Trees architectural study shows gradients in the meristematic activity. This activity is described by the number of internodes per growth unit, which is considered as the output of a dynamic random process. Several species were observed, which led us to propose and then estimate some mathematical models. Computing the functioning of a tree in a given environment therefore involves finding the probability function of the meristems and following the evolution of the parameters of this law along the botanical gradients (order, (...) trend, acrotony) within its architecture. (shrink)

Animal and human studies suggest that parenting style is transmitted from one generation to the next. The hypotheses of this study were that a mother’s rearing experiences would predict her own parenting resources and current maternal mood, motivation to care for her offspring, and relationship with her parents would underlie this association. In a subsample of 201 first-time mothers participating in the longitudinal Maternal Adversity, Vulnerability and Neurodevelopment project, we assessed a mother’s own childhood maltreatment and rearing experiences using the (...) Childhood Trauma Questionnaire and the Parental Bonding Instrument. At 6 months postpartum, mothers completed questionnaires on parenting stress, symptoms of depression, maternal motivation, and current relationship with their own parents. The sample consisted of mostly high socioeconomic status mothers recruited from Montréal or Hamilton, Canada, with an age range from 18 to 43 years. More severe maltreatment and less supportive rearing by the mother’s parents predicted increased parenting stress at 6 months. These associations were mediated through distinct psychosocial pathways: maltreatment on parenting stress through symptoms of depression ; maternal rearing on parenting stress through maternal motivation and symptoms of depression ; and paternal rearing on parenting stress through current relationship with the father. Maternal rearing experiences predict a mother’s own parenting resources though distinct psychosocial pathways, including depressed mood, maternal motivation, and social support. (shrink)

Animal and human studies suggest that parenting style is transmitted from one generation to the next. The hypotheses of this study were that a mother’s rearing experiences would predict her own parenting resources and current maternal mood, motivation to care for her offspring, and relationship with her parents would underlie this association. In a subsample of 201 first-time mothers participating in the longitudinal Maternal Adversity, Vulnerability and Neurodevelopment project, we assessed a mother’s own childhood maltreatment and rearing experiences using the (...) Childhood Trauma Questionnaire and the Parental Bonding Instrument. At 6 months postpartum, mothers completed questionnaires on parenting stress, symptoms of depression, maternal motivation, and current relationship with their own parents. The sample consisted of mostly high socioeconomic status mothers recruited from Montréal or Hamilton, Canada, with an age range from 18 to 43 years. More severe maltreatment and less supportive rearing by the mother’s parents predicted increased parenting stress at 6 months. These associations were mediated through distinct psychosocial pathways: maltreatment on parenting stress through symptoms of depression ; maternal rearing on parenting stress through maternal motivation and symptoms of depression ; and paternal rearing on parenting stress through current relationship with the father. Maternal rearing experiences predict a mother’s own parenting resources though distinct psychosocial pathways, including depressed mood, maternal motivation, and social support. (shrink)

A travers une phénoménologie où l'art éclaire le réel, à travers son choix des auteurs et des oeuvres qu'il a commentés, le philosophe Henri Maldiney (1912-2013) a proposé un décentrement du regard et du savoir propres à renouveler l'étude du paysage. Il part d'une question trompeusement simple : sommes-nous "devant" ou "dedans" le paysage? Comment s'approche le paysage? Comment se fait-il image? Ce recueil présente une pensée complexe de manière accessible à tous les spécialistes et les passionnés de littérature et (...) d'études visuelles. Exemples littéraires, picturaux et photographiques, témoignent de la fécondité d'une pensée fondée sur l'aisthèsis, la présence et le rythme."--Page 4 of cover. (shrink)

The federal government's introduction in 1983 of DRG‐based reimbursement for Medicare patients shook the entire health care industry into the vigorous and dramatic cost containment efforts which today are reshaping health care in America.

In response to rapidly rising health care costs in the United States, federal and state governments and private industry are instituting numerous and diverse cost-containment plans. As devices for coping with a scarcity of resources, such plans present serious challenges to physicians' traditional single-minded devotion to patient welfare. Those which contain costs by directly limiting medical options or by controlling physicians' daily clinical decisions can threaten the quality of medical care by allowing economic authorities to make essentially medical judgments. In (...) contrast, other plans coax compliance by arranging incentives, e.g., offering financial rewards for successful cost containment. While they allow for clinical freedom, these plans create conflicts between physicians' fiduciary obligations to their patients and the competing interests of the payers. Such conflicts arise as physicians try to work within governmental or corporate cost containment policies, and also as they attempt to streamline clinical efficiency. Throughout, issues of justice emerge as physicians seek to reconcile their own patients' claims upon limited common resources with others' equally legitimate claims. (shrink)

Cost‐containment pressures impose fiscal responsibilities upon physicians that can conflict with their fiduciary commitment to patients. Should the law permit health care providers to adjust standards of care according to patients' financial resources? The legal concept of “rebuttable presumption” should be used to reconceive the traditional requirement of a uniform standard of care.

The moral significance of preserving natural environments is not entirely an issue of rights and social utility, for a person’s attitude toward nature may be importantly connected with virtues or human excellences. The question is, “What sort of person would destroy the natural environment--or even see its value solely in cost/benefit terms?” The answer I suggest is that willingness to do so may well reveal the absence of traits which are a natural basis for a proper humility, self-acceptance, gratitude, and (...) appreciation of the good in others. (shrink)

Universal access to health care is still a dream rather than a reality in the United States. This is partly because a rule of rescue, by impelling us to help people in need, urges us to ignore the limits of our health care policies wherever those limits would adversely affect a given individual. As the rule of rescue undermines whatever limits we set on health care entitlements, it can thwart the cost containment so essential to expanding access. Rather than accept (...) unlimited expense, we have thus far declined to universalize health care. The situation is exacerbated by an economic insulation shielding patients and physicians from the costs of care, prompting both to regard health care as free, an unlimited right. To reverse this costly entitlement mentality and place reasonable limits on rescue, patients must exercise greater personal responsibility for the costs of their care by directly experiencing some of the economic consequences of their health care decisions. Several mechanisms are available to accomplish this goal without posing economic barriers to needed care or penalizing people for becoming ill. Keywords: Clinton health plan, rationing, rule of rescue CiteULike Connotea Del.icio.us What's this? (shrink)

There has been much discussion of changing agricultural structure in the United States. In this paper, the author reviews some of the factors contributing to structural change in the United States and describes the policies adopted by the European Community with respect to agricultural structure. The European experience with structural policies suggests that this approach is not very promising for the United States where no specific structural policies exist. The argument developed in this paper is that structural changes in agriculture (...) are simply one example of economic adjustment in a capitalist economy, that economic adjustments are generally desirable although they are not costless, and that discussions of agricultural structure should focus on methods to alleviate the costs of adjustment rather than on efforts to prevent change. (shrink)

Tort and contract law have not kept pace with the stunning changes in medicine's economics. Physicians are still expected to deliver the same standard of care to everyone, regardless whether it is paid for. Health plans increasingly face liability for unfortunate outcomes, even those stemming from society's mandate to keep costs down while improving population health. This book sorts through the chaos. After reviewing the inadequacies of current tort and contract law, Morreim proposes that an intelligent assignment of legal liability (...) must rest on an intelligent division of labor between health plans and providers, beginning with the question "who should be doing what, for the best delivery of health care." She also provides a comprehensive reference source of case law, commentary, and empirical literature. (shrink)

This article proposes a geostatistical solution for area-to-point spatial prediction (downscaling) taking into account boundary effects. Such effects are often poorly considered in downscaling, even though they often have significant impact on the results. The geostatistical approach proposed in this article considers two types of boundary conditions (BC), that is, a Dirichlet-type condition and a Neumann-type condition, while satisfying several critical issues in downscaling: the coherence of predictions, the explicit consideration of support differences, and the assessment of uncertainty regarding the (...) point predictions. An updating algorithm is used to reduce the computational cost of area-to-point prediction under a given BC. In a case study, area-to-point prediction under a Dirichlet-type BC and a Neumann-type BC is illustrated using simulated data, and the resulting predictions and error variances are compared with those obtained without considering such conditions. (shrink)

In QALY-thinking, an activity that takes N people from a bad state (including 'dying') to the state of healthy for X years should have priority over an activity that takes N other people from the same bad state to a state of moderate illness for the same number of years (given equal costs). An empirical study indicates that this view may not be shared by the general public in Norway. Subjects tended to emphasise equality in value of life and in (...) entitlement to treatment rather than level of health after treatment. The relevance of costs per QALY in prioritising between different health care programmes in Norway is thereby brought in to doubt. While the sample in the study is too small to support firm policy conclusions, the results should contribute to an increased interest among health economists in actually measuring people's ethical preferences in matters of prioritising, rather than taking it for granted that their own values are shared by the general public. (shrink)

This book brings together in one place the work of one of our most respected economic theorists, on a field in which he has played a large part in originating: the New Institutional Economics. Transaction cost economics, which studies the governance of contractual relations, is the branch of the New Institutional Economics with which Oliver Williamson is especially associated.Transaction cost economics takes issue with one of the fundamental building blocks in microeconomics: the theory of the firm. Whereas orthodox economics describes (...) the firm in technological terms, as a production function, transaction cost economics describes the firm in organizational terms, as a governance structure. Alternative feasible forms of organization--firms, markets, hybrids, bureaus--are examined comparatively. The analytical action resides in the details of transactions and the mechanisms of governance.Transaction cost economics has had a pervasive influence on current economic thought about how and why institutions function as they do, and it has become a practical framework for research in organizations by representatives of a variety of disciplines. Through a transaction cost analysis, The Mechanisms of Governance shows how and why simple contracts give way to complex contracts and internal organization as the hazards of contracting build up. That complicates the study of economic organization, but a richer and more relevant theory of organization is the result. Many testable implications and lessons for public policy accrue to this framework. Applications of both kinds are numerous and growing.Written by one of the leading economic theorists of our time, The Mechanisms of Governance is sure to be an important work for years to come. It will be of interest to scholars and students of economics, organization, management, and law. (shrink)

Despite its theoretical importance, little is known about how semantic memory structure facilitates and constrains creative idea generation. We examine whether the semantic richness of a concept has both benefits and costs to creative idea generation. Specifically, we tested whether cue set size—an index of semantic richness reflecting the average number of elements associated with a given concept—impacts the quantity (fluency) and quality (originality) of responses generated during the Alternate Uses Task (AUT). Across four studies, we show that low-association, sparse, (...) AUT cues benefit originality at the cost of fluency compared to high-association, rich, AUT cues. Furthermore, we found an interaction with individual differences in fluid intelligence in the low-association AUT cues, suggesting that constraints of sparse semantic knowledge can be overcome with top-down intervention. Our findings indicate that semantic richness differentially impacts the quality and quantity of generated ideas, and that cognitive control processes can facilitate idea production when conceptual knowledge is limited. (shrink)

The Common Agricultural Policy (CAP) of the European Community (EC) has been criticized for causing a misallocation of resources, inequitable income transfers, and enormous budgetary costs. The purpose of this paper is to examine the political economy of agriculture and agricultural policy in the EC. The results of the analysis indicate that conflicts between national political objectives and broader, community-wide concerns are important factors in the performance of EC agriculture. The pressures for reform of the CAP will lead to modification (...) of the system, but changes in EC agricultural policy are likely to be moderate because of the inherent inertia of the policy-making process. As a result, the agricultural system in the EC will probably continue to evolve in an atmosphere of crisis with most reforms directed at symptoms rather than fundamental problems. (shrink)

Two experiments examine the effects of unreportable hints on anagram solving performance and on solvers' subjective experience of insight. In Experiment 1, after seeing a hint presented too briefly to identify, participants solved anagrams preceded by the solution fastest and solved anagrams preceded by unrelated hints slowest. Participants' “warmth” ratings for solution hints were more insight-like than those for unrelated hints. In Experiment 2 a hint, or no hint, was presented at one of three different exposure durations . Participants benefited (...) from solution-relevant hints that were either unreportable or reportable, but showed a cost only for unrelated hints that were reportable. Participants' ratings of their insight experiences showed that unreportable solution and semantically related hints produced more insight-like experiences than did unrelated hints. The results suggest that unreportable processing of solution-related information is important for the insight experience. (shrink)

This paper examines the UK’s response to a recent European Clinical Trials Directive, namely the Department of Health, Central Office for Research Ethics Committee guidance, Governance Arrangements for NHS Research Ethics Committees. The revisions have been long awaited by researchers and research ethics committee members alike. They substantially reform the ethical review system in the UK. We examine the new arrangements and argue that though they go a long way toward addressing the uncertainty surrounding ethics committee function, the system favours (...) the facilitation of research over the protection of the dignity and welfare of research participants. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

Suppose that you prefer A to B, B to C, and C to A. Your preferences violate Expected Utility Theory by being cyclic. Money-pump arguments offer a way to show that such violations are irrational. Suppose that you start with A. Then you should be willing to trade A for C and then C for B. But then, once you have B, you are offered a trade back to A for a small cost. Since you prefer A to B, you (...) pay the small sum to trade from B to A. But now you have been turned into a money pump. You are back to the alternative you started with but with less money. This Element shows how each of the axioms of Expected Utility Theory can be defended by money-pump arguments of this kind. The Element also defends money-pump arguments from the standard objections to this kind of approach. This title is also available as Open Access on Cambridge Core. (shrink)

Professor Hall is to be congratulated on his thoughtful analysis of an issue that, as he rightly suggests, “is one of the most important issues that will confront health care tort law throughout the remainder of the century.”’ He argues that malpractice law currently can accommodate considerable latitude both for a conservative streamlining of medical practices in general and for a cost-sensitivity in individual treatment decisions. And he further argues that existing tort principles, such as the locality rule, can comfortably (...) be stretched to embrace still greater room for economics in the medical standard of care. I quite agree.Unfortunately, Hall's arguments do not go nearly far enough, for they are framed around a seriously oversimplified picture of the economic changes that are revolutionizing medicine in the United States. He envisions a fairly uniform, global set of resource constraints that generally pressure physicians to conserve on care—pressures that tort law can then encompass equally globally as it accepts more cost-efficient standards of care. However, neither the changing economics of medicine nor the resulting jurisprudential challenges are anywhere near this generalized. (shrink)

The moral significance of preserving natural environments is not entirely an issue of rights and social utility, for a person’s attitude toward nature may be importantly connected with virtues or human excellences. The question is, “What sort of person would destroy the natural environment--or even see its value solely in cost/benefit terms?” The answer I suggest is that willingness to do so may well reveal the absence of traits which are a natural basis for a proper humility, self-acceptance, gratitude, and (...) appreciation of the good in others. (shrink)

The fitness of any evolutionary unit can be understood in terms of its two basic components: fecundity (reproduction) and viability (survival). Trade-offs between these fitness components drive the evolution of life-history traits in extant multicellular organisms. We argue that these trade-offs gain special significance during the transition from unicellular to multicellular life. In particular, the evolution of germ–soma specialization and the emergence of individuality at the cell group (or organism) level are also consequences of trade-offs between the two basic fitness (...) components, or so we argue using a multilevel selection approach. During the origin of multicellularity, we study how the group trade-offs between viability and fecundity are initially determined by the cell level trade-offs, but as the transition proceeds, the fitness trade-offs at the group level depart from those at the cell level. We predict that these trade-offs begin with concave curvature in single-celled organisms but become increasingly convex as group size increases in multicellular organisms. We argue that the increasingly convex curvature of the trade-off function is driven by the cost of reproduction which increases as group size increases. We consider aspects of the biology of the volvocine green algae – which contain both unicellular and multicellular members – to illustrate the principles and conclusions discussed. (shrink)

Changes in global patterns of grain production have affected the profitability of commercial, cash-crop agriculture in North America. The current financial crisis has highlighted a perceived conflict between the priorities of (1) strengthening net farm profit, (2) maintaining the productive potential of the land base, (3) enhancing the health and cohesiveness of the agricultural community, and (4) addressing societal demands for safe foodstuffs. Reducing input costs by reducing the need for privately owned machinery can minimize the scale-dependence of agricultural practices, (...) as illustrated with examples involving silage and intensively managed pasture in Ontario. This approach could improve farming opportunities for nontraditional, part-time farmers, and at the same time, create a niche for professional custom operators and managers. Enhancing the viability of nontraditional farm operations, a historically neglected component of the farming community, as well as commercial farms is viewed as one approach to sustaining and improving both the agricultural land base and the agricultural community. Applying resource-extensive rather than resource-intensive approaches to forage management reveals that these apparently divergent priorities are, in fact, interlocking pieces of the same puzzle. (shrink)

Within Piaget there is an implicit theory of the development of explicit memory. It rests in the dynamical trajectory underlying the development of causality, object, space and time – a complex (COST) supporting a symbolic relationship integral to the explicit. Cassirer noted the same dependency in the phenomena of aphasias, insisting that a symbolic function is being undermined in these deficits. This is particularly critical given the reassessment of Piaget’s stages as the natural bifurcations of a self-organizing dynamic system. The (...) elements of a theoretical framework required to support explicit memory are developed, to include, (1) the complex developmental trajectory supporting the emergence of the explicit in Piaget, (2) the concrete dynamical system and the concept of a non-differentiable time contained in Bergson’s theory required to support a conscious, as opposed to an implicit remembrance, (3) the relation to current theories of amnesia, difficulties posed by certain retrograde amnesic phenomena, the role of the hippocampus and limitations of connectionist models, (4) the fact that nowhere in this overall framework does the loss of explicit memory imply or require the destruction of experience “stored in the brain.”. (shrink)

The aim of the paper is to prove the consistency of libertarianism. We examine the example of Jane, who deliberates at length over whether to vacation in Colorado (C) or Hawaii (H), weighing the costs and benefits, consulting travel brochures, etc. Underlying phenomenological deliberation is an indeterministic neural process in which nonactual motor neural states n(C) and n(H) corresponding to alternatives C and H remain physically possible up until the moment of decision. The neurophysiological probabilities pr(n(C)) and pr(n(H)) evolve continuously (...) according to the different weights Jane's judgement attaches to C and H at different times during the deliberation. The overall process is indeterministic, since Jane's exact judgemental weighting would vary slightly were the process to be repeated from the same initial conditions. The weighting is however rational, and entirely under Jane's control. This controlled, rational, indeterministic process shows that libertarianism is a consistent philosophical thesis. (shrink)

The financial Crunch of 2008 was easily explained by both the left and right–too easily. Each insisted that events thoroughly confirmed its own long-held views and utterly refuted those of the opposed camp. This essay argues that there are indeed new lessons to be drawn from the Crunch, lessons that involve balancing the bounty of the Invisible Hand against perils of the Prisoner's Dilemma. Liberal moral imperatives are traced to variables of Personal Choice and External Cost that are typically in (...) tension with each other and thus generate needs for institutional reconstructions that change according to time and circumstance. Personal bankruptcy protection, limited liability corporations, and intellectual property are cited as examples. It is argued that the Crunch occurred because of failure adequately to balance these variables. Three paradoxes came to a head in 2008: Paradox of Efficient Markets; Paradox of Reduced Risk; Paradox of Hard-won Knowledge. The essay concludes with suggestions concerning specific lessons to be drawn from the Crunch and a corresponding list of lessons not to be drawn. (shrink)

In recent years a number of commentators have discussed the importance of measuring quality of life in health care. We want to know whether an intervention will help people to live better, not just longer, and whether some treatments cause more trouble than they are worth. New technologies promise wondrous benefits. But when millions of people have no insured access to health care, and when many others face increasingly stringent limits on care, technologies’ high costs require us to choose what (...) we should do from the broader universe of what we can do.The challenges to measuring QL are formidable. Researchers debate whether to measure general QL or disease-specific QL; whether to focus on functional status such as the patient's ability to walk and dress himself, or on the value people ascribe to that functional status; whether to seek the values of the general public, or to concentrate on people actually affected by a given disease or disability. (shrink)

In recent years a number of commentators have discussed the importance of measuring quality of life in health care. We want to know whether an intervention will help people to live better, not just longer, and whether some treatments cause more trouble than they are worth. New technologies promise wondrous benefits. But when millions of people have no insured access to health care, and when many others face increasingly stringent limits on care, technologies’ high costs require us to choose what (...) we should do from the broader universe of what we can do.The challenges to measuring QL are formidable. Researchers debate whether to measure general QL or disease-specific QL; whether to focus on functional status such as the patient's ability to walk and dress himself, or on the value people ascribe to that functional status; whether to seek the values of the general public, or to concentrate on people actually affected by a given disease or disability. (shrink)

This book brings together in one place the work of one of our most respected economic theorists, on a field in which he has played a large part in originating: the New Institutional Economics. Transaction cost economics, which studies the governance of contractual relations, is the branch of the New Institutional Economics with which Oliver Williamson is especially associated.Transaction cost economics takes issue with one of the fundamental building blocks in microeconomics: the theory of the firm. Whereas orthodox economics describes (...) the firm in technological terms, as a production function, transaction cost economics describes the firm in organizational terms, as a governance structure. Alternative feasible forms of organization--firms, markets, hybrids, bureaus--are examined comparatively. The analytical action resides in the details of transactions and the mechanisms of governance.Transaction cost economics has had a pervasive influence on current economic thought about how and why institutions function as they do, and it has become a practical framework for research in organizations by representatives of a variety of disciplines. Through a transaction cost analysis, The Mechanisms of Governance shows how and why simple contracts give way to complex contracts and internal organization as the hazards of contracting build up. That complicates the study of economic organization, but a richer and more relevant theory of organization is the result. Many testable implications and lessons for public policy accrue to this framework. Applications of both kinds are numerous and growing.Written by one of the leading economic theorists of our time, The Mechanisms of Governance is sure to be an important work for years to come. It will be of interest to scholars and students of economics, organization, management, and law. (shrink)

Bracket out the wrong of committing a wrong, or conspiring or colluding or conniving with others in their committing one. Suppose you have done none of those things, and you find yourself merely benefiting from a wrong committed wholly by someone else. What, if anything, is wrong with that? What, if any, duties follow from it? If straightforward restitution were possible — if you could just ‘give back’ what you received as a result of the wrongdoing to its rightful owner (...) — then matters are morally more straightforward. But in real-world cases that is often impossible, and questions of ‘how much, from whom and to whom?’ become far more vexing. The beneficiary disgorging all benefits of the wrong is part of the story, but where that is not possible or will not suffice to compensate the victim of wrongdoing we discuss various ways of allocating the cost of making the victim whole, including supplementation from public coffers. (shrink)

In 2008 New Zealand's pharmaceutical management agency, PHARMAC, made its final decision on the funding of trastuzumab (Herceptin) for HER2-positive early stage breast cancer. PHARMAC declined to fund the 12-month Herceptin regimen requested by the drug's manufacturer, funding instead a 9-week treatment regimen. The decision was justified on the grounds that there was insufficient evidence of additional long-term health benefits from the longer treatment course, which, coupled with the high cost of the drug, did not make the 12-month regimen sufficiently (...) cost-effective. This paper examines the criticism of PHARMAC's decision that ultimately led to the government's decision to expand the health budget in order to fund the 12-month regimen. It defends PHARMAC's decision against the charge of unfairness, arguing that for high-cost drugs with limited proven effectiveness it is not unfair to deny funding on grounds of cost-effectiveness, since although some moral priority must be given to helping those with serious diseases like breast cancer, the capacity of such drugs to swamp health care budgets is itself a significant moral issue. It concludes that the decision to expand the health budget to pay for Herceptin exacerbates rather than solves the political and moral problems involved in prioritizing health care resources. (shrink)

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state, cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization. Similarly, Baby K was an anencephalic infant whose mother, believing that all (...) life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer. (shrink)

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state, cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization. Similarly, Baby K was an anencephalic infant whose mother, believing that all (...) life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer. (shrink)

This newly revised edition of Bonhoeffer's classic statement of the Christian life contains the full text of Bonhoeffer's Nachfolge.--F. E. B.

ABSTRACT Medicines that are vital for the saving and preserving of life in conditions of public health emergency or endemic serious disease are known as essential medicines. In many developing world settings such medicines may be unavailable, or unaffordably expensive for the majority of those in need of them. Furthermore, for many serious diseases (such as HIV/aids and tuberculosis) these essential medicines are protected by patents that permit the patent‐holder to operate a monopoly on their manufacture and supply, and to (...) price these medicines well above marginal cost. Recent international legal doctrine has placed great stress on the need to globalise intellectual property rights protections, and on the rights of intellectual property rights holders to have their property rights enforced. Although international intellectual property rights law does permit compulsory licensing of protected inventions in the interests of public health, the use of this right by sovereign states has proved highly controversial. In this paper I give an argument in support of states’ sovereign right to expropriate private intellectual property in conditions of public health emergency. This argument turns on a social contract argument for the legitimacy of states. The argument shows, further, that under some circumstances states are not merely permitted compulsory to license inventions, but are actually obliged to do so, on pain of failure of their legitimacy as sovereign states. The argument draws freely on a loose interpretation of Thomas Hobbes's arguments in his Leviathan, and on an analogy between his state of War and the situation of public health disasters. (shrink)

Software plays an important role in contemporary research. Aside from its use for administering traditional instruments like surveys and in data analysis, the widespread use of mobile and web apps for social, medical and lifestyle engagement has led to software becoming a research intervention in its own right. For example, it is not unusual to find apps being studied for their utility as interventions in health and social life. Since the software may persist in use beyond the life of an (...) investigation, this raises questions as to the extent of ethical duties for researchers involved in its production and/or study towards the participants involved. Key factors identified include the extent of affect created by the software, the effect it has on a participant’s life, the length of investigation, cost of maintenance and participant agency. In this article we discuss the issues raised in such situations, considering them in the context of post-research duties of care and suggesting strategies to balance the burden on researchers with the need for ongoing participant support. (shrink)

The aim of the paper is to prove the consistency of libertarianism. We examine the example of Jane, who deliberates at length over whether to vacation in Colorado (C) or Hawaii (H), weighing the costs and benefits, consulting travel brochures, etc. Underlying phenomenological deliberation is an indeterministic neural process in which nonactual motor neural states n(C) and n(H) corresponding to alternatives C and H remain physically possible up until the moment of decision. The neurophysiological probabilities pr(n(C)) and pr(n(H)) evolve continuously (...) according to the different weights Jane's judgement attaches to C and H at different times during the deliberation. The overall process is indeterministic, since Jane's exact judgemental weighting would vary slightly were the process to be repeated from the same initial conditions. The weighting is however rational, and entirely under Jane's control. This controlled, rational, indeterministic process shows that libertarianism is a consistent philosophical thesis. (shrink)

As managed care organizations provide an increasing proportion of citizens' health care, the move toward asking individuals to help control costs by taking more responsibility for their health is likely to intensify. Economic, medical, and legal responses to lifestyle‐induced health care costs raise concerns as well as possibilities for using resources responsibly.

Innovations in web technologies, data warehousing and data mining enable Internet marketers to collect, process and analyze personal data gathered from web users browsing and online purchase habits on a much greater scale as it is now quicker and more economical to do so. Recent surveys indicate that consumers are not comfortable with these practices, especially when the data is collected or sold without their consent. The resulting conflict of interest demands a solution. In this paper, a framework of incomplete (...) markets, property rights and transaction costs is used to analyze the problem and propose some preliminary solutions. (shrink)