In the mid-1990s, several state legislatures enacted a "second generation" of small group health insurance reforms that required guaranteed issue of all products and prohibited the use of health as a rating factor. We use data from two large employer surveys to compare the behavior of small business in nine states that adopted these reforms between 1993 and 1997 to the behavior of small business in 11 states and the District of Columbia, where neither of these small group health insurance (...) market reforms existed prior to 1997 (N = 8,465 in 1993; N = 12,219 in 1997). Our analyses focus on several outcomes: health insurance offer and enrollment rates in any employer plan, and in an HMO plan; turnover in offer decisions; and premiums, variability in premiums, and the rate of change in premiums. Overall, we find no effect of small group reform on any of the outcomes; the sign of the effect is not consistent across reform states, the estimates rarely attain statistical significance, and they show no consistent pattern across the outcomes within each state. Therefore, predictions of the harm these regulations might cause to the market have not come to pass. On the other hand, proponents' hopes for a solution to low coverage rates among small businesses have not materialized either. (shrink)

It is hardly necessary to rent I Spit on Your Grave or Tool Box Murders for your VCR in order to find images of sexuality contaminated by depersonalization or violence. As far back as Rabelais’ Gargantua, for example, Panurge proposes to build a wall around Paris out of the pleasure-twats of women [which] are much cheaper than stones”: “the largest … in front” would be followed by “the medium-sized, and last of all, the least and smallest,” all interlaced with “many (...) horney joy-dinguses” so that fortification would be impregnable, except for the “ordure and excretions” of the flies it would doubtlessly attract.1 Two centuries later, one of Rabelais’ compatriots, the Marquis de Lade, described the rage of a sexually initiated daughter against a woman who refuses to consider her “pleasure-twat” “cheaper than stones.” The Sadeian heroine first sodomizes her puritanical mother with an artificial penis, then has her infected with syphilis, and finally performs infibulations to prevent the infected semen from leaking out: “Quickly, quickly, fetch me needle and threat! … Spread your thighs, Mama, so I can stitch you together.”2One century later in England, the author of My Secret Life explained that, when in a state of sexual excitement, “he is ready to fuck anything,” from his sister to his grandmother, from a ten-year-old, to a woman of sixty, for a standing prick has no conscience.” To this credo, he adds the admonition, “Woe be to the female whom he gets a chance at, if she does not want him, for he will have her if he can.”3 The sexually aroused man in the contemporary American film Looking for Mr. Goodbar curses the woman who does not want him as much as she wants a room of her own and the freedom to choose a succession of male lovers. After he resentfully determines to have her when he gets the chance , he rapes her and finally knifes her to death, exclaiming “That’s what you want, bitch, right? That’s what you want.”However these individual works are labeled, such passages remind us of the long history of pornography, a gender-specific genre produced primarily by and for men but focused obsessively on the female figure. In their depictions of female sexuality, narratives from Gargantua to La Philosophie dans le boudoir, My Secret Life, and Looking for Mr. Goodbar explain why definitions of the pornographic have recently moved away from “obscenity,” a term that generally refers to the sexually stimulating effects of a picture, a novel, or a film on the male reader/observer, and toward “dehumanization,” a word that is used to evoke the objectification of women. As Irene Diamond has demonstrated, during the past decade the generally held assumption that pornography is about male sexuality has been qualified by those who argue that “the ‘what’ of pornography is not sex but power and violence, and the ‘who’ of concern are no longer male consumers and artists but women.”4 1. François Rabelais, Gargantua and Pantagruel, trans. Jacques Le Clercq , bk. 2, chap. 15. I have used this translation because it is employed in Helene Iswolsky’s translation of Mikhail Bakhtin’s Rabelais and His World . With no analysis of gender, Bakhtin’s exclusive focus on the grotesque wipes out the significance of Rabelais’ sexual imagery.2. Marquis de Sade, quoted in a brilliant reading of this text by Angela Carter, The Sadeian Woman and the Ideology of Pornography , p. 127; all further references to this work , abbreviated SW, will be included in the text.3. My Secret Life , p. 361.4. Irene Diamond, “Pornography and Repression: A Reconsideration,” in Women: Sex and Sexuality, ed. Catharine Stimpson and Ethel Spector Person , p. 132. Susan Gubar is professor of English and women’s studies at Indiana University, Bloomington. Together with Sandra M. Gilbert, she has coauthored The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination and co-edited both Shakespeare’s Sisters: Feminist Essays on Women Poets and the Norton Anthology of Literature by Women: The Tradition in English. This fall they will publish the first volume of a three-volume work, No Man’s Land: The Place of the Woman Writer in the Twentieth Century. Her previous contribution to Critical Inquiry is “ ‘The Blank Page’ and the Issues of Female Creativity”. (shrink)

Dolly is a lamb that was cloned by Dr. Ian Wilmut, a Scottish embryologist. But she is also a Rorschach test. The public response to the production of a lamb by cloning a cultured cell line reflects the futuristic fantasies and Frankenstein fears that have more broadly surrounded research in genetics and especially genetic engineering. Cloning was a term originally applied to a botanical technique of asexual reproduction. But following early experiments in the manipulation of the hereditary and reproductive process (...) during the mid-1960s, the term became associated with human biological engineering. It also became a pervasive theme in horror films and science fiction fantasies. Appearing to promise both amazing new control over nature and terrifying dehumanization, cloning has gripped the popular imagination. (shrink)

Bioethics has paid surprisingly little attention to the special problems faced by women and to feminist analyses of current health care issues other than ...

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

We propose that the generalizations of linguistic theory serve to ascribe beliefs to humans. Ordinary speakers would explicitly (and sincerely) deny having these rather esoteric beliefs about language--e.g., the belief that an anaphor must be bound in its governing category. Such ascriptions can also seem problematic in light of certain theoretical considerations having to do with concept possession, revisability, and so on. Nonetheless, we argue that ordinary speakers believe the propositions expressed by certain sentences of linguistic theory, and that linguistics (...) can therefore teach us something about belief as well as language. Rather than insisting that ordinary speakers lack the linguistic beliefs in question, philosophers should try to show how these empirically motivated belief ascriptions can be correct. We argue that Stalnaker's (1984) "pragmatic" account--according to which beliefs are dispositions, and propositions are sets of possible worlds--does just this. Moreover, our construal of explanation in linguistics motivates (and helps provide) responses to two difficulties for the pragmatic account of belief: the phenomenon of opacity, and the so-called problem of deduction. (shrink)

This work examines the evolution of law and legal method, and challenges the law's claim to neutrality by examining its role in creating and reproducing inequality between the sexes. It considers many of the current debates, and in each, the law is stated with reference to recent developments in statute and judicial decisions in the UK and other jurisdictions. The author illustrates how each issue is shaped by the current political climate and, where relevant, by the European Court. Reference is (...) also made to US and Australian case law. The book should be of interest to students studying women and the law, family law, criminal law and jurisprudcence, as well as those on criminology and sociology courses. It should also be useful to family and criminal practitioners. (shrink)

The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XXIII, Number 2, November 1997, pp. 195-212 The Moral Self and the Indirect Passions SUSAN M. PURVIANCE David Hume1 and Immanuel Kant are celebrated for their clear-headed rejection of dogmatic metaphysics, Hume for rejecting traditional metaphysical positions on cause and effect, substance, and personal identity, Kant for rejecting all judgments of experience regarding the ultimate ground of objects and their relations, not just judgments of (...) cause and substantiality. Nevertheless, each argues that practical activity is not compromised by the rejection of metaphysical claims that others had taken to be crucial. Kant and Hume thought that political and moral life did not depend upon theoretical knowlege of the nature of the self, free will, or knowledge of the true motives of actions or the character of the agent. Because the grounds of morality and politics were too important to leave to the mercies of speculative metaphysics, each moved their foundations to higher ground, insulating the grounds of practical activity from the threat of metaphysical turmoil and skepticism. Contemporary philosophers have generally followed Hume and Kant in this regard, but often select very different strategies. Some think that the best way to avoid the problems associated with contemporary scientific ontologies is to separate ethics from the factual domain entirely. Some give moral and political language a noncognitivist interpretation, and others have interpreted values as a projection of the passions and affections of the subject or as the constructions of suitably situated practical reasoners.2 At the same time there has been a resurgence of interest in moral realism. Moral realists think that the objectivity of moral discourse, and hence the Susan M. Purviance is at the Department of Philosophy, The University of Toledo, Toledo OH 43606-3390 USA. 196 Susan M. Purviance possibility of moral truth, depend upon the existence of moral facts.3 Moral realists have tended to concentrate on the role of facts in establishing the truth of general moral principles, or the Tightness or moral value of particular individual actions. For moral realists, moral facts are the states of affairs that make general moral principles or particular moral judgments true. Whether these facts are of a naturalistic sort or not, whether they are literally on a par with natural facts, or whether they simply play the same role in practical knowledge that natural facts play in theoretical knowledge, is an open question. Moral realists often are naturalists, like David O. Brink and Jonathan Dancy, but they may be nonnaturalists, like G. E. Moore.4 Ethical naturalism accounts for moral motivation and the cultivation of good character in terms of moral qualities, and many hope to ground it in (or at least show that it is compatible with) the scientific understanding of objects and their relations and qualities. Naturalism is only one option, but realism has received support because it is not clear that antirealists have developed a convincing alternative to the grounding of concepts of moral agency and moral judgment in some sort of moral facts. Questions abound about what it means to ascribe responsibility to a moral self and how we can defend a notion of enduring character. Although moral realists have paid less attention to the ontological status of virtues and character traits than to moral principles, their status is equally important. Here the concern is with the sort of metaphysics of the self thought to be necessary to account for moral agency, responsibility, praise, and blame. I shall argue that there is a class of moral facts that justify or perhaps merely vindicate the ascription of moral powers to agents, and that these are the sorts of facts another sort of theorist is interested in, whereas the states of affairs that make moral judgments true are the sorts of facts that moral realists have been interested in. In order to distinguish this use of moral facts I shall call this sort of theory a Fact of Agency Theory, and it is a version of this theory that can be found in Hume's discussion of the problem of the self and the indirect passions. A realist metaphysics of morals needs to address two questions, the question of the reality of the... (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

In 2004, the United States Sentencing Commission amended the Federal Sentencing Guidelines to allow firms that create “effective compliance and ethics programs” to receive better treatment if prosecuted for fraud. Effective compliance and ethics, however, appear to be limited to activities focused on complying with the firms’ internal legal and ethical standards. We explored a potential connection between the firms’ external corporate social responsibility (CSR) behaviors and internal compliance: Is there an organizationally valid relationship between these two firm activities? That (...) is, when organizations demonstrate CSR with behaviors external to the firm, such as employee volunteerism, are their employees more likely to demonstrate uncompromised legal and ethical compliance behavior internally? We collected data from 164 working professionals enrolled in a top-tier MBA program in the southeastern United States regarding their employer-sponsored volunteer activities and their intentions to comply in various organizational compliance vignettes. We found that employer-sponsored volunteerism is associated with uncompromised compliance choices in one of the three vignettes. This finding indicates preliminary support for further inquiry into the relationship within the firm between external CSR behaviors and policies regarding organizational compliance. Post hoc analyses suggest that employer-sponsored volunteerism is strongly associated with a positive organizational identity, but organizational identity is not associated with the significant compliance vignette. This evidence suggests that the underlying mechanism that connects external CSR behaviors and internal compliance intentions is complex and requires future study. (shrink)

This study investigates the effectiveness of pedagogical practices used to teach business ethics. The business community has greatly increased its demands for better ethics education in business programs. Educators have generally agreed that the ethical principles of business people have declined. It is important, then, to examine how common methods of instruction used in business ethics could contribute to the development of higher levels of moral judgment competence for students. To determine the effectiveness of these methods, moral judgment competence levels (...) for undergraduate and graduate students from three institutions were measured and compared based upon the pedagogical method used in a business class. Significant differences were found for moral reasoning and moral competence scores depending on the method used for ethics instruction. Students in classes with more highly integrated ethics coverage scored higher in moral reasoning and moral competence. (shrink)

ABSTRACT In establishing National Bioethics Organisations (NBOs), liberal democracies seek to acknowledge the diversity of strongly held ethical positions and the imperative to engage in public debate about important bioethical decisions. NBOs are typically given a range of responsibilities, including contributing to and stimulating public debate; providing expert opinion on relevant issues for policy deliberations; and developing public policy. The state is now found to have an interest in areas previously thought to be a matter of individual choice. NBOs can (...) provide one way of opening up public debate to allow the diversity of views to be heard in a manner that is well‐informed, articulate and responsive to both expert and ‘lay’ public views. We draw on debates in political theory about democratic decision‐making and on the policy making roles of some key NBOs. We are particularly interested in examining the capacity of NBOs to meet the democratic ideal of effective participation by the public, or citizenry, especially by those who are directly affected by the policies, in the development of effective public policy. We provide a basic framework for policy development involving NBOs that can begin to meet this ideal, a process of ‘contested deliberation’. (shrink)

Health care reform proposals threaten to exacerbate tensions physicians already face in trying to balance traditional duties to individual patients against increasing pressure to serve broader societal and institutional goals. To cope with reform, medical ethics must clarify physicians' moral obligations, change existing ethical codes, and develop an ethics of institutions.

The current explosion of genetic knowledge and the rapid proliferation of genetic tests has rightly provoked concern that we are approaching a future in which people will be labeled and disadvantaged based on genetic information. Indeed, some have already suffered harm, including denial of health insurance. This concern has prompted an outpouring of analysis. Yet almost all of it approaches the problem of genetic disadvantage under the rubric of “genetic discrimination.”This rubric is woefully inadequate to the task at hand. It (...) ignores years of commentary on race and gender demonstrating the limits of antidiscrimination analysis as an analytic framework and corrective tool. Too much discussion of genetic disadvantage proceeds as if scholars of race and gender had not spent decades critiquing and developing antidiscrimination theory.Indeed, there are multiple links among race, gender, and genetics. Dorothy Roberts has discussed the historical links between racism and genetics, while she and others have begun to map connections between gender and genetics. (shrink)

Participant-driven research is a burgeoning domain of research innovation, often facilitated by mobile technologies. Return of results and data are common hallmarks, grounded in transparency and data democracy. PDR has much to teach traditional research about these practices and successful engagement. Recommendations calling for new state laws governing research with mHealth modalities common in PDR and federal creation of review mechanisms, threaten to stifle valuable participant-driven innovation, including in return of results.

Using the infamous research studies in Tuskegee and Guatemala, the article examines the difference between victims and bystanders. The victims can include families, sexual partners, and children not just the participants. There are also the bystanders in the populations who are affected, even vaguely, decades after the initial studies took place. Differing reparations for victims and bystanders through lawsuits and historical acknowledgments has to be part of broader discussions of historical justice, and the weighing of the impact of racism and (...) imperial research endeavors. (shrink)

Heroism is apparently nonadaptive in Darwinian terms, so why does it exist at all? Risk-taking and heroic behavior are predominantly male tendencies, and literature and legend reflect this. This study explores the possibility that heroism persists in many human cultures owing to a female preference for risk-prone rather than risk-averse males as sexual partners, and it suggests that such a preference may be exploited as a male mating strategy. It also attempts to quantify the relative influences of altruism and bravery (...) in the evolution of heroism. Our study found that females do prefer risk-prone brave males to risk-averse non-brave males, and that men are aware of this preference. Bravery in a male was shown to be the stronger factor influencing female choice of short-term partners, long-term partners, and male friends, with altruism playing a lesser part in their choice. Altruism was deemed important in long-term relationships and friendships, but for short-term liaisons, non-altruists were preferred to altruists. Heroism may therefore have evolved owing to a female preference for brave, risk-prone males because risk-taking acts as an honest cue for "good genes." Altruism was judged to be a less influential factor in the evolution of heroism than bravery and a demonstrated willingness to take risks. (shrink)

Technology has outpaced the capacity of researchers performing research on human participants to interpret all data generated and handle those data responsibly. This poses a critical challenge to existing rules governing human subjects research. The technologies used in research to generate images, scans, and data can now produce so much information that there is significant potential for incidental findings, findings generated in the course of research but beyond the aims of the study. Neuroimaging scans may visualize the entire brain and (...) even the entire head; computed tomography colonography research may visualize the entire torso, from the base of the lungs to the pubis; genetics studies may reveal “extra” and sometimes unwanted information about the family, such as misattributed paternity and undisclosed adoption; and genomic microarray research increasingly involves whole-genome analysis revealing an individual’s complete genotype, with enormous potential for uncovering unexpected information about an individual’s genetics and risks of developing future conditions. (shrink)

Human genomics is a translational field spanning research, clinical care, public health, and direct-to-consumer testing. However, law differs across these domains on issues including liability, consent, promoting quality of analysis and interpretation, and safeguarding privacy. Genomic activities crossing domains can thus encounter confusion and conflicts among these approaches. This paper suggests how to resolve these conflicts while protecting the rights and interests of individuals sequenced. Translational genomics requires this more translational approach to law.