In his 1970s work Chance and Necessity, Jacques Monod provided an explanatory framework not only for the biological evolution of species, but, as has become recently apparent, for the evolutionary development of cancers. That is, contemporary oncological research has demonstrated that cancer is an evolutionary disease that develops according to the same dynamics of chance and necessity at work in all evolutionary phenomena. And just as various challenges are raised for religious thought by the operations of chance and necessity within (...) biological evolution, so this particular theological question is raised by the findings of contemporary cancer science: Where is love, divine and human, within the evolutionary chance and necessity operative in all dimensions of cancer? In this article, we contribute to the dialogue in science and religion by offering the following responses to this question: the thought of Arthur Peacocke to claim that divine love may be understood to be at work in, with, and under our very efforts to make theological meaning of the chance and necessity that inform the evolution of cancers; and Charles Sanders Peirce's evolutionary philosophy to make this claim: that the work of scientific communities of inquiry to understand and to find better ways to cope with the disease of cancer is itself the work of divine love amid the chance and necessity of cancer. (shrink)

Abstract:The American College of Physicians in its ethics manual endorsed the idea that physicians ought to improve their ability to provide care to their patients more parsimoniously. This elicited a critical backlash; critics essentially claimed that what was being endorsed was a renamed form of rationing. In a recent article, Tilburt and Cassel argued that parsimonious care and rationing are ethically distinct practices. In this essay I critically assess that claim. I argue that in practice there is considerable overlap between (...) what they term parsimonious care and what they define as rationing. The same is true of the Choosing Wisely campaign endorsed by the American Board of Internal Medicine. In both cases, if the goal is to control healthcare costs by reducing the use of marginally beneficial care that is not cost effective, then a public conversation about the justness of specific choices is essential. (shrink)

The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).

The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).

Thought-intrusions, automatic inferences, and other unintended thought are beginning to play an important role in the study of psychiatric disease as well as normal thought processes. We examine one method for study of task-unrelated imagery and thought . TUIT likelihood was shown to be reliably measured over a wide range of vigilance tasks, to have high short-term and long-term test-retest reliability, and to be sensitive to information processing demands. Likelihood of TUITs was shown to be different as a function of (...) aging, hyperactivity, time of day, and level of depression. Thus, we now can reliably measure the influence of endogenous and exogenous influences on TUITs. In addition, TUIT measurement was proposed as a minimally interfering and natural second task for determining resource utilization in a primary task. Finally, this method was offered as a reliable approach to quantification of such mental states as obsessions and drug craving and addiction. (shrink)

It is shown that many different problems have the same degree of unsolvability. Among these problems are: THE INDUCTIVE INFERENCE PROBLEM. Infer in the limit an index for a recursive function f presented as f(0), f(1), f(2),.... THE RECURSIVE INDEX PROBLEM. Decide in the limit if i is the index of a total recursive function. THE ZERO NONVARIANT PROBLEM. Decide in the limit if a recursive function f presented as f(0), f(1), f(2),... has value unequal to zero for infinitely many (...) arguments. Finally, it is shown that these unsolvable problems are strictly easier than the halting problem. (shrink)

If we accept the premise that some sort of rationing of access to health care resources is necessary to contain escalating health care costs effectively, then we need to ask how that rationing might be accomplished most fairly. Calabresi and Bobbitt have argued in their book Tragic Choices that there is no 'perfectly fair' or even 'reasonably fair' way to bring this about.

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic (...) cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) (...) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research. (shrink)

Few in our society believe that access to health care should be determined primarily by ability to pay. We believe instead that society has an obligation to assure access to adequate health care for all. This is the view explicitly endorsed in the President's Commission Report Securing Access to Health Care. But there is an important moral ambiguity here, for this obligation may be construed as being either beneficence-based or justice -based. A beneficience-based construal would yield a much weaker obligation (...) with respect to the distribution of health care. In the first section of this paper I argue that the President's Commission is committed only to this weaker construal of this obligation. In the second section I argue that such a beneficence-based obligation is really rooted in a libertarian conception of justice, similar to that recently articulated by Engelhardt, and that this conception is seriously flawed when it comes to effecting a just distribution of health care. (shrink)

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1].Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than (...) strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a non-ideal mode, a framework in which philosophers have done little. (shrink)

An appeal to all that doubt or disbelieve the truths of the Gospel, whether they be deists, Arians, Socinians, or nominal Christians, by W. Law.--Siris; a chain of philosophical reflexions and inquiries concerning the virtues of tar water, and divers other subjects, by G. Berkeley.--Observations on man, his frame, his duty, and his expectations, by D. Hartley.--The theory of moral sentiments, by A. Smith.--An essay on original genius, by W. Duff.--The light of nature pursued, by A. Tucker.--A new system; or, (...) An analysis of antient mythology, by J. Bryant.--Enquiry concerning political justice and its influence on morals and happiness, by W. Godwin. (shrink)

Building on the theoretical research of community psychology and cultural psychology, I focus in this paper on these two questions: What kind of religious coping is practiced by some members of the Lutheran tradition? What does an understanding of the relationship between the tradition and religious coping of these members indicate that may be distinctive or unexpected about their religious coping? I do this by: reviewing the background of my research in community psychology, cultural psychology, and tradition-specific research on religious (...) coping - particularly in the United States; outlining a method for a qualitative study of nine Lutheran co-researchers in the United States who had experienced a significant negative event; reporting some of the results of that study; using the results of the study to discuss the two questions above; concluding with some suggestions for future research of the specific religious traditions in which religious coping phenomena may occur, and of the phenomena of religious coping in specific religious traditions. (shrink)

Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...) older potential American patients needing the drug; (2) physicians will feel ethically compelled to provide the drug to desperate, insistent patients, given FDA approval and in spite of side effects of brain bleeds and brain swelling; (3) and false hopes are generated for patients. A needed corrective by the federal government would reduce reimbursement to the bare cost of producing the drug (plus only a modest profit) until a phase IV trial has been successfully completed. (shrink)

The phrase "personalized medicine" has a built-in positive spin. Simple genetic tests can sometimes predict whether a particular individual will have a positive response to a particular drug or, alternatively, suffer costly and debilitating side effects. But little attention has been given to some challenging issues of justice raised by personalized medicine. How should we determine who would have a just claim to access particular treatments, especially very expensive ones? How effective do those treatments need to be?If there were a (...) thick, bright line separating minimal responders from maximal responders, then we could allocate these treatments in a fair and cost-effective way. But there is no bright line. The .. (shrink)

. In his work The Cosmos in Light of the Cross physicist and Lutheran pastor George L. Murphy extends the religious rationales of Dietrich Bonhoeffer and Eberhard Jüngel to argue specifically for a nonreligious, scientific study of and appreciation for the world. In doing so, Murphy offers a clear and coherent theology of the cosmos within the bounds of piety alone. Like Calvin and Schleiermacher before him who strove to stay within these bounds, Murphy shares their endpoint of a practical (...) theology—that is, faithful reflections that will encourage wise and faithful existence. In doing so, Murphy has written a brilliant and extraordinarily readable account of a chiasmic cosmos. He also quite practically and indeed pastorally offers suggestions for how the God of that cosmos may be not only understood but also worshiped and adored. (shrink)

John Rawls has held up as a model of public reason the U.S. Supreme Court. I argue that the Dobbs Court is justifiably criticized for failing to respect public reason. First, the entire opinion is governed by an originalist ideological logic almost entirely incongruent with public reason in a liberal, pluralistic, democratic society. Second, Alito’s emphasis on “ordered liberty” seems completely at odds with the “disordered liberty” regarding abortion already evident among the states. Third, describing the embryo/fetus from conception until (...) birth as an “unborn human being” begs the question of the legal status of the embryo/fetus, as if an obiter dictum settled the matter. Fourth, Alito accuses the Roe court of failing to exercise judicial restraint, although Alito argued to overturn Roe in its entirety. In brief, the Dobbs opinion is an illiberal, disingenuous, ideological swamp that swallows up public reason and the reproductive rights of women. (shrink)

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden (...) rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels. Keywords: cost containment, democratic deliberation, fairness, justice, rationing CiteULike Connotea Del.icio.us What's this? (shrink)

It's not only necessary, but possible, if the public can be educated.