The distinction between negative and positive liberty remains a standard approach to the idea of freedom in contemporary political theory. In Rethinking Positive and Negative Liberty, Maria Dimova-...

This paper compares and contrasts three different substantive principles of justice for making health care priority-setting or “rationing” decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, (...) it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of health care rationing which accords with public opinions. (shrink)

When thinking about population level healthcare priority setting decisions, such as those made by the National Institute for Health and Care Excellence, good medical ethics requires attention to three main principles of health justice: (1) cost-effectiveness, an aspect of beneficence, (2) non-discrimination, and (3) priority to the worse off in terms of both current severity of illness and lifetime health. Applying these principles requires consideration of the identified patients who benefit from decisions and the unidentified patients who bear the opportunity (...) costs. (shrink)

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue (...) in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. (shrink)

Parkinson's disease (PD) is generally sporadic but a number of genetic diseases have parkinsonism as a clinical feature. Two dominant genes, α‐synuclein (SNCA) and leucine‐rich repeat kinase 2 (LRRK2), are important for understanding inherited and sporadic PD. SNCA is a major component of pathologic inclusions termed Lewy bodies found in PD. LRRK2 is found in a significant proportion of PD cases. These two proteins may be linked as most LRRK2 PD cases have SNCA‐positive Lewy bodies. Mutations in both proteins are (...) associated with toxic effects in model systems although mechanisms are unclear. LRRK2 is an intracellular signaling protein possessing both GTPase and kinase activities that may contribute to pathogenicity. A third protein, tau, is implicated as a risk factor for PD. We discuss the potential relationship between these genes and suggest a model for PD pathogenesis where LRRK2 is upstream of pathogenic effects through SNCA, tau, or both proteins. (shrink)

The aim of this paper is to propose a research agenda for future studies of local forms of caregiving. It does this by exploring practices of care giving and receipt through the prism of childcare. Focusing on Nairobi, it investigates one critical form of care work in the city: the labour of women who work as ‘nannies’ in private homes, a form of labour that has received little systematic study or scholarly attention. Every day, women in Nairobi construct complex and (...) far-ranging care chains that ensure that the socially necessary labour of childcare takes place. The phenomenon of ‘diverted mothering’ that has been associated with the globalisation of care can also be understood as a local phenomenon. Whereas global care chains involving migrant domestic workers have been the focus of detailed investigation, hitherto the workings of more widespread and highly fragile local care chains in the cities of the third world have been neglected. We argue that it is critical to understand practices of intimate and emotional labour in the context not just of global migration but in situations of severe intersecting inequalities within the global south. (shrink)

(1998). T.H. Green as a phenomenologist: linking British idealism and continental phenomenology. Angelaki: Vol. 3, Impurity, authenticity and humanity, pp. 77-88.

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

The main aim of this paper is to investigate the views of healthcare professionals in Portugal about healthcare rationing, and compare them with the views of college students. A self-administered questionnaire was used to collect data from a sample of 60 healthcare professionals and 180 college students. Respondents faced a hypothetical rationing dilemma where they had to order four patients and justify their choices. Multinomial logistic regressions were used to test for differences in orderings, and content analysis to categorize the (...) written justifications. The findings suggest that both groups appeared to support three main rationing principles: health maximization, priority to the severely ill and priority to the young. However, professionals seemed to give less weight to the latter principle. In conclusion, professionals have similar views to students about healthcare rationing, though may be slightly less inclined to give priority to the young. (shrink)

Progressive supranuclear palsy is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer's disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP and 3,247 controls followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the (...) stage 1 SNPs that yielded P ≤ 10-3. We found significant previously unidentified signals associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression. The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component. © 2011 Nature America, Inc. All rights reserved. (shrink)

La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo (...) tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud. (shrink)

This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage.

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.2 (2003) 280-281 [Access article in PDF] Maria Dimova-Cookson. T. H. Green's Moral and Political Philosophy: A Phenomenological Perspective. New York: Palgrave, 2001. Pp. xiii + 175. Cloth, $60.00 Like most today who study Green's idealism, Dimova-Cookson finds only his ethics to be still relevant. She rejects his metaphysical epistemology and consequently his teleology, but offers an alternative. (...) class='Hi'>Dimova-Cookson proposes a Husserlian analysis of Green's positions on goodness and a critical defense that attempts to rectify his apparently inconsistent formulations of that concept. Provided we recall that Husserl's method is not unproblematic and resist the tendency to adjust the doctrine analyzed for the sake of methodological fidelity, there is reason to be open to the author's proposal. Several of Husserl's ideas seem relevant to Green's thought: intentionality; "noematic content of the determinable X" and "horizon" developed in Ideas; intersubjectivity; and Husserl's teleological descriptions of phenomenological consciousness. But Dimova-Cookson pursues none of these. She employs Husserl's problematic "epoche" and a "necessary feature of human practice" she calls "the phenomenological circle" (69, hereafter, PC).Dimova-Cookson uses PC to resolve certain confusions imputed to Green. Green himself anticipates the charge of vicious circularity concerning the moral ideal when he reasons that "the unconditional good for man" is the good will and that the good will is to will the unconditional good. He subsequently explains that the circularity is not logically vicious for the two terms describe different states of one teleological process of a will actualizing its potential for perfection, and are distinguished "as the complete from the incomplete." According to Dimova-Cookson, Green hasn't escaped the charge and needn't try. Rather, he has unwittingly stumbled upon PC, but confused matters by carelessly conflating perspectives on the senses of "good" which she believes are two different definitions of two different things, elements in PC. "Circularity in explaining morality can be legitimized," she says, provided one rigorously clarifies the shift in perspective between the two elements in PC (70ff.). This move, she holds, can resolve certain contemporary criticisms. But note that if Green hasn't escaped the charge, and it is a genuine logical circle, then, as Husserl recognized, it cannot be avoided simply by making a rigorously clear shift in perspective. That would be a psychologistic response to a logical problem. Moreover, even if clarity of perspectival shift is useful here, it fails to capture the continuity in the moral progress of the self-actualization of moral agent to moral citizen. Finally, had Green represented his distinction in such dichotomous fashion, this would have compromised the teleological component of his explanations and made it more difficult to keep his theory from being conflated with utilitarianism. Green is far-sighted here, given recent tendencies to confuse utilitarianism and teleology on the basis that both can be represented as versions of consequentialism, a confusion based on the fallacy of undistributed middle.Most of Dimova-Cookson's connections are highly suggestive and many of her distinctions useful. She teases out several possible meanings of Green's conception of good, and is to be commended for having tried to answer some of his critics and calling attention to the valuable content of Green's doctrine. Her attempt at a phenomenological approach is novel.It is troubling, though, that Dimova-Cookson thinks it is also transcendental, for her words reveal a grave confusion about what this means. When discussing what she thinks is either transcendental or phenomenological, she uses the language of contingent psychological experience; e.g., "storing experience" (44), and projecting and relating to one's self-image (65). The process of learning she describes is more reminiscent of Piaget's "assimilation-accommodation" model than anything Husserlian or transcendental. Yet the author considers this an "advanced transcendentalism" wherein "our experience is preconditioned—that is, made possible—by the conceptual baggage that has accumulated and is always present at the back of our minds" (27). If one holds that we accumulate... (shrink)

Axiomatic utility theory plays a foundational role in some accounts of normative principles. In this context, it is sometimes argued that transitivity of “better than” is a logical truth. Larry Temkin and Stuart Rachels use various examples to argue that “better than” is non–transitive, and that transitivity is not a logical truth. These examples typically involve some sort of “discontinuity.” In his discussion of one of these examples, John Broome suggests that we should reject the claim which involves “discontinuity.” We (...) can, I suggest, make sense of the examples which Temkin uses while sacrificing neither transitivity nor “discontinuity.” This response to Temkin's examples involves developing and modifying James Griffin's account of “discontinuity.” If the account of “discontinuity” seems implausible, that is because of a failure to allow for vagueness. A similar argument can be made in the context of the well-known “repugnant conclusion.” Footnotes1 This paper emerged from a discussion in one of John Broome's seminars. I am very grateful to John Broome, Erik Carlson, James Griffin, Wlodek Rabinowicz, Stuart Rachels, and Larry Temkin for allowing me to read various forthcoming manuscripts which are mentioned in the paper. I am also extremely grateful to Gustaf Arrhenius, Walter Bossert, Luc Bovens, John Broome, Richard Cookson, Robin Cubitt, James Griffin, Graham Loomes, Ben McQuillin, Shepley Orr, Wlodek Rabinowicz, Stuart Rachels, Bob Sugden, and two anonymous referees for comments on earlier versions. Any errors or omissions are mine. (shrink)

The British Armed Nation, 1793?1815. By J. E. Cookson (Oxford: Oxford University Press, 1997) vi + 286 pp. £45.00/ $87.00 cloth. The Arming of Europe and the Making of the First World War. By David G. Herrmann (Princeton: Princeton University Press, 1997) 307 pp. $16.95 paper. State, Society and Mobilization in Europe during the First World War. John Horne, ed. (Cambridge U.K.: Cambridge University Press, 1997) xv + 292 pp. £35.00/ $59.95 cloth.