The proliferation of personal data collection practices fundamentally reshapes how society is ordered and commercialized, and demands reconsideration of the possibilities for a just and equitable s...

This study investigates the ability of individuals with psychopathy to perform passive avoidance learning and whether this ability is modulated by level of reinforcement/punishment. Nineteen psychopathic and 21 comparison individuals, as defined by the Hare Psychopathy Checklist Revised (Hare, 1991), were given a passive avoidance task with a graded reinforcement schedule. Response to each rewarding number gained a point reward specific to that number (i.e., 1, 700, 1400 or 2000 points). Response to each punishing number lost a point punishment specific (...) to that number (i.e., the loss of 1, 700, 1400 or 2000 points). In line with predictions, individuals with psychopathy made more passive avoidance errors than the comparison individuals. In addition, while the performance of both groups was modulated by level of reward, only the performance of the comparison population was modulated by level of punishment. The results are interpreted with reference to a computational account of the emotional learning impairment in individuals with psychopathy. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Présentation de cinq grands intellectuels catholiques. Réflexion sur la foi et la raison. Essai engagé et sujet à débat.

The foundations of law. The digest title, De diversis regulis iuris antiqui, and the general principles of law, by P. Stein. Equity in Chinese customary law, by W. Y. Tsao. Prolegomena to the theory and history of Jewish law, by H. Cohn. Juridical evolution and equity, by J.P. Brutau. Reflections on the sources of the law, by P. Lepaulle. The true nature and province of jurisprudence from the viewpoint of Indian philosophy, by M.J. Sethna. On the functions and aims of (...) the state, by G. Del Veccchio.--Concepts of jurisprudence. Legal language and reality, by K. Olivecrona. The logic of the reasonable as differentiated from the logic of the rational (human reason in the making and the interpretation of the law) by L. Recaséns-Siches. Some refections on status and freedom, by W.G. Friedmann. Law and power and their correlation, by M. Reale. The notion of canonical auctoritas with respect to statute, custom and usage, by B.F. Brown. Two theories of "the institution," by J. Stone. (shrink)

Books Reviewed in this Article: Reason, Truth and History. By Hilary Putnam. Pp.xii, 222, Cambridge University Press, 1982, £15.00 , £4.95 . Fundamentals of philosophy. By David Stewart and H. Gene Blocker. Pp.xiii, 378, New York, Macmillan, 1982, £12.95. Modern Philosophy: An Introduction. By A.R. Lacey. Pp.vii, 246, London and Boston, Routledge & Kegan Paul, 1982, £7.95 , £3.95 . Merleau‐Ponty's Philosophy. By Samuel B. Mallin. Pp.xi, 302, New Haven and London, Yale University Press, 1979, £14.20. Thought and Object: Essays (...) on Intentionality. Edited by Andrew Woodfield. Pp.xvi, 316, Oxford, Clarendon Pressl Oxford University Press, 1982, £16.00. Philosophical Ethics: An Introduction to Moral Philosophy. By Tom L. Beauchamp. Pp.xv, 396, New York & London, McGraw‐Hill, 1982, £14.25. The Limits of Obligation. By James S. Fishkin. Pp.viii, 184, New Haven and London, Yale University Press, 1982, £12.95. Religion and the One: Philosophies East and West. By Frederick Copleston. Pp.281, London, Search Press, 1982, £10.50. Religious Experience and Christian Faith. By F.W. Dillistone. Pp.viii, 120. London, SCM Press, 1982, £4.95. Exploring Inner Space: Scientists and Religious Experience. By David Hay. Pp.256, Harmondsworth, Penguin Books, 1982, £2.95. Judaism and Psychoanalysis. Edited by Mortimer Ostrow. Pp.ix, 305, New York, Ktav, 1982, $20.00. Ecclesial Reflection: An Anatomy of Theological Method. By Edward Farley. Pp.xix, 380, Philadelphia, Fortress Press, 1982, $29.95. The Pastoral Nature of the Ministry. By Frank Wright. Pp.89, London, SCM Press, 1980, £2.50. Power and Authority in the Catholic Church. By Charles Dahm in collaboration with Robert Ghelardi. Pp.xviii, 334, Notre Dame, University of Notre Dame Press, 1981, £12.35. Religion in Sociological Perspective. By Bryan Wilson. Pp.vii. 187, Oxford University Press, 1982, £8.50. Myth, Religion and Society: Structuralist Essays. By M. Detienne, L. Gernet, J.‐P. Vernant and P. Vidal‐Naquet. Pp.xviii, 306, Cambridge University Press, 1981, £20.00 , £6.95 . Seven Theories of Human Society. By Tom Campbell. Pp.244, Oxford, Clarendon Press: Oxford University Press, 1981, £10.00. The Aims of Education Restated. By John White. Pp.xi, 177, London, Routledge & Kegan Paul, 1982, £8.95 , £4.95 . Love and Meaning in Religious Education: An Incarnational Approach to Teaching Christianity. By D.J. O'Leary and T. Sallnow. Pp.147, Oxford University Press, 1982, £3.50. Servant and Son: Jesus in Parable and Gospel. By J. Ramsey Michaels. Pp.xiii, 323, Atlanta, John Knox Press, 1981, £7.80. Parables for Now. By Edmund Flood. Pp.98, London, Darton, Longman and Todd, 1981, £2.50. More Parables for Now. By Edmund Flood. Pp.102, London, Darton, Longman and Todd, 1981, £2.50. Councils and Synods: With other Documents relating to the English Church, Vol.1 , A.D. 871–1204. Edited by D. Whitelock, M. Brett and C.N. Brooke. Pp.1 xxix, xii, 1151, Oxford University Press, 1981, £65.00. The Architectural History of Canterbury Cathedral. By Francis Woodman. Pp.xviii, 282, London, Routledge and Kegan Paul, 1981, £35.00. The Correspondence of Erasmus, Volume VI. Translated by R.A.B. Mynors and D.F.S. Thomson, annotated by Peter G. Bietenholz. Pp.xxii, 448, Toronto, University of Toronto Press, 1982, £56.25. Erasme: Vie de Jean Vitrier et de John Colet. Edited by Andrd Godin. Pp.160, Angers, Editions Moreana, 1982, $7.00. Erasme, lecteur d'Origène. By André Godin. Pp.ix, 724, Geneva, Librairie Droz, 1982, no price given. Thomas More: history and providence. By Alistair Fox. Pp.xi, 271, Oxford, Basil Blackwell, 1982, no price given. Thomas More: Essays on the Icon. Edited by D. Grace and B. Byron. Pp.129, Melbourne, Dove Communications, 1980, no price given. The Cambridge Connection and the Elizabethan Settlement of 1559. By W.S. Hudson. Pp.x, 158, Durham , Duke University Press, 1980, $14.75. Faith by Statute: Parliament and the Settlement of Religion, 1559. By Norman L. Jones. Pp.viii, 245 , London, Royal Historical Society, 1982, £17.52. Richard Hooker and the Politics of a Christian England. By Robert K. Faulkner. Pp.x, 190, Berkeley, University of California Press, 1981, £15.75. Icon and Conquest. By Bernadette Bucher. Pp.xvii, 220, Chicago, The University of Chicago Press, 1981, £9.95. The Wooden Churches of Eastern Europe: An Introductory Survey. By David Buxton. Pp.viii, 405, Cambridge University Press, 1982, £42.50. American Catholics: A History of the Roman Catholic Community in the United States. By James Hennessey. Pp.xii, 397, New York, Oxford University Press, 1981, £13.50. Peter Maurin: Prophet in the Twentieth Century. By Marc H. Ellis. Pp.191, Ramsey, New Jersey and Leominster, England, Paulist Press/Fowler Wright Books, 1981, £7.45. The Newman Movement: Roman Catholics in American Higher Education, 1883–1971. By John Whitney Evans. Pp.xvi, 248, Notre Dame, University of Notre Dame Press, 1980, $14.95. Priests and People in Pre‐Famine Ireland, 1780–1845. By S.J. Connolly. Pp.338, Dublin, Gill & Macmillan, 1982, £17.00. The Nonconformist Conscience: Chapel and Politics, 1870–1914. By D.W. Bebbington. Pp.x, 193, London, George Allen and Unwin, 1982, £10.00. Heinrich Pesch: sein Leben und seine Lehre. By Franz H. Mueller. Pp.220, Cologne, J.P. Bachem, 1980, no price given. Beyond Survival: Reflections on the Future of Judaism. By Dow Marmur. Pp.xix, 218, London, Darton, Longman and Todd, 1982, £7.95. (shrink)

Recent scholarship on technology-induced ‘conceptual disruption’ has spotlighted the notion of a conceptual gap. Conceptual gaps have also been discussed in scholarship on epistemic injustice, yet up until now these bodies of work have remained disconnected. This article shows that ‘gaps’ of interest to both bodies of literature are closely related, and argues that a joint examination of conceptual disruption and epistemic injustice is fruitful for both fields. I argue that hermeneutical marginalization—a skewed division of hermeneutical resources, which serves to (...) diminish the experiences of marginalized folk—does not only transpire because of conceptual gaps, but also because of two other kinds of conceptual disruption: conceptual overlaps and conceptual misalignments. Hence, there are multiple kinds of conceptual disruption that can be usefully studied through the normative lens of epistemic injustice. Technology can play different roles vis-a-vis epistemic injustices, both as a causal trigger of conceptual disruption, but also as a mediator of hermeneutical resources. Its role is normatively significant, in particular because socially disruptive technologies can have different epistemic implications for different groups: they may amplify the epistemic resources of some groups, while diminishing those of others. (shrink)

This article revisits long-standing questions about consent, membership and emigration in Locke’s thought. Commentators such as A John Simmons have argued that Locke opens political membership to both express consenters and some kind of tacit consenters, and not just to the former, as some have suggested. Simmons’s reading seems to render Locke more sensible in that it does not exclude large numbers of people from membership or burden the few members with all the civic duties, and also in that it (...) allows at least tacit-consenting members the right to relocate, while this right is denied to express-consenting members. Against this reading, the article shows, by resolving seemingly conflicting claims in the text, that people become members only by express consent. It also responds to the criticism that the express-consent-only reading would limit membership to a few and so would render Locke’s account implausible from a practical point of view. The article then addresses the purported restriction Locke imposes on express consenters’ right to emigrate, arguing that the restriction concerns the change of membership and not the right to relocate. (shrink)

Mason and McCall Smith's classic textbook discusses the relationship of medical practice and ethics with the operation of the law. The subjects covered include natural and assisted reproduction, the impact of modern genetics on medicine, medical confidentiality, consent to medical treatment, the use of resources and problems surrounding death in the new medical era. It is of significance to anyone with an interest in the ethical and legal practice of medicine.

In lieu of an abstract, here is a brief excerpt of the content:MACINTYRE'S REPUBLIC J. K. SWINDLER Westminster College Fulton, Missouri CONTRARY TO HIS own evident intentions and perceptions, in After Virtue A'lasdair Macinty!l.·e is much more of a Ptlatonist 1than the A1 ristotelian he aims to be. I hase this judgment both on the positive evidence that Macintyre and Plato (in the Republic) m1gue for and against the same crucial theses and on the negative evidence that Plato has read (...) answers to the very issues which Macintyre finds 1 intractable from an AristoteHan point of viiew. My thesis can be made out in terms of a half dozen issues which Maclntyire takes as crucial to his case: (1) Can there he a science of government? (2) Is there an answer to the sophist's chaillenge to morality? (3) How oan the fragmentation of the modern self he theoretically overcome? (4) What are the hi1stocical and social determinants of morality? (5) Is there a unity of virtue in addition to individual virtues? (6) Can we reconcile ourselves to teleofogy, the absence of the polis, and the tragedy of human 1:ife? I will consider each of these in turn. I. Wisdom Plato defines wisdom as knowledge of how to rule, and Aristotle (in the Nichomachean Ethics) distinguishes between theoretical and practical wisdom, 1suggesting thereby an interesting ambiguity in Plato's view, an ambiguity of which Macintyre makes a great deal. One may rule eithecr hy law or by judgment. In his attack on the Enlightenment, MacIntyre showis quite clearly tha;t the idea of a social science that would p11ovide laws of human behavior, which could in 343 344 J. K. SWINDLER turn be used by il"ulers and managers to predict and therefore manipulate!human action, was an invention of the eighteenth century. He offers an extensive 1oritique o.f this conception of socirul science, grounded primarily in the claim that human.behavior is essentially unlawful, at least if we judge it by the standards of the physical sciences. There is in human affairs a farge 1and uneliminwble element of fortiuna which makes it impossrible rto.formulate laws of human nature or behavior that would he exceptionless and therefore underwrite predictions of behavior. For there is nothing to be done about the unpredictability of innovations or, from one's own point of view, of one's own future actions; nor can the uncertainties of gametheoretie decisions and 1 the general contingency of the outcomes of ruction,be remedied. There is therefore no possibility of a social science in the sense in which Hume tried to imitate Newton. So much for Marx and Weber and the horde of modern.social scientists. This is not to say that life is completely uncertain; on the contrary, there are genuine and general regularities in society, some natural, some social, ·some statistical, some causal, wihich make life bearable. But these provide a,ground for the Aristotelian idea, endorsed by MacIntyre, that the principles of conduct, such as they might be, hold only for the most part and not universa1ly. There is therefore in Maclntyre's view no justification for 1a mora;l oode in the modern sense, nor ev;en of moral principles of the kind we are used to from Kant ·and Mill, Rawls and Nozick, which purport to istand as a sufficient criterion of right in all cases. But, importantly, we do not find any such rules or codes in Pla.to either. For Plato, too, insists on the mixed reign of chaos and logos in the materia;l world and in our Jives and concludes that judgment is essential to· determining right conduct. He tellrs us that wise rule comes only &om good oharructer and good institutions, that legislating in such detaii1 as to eliminate judgment is "cut:ting off the heads of a hy:dra." One cannot help hut think that tMs (essentially Hemclitean) point is something Aristotle ~earned at his MACINTYRE'S REPUBLIC 345 master's knee. And both aspects of Plato's :point ~e ipresent in Aristotle, viz., that s~nce the:ve is chance in nature, there is luck (good 'and had) in life, and since no rule can capture the particularity of conorete situations right... (shrink)

This new edition of Law and Medical Ethics continues to chart the ever-widening field that the topics cover. The interplay between the health caring professions and the public during the period intervening since the last edition has, perhaps, been mainly dominated by wide-ranging changes in the administration of the National Health Service and of the professions themselves but these have been paralleled by important developments in medical jurisprudence.

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions.

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

Medical ethics and medical practice -- Public health and the state-patient relationship -- Health rights and obligations in the European Union -- Consent to treatment -- Liability for medical injury -- Medical confidentiality -- Genetic information and the law -- The management of infertility and childlessness -- The control of fertility -- Civil and criminal liability in reproductive medicine -- Health resources and dilemmas in treatment -- Treatment of the aged -- Mental health and human rights -- The body as (...) property -- Medical futility -- The diagnosis of death -- The donation of organs and transplantation -- Euthanasia and assistance in dying -- Biomedical human research and experimentation -- Research on children, fetuses and embryos. (shrink)

University human research ethics application procedures can be complicated and daunting, especially for international students unfamiliar with the process and the language. We conducted focus groups and interviews with four research higher degree and 21 Master’s coursework international students at an Australian university to gain their views on the human ethics application process. We found the most important influences on their experience were: the time it took to do an application; support from supervisors, peers and others; their own language skills; (...) and their lack of familiarity with research ethics procedures. To improve the experience of international students undertaking research involving human research ethics applications, we recommend universities provide guidance on institutional ethics review processes, concepts and terminology, with translations in a range of languages, together with guidance on how to conduct research ethically within and outside the students’ own countries. We also recommend curricula be developed to further students’ understanding of the importance of ethical research practice, and that these curricula be embedded in undergraduate and postgraduate degree programs and reflected in course learning outcomes. (shrink)

There is a growing consensus in Britain on the importance of character, and on the belief that the virtues that contribute to good character are part of the solution to many of the challenges facing modern society. Parents, teachers and schools understand the need to teach basic moral virtues to pupils, such as honesty, self-control, fairness, and respect, while fostering behaviour associated with such virtues today. However, until recently, the materials required to help deliver this ambition have been missing in (...) Britain. The Knightly Virtues Programme, devised by the Jubilee Centre for Character and Virtues, aims to help solve this challenge. The programme, designed for 9 to 11 year olds, draws on selected classic stories to help teach moral character in schools. This approach has proved to be popular with children and teachers, with more than 5,000 pupils from one hundred schools having participated in the programme so far. Fifty-five of these schools and 3,272 pupils were directly involved in different stages of the research. Based at the University of Birmingham, the Jubilee Centre houses leading academics dedicated to researching the various ways in which good character, which underpins the building blocks of society, can be developed. Recent research from the Centre has shown that the qualities that make up character can be learnt and taught, and suggests that we need a new emphasis on their importance in schools and in professional education. This report from the Centre into the use of classic literature within schools sets out the ways in which the Knightly Virtues Programme is able to develop the virtue literacy of school pupils, and the extent to which an understanding and awareness of good moral character can make positive changes to behaviour. The impact of the programme has been tested using several rigorous research methods, detailed in this report alongside their findings, which provide substantial empirical evidence for the effectiveness of using stories to develop virtue literacy. (shrink)

It is proved that the relevance logic \ has no structurally complete consistent axiomatic extension, except for classical propositional logic. In fact, no other such extension is even passively structurally complete.

Books Reviewed in this Article: Towards a New Mysticism, Teilhard de Chardin and Eastern Religions. By Ursula King. Zen and the Bible: A Priest's Experience. By J.K. Kadowaki. Buddhism and Christianity, A Preface to Dialogue. By Georg Siegmund. Roman Catholicism: The Search for Relevance. By Bill McSweeney. The Church ‐ Maintained in Truth. By Hans Küng. The Communion of Saints. By Michael Perham. Identity and the Sacred: A Sketch for a New Social‐Scientific Theory of Religion. By Hans Mol. Sacrifice. Edited (...) by M.F.C. Bourdillon and Meyer Fortes. Theists and Atheists: A Typology of Non‐Belief By Thomas Molnar. Myth and Society in Ancient Greece. By Jean‐Pierre Vernant. The Alternative Tradition: Religion and the Rejection of Religion in the Ancient World. By James Thrower. Paulus im ältesten Christentum: Das Bild des Apostels and die Rezeption der paulinischen Theologie in der frühchristlichen Literatur bis Marcion. By Andreas Lindemann. Christ: the Christian Experience in the Modern World. By Edward Schillebeeckx. Interim Report on the Books “Jesus” and “Christ”. By Edward Schillebeeckx. Christologie im Präsens: Kritische Sichtung neuer Entwürfe. By Arno Schilson & Walter Kasper. Disput um Jesus and um Kirche. By Walter Kern. It is Not Lawful For Me To Fight: Early Christian Attitudes Toward War, Violence and the State. By Jean‐Michel Hornus. Byzantium and the Rise of Russia: A Study of Byzantino‐Russian Relations in the Fourteenth Century. By John Meyendorff. Reformation Principle and Practice: Essays in Honour of Arthur Geoffrey Dickens. Edited by Peter Newman Brooks. Adrianus Saravia. By Willem Nijenhuis. Rome and the Counter‐Reformation in Scandinavia, II. By Oskar Garstein. Winstanley the Digger: A Literary Analysis of Radical Ideas in the English Revolution. By T. Wilson Hayes. Perfect Fools. By John Saward. Lord Abbot of the Wilderness: The Life and Times of Bishop Salvado. By George Russo. St Edmund's House: The First Eighty Years. By Garrett Sweeney. Doubt and Religious Commitment: the Role of the Will in Newman's Thought. By M. Jaime Ferreira. The Philosophers: Their Lives and the Nature of Their Thought. By Ben‐Ami Scharfstein. Philosophies and Cultures. By Frederick C. Copleston. The Sceptical Feminist. By Janet Radcliffe Richards. Homosexuality and Ethics. Edited by Edward Batchelor, Jr. (shrink)

In this moderate realist account of the whole range of issues facing contemporary analytic philosophy, J. K. Swindler aims to fill the gap in the literature between extreme realism and extreme nominalism. He discusses such fundamental concepts as existence, property, universality, individual, and necessity; analyzes the paradoxes of negative existentials and the substitutivity of co-referential terms; and defends objectivity in philosophy. The study moves through three phases: first, an argument that objective philosophical truth is attainable; second, an extended realist analysis (...) of fundamental ontological concepts; and finally, a demonstration of advantages of this ontology over leading alternatives. Weaving: An Analysis of the Constitution of Objects will be of interest to all philosophers working in contemporary philosophy, philosophy of language, logic, and metaphysics, and will serve as an excellent text for advanced undergraduate and graduate courses in metaphysics. (shrink)

Conservationists have two types of arguments for why we should conserve ecosystems: instrumental and intrinsic value arguments. Instrumental arguments contend that we ought to conserve ecosystems because of the benefits that humans, or other morally relevant individuals, derive from ecosystems. Conservationists are often loath to rely too heavily on the instrumental argument because it could potentially force them to admit that some ecosystems are not at all useful to humans, or that if they are, they are not more useful than (...) alternative configurations of those ecosystems. Consequently, conservationists often resort to an intrinsic value argument, contending that ecosystems are objectively valuable as ends in themselves, rather than merely as means to an end. If ecosystems have intrinsic value, then they have moral standing, which means that we must consider their needs and interests in any decisions we make about them. This paper concerns the significance of this move for... (shrink)

A set is said to be amorphous if it is infinite, but is not the disjoint union of two infinite subsets. Thus amorphous sets can exist only if the axiom of choice is false. We give a general study of the structure which an amorphous set can carry, with the object of eventually obtaining a complete classification. The principal types of amorphous set we distinguish are the following: amorphous sets not of projective type, either bounded or unbounded size of members (...) of partitions of the set into finite pieces), and amorphous sets of projective type, meaning that the set admits a non-degenerate pregeometry, over finite fields either of bounded cardinality or of unbounded cardinality. The hope is that all amorphous sets will be of one of these types. Examples of each sort are constructed, and a reconstruction result for bounded amorphous sets is presented, indicating that the amorphous sets of this kind constructed in the paper are the only possible ones. The final section examines some questions concerned with the resulting cardinal arithmetic. (shrink)

This chapter contains sections titled: Why a Philosophy of Fatherhood? Role Responsibilities Autonomy Autonomy and Fatherhood Conclusion Notes.

It is shown that all the countable superatomic boolean algebras of finite rank have the small index property.

Why do we persist in the relentless pursuit of artificial nourishment and other treatments to maintain a permanently unconscious existence? In facing the future, if not the present world-wide reality of a huge number of persistent vegetative state (PVS) patients, will they be treated because of our ethical commitment to their humanity, or because of an ethical paralysis in the face of biotechnical progress? The PVS patient is cut off from the normal patterns of human connection and communication, with a (...) life unlike other forms of human existence. Why the struggle to justify ending a life which, it is said, has suffered an irreversible loss of the content of consciousness? Elsewhere, the authors have addressed the ethical controversies and confusion engendered by ambiguous terminology, misuse of medical facts and the differing interpretations of what constitutes 'effective' treatment: in particular, the issue of whether in fact artificial nutrition and hydration is a medical treatment, or simply part of the obligatory care owed to all patients, permanently unconscious or not. In this paper, we intend to argue that recent analyses of medical futility, its meaning and ethical implications, despite an absence of public consensus, permit some tentative re-evaluation of our ethical obligations to the PVS patient. (shrink)

The private sector has implemented many cost containment measures in efforts to control rising health care costs. However, these measures have not controlled costs in the long run, and can be expected not to succeed as long as business cannot control factors within the health care system which affect costs. Controlling private sector health care costs requires constraints on cost shifting which necessitates a unified financing system with expenditure limits. A unified financing system will involve a partnership between the public (...) and private sectors. (shrink)