Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.

_Just Doctoring_ draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the (...) way to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems—from informed consent to care rationing and the repercussions of the HIV epidemic—and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century. (shrink)

_Just Doctoring_ draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the (...) way to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems—from informed consent to care rationing and the repercussions of the HIV epidemic—and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century. (shrink)

Three major trends in American health policy are intersecting in a fascinating way. First, managed care has grown to become the most dominant form of health-care delivery, leading to reductions in health-care costs as insurers are able to influence health-care providers with financial incentives. Second, the present growth of managed care has slowed, almost to a standstill, largely on account of consumers questioning what effects these financial incentives are having on the care of patients — questioning that has been expressed (...) in particular through lawsuits against managed care companies.Third, we are experiencing a renewed interest in the existence of medical error and how it may be reduced as a result of the Institute of Medicine’s report, To Err Is Human: Building a Safer Health System. The most important aspect of this renaissance in error reduction has been its emphasis on health care as a system that can be made better through system-oriented change. The most frustrating aspect is that the IOM did not endorse change in malpractice liability, which consistently puts the impetus for reducing medical error on the individual provider rather than the system as a whole. (shrink)

Three major trends in American health policy are intersecting in a fascinating way. First, managed care has grown to become the most dominant form of health-care delivery, leading to reductions in health-care costs as insurers are able to influence health-care providers with financial incentives. Second, the present growth of managed care has slowed, almost to a standstill, largely on account of consumers questioning what effects these financial incentives are having on the care of patients — questioning that has been expressed (...) in particular through lawsuits against managed care companies.Third, we are experiencing a renewed interest in the existence of medical error and how it may be reduced as a result of the Institute of Medicine’s report, To Err Is Human: Building a Safer Health System. The most important aspect of this renaissance in error reduction has been its emphasis on health care as a system that can be made better through system-oriented change. The most frustrating aspect is that the IOM did not endorse change in malpractice liability, which consistently puts the impetus for reducing medical error on the individual provider rather than the system as a whole. (shrink)

Numerous studies have shown almost uniformly positive opinions among patients and physicians regarding theconceptof advance directives (either a healthcare proxy or living will). Several of these studies have also shown that the actual use of advance directives is significantly lower than this enthusiasm would suggest, but they have not explained the apparent discordance. Nor have researchers explained why members of minority groups are much less likely to complete advance directives than are white patients. In this study, we used a focus (...) group methodology to examine the ways in which diverse populations of patients view the medical, philosophical, and practical issues surrounding advance directives. We were motivated by the significantly lower prevalence of advance directives among African-American and Hispanic patients at one urban teaching hospital (18% for Caucasians, 4% for African-Americans, and 2% for Hispanics). Our premise was that African-American and Hispanic populations, who have had higher rates of morbidity and mortality across numerous disease categories, and historically have had limited access to care and opportunities to discuss health concerns, may be more suspicious about the right of autonomy that an advance directive is designed to ensure. (shrink)

Numerous studies have shown almost uniformly positive opinions among patients and physicians regarding theconceptof advance directives (either a healthcare proxy or living will). Several of these studies have also shown that the actual use of advance directives is significantly lower than this enthusiasm would suggest, but they have not explained the apparent discordance. Nor have researchers explained why members of minority groups are much less likely to complete advance directives than are white patients. In this study, we used a focus (...) group methodology to examine the ways in which diverse populations of patients view the medical, philosophical, and practical issues surrounding advance directives. We were motivated by the significantly lower prevalence of advance directives among African-American and Hispanic patients at one urban teaching hospital (18% for Caucasians, 4% for African-Americans, and 2% for Hispanics). Our premise was that African-American and Hispanic populations, who have had higher rates of morbidity and mortality across numerous disease categories, and historically have had limited access to care and opportunities to discuss health concerns, may be more suspicious about the right of autonomy that an advance directive is designed to ensure. (shrink)

The prelims comprise: Introduction The Foundations of Altruism and Autonomy in Medical Ethics The Problem of Medical Injury and the Emergence of Safety The Ancient Practices of Malpractice Litigation What Do We Disclose Today, and What Will We Disclose in the Future? Malpractice Reform: Health Courts References.

This article explores the ethics and economics of a market in donated kidneys in the United States. With the impending changes in the health care system, the author argues that a full turn to the market for distribution of kidneys is not appropriate. However, he would sanction a regulated market, as outlined in the article.

Recent developments in organ procurement have revived the much-debated role of markets in our health care system. The unique American health care system, with its presumption of universality alongside private health insurance and relatively limited federal and state programs, is in many ways consumer-driven today. We certainly tolerate more broad disparities in availability of care and in outcomes of care largely based on socioeconomic status than do many other developed countries, where notions of universal access are supported by broader public (...) financing. (shrink)

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...

History and Systems of Psychology provides an engaging introduction to the rich story of psychology's past. Retaining the clarity and accessibility praised by readers of earlier editions, this classic textbook provides a chronological history of psychology from the pre-Socratic Greeks to contemporary systems, research, and applications. The new edition also features expanded coverage of Eastern as well as Western traditions, influential women in psychology, professional psychology in clinical, educational, and social settings, and new directions in twenty-first century psychology as a (...) cognitive and a positive science. Assuming little prerequisite knowledge, the authors discuss the people, places, and concepts that have shaped psychology's story, and show that we remain fascinated by the same enduring questions that confronted our ancestors - namely, our wonder at our subjectivity and consciousness of self. The seventh edition is fully supported by robust pedagogical features, instructor resources, and a companion website to aid student learning. (shrink)

The essays in this volume present versions of feminism that are explicitly liberal, or versions of liberalism that are explicitly feminist. By bringing together some of the most respected and well-known scholars in mainstream political philosophy today, Amy R. Baehr challenges the reader to reconsider the dominant view that liberalism and feminism are 'incompatible.'.

In this unique volume, some of today's most eminent political philosophers examine the thought of John Rawls, focusing in particular on his most recent work. These original essays explore diverse issues, including the problem of pluralism, the relationship between constitutive commitment and liberal institutions, just treatment of dissident minorities, the constitutional implications of liberalism, international relations, and the structure of international law. The first comprehensive study of Rawls's recent work, The Idea of Political Liberalism will be indispensable for political philosophers (...) and theorists interested in contemporary political thought. (shrink)

In this study, we used a word search puzzle paradigm to investigate age differences in the rate of information gain and the cues used to make patch-departure decisions in information foraging. The likelihood of patch departure increased as the profitability of the patch decreased generally. Both younger and older adults persisted past the point of optimality as defined by the marginal value theorem, which assumes perfect knowledge of the foraging ecology. Nevertheless, there was evidence that adults were rational in terms (...) of being sensitive to the change in RG for making the patch-departure decisions. However, given the limitations in cognitive resources and knowledge about the ecology, the estimation of RG may not be accurate. Younger adults were more likely to leave the puzzle as the long-term RG incrementally decreased, whereas older adults were more likely to leave the puzzle as the local RG decreased. However, older adults with better executive control were more likely to adjust their likelihood of patch-departure decisions to the long-term change in RG. Thus, age-dependent reliance on the long-term or local change in RG to make patch-departure decisions might be due to individual differences in executive control. (shrink)

Pickering & Garrod's (P&G's) call to study language processing in dialogue context is an appealing one. Their interactive alignment model is ambitious, aiming to explain the converging behavior of dialogue partners via both intra- and interpersonal priming. However, they ignore the flexible, partner-specific processing demonstrated by some recent dialogue studies. We discuss implications of these data.

The search for 'ecological insights' in venerable Asian traditions of thought prompts questions about how such traditions understood humans in relation to nature. Answers which focus on philosophical and religious ideas may overlook culturally important understandings of people and places articulated within scientific and medical thinking. The paper tentatively explores the prospects for gleaning a form of ethics of place from the study of traditional Hindu and Chinese medical sources. Although there are serious problems with the idea that any unadulterated (...) assimilation from other traditions can take place, these sources can be thought of as incorporating a place-centred ethic. By looking closely at Francis Zimmerman's study of Hindu medicine, it is argued that a poetics of place can be ascribed to Ayurvedic discourses on health and disease. It may be possible to associate a similar poetics with classical Chinese medical worldviews, these being reconcilable with-though not the same as-contemporary ecological understandings of humans in relation to the world. Although no pristine reconstruction of Asian traditions of medical thought can be made, the conclusion of the present paper is that it would be wrong to dismiss these traditions as 'antienvironmental', based purely on the study of philosophical and religious texts. (shrink)

Work on dispositions focuses chiefly on dispositions that are manifested in dynamic causal processes. Williams, Neil. 2005. “Static and Dynamic Dispositions.” Synthese 146: 303–24 has argued that the focus on dynamic dispositions has been at the expense of a richer ontology of dispositions. He contends that we ought to distinguish between dynamic and static dispositions. The manifestation of a dynamic disposition involves some change in the world. The manifestation of a static disposition does not involve any change in the world. (...) In this paper, we concede that making a conceptual distinction between dynamic and static dispositions is useful and we allow that we can truthfully represent objects as manifesting static dispositions. However, we argue that the distinction is not ontologically deep. Rather, the truthmakers for our representations of static dispositions are actually dynamic dispositions to whose manifestations we may fail to be sensitive. (shrink)

There has been a strong tendency in recent years, in countries such as Australia and the United States, for governmental and corporate spokespersons to present advice and information that comes from independent scientific sources as if it were no better grounded than that from any other source. Such a leveling out of all advice and information into mere “opinion” has been a key strategy in the assertion of corporate and governmental control over public debate and policy. In this paper, we (...) aim to explore some of the factors that diminish the credibility and reliability of information within organizational structures, effectively undermining the value of that information; we argue for the importance of processes like those of peer review in maintaining the credibility and reliability of information that is so important to effective action and decision; and we also provide an analysis of the rationale that underpins such processes. One of our conclusions will be that processes like those of peer review succeed largely because of the way in which they depend upon, but also support, the dispersal of information and authority within an organizational structure so as to ensure both that information is accessible within the structure and also remains open to challenge and scrutiny. (shrink)

Parfit argues that survival, Not identity, Is the important thing in cases of personal resurrection, Fission, Etc. I argue that parfit's and dennett's well known cases--And fantasies about cloning and telecloning--Suggest a distinction between type and token persons, Memories, Intentions, Etc. Parfit is wrong, I suggest, To think survival more determinate than identity; with quine I hold that there is no objective matter to be right or wrong about.

_Exhausting Modernity_ is a bold new work on the exhaustion of our resources, both natural and human. Drawing on the insights of Marx and Freud, it provides a compelling analysis of the exhaustion pervading modern capitalism: environmental collapse, rising poverty levels and increasing global economic disparity. This is essential reading for political and social theorists, philosophers, economists, and all those interested in the environment.

Lacan was not an ahistorical post-structuralist. Starting from this controversial premiss, Teresa Brennan tells the story of a social psychosis. She begins by recovering Lacan's neglected theory of history which argued that we are in the grip of a psychotic's era which began in the seventeenth century and climaxes in the present. By extending and elaborating Lacan's theory, Brennan develops a general theory of modernity. Contrary to postmodern assumptions, she argues, we need general historical explanation. An understanding of (...) historical dynamics is essential if we are to make the connections between the outstanding facts of modernity - ethnocentrism, the relationship between the sexes and ecological catastrophe. (shrink)