The prelims comprise: Introduction The Physician and the Provider Organization The Physician and the Payer Organization Dealing with Systems Conclusion Notes References.

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total QualityManagement, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, (...) and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system. (shrink)

The problem is a simple one. A placebo is “a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated” (AMA 2007). 1 But i...

Most organizations and/or their sub-units like ethics programs want to acquire the knowledge, skills and other resources needed to achieve their goals efficiently and effectively. Thus, they want to acquire or develop needed capacity. But there are pre-conditions to building capacity that are often overlooked or forgotten, but which nevertheless, must be in place before capacity can be developed. This essay identifies these pre-conditions and discusses why they are necessary before attempts are made to enhance the capacity of any ethics (...) program. The essay closes by offering a series of questions that ethics program leaders/and or members can asked themselves to assess whether or not these pre-conditions exist. (shrink)

Bioethics, clinical ethics, and professional ethics are mature, well-developed fields of applied ethics that focus on medical research, patient autonomy and patient care, patient–healthcare professional relationships, and issues that arise in clinical and other medical settings. However, despite these developments, little attention has been paid to the organizational aspects of healthcare in these fields. This is surprising, because in the last 30 years healthcare has become more and more institutionalized in provider, management, and insurer organizations. Despite JCAHO's preoccupation with organizational (...) ethics during the last decade, the philosophical underpinnings of their requirements have been less explored in the literature. Clinical ethics remains preoccupied with clinical patient care and professional ethics with individual professional guidelines; even the American College of Healthcare Executives focuses primarily on healthcare managers, not on healthcare organizations. (shrink)

This case describes a psychiatric patient who stalked and harassed her former psychiatrist. Balancing the safety risk to her physician against the duty to continue to treat this vulnerable patient, what should the current psychiatrist and the treating institution do?

Originally published in 1908, this book contains six essays on various aspects of the Platonic theory of knowledge as expounded in the later dialogues reviewed by Aristotle. The text was written during the author's period as Marion Kennedy Student at Newnham College, Cambridge. Textual notes are also included. This book will be of value to anyone with an interest in Plato, Aristotle and classical philosophy.

In this case, an adolescent with a life-threatening immune disease experiences increased social complexity, child welfare involvement, and placement into foster care, which could disrupt a medical...

This work reviews and critically evaluates contemporary American Catholic moral theological reflections, both non-magisterial and magisterial, from 1975 to the present. It also considers relevant reflections from papal and papally related literature, and from the older tradition. It examines the following: criteria used in distinguishing between "ordinary" and "extraordinary" means, e.g., benefit and burden; miscellaneous elements employed in regard to these means, e.g., treatment and care; definitions given for these means. Based on the results of the foregoing, it proposes original (...) working definitions of these two main types of means. ;This work confirms the need, already recognized by some moral theologians, for a broad foundational criterion on which to base contemporary definitions of and distinctions between "ordinary" and "extraordinary" means. It finds the criteria offered thus far to be suggestive but flawed. Accordingly, its own working definitions are grounded in a foundational criterion of "integral human fulfillment in Jesus," a concept taken from the fundamental moral theological system developed by Germain Grisez. (shrink)

The primary subject of this study is the assessment ofJohann B. Metz’s judgment that Karl Rahner’s transcendental anthropology abstracts from concrete experience and succumbs to a kind of Idealist tautology. Secondarily consideration is given to the broader range of similar criticisms of Rahner’s construal of the God-human relation.

Human rights legislation pertaining to applications of human genetic science is still lacking at an international level. Three international human rights documents now serve as guidelines for countries wishing to develop such legislation. These were drafted and adopted by the United Nations Educational, Scientific and Cultural Organization, the Human Genome Organization, and the Council of Europe. It is critically important that the international nursing community makes known its philosophy and practice-based knowledge relating to ethics and human rights, and contributes to (...) the globalization of genetics. Nurses have particular expertise because they serve in a unique role at grass roots level to mediate between genetic science and its application to public health policies and medical interventions. As a result, nurses worldwide need to focus a constant eye on human rights ideals and interpret these within social, cultural, economic and political contexts at national and local levels. The purpose of this article is to clarify and legitimate the need for an international declaration on nursing, human rights, human genetics and public health policy. Because nurses around the world are the professional workforce by which genetic health care services and genetic research protocols will be delivered in the twenty-first century, members of the discipline of nursing need to think globally while acting locally. Above all other disciplines involved in genetics, nursing is in a good position to articulate an expanded theory of ethics beyond the principled approach of biomedical ethics. Nursing is sensitive to cultural diversity and community values; it is sympathetic to and can introduce an ethic of caring and relational ethics that listen to and accommodate the needs of local people and their requirements for public health. (shrink)

As concern over the use of questionable research practices in academic science has increased over the last couple of decades, some reforms have been implemented and many others have been debated and recommended. While many of these proposals have merit, efforts to improve scientific practices are more likely to succeed when they are responsive to the prevailing views and concerns of scientists themselves. To date, there have been few efforts to solicit wide-ranging input from researchers on the topic of needed (...) reforms. This article is a qualitative report of responses from federally funded scientists to the question of what should be done to address the problem of QRPs in their disciplines. Overall, participants were concerned about how institutional and career-oriented incentives encourage the use of QRPs. Compared to previous recommendations, participants had surprisingly little confidence in the ability of ethics training to improve research integrity. (shrink)

This topically organized, interdisciplinary anthology provides competing perspective on the claim that western culture faces a moral crisis. Using clearly written, accessible essays by well-known authors in philosophy, the social sciences, and the humanities, the book introduces students to a variety of perspectives on the current cultural debate about values that percolates beneath the surface of most of our social and political controversies.

The explanatory value of niche construction can be strengthened by firm footing in semiotic theory. Anthropologists have a unique perspective on the integration of such diverse approaches to human action and evolutionary processes. Here, we seek to open a dialogue between anthropology and biosemiotics. The overarching aim of this paper is to demonstrate that niche construction, including the underlying mechanism of reciprocal causation, is a semiotic process relating to biological development as well as cognitive development and cultural change. In making (...) this argument we emphasize the semiotic mechanisms underlying the niche concept. We argue that the “niche” in ecology and evolutionary biology can be consistent with the Umwelt of Jakob von Uexkull. Following John Deely we therefore suggest that investigations into the organism—environment interface constituting niche construction should emphasize the semiotic basis of experience. Peircean signs are pervasive and allow for flexible interpretations of phenomena in relation to the perceptual and cognitive capacities of the behaving organism, which is particularly pertinent for understanding the relation of proximate/ultimate selective forces as co-productive. Additionally, theoretical work by Kinji Imanishi on the evolution of daily life and Gregory Bateson’s relational view of evolution both support the linkage between proximate and ultimate evolutionary processes of causation necessitated by the niche construction perspective. We will then apply this theoretical framework to two specific examples: 1) hominin evolution, including uniquely human cultural behaviors with niche constructive implications; and 2) the multispecies and anthropocentric niche of human-dog coevolution from which complex cognitive capacities and semiotic relationships emerged. The intended outcome of this paper is the establishment of concrete semiotic mechanisms and theory underlying niche constructive behavior which can then be applied to a broad spectrum of organisms to contextualize the reciprocal relation between proximate and ultimate drivers of behavior. (shrink)

2. The equal status mentioned in Thesis 2 need not mean, "equally concrete" or "inclusive," but only, "equally real," where "real" means having a character of its own with reference to which opinions can be true or false. But becoming or process is alone fully concrete or inclusive, since if A is without becoming, and B becomes, then the togetherness of AB also becomes. A new constituent means a new totality. In this sense, becoming is the ultimate principle.