion restrictions primarily imposed penalties on doctors who induced abortions rather than the women who seek them. Second, it explains why the advent of ectogestation will not prompt anti-abortionists to compromise on 'disconnect abortions,' which putatively let the embryo die by extracting it from the mother's womb. [ABSTRACT FROM AUTHOR]

Increasing comfort conditions in buildings imply higher energy demands. However, these needs can be mitigated by solar cooling solutions. These systems, such as absorption chillers, are complex and require stable operation, with strict control to maximise the solar fraction and minimise gas consumption. This is incompatible with the variability of renewable resources, so they are often coupled with auxiliary gas systems. Although gas-free operation is possible if these systems are optimally controlled, they would require special supervision. This paper aims to develop an experimental validation of an inverse model to manage an absorption chiller coupled with a solar cooling plant. To know its real behaviour, long-term experiments have been performed using this plant, which consists of a linear Fresnel solar collector and an auxiliary natural gas boiler. The inverse model is used as a predictive control tool to decide the auxiliary boiler commands of the absorption chiller to optimise its operation: maximum cooling production by minimising gas consumption and maximising solar contribution. It has been identified with data from two weeks and validated with data from one summer month. Results show that the model estimates, on a time base of fewer than 30 min, are acceptable with errors of less than 5%. In addition, the maximum error of the estimated seasonal COP and the renewable fraction are less than 6% per day. Therefore, the results prove the usefulness of the proposal as a predictive control for optimal operation. Furthermore, it could be used as a baseline for preventive maintenance. If the proposed model is used for optimal management of the absorption chiller, the thermal efficiency of the plant increases significantly, doubling the solar contribution. As a result, the gas consumption of the solar cooling plant is halved and the total cost of air conditioning the building decreases by 16%.

• Examines external whistleblowing from the perspective of its permissibility vis-à-vis the negative effect it may have on a health care organization or service. • Proposes the Principle of Double Effect as an ethical criterion to assess the permissibility of external whistleblowing in the context of a negative effect. • Argues that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e., the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect. Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect. [ABSTRACT FROM AUTHOR]

• Double effect adsorption cycle with adsorption heat recovery was investigated. • Adsorbent combinations were examined with the heat source temperature of 90 degC. • FAM-Z01 and FAM-Z02 for low and high temperature cycles, respectively, are the best. • COP can attain 1.0 when adsorbent mass and cycle time are selected appropriately. • The total cooling power is maximized when COP=0.9. This study investigates the performance of double effect adsorption refrigeration cycle that utilizes the adsorption heat of a high-temperature adsorbent heat exchanger for desorption of a low-temperature one. Because there is a freedom to select an adsorbent for each adsorbent heat exchanger, the combination of adsorbents such as silica gel, FAM-Z01, FAM-Z02 and FAM-Z05 were examined. The temperature of an external heat source was assumed to be 90°C. Dynamic cycle simulation was employed to estimate the performance in terms of coefficient of performance (COP) and specific cooling power (SCP). The results show that the combination of the adsorbents FAM-Z01 and FAM-Z02 for the low-temperature heat exchanger and high-temperature one, respectively, is the most effective to achieve high COP as well as high SCP. The results also indicate that the COP=1.0 is attainable when the mass allocation of the adsorbents and the cycle time are selected appropriately. From the viewpoint of maximizing the cooling power, COP=0.9 is suggested for the best design, where the mass of high-temperature side is equal to the mass of low-temperature side. [ABSTRACT FROM AUTHOR]

The dead donor rule (DDR) prohibits retrieval protocols that would be lethal to the donor. Some argue that compliance with it can be maintained by satisfying the requirements of double‐effect reasoning (DER). If successful, one could support organ donation without reference to the definition of death while being faithful to an ethic that prohibits intentionally killing innocent human life. On the contrary, I argue that DER cannot make lethal organ donation compatible with the DDR, because there are plausible ways it fails DER's requirements. A key takeaway is that the theories of intention and proportionality assumed in DER matter for its plausibility as a constraint on practical reasoning. [ABSTRACT FROM AUTHOR]

The relevance of double effect for end-of-life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life; therefore, no secondary "double" effect is brought about. In my article, I argue against this view, showing how the doctrine of double effect is relevant to the administration of opioids at the end of life. I contend that the prevailing view suffers from a misunderstanding of the nature of double effect, which includes application to risking a grave harm. [ABSTRACT FROM AUTHOR]

A research project by the Schools of Theology and Psychology of Australia's Charles Sturt University surveyed a large sample of Salvation Army officers. This article considers survey responses to two questions relating to end-of-life care: the use of pain medications that may shorten life, and the cessation of fluid and food intake. The results of the analyses are evaluated in terms of Michael Banner's proposal that moral theology should more assiduously converse with 'patient ethnographic study', which the survey instantiates to some extent. Banner's proposal and the results of the survey are contrasted to Peter Singer's analytical moral philosophical dictums on end-of-life care. The results are also compared to a metastudy by Andrea Rodríguez-Prat and Evert van Leeuwen of 14 ethnographic studies of those who wish to hasten death at the end of life. We conclude that respondents exemplify a form of moral reasoning that is embedded within Christian spirituality; counters the assumptions of Singer's approach; contrasts the diminishment of 'meaning' at the end of life, as seen in Rodríguez-Prat and van Leeuwen; and deserves further respectful ethnographic study. [ABSTRACT FROM AUTHOR]

• A hybrid system of PAFC, TEG, and AC is developed for the first time. • Detailed analytical model is built for a double effect AC. • Hybrid system performance is analyzed under different operating conditions. • Both power output and efficiency are higher than standalone PAFC. • Further enhancement can be obtained by using optimum values of operating conditions. In this work, a new hybrid system for combined power and cooling applications is developed and investigated. The novelty of this research originates from two major achievements. First, the use of detailed analytical model for double-effect AC with fuel cell. Second, using two heat recovery systems (TEG and AC) to utilize the waste heat from a fuel cell. The system consists of a phosphoric acid fuel cell (PAFC), ThermoElectric generator (TEG), and an absorption chiller (AC). The internal heat generation in PAFC is utilized using TEG to achieve additional electricity production, while the exhaust heat by PAFC is utilized to run an AC to produce cooling power. The results show that the maximum useful power (electricity and cooling) obtained from this hybrid system is 11% greater than the maximum electrical power generated by the standalone PAFC. The maximum efficiency of this hybrid system is 7% greater than the maximum standalone PAFC efficiency, but the improvement can reach 10% when optimizing the system operating conditions. The sensitivity analysis study demonstrates that decreasing the operating temperature, increasing the fuel pressure, and decreasing the ambient temperature could enhance the overall hybrid system performance. Additionally, we found that a better performance is achieved when the heat utilized by TEG is minimized and majority of the useful heat is used in the AC. [ABSTRACT FROM AUTHOR]

This paper represents the detailed thermodynamic study to compare the performance of solar assisted double effect LiBr-H2O and LiCl-H2O vapour absorption refrigeration systems (VARS) coupled with several solar collectors. A 100 kW absorption cooling system is analysed at evaporator temperature 5 °C and two condensation temperatures 30 °C and 40 °C integrated with evacuated tube collector (ETC) and parabolic trough collector (PTC) connected with storage tank to operate the absorption system. In this study, minimum heat source temperature required to operate the system is evaluated for both solar-assisted cooling systems. Analysis of Variance (ANOVA) is performed to find out most critical parameters for minimum heat source temperature. The influence of heat source temperature on thermodynamic and economic aspects of systems is depicted. It is found that LiCl-H2O VARS depicted enhanced thermodynamic and economic performance compared to LiBr-H2O system. Furthermore, it is found that required mean specific collecting area for LiCl-H2O pair is close to 1.25 m2/kW, which is relatively low value. From the comparison assessment, it is found that ETC based system is favorable from economic perspectives and PTC based system is recommended from thermodynamic performance perspectives. [ABSTRACT FROM AUTHOR]

Efforts to resolve the tension within the Christian moral theological tradition between just war theory and pacifism have so far not produced any broadly accepted resolution. Key sticking points lie both in the fact that even a just war typically involves the taking of human life, both combatant and civilian, and that the distinction between intentional and unintentional killing, so important to Christian moral reflection, is difficult to sustain in practice. Yet, with the prospect of the development of effective non-lethal weapons, the path may be opened up to a genuine resolution of the tension. This article describes in general terms the way that such a development might be pursued, but also argues that the use of non-lethal weaponry would necessitate a re-interpretation of warfare as an exercise in a form of international policing. A number of potential criticisms of such a proposal are considered. [ABSTRACT FROM AUTHOR]

In this study, the effects of critical operational constraints on the operational domain of a double-effect lithium bromide/water absorption refrigeration system and its performance were investigated. These constraints were determined as the equivalence state of concentrations, the thermal unbalance between the system components of high-pressure condenser and low-pressure generator, freezing and crystallization risk of lithium bromide/water solution. For the system analysis, a simulation program was developed, and its detailed solution procedure was presented. The program outputs were initially validated with the literature. Subsequently, parametric studies were conducted for broad ranges of the component temperatures. The results demonstrate that the considered constraints were essential for acceptable design and the operational control of double-effect absorption refrigeration systems. The simulations will help to figure out under which operating conditions a double-effect absorption refrigeration system functions effectively and what kind of control strategies are essentially required to increase the coefficient of performance. Based on the operation scenario of fixed high-pressure generator temperature, the proposed system can enhance the coefficient of performance up to 31% and 84% as compared to its counterparts which function under the variable high-pressure generator temperature and the pinch point temperature difference (5 K between the high-pressure condenser and the low-pressure generator), respectively. [ABSTRACT FROM AUTHOR]

Producing food on a large scale without killing any animals seems currently impossible. This poses a challenge for deontological positions that involve a prohibition against killing sentient creatures: it seems that according to these positions omnivorous, vegetarian and vegan diets all rely on food produced in impermissible ways. In order to meet this challenge, deontologists might introduce consequentialist considerations into their theories, for example some principles that effectively require to kill as few animals as possible. This is the kind of strategy Tom Regan has pursued. However, we argue that the challenge for deontological positions on the ethics of food production can also be met by invoking a prominent deontological principle. The doctrine of double effect (DDE), with its distinction between bringing about harm intentionally and bringing about harm as a merely foreseen consequence of one's action, enables us to see a morally significant difference between the various ways to produce food other than the number of animals killed. In this paper we will review some of these ways using Warren S. Quinn's version of the DDE and show that a more thoroughgoing deontological ethics of food production than Regan's classic theory is possible. We thereby present a novel way of evaluating modes of food production. [ABSTRACT FROM AUTHOR]

Considering the ethylene effect and the perspective of learning theory from an interdisciplinary perspective, this paper studies the optimal inventory management of deteriorating items' two-stage supply chain consisting of suppliers and retailers. It is suggested that the inventory level of the two-stage supply chain will affect the dynamic deterioration problem of deterioration degree through the ethylene intensity coefficient. Based on the learning effect theory, the two-stage inventory model of deteriorating items' supply chain is constructed. By analyzing the cost structure under the influence of learning effect of suppliers and retailers, the profit of supply chain is solved by optimization method and optimal price and optimal learning coefficient are derived. The optimal solution of learning coefficient is obtained from various scenarios with theoretical analysis. Meanwhile, the influence of learning effect coefficient on system profit is compared under different ethylene intensity levels. Finally, the paper presents a numerical example to illustrate the rationality and applications of theoretical results. Through this research, it is aimed to reveal the multimedia system could be used to show the data change to help the business decision be more reasonable to attain more profit for managers. Furthermore, the multimedia technology could intensify the learning effect and in return could maximize the system profit of supply chain. This work is mainly modeling analysis, while the research outcomes could be developed into a good system by using multimedia technology. [ABSTRACT FROM AUTHOR]

The aim of this paper is to confront the main arguments employed by advocates of Universal Moral Grammar (UMG) with the results obtained in empirical studies from different fields of cognitive science and also with constructivist arguments proposed by Prinz and Sterelny, among others. From this analysis, I conclude that the Poverty of the Stimulus Argument is unconvincing when applied to the field of morality. The research with the trolley problems, often used to support the existence of UMG, is also insufficient to sustain the thesis that morality works similarly to language, especially when the existence of simpler explanations is considered. Furthermore, in spite of the universality of morality, the unlimited variation in moral norms across groups is a serious problem for any account relying on the principles and parameters model of the linguistic analogy.

A solar cooling system with an optimized air-cooled double-effect water/LiBr absorption machine is proposed as a sustainable alternative to meet cooling demands in dry hot climates. This system allows eliminating the cooling towers in those regions of the planet where water is scarce. This work analyses the environmental benefits of this air-cooled system, as well as its environmental footprints, compared to a solar water-cooled single effect. In this regard, a methodology has been applied to calculate the annual saving in water consumption produced in a case study: a hospital located in Almería, in South of Spain. Furthermore, the reduction in energy consumption and CO2 emissions is also quantified since this machine can be driven by solar energy and with higher efficiency than those of single effect. [ABSTRACT FROM AUTHOR]

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: (1) double-effect sedation, (2) parsimonious direct sedation, and (3) sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient's consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. [ABSTRACT FROM AUTHOR]

Among the oldest extant medical ethics, the Hippocratic Oath prohibits the giving of a deadly drug, regarding this act as an egregious violation of a medical ethic that is exclusively therapeutic. Proportionate palliative sedation involves the administration of a deadly drug. Hence it seems to violate the venerable Hippocratic promise associated with the dawn of Western medicine not to give a deadly drug. Relying on distinctions commonly employed in the analysis and evaluation of human actions, this article distinguishes physician-assisted suicide and euthanasia, as acts that necessarily violate the prohibition against giving a deadly drug, from proportionate palliative sedation, as an act that does not. [ABSTRACT FROM AUTHOR]

This essay considers whether palliative sedation is or is not appropriate medical care. This requires one to consider (a) whether, in addition to the good of health, relief of suffering is also a proper end of medicine; (b) whether unconsciousness can ever be a good for a human being; and (c) how double-effect reasoning can help us think about difficult cases. The author concludes that palliative sedation may be proper medical care, but only in a limited range of cases. [ABSTRACT FROM AUTHOR]

At a time when death-and-dying are increasingly thought of as medical events, even to the point where professionals traditionally oriented towards healing are sometimes thought to be responsible for intentionally ending the lives of patients, it is becoming increasingly clear that palliative care is both unique and critically important. In this paper I show the need for clear articulation of the philosophy of this distinctive practice that properly acts with intent towards neither health in a narrowly medical sense nor patient death. I propose four lenses through which a rigorous philosophy of palliative care may be approached: trust, intent, authenticity, and the foundational question of good dying - literally euthanasia. I contend that proper palliative care seeks to cloak ( palliare) pain within the context of trusting relationships both as a good in itself and as way of de-cloaking the things that form important components of most people's narratives of good dying: opportunities to authentically engage with trusted others with the aim of finding some kind of meaning in life and community, even during the process of dying. Furthermore, palliative care is characterized by a non-paternalistic willingness to point outside of itself in order to help patients authentically engage the important existential questions of human mortality via lenses that extend beyond those offered by scientific medicine. [ABSTRACT FROM AUTHOR]

On the strict view of intention, one intends only what is included in the plan of action or proposal adopted by choice. According to broader views of intention what one intends includes that plus some known features of the selected physical action that are not included in the proposal adopted by choice. I defend the strict view of intention, reply to important recent objections to it from Steven Jensen, Alexander Pruss and Luke Gormally, and examine concrete applications in light of those different views of intention. [ABSTRACT FROM AUTHOR]

Palliative sedation at the end of life is a necessary option for patients who have intractable symptoms and are suffering when other palliative interventions have been ineffective. Although recognized in palliative care as an ethically sound and legally sanctioned practice, some nurses continue to express concern that death is being hastened. The intent of this article is to provide clarity to the practice of palliative sedation at end of life. [ABSTRACT FROM AUTHOR]

This essay argues that Aquinas's position regarding the killing of innocent people differs significantly from other representatives of the Christian just war tradition. While his predecessors, notably Augustine, as well as his successors, from Cajetan and Vitoria onward, affirm the legitimacy of causing the death of innocents in a just war in cases of necessity, Aquinas holds that causing the death of innocents in a foreseeable manner, whether intentionally or indirectly, is never justified. Even an otherwise legitimate act of just war cannot legitimate causing the death of innocent people, as this can never advance the common good. This stance also contrasts sharply with much modern and contemporary double effect theorizing in relation to jus in bello. In this regard, Aquinas's position, shaped decisively by his biblical and theological commitments, may point the way towards an ethical orientation beyond the typical divisions of 'pacifism' and 'just war.' [ABSTRACT FROM AUTHOR]

Experimental research suggests that people draw a moral distinction between bad outcomes brought about as a means versus a side effect (or byproduct). Such findings have informed multiple psychological and philosophical debates about moral cognition, including its computational structure, its sensitivity to the famous Doctrine of Double Effect, its reliability, and its status as a universal and innate mental module akin to universal grammar. But some studies have failed to replicate the means/byproduct effect especially in the absence of other factors, such as personal contact. So we aimed to determine how robust the means/byproduct effect is by conducting a meta-analysis of both published and unpublished studies (k=101; 24,058 participants). We found that while there is an overall small difference between moral judgments of means and byproducts (standardized mean difference=0.87, 95% CI 0.67-1.06; standardized mean change=0.57, 95% CI 0.44-0.69; log odds ratio=1.59, 95% CI 1.15-2.02), the mean effect size is primarily moderated by whether the outcome is brought about by personal contact, which typically involves the use of personal force. [ABSTRACT FROM AUTHOR]

Many philosophers display relaxed scepticism about the Doctrine of Doing and Allowing (DDA) and the Doctrine of Double Effect (DDE), suspecting, without great alarm, that one or both of these Doctrines is indefensible. This relaxed scepticism is misplaced. Anyone who aims to endorse a theory of right action with Nonconsequentialist implications (henceforth any Nonconsequentialist) should accept both the DDA (or a replacement) and the DDE (or a replacement). First, even to state a Nonconsequentialist theory requires drawing a distinction between respecting and promoting values. This cannot be done without accepting some deontological distinction. Second, if someone is going to accept any deontological distinction she should accept either the DDE or the DDA or some replacement. Finally, anyone who accepts either the DDE or the DDA should accept both doctrines or a replacement of each. Unless both Doctrines can be defended or given a defensible replacement, any Nonconsequentialist is in trouble. [ABSTRACT FROM PUBLISHER]

The authors examine the nursing practice of disposing unaltered controlled substances into public water systems as an issue for nurses concerned with the environmental harm it can cause. A summary of the history of controlled substance management reveals inconsistencies in the interpretation of current regulations that have led to disposal policies that vary by institution, according to a benchmarking survey of regional hospitals. Much attention has been given to the phenomenon of conscientious objection in the context of patient care that conflicts with a nurse's moral integrity. Nurses who are compelled to dispose narcotics down drains may also face this struggle. The authors submit that this disposal method is based on a type of double effect logic where preventing diversion is viewed as a good effect of flushing unused controlled substances that outweighs any harm it may cause, though there is little evidence to support this conclusion. Consequently, the topic deserves further study so that nurse managers and administrators can support and offer alternatives to nurses who object to flushing drugs down the drain. [ABSTRACT FROM AUTHOR]

This article provides a friendly criticism of Meilaender’s positions on the beginning of life and decision making at the end of life. It is argued that his version of the self is narrowly physicalist and individualist with no room for the essentially social and psychological parts of identity or selfhood. That in turn leads to his rigoristic or tutioristic judgments on end of life care. [ABSTRACT FROM AUTHOR]

Energy and exergy analyses of double effect lithium bromide-water vapour absorption cycle has been carried out to optimize the operating temperatures in the main generator and the secondary condenser/ generator for maximum coefficient of performance (COP) and exergetic efficiency. There exists maximum COP and also maximum exergetic efficiency as the temperature in the secondary generator and the main generator are varied, thus leading to the optimum temperatures. Because of two generators in the double effect cycle, the optimization has been done in two steps. Since the secondary generator operates by using the heat of condensation release in the secondary condenser, the temperature in the secondary condenser will be nearly same as in the secondary generator. The analysis has been done for fixed temperatures in the evaporator, main condenser and the absorber. Results show that the COP increases while the exergetic efficiency decreases with increases in the evaporator temperature. The optimum parameters such as temperatures in the main generator, secondary generator and condenser, including the LiBr-Salt concentrations in the two generators, are presented for different values of the evaporator, main condenser and the absorber temperatures. A computer program has been developed for simulating the cycle. [ABSTRACT FROM AUTHOR]

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices—though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. While hypocrisy is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. [ABSTRACT FROM AUTHOR]

In this work, optimum operating condition maps are generated covering wide ranges of refrigeration and sink temperatures for single- and double-effect LiBr-water vapour absorption refrigeration cycle. These optimum condition maps will be useful to choose optimum operating conditions while designing LiBr-water cycle for desired applications. Methodology for generating such maps is discussed in detail, which can also be used for other absorption refrigeration cycles with various working fluids. Three configurations of LiBr-water absorption refrigeration cycles, single effect, double-effect series flow and double-effect parallel flow, are analysed with the most accurate thermodynamic property correlation available in the literature. Sensitivity of cycle performance to various operating variables such as generator, absorber and condenser temperatures is determined. Second law analysis shows that when a higher temperature heat source is available, double-effect cycles are more effective over single effect as they have higher coefficient of performance. [ABSTRACT FROM AUTHOR]

In this paper, we defend the general thesis that intentions are relevant not only to moral permissibility and impermissibility, but also to criminal wrongdoing, as well as a specific version of the Doctrine of Double Effect that we believe can help solve some challenging puzzles in the criminal law. We begin by answering some recent arguments that marginalize or eliminate the role of intentions as components of criminal wrongdoing [e.g., Alexander and Ferzan (Crime and culpability: a theory of criminal law. Cambridge University Press, New York, 2009), Chiao (Crim Law Philos 4:37-55, 2010), Walen (Crim Law Philos 3:71-78, 2009)]. We then turn to some influential theories that articulate a direct role for intentions [e.g., Duff (Answering for crime: responsibility and liability in the criminal law. Hart Publishing, Portland, 2007), Husak (Crim Law Philos 3:51-70, 2009)]. While we endorse the commitment to such a role for intentions, we believe that extant theories have not yet been able to adequately address certain objections or solve certain puzzles, such as that some attempt convictions require criminal intent when the crime attempted, if successful, requires only foresight, and that some intended harms appear to be no more serious than non-intended ones of the same magnitude, for example. Drawing on a variety of resources, including the specific version of the Doctrine of Double Effect we have developed in recent published work, we present solutions to these puzzles, which in turn provide mutual support for our general approach to the role of intentions and for thinking that using others as means is itself a special kind of wrongdoing. [ABSTRACT FROM AUTHOR]