Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Conclusions and Recommendations, are particularly interesting in view of the controversies aroused by the Warnock Report. Many of the recommendations contained here are similar to Warnock's (for example, concerning the legitimacy of AID children, the need for a licensing authority to supervise the work ofAID and IVF centres, etc), but others are at odds with the corresponding Warnock recommendations. In general, the authors place higher value on the family as an institution than did the Warnock Committee and display a much livelier awareness of the possible social dangers of the new techniques. One weakness of the book is that since its authors are approaching these topics from the standpoint of social scientists, their recommendations for legislative action which surely must be based on properly ethical considerations, not merely sociological ones seem devoid of any satisfactory rational support. For example, they concede that experimentation on human embryos is an objectionable practice, since 'the material acting as the subject of the experimentation is a human being at the beginning of its individual development' (p 178); but the practical recommendation which they make concerning this practice is disappointingly feeble:

https://jme.bmj.com/content/medethics/12/3/165.full.pdf

Ethics and the Limits of Philosophy

Hume's Moral Theory

Switzerland has an unusual position on assisted suicide: it is legally condoned and can be performed by non-physicians. Euthanasia is illegal, but there is a debate about decriminalisation that also discusses participation by non-physicians

Assisted Suicide and Euthanasia in Switzerland: Allowing a Role for Non-Physicians. (Abstracts)

Double-Effect Reasoning: Doing Good and Avoiding Evil

Some disability rights advocates criticise prenatal testing and selective abortion on the grounds that these practices express negative attitudes towards existing persons with disabilities Disability rights advocates also commonly criticise and oppose physician-assisted suicide (PAS) and euthanasia on the same grounds Despite the structural and motivational similarity of these two kinds of arguments, there is no literature comparing and contrasting their relative merits and the merits of responses to them with respect to each of these specific medical practices This paper undertakes such a comparison My thesis is that a number of potentially significant weaknesses of the expressivist argument against reproductive technologies are avoided when the argument is used against PAS In particular, I try to show that three common criticisms of the expressivist argument applied to reproductive technologies, whatever merit they have, have even less merit when they are used to reply to the expressivist argument applied to PAS This is important because the expressivist argument applied to the end of life scenario does not get as much attention as the argument applied to the beginning of life scenario, and yet it has a relatively stronger position

https://jme.bmj.com/content/medethics/46/8/538.full.pdf

Expressivism at the beginning and end of life

Evidence-based crisis standards of care for out-of-hospital cardiac arrests in a pandemic.

In this article I argue that vanity, the desire for and delight in the favorable opinion of others, plays a fundamental role in Hume's account of moral motivation. Hume says that vanity and virtue are inseparable, though he does not explicitly say how or why this should be. I argue that Hume's account of sympathy can explain this alliance. In resting moral sentiment on sympathy, Hume gives a fundamental role to vanity as it becomes either a mediating motive to virtue or else strengthens the otherwise weak motive of moral sentiment.

The Alliance of Virtue and Vanity in Hume's Moral Theory

The practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are no good conceptual or philosophical reasons to avoid the suicide label. I contend that intending one’s death is essential to the nature of suicide, and this intention is normally required on the part of the terminally ill patient when she knowingly takes a life-ending drug. Additionally, the analysis shows that any plausible strategy that avoids the term suicide is counteracted by the way in which advocates of the practice want to make it legal.

Is “aid in dying” suicide?

Situationists contend that virtue ethics is empirically inadequate. However, it is my contention that there is much confusion over what “empirical adequacy” or “empirical inadequacy” actually means in this context. My aim in this paper is to clarify the meanings of empirical adequacy in order to see to what extent virtue ethics might fail to meet this standard. I argue that the situationists frequently misconstrue the empirical commitments of virtue ethics. More importantly, depending on what we mean by empirical adequacy, either virtue ethics has no need to be empirically adequate or where it does have such a need, the psychological evidence fails to show that it is empirically inadequate. An additional contribution the paper intends to make is to provide a more detailed discussion of the explanatory nature of virtue ethics.

Philip A. Reed

Papers

Expressivism at the beginning and end of life

Evidence-based crisis standards of care for out-of-hospital cardiac arrests in a pandemic.

The Alliance of Virtue and Vanity in Hume's Moral Theory

Is “aid in dying” suicide?

Empirical Adequacy and Virtue Ethics