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Gandjour A. Vaccination Mandates, Physically Forced Vaccination, and Rationing in the Intensive Care Unit: Searching for Ethical Coherence in the COVID-19 Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:11-14. [PMID: 35225748 DOI: 10.1080/15265161.2022.2043017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Morris J, Holt J. Applying utilitarianism to the presumed consent system for organ donation to consider the moral pros and cons. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1127-1131. [PMID: 34723668 DOI: 10.12968/bjon.2021.30.19.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In May 2020, England adopted an opt-out approach for organ donation, also referred to as the deemed consent system, with the aim of alleviating the demand for organs in the UK. This system dictates that those who have not opted out will have their organs donated following their death, with the exception of those meeting certain criteria. This article applies the philosophical theory of utilitarianism to the deemed consent system for organ donation, focusing particularly on topics such as that of informed consent and family refusal. Utilitarianism is a consequentialist theory that attempts to determine whether an action is morally right or wrong based on whether or not it maximises the preferences of the greatest number of people, with each person's satisfaction being considered as equal to another's.
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Zimmermann BM, Eichinger J, Baumgartner MR. A systematic review of moral reasons on orphan drug reimbursement. Orphanet J Rare Dis 2021; 16:292. [PMID: 34193232 PMCID: PMC8247078 DOI: 10.1186/s13023-021-01925-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/20/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients suffering from rare diseases, they are usually very expensive. The growing number of approved OMPs increases their budget impact despite their low prevalence, making it pressing to find solutions to ethical challenges on how to fairly allocate scarce healthcare resources under this context. One potential solution could be to grant OMPs special status when considering them for reimbursement, meaning that they are subject to different, and less stringent criteria than other drugs. This study aims to provide a systematic analysis of moral reasons for and against such a special status for the reimbursement of OMPs in publicly funded healthcare systems from a multidisciplinary perspective. RESULTS With a systematic review of reasons, we identified 39 reasons represented in 243 articles (scientific and grey literature) for and against special status for the reimbursement of OMPs, then categorized them into nine topics. Taking a multidisciplinary perspective, we found that most articles came from health policy (n = 103) and health economics (n = 49). More articles took the position for a special status of OMPs (n = 97) than those against it (n = 31) and there was a larger number of reasons identified in favour (29 reasons) than against (10 reasons) this special status. CONCLUSION Results suggest that OMP reimbursement issues should be assessed and analysed from a multidisciplinary perspective. Despite the higher occurrence of reasons and articles in favour of a special status, there is no clear-cut solution for this ethical challenge. The binary perspective of whether or not OMPs should be granted special status oversimplifies the issue: both OMPs and rare diseases are too heterogeneous in their characteristics for such a binary perspective. Thus, the scientific debate should focus less on the question of disease prevalence but rather on how the important variability of different OMPs concerning e.g. target population, cost-effectiveness, level of evidence or mechanism of action could be meaningfully addressed and implemented in Health Technology Assessments.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany.
| | - Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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Hartog ID, Willems DL, van den Hout WB, Scherer-Rath M, Oreel TH, Henriques JPS, Nieuwkerk PT, van Laarhoven HWM, Sprangers MAG. Influence of response shift and disposition on patient-reported outcomes may lead to suboptimal medical decisions: a medical ethics perspective. BMC Med Ethics 2019; 20:61. [PMID: 31510994 PMCID: PMC6737596 DOI: 10.1186/s12910-019-0397-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/25/2019] [Indexed: 01/27/2023] Open
Abstract
Background Patient-reported outcomes (PROs) are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts (changes in interpretation) and dispositions (stable characteristics). Main text We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. Conclusion If influences of response shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used.
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Affiliation(s)
- Iris D Hartog
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Postbus 9103, 6500 HD, Nijmegen, The Netherlands.
| | - Dick L Willems
- Department of Medical Ethics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making & Quality of Care, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Michael Scherer-Rath
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Postbus 9103, 6500 HD, Nijmegen, The Netherlands
| | - Tom H Oreel
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Pillai K, Nallavalli S, Immaculate C. Inexorable transformation in healthcare-seeking behaviour: a paradigm of choice. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2019. [DOI: 10.1108/ijphm-03-2018-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Healthcare is traditionally considered an indispensable service in both personal and social points of views. In this regard, healthcare-seeking behaviour is driven by utilitarian orientation, given its existential value. But this trend is changing, as the propensity to avail (un)necessary healthcare services is burgeoning with changing lifestyle and practices. From the supply point of view, the market appears to be relentless in enforcing propensity to seek healthcare. The service providers, generally, create unnecessary needs and aspirations, taking undue advantage of the prospects’ over-conscious health concerns and overzealous longing for wellness. This study aims to find whether utilitarianism or hedonism is the prominent paradigm of healthcare-seeking behaviour in the onset of changing preferences and lifestyles and supply-driven market forces.
Design/methodology/approach
The study followed an empirical approach to accomplish the aim of research. Subjects for the study constitute sample respondents in the age of 18-60 years, who were identified on inspection. A structured questionnaire, drawn upon literature, was used to elicit information.
Findings
The study offered new insight into the basic psychological motive for healthcare-seeking. The results have empirically validated the pre-eminence of a hedonic attribute of consumer behaviour in healthcare-seeking.
Practical implications
The outcome of the study has implications for healthcare providers to tailor-make their future products and services and for governing bodies to design suitable policy guidelines.
Originality/value
The study explores the emerging trends in health-seeking behaviour.
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Hofmann B, Magelssen M. In pursuit of goodness in bioethics: analysis of an exemplary article. BMC Med Ethics 2018; 19:60. [PMID: 29902999 PMCID: PMC6003140 DOI: 10.1186/s12910-018-0299-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND What is good bioethics? Addressing this question is key for reinforcing and developing the field. In particular, a discussion of potential quality criteria can heighten awareness and contribute to the quality of bioethics publications. Accordingly, the objective of this article is threefold: first, we want to identify a set of criteria for quality in bioethics. Second, we want to illustrate the added value of a novel method: in-depth analysis of a single article with the aim of deriving quality criteria. The third and ultimate goal is to stimulate a broad and vivid debate on goodness in bioethics. METHODS An initial literature search reveals a range of diverse quality criteria. In order to expand on the realm of such quality criteria, we perform an in-depth analysis of an article that is acclaimed for being exemplary. RESULTS The analysis results in eleven specific quality criteria for good bioethics in three categories: argumentative, empirical, and dialectic. Although we do not claim that the identified criteria are universal or absolute, we argue that they are fruitful for fueling a continuous constitutive debate on what is "good bioethics." CONCLUSION Identifying, debating, refining, and applying such criteria is an important part of defining and improving bioethics.
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Affiliation(s)
- Bjørn Hofmann
- The Institute for the Health Sciences, at the Norwegian University for Science and Technology (NTNU), Gjøvik, Norway
- Centre for Medical Ethics, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway
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Gandjour A, Müller D. Ethical objections against including life-extension costs in cost-effectiveness analysis: a consistent approach. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:471-476. [PMID: 25027546 DOI: 10.1007/s40258-014-0112-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
One of the major ethical concerns regarding cost-effectiveness analysis in health care has been the inclusion of life-extension costs ("it is cheaper to let people die"). For this reason, many analysts have opted to rule out life-extension costs from the analysis. However, surprisingly little has been written in the health economics literature regarding this ethical concern and the resulting practice. The purpose of this work was to present a framework and potential solution for ethical objections against life-extension costs. This work found three levels of ethical concern: (i) with respect to all life-extension costs (disease-related and -unrelated); (ii) with respect to disease-unrelated costs only; and (iii) regarding disease-unrelated costs plus disease-related costs not influenced by the intervention. Excluding all life-extension costs for ethical reasons would require-for reasons of consistency-a simultaneous exclusion of savings from reducing morbidity. At the other extreme, excluding only disease-unrelated life-extension costs for ethical reasons would require-again for reasons of consistency-the exclusion of health gains due to treatment of unrelated diseases. Therefore, addressing ethical concerns regarding the inclusion of life-extension costs necessitates fundamental changes in the calculation of cost effectiveness.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Sonnemannstr. 9-11, 60314, Frankfurt am Main, Germany,
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Gandjour A. Theoretical Foundation of Patient v. Population Preferences in Calculating QALYs. Med Decis Making 2010; 30:E57-63. [DOI: 10.1177/0272989x10370488] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The cost-effectiveness of health care interventions is often evaluated using quality-adjusted life years (QALYs) as a measure of outcome. There is a debate on whether QALYs should use patient preferences as opposed to community preferences. This article shows that patient preferences have a theoretical foundation in preference-utilitarian theory and welfare economics. In contrast, this study found no compelling theoretical basis for community preferences. There is a need for further development of a normative framework to inform the choice of preference source.
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Affiliation(s)
- Afschin Gandjour
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, , The James A. Baker Institute for Public Policy, Rice University, Houston, Texas, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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Abstract
Background: Past debate on ethics in goal planning for rehabilitation has tended to focus on tensions that can arise between ethical principles; in particular the principles of autonomy and beneficence. When setting goals, clinicians tend to prioritize the wishes of patients, justifying this from the perspective of maximizing patient autonomy. This is tempered by consideration of what is `realistic' and what the pursuit of `unrealistic goals' might be on patient well-being. Rationale: In this paper it is argued that clinicians also have an ethical obligation to take into account the resource implications of goal planning. Utilitarianism provides one perspective on addressing such issues. A utilitarian approach to goal planning would necessitate a focus on maximizing the benefits of rehabilitation to the whole community served when negotiating goals with individual patients. Critique: Clinicians may, however, have a number of concerns about utilitarianism. One assumption is that the quality of life of people with severe disability will be judged as being intrinsically low, and therefore valued less from a utilitarian perspective. A second assumption is that for people with severe disability the large effort expended in rehabilitation to achieve small gains cannot possibly repay itself in a utilitarian equation, specifically in financial terms. Evidence from the literature however has demonstrated that in fact both of these assumptions are probably false. Conclusion: Rehabilitation professionals should not be hesitant to consider utilitarianism as an ethical framework for rehabilitation. In fact, rehabilitation may well gain if people were to use this approach.
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Affiliation(s)
- William MM Levack
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand,
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Hom GG, Chous AP. The prospect of pandemic influenza: why should the optometrist be concerned about a public health problem? OPTOMETRY (ST. LOUIS, MO.) 2007; 78:629-43. [PMID: 18054133 PMCID: PMC7106072 DOI: 10.1016/j.optm.2007.04.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 04/23/2007] [Accepted: 04/25/2007] [Indexed: 11/05/2022]
Abstract
BACKGROUND Optometrists are uniquely placed in the health care field because they provide both services as well as goods to patients. In the event of an influenza pandemic, optometrists may be challenged with a host of issues, including impediments to clinical patient care, manufacture and delivery of ophthalmic devices, and maintaining business continuity and infection control. OVERVIEW This report reviews pandemic influenza, the effect of a pandemic event on business survival, and response measures for the primary eye care provider. The ethical and legal issues surrounding control of a pandemic influenza and the prospect of telemedicine as a form of social distancing are also discussed. CONCLUSIONS Knowledge of the pharmacologic and nonpharmacologic measures to control a pandemic influenza will help prepare the eye care provider for addressing challenges to patient care and business continuity in the face of a highly contagious disease. Understanding the legal and ethical issues that arise during a pandemic event will help optometrists make informed choices as health care professionals and as citizens.
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Abstract
In this article, we argue that the scope of bioethical debate concerning justice in health should expand beyond the topic of access to health care and cover such issues as occupational hazards, safe housing, air pollution, water quality, food and drug safety, pest control, public health, childhood nutrition, disaster preparedness, literacy, and many other environmental factors that can cause differences in health. Since society does not have sufficient resources to address all of these environmental factors at one time, it is important to set priorities for bioethical theorizing and policy formation. Two considerations should be used to set these priorities: (1) the impact of the environmental factor on health inequality, and (2) the practicality of addressing the factor.
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Affiliation(s)
- David B Resnik
- National Institute of Environmental Health Sciences, National Institutes of Health, Box 12233, Mail Drop NH 06, Research Triangle Park, NC 27709, USA.
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McEvoy P, Richards D. Gatekeeping access to community mental health teams: a qualitative study. Int J Nurs Stud 2006; 44:387-95. [PMID: 16843468 DOI: 10.1016/j.ijnurstu.2006.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 05/13/2006] [Accepted: 05/21/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gatekeeping access to services at the interface with primary care has been identified as one of the key issues that community mental health teams (CMHTs) have to confront. OBJECTIVES The aim of this study was to develop a better understanding of the contextual influences that impact upon the outcome of gatekeeping decisions. DESIGN An interview-based qualitative study, informed by the philosophy of critical realism. SETTING An urban catchment area in Northern England. PARTICIPANTS Twenty-nine interviews were conducted with gatekeeping clinicians and service managers. METHOD A convenience sample of clinicians was initially approached to take part in a series of semi-structured interviews. This was followed up by a purposive sample of clinicians and service managers, as specific contextual influences were identified and explored in detail. The emerging analysis was then subjected to critical scrutiny by a further sample of gatekeeping clinicians. FINDINGS A clear hierarchy of appropriateness was identified with four dimensions: severity, risk, beneficence and a moral dimension. It was suggested that the salient contextual influences that shaped the hierarchy were: (a) the need to fit in with strategic planning directives, (b) the burden of responsibility that clinicians carried, (c) the high number of referrals and the relatively slow turnover of patients on clinical caseloads, (d) the position of CMHTs in the economy of care and (e) the character of the relationship between clinicians and service managers. CONCLUSION The findings from the study support a multi-level view of the gatekeeping process within CMHTs, which takes account of the role that key contextual influences play in shaping the range of options that are available to gatekeeping clinicians.
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Affiliation(s)
- Phil McEvoy
- Salford PCT/University of Manchester, Manchester, UK.
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Clará A, Merino J, Mateos E, Ysa A, Román B, Vidal-Barraquer F. The vascular surgeon facing clinical ethical dilemmas (the VASCUETHICS Study): 'V'-shaped association between compassionate attitudes and professional seniority. Eur J Vasc Endovasc Surg 2006; 31:594-9. [PMID: 16413800 DOI: 10.1016/j.ejvs.2005.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2005] [Accepted: 11/08/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the association between compassionate attitudes and seniority in vascular surgeons facing clinical ethical dilemmas (CED). SUBJECTS AND METHODS (1) DESIGN: Cross-sectional. (2) SUBJECTS: Vascular surgeons (residents included) from the 28 vascular teaching departments of one European country. (3) MEASUREMENTS: Multidisciplinary team-designed, structured and self-administered questionnaire consisting of five clinical ethical dilemmas, of which four had conflict between compassion towards a 'small' or 'very costly' beneficial action vs. a reasonable but more 'pragmatic' allocation of health resources. Participants stated their degree of agreement with eight answers representing the two attitudes on a continuous scale. (4) STATISTICS: Cluster analysis and logistic regression model adjusted by confounding factors. RESULTS Two hundred and fifty three vascular surgeons (median age 37 years, 74% male) from the 26 participating teaching vascular departments (public hospitals) completed the questionnaire (88% surgeons/department). Cluster analysis identified two groups of surgeons according to their pattern of answers: Group I (n=63) were mainly compassionate whereas Group II (n=180) were mainly pragmatic. The multivariate analysis disclosed, after adjusting for additional private practice, on call services and career status, a significant V-shaped relationship between the compassionate behaviour and seniority. Surgeons with 8-15 years experience were the least compassionate. CONCLUSIONS The youngest and the most senior vascular surgeons were more prone to favour compassionate attitudes when facing clinical ethical dilemmas. Although both compassionate and pragmatic attitudes may be legitimate ethically, physicians not favouring compassion may be at risk of leaving the patient without an advocate within the health care system.
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Affiliation(s)
- A Clará
- Vascular Surgery Department, Hospital del Mar, Barcelona, Spain.
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