The availability of willing providers of medical assistance in dying in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This study occurred at (...) the outset of MAiD practice in 2016, and 1 year later, once MAiD practice was established. Our study reveals that professional identity and values, personal identity and values, experience with death and dying, and organisation context are the most significant contributors to conscientious participation for MAiD providers and supporters. The stories of study participants were used to create a model that provides a framework for values clarification around MAiD practice, and can be used to explore beliefs and reasoning around participation in MAiD across the moral spectrum. This research addresses a significant gap in the literature by advancing our understanding of factors that influence participation in taboo clinical practices. It may be applied practically to help promote reflective practice regarding complex and controversial areas of medicine, to improve interprofessional engagement in MAiD practice and promote the conditions necessary to support moral diversity in our institutions. (shrink)

A critical account of the key connections between twentieth-century French philosopher Gilles Deleuze and nineteenth-century German idealist G. W. F. Hegel. Hegel, Deleuze, and the Critique of Representation provides a critical account of the key connections between twentieth-century French philosopher Gilles Deleuze and nineteenth-century German idealist G. W. F. Hegel. While Hegel has been recognized as one of the key targets of Deleuze’s philosophical writing, Henry Somers-Hall shows how Deleuze’s antipathy to Hegel has its roots in a problem the (...) two thinkers both try to address: getting beyond a philosophy of judgment and the restrictions of Kant’s transcendental idealism. By tracing the development of their attempts to address this problem, Somers-Hall offers an interpretation of the sweep of nineteenth- and twentieth-century philosophy, providing a series of analyses of key moments in the history of thought, including the logics of Aristotle and Russell, Kant’s own philosophy of judgment, and the philosophy of Bergson. He also develops a novel interpretation of Deleuze’s philosophy of difference, and situates his philosophy in relation to the broader post-Kantian tradition. In addition to Deleuze’s relation to Hegel, the book makes important contributions to the study of Deleuze’s philosophy of mathematics, as well as to the study of several underappreciated areas of Hegel’s own philosophy. (shrink)

In debates about the proper analysis of demonstrative expressions, ostensive gestures and speaker intentions are often seen as competing for primary importance in securing reference. Underlying some of these debates is the mistaken assumption that ostensive gestures always make the demonstrated object maximally salient to interlocutors. When we abandon this assumption and focus on an object’s mutually-recognized salience itself, rather than on how the object came to be salient, we can work towards a more promising analysis with a uniform treatment (...) of demonstrative reference whether or not there is an ostensive gesture, and whether reference is ordinary or deferred. (shrink)

Fashion design is a feminized occupation, but there is a widespread perception that gay male designers are advantaged in receiving awards, publicity, and praise. This article develops the notion of a “glass runway” to explain this inequality. First, using design canons and lists of award recipients, I show that men, especially gay men, receive more consecration than women. Second, I show how men and women are consecrated differently by analyzing the content of 157 entries in Voguepedia’s design canon and 96 (...) fashion media articles. Attributions of value and legitimacy construct a gendered image of the ideal fashion designer through discourses of art and culture that reinforce essentialist ideas about gender difference. Because cultural value is ambiguous, processes of valorization are shaped by gender essentialism, pushing male cultural producers down the glass runway and into the spotlight of fame, consecration, and legitimation. Finally, the case of fashion design offers insights into how intersecting inequalities can shape the glass runway. Gay designers experience both valorization and discrimination from intersections of gender and sexuality. (shrink)

Within the class of indexicals, a distinction is often made between “pure” or “automatic” indexicals on one hand, and demonstratives or “discretionary” indexicals on the other. The idea is supposed to be that certain indexicals refer automatically and invariably to a particular feature of the utterance context: ‘I’ refers to the speaker, ‘now’ to the time of utterance, ‘here’ to the place of utterance, etc. Against this view, I present cases where reference shifts from the speaker, time, or place of (...) utterance to some other object, time, or place. I consider and reject the claim that these counterexamples to the automatic indexical theory all involve non-literal uses of indexicals and argue that they cannot be explained away on the grounds that they involve conversational implicature or pretense. (shrink)

"This volume brings together a team of international specialists on Deleuze and Guattari to provide in-depth critical studies of each plateau of their major work, A Thousand Plateaus. It combines an overview of the text with deep scholarship and brings a renewed focus on the philosophical significance of their project.'A Thousand Plateaus' represents a whole new way of doing philosophy. This collection supports the critical reception of Deleuze and Guattari's text as one of the most important and influential works of (...) modern theory. Key Features : emphasises the philosophical nature of A Thousand Plateaus, provides detailed coverage of the text as a whole, brings together cutting edge research from some of the leading lights in scholarship on Deleuze and Guattari, an ideal companion to a plateau-by-plateau reading of Deleuze and Guattari's work."--Back cover. (shrink)

There is an expectation that all researchers will act ethically and responsibly in the conduct of research involving humans and animals. While research ethics is mentioned in quality indicators and codes of responsible researcher conduct, it appears to have little profile in doctoral assessment. There seems to be an implicit assumption that ethical competence has been achieved by the end of doctoral candidacy and that there is no need for candidates to report on the ethical dimensions of their study nor (...) for examiners to assess this integral aspect of researcher development. In the context of ensuring that institutions are fulfilling their responsibility of producing ethically sensitive and competent researchers, it is salient to investigate whether doctoral thesis examiners make comment about ethical issues in their reports. This study analysed an archive of examiner reports to identify the frequency, magnitude and nature of examiner comment about ethics. Although comment was rare examiners provided: prescriptive instruction on ethical review processes; formative instruction on the design, conduct, and reporting of research projects; and positive or negative judgments about a candidate's ethical competence, the latter often aligned with meeting, or not meeting, 'doctoral standards'. The scarcity of ethics in examination criteria and examiner reports implies a silence that needs to be addressed to ensure graduating candidates are prepared to conduct ethical and responsible research. (shrink)

My aim in this paper is to explore how we might understand the relation of Deleuze’s early works to ethics, and to develop the connections between this way of understanding Deleuze and the work of Søren Kierkegaard. I will claim that we can view both figures as arguing that the sense or meaning we take from the world, and the metaphysical structure we ascribe to it, is secondary to an ethical stance we take in the face of a world of (...) becoming. As such, the central preoccupation of both Kierkegaard and Deleuze is how we make sense of an existence which is necessarily temporal. As we shall see, recognizing the importance of temporality involves a move away from the traditional resolution of the problem of sense that operates by making temporality an accidental aspect of a world. In the first half of this paper, I want to explore this claim in relation to Deleuze’s reading of Plato, tying his claim that Plato is essentially developing an ethical rather than metaphysical doctrine with the claim that “the task of modern philosophy has been defined: to overturn [renversement] Platonism” (DR 59). My emphasis in this section is how Deleuze, rather than “overturning” Platonism by simply rejecting the priority it gives to Forms or essences over appearances, the renversement of Deleuze’s reading inverts the relation to show how the search for essence is in fact grounded in an ethical decision, or “selection,” in the world of appearances/simulacra itself. As such, both Plato and Deleuze can be seen as presenting different trajectories for making sense of a world of becoming, either by grounding it in a transcendent, atemporal realm, or by seeing it as an intensive field of processes. In the second half, I will argue that Kierkegaard’s philosophy rests on a claim, similar to the one we find in Deleuze’s work, that we need to develop a logic of sense in response to a world of becoming. I will conclude that Deleuze’s reading of Kierkegaard is limited by a focus on the theological aspects of his thought, and that Kierkegaard provides a sophisticated and complementary taxonomy of the ways in which we try to make sense of our existence in a world of becoming by developing diverse ethical postures. (shrink)

Denunciations of child sexual abuse in the sport context have been increasing in the last decades. Studies estimate that between 14 and 29% of athletes have been victim of at least one form of sexual violence in sport before the age of 18. However, studies suggest that many do not disclose their experience of CSA during childhood. This finding is alarming since studies have shown that the healing process usually starts with disclosure. Moreover, little is known about the healing process (...) of CSA experienced in the sport context. The aim of the study is to present a single case study of a CSA in sport to better understand the global experience over time from the perspective of the athlete. A narrative inquiry approach was adopted. Three non-structured interviews were conducted with the participant. Three pathways in the survivor journey have been identified through inductive thematic analysis: pathway to understanding, pathway to disclosure, and pathway to healing. These pathways represent distinct processes but are intertwined as they are dynamic and iterative. Indeed, the survivor explained how she had been, and is still, going back and forth between them. Results are consistent with those found in the literature on CSA in the general population. It suggests that theoretical models of CSA in the general population could be applied to CSA in sport. Practical implications include a need for education and clearer boundaries in the coach-athlete relationship. Sport stakeholders also need to be better equipped to recognize the signs of sexual violence in sport. Our results indicate that qualitative research could be a potential avenue to help victims heal from CSA. It gives them the chance to talk about and make sense of their abuse in a safe space. Finally, our results demonstrate the importance of reviewing the current justice system for victims. It should be based on a trauma-informed approach that places the victim at the center of the judicial process. (shrink)

Empathy is widely touted as a springboard for social change. Within the academy, ‘identification’ is often used to promote the social value of literary and cultural studies. But to what degree have scholars, in seeking to defend the value of literary and cultural studies, conceived the act of reading in problematic ways? ‘An Ethics of Reading’ argues that adopting a Lacanian paradigm of self (reader) and text (other) to discuss the act of textual interpretation reduces a complex event involving multiple (...) actors to a simple dualism, while ineluctably consigning any act of interpretation to simple projection. Turning instead to psychoanalyst Jean Laplanche’s concept of the enigmatic signifier, this article rethinks the relation between reader and cultural text – reconceiving the act of interpretation by situating it within a dynamic of transference, as opposed to projection. When conceived via this Laplanchian framework, reading becomes not only an effective path to cognition and knowledge, but a radical means of subjective transformation. (shrink)

Core indexicals like ‘I’, ‘here’, and ‘now’ sometimes appear to refer to an object, place, or time other than the speaker, location, or time of utterance. This presents well-known problems for Kaplan's view, which treats reference shifting as a violation of the character rules that give the meaning of indexicals. I propose a view according to which indexical reference is essentially a matter of the mutually-accepted perspective of interlocutors. It follows that contexts need not be ‘proper’ in Kaplan's sense, and (...) a successful convergence of perspectives is needed for indexical reference to succeed. I provide reasons for embracing these conclusions. (shrink)

The COVID-19 pandemic introduced significant disruptions and challenges to the learning environment for many post-secondary students with many shifting entirely to remote online learning. Barriers to academic success already experienced in traditional face-to-face classes may be compounded in the online environment and exacerbated by stressors related to the pandemic. In 2020–2021, post-secondary institutions were faced with the reality of rolling out fully online instruction with limited access to resources for assisting students in this transition. Instructional interventions that target students’ ability (...) to self-regulate their learning have been shown to improve academic performance and self-regulated learning competencies have also been found to mediate the effect of SRL interventions on higher education. However, few studies have examined the efficacy of fully online SRL intervention on mitigating the impact of psychological distress and academic challenges on academic success. This study examined the moderating roles of self-regulatory practices and SRL intervention in buffering the influence of COVID-related psychological distress and academic challenges on academic outcomes and academic challenges) in a Canadian sample of undergraduate students. We found levels of metacognitive and motivational challenges fully mediated the impact of COVID distress on GPA, SRL adapting practices moderated the impact of metacognitive challenges on GPA, and semester-long SRL intervention buffered the impact of COVID distress on academic challenges and resulted in lower levels of social-emotional, cognitive, and metacognitive challenges for first year undergraduate students. (shrink)

This book addresses the question of what unifies the French philosophical tradition across the twentieth century by exploring these two questions. Kant claimed that the structure of experience mirrored the categories of thought because the cognitive faculties of the subject played a constitutive role in structuring experience. As such, the structure of thought for Kant is fundamentally tied to the nature of metaphysics. In developing his account of what thinking entailed, Kant took judgement, the attribution of a predicate to a (...) subject, to be the paradigm act of thinking. Throughout the nineteenth century, efforts to move beyond Kant's model of thinking as judgement centred on the attempt to augment that model. For instance, Hegel saw Kant's account of judgement as an essentially fixed form of the true nature of thinking, and therefore developed a more processual account of thinking. His account still ultimately operates by putting judgement into motion, however, rather than rejecting the model of thinking as judgement itself. Conversely, philosophers such as Schelling who do not understand thinking solely in terms of judging often retreat into an indeterminate mysticism, thus retaining the idea that anything positive that can be said about thought must take judgement as a model. (shrink)

In the clinical setting, not enough attention is paid to the role that emotion plays. It is at worst ignored or avoided, isolating those who are suffering, at best treated as something to help another to endure. This is the result, in part, of an impoverished idea that views emotion as mere feelings. However, emotions are not just feelings, they are cognitive. If we look beneath the surface, emotions can provide information about values and beliefs, some of which may be (...) false or unreasonable. When they are motivating decisions that seriously affect the lives of others, there is a moral obligation to ferret them out and correct or deal with them. Attention needs to be paid to the emotions of healthcare providers as well as to the emotions of patients and their loved ones, and more done to train healthcare providers to deal effectively and productively with emotion – their own and others’. A son tearfully requests everything be done for his dying father. He fears limiting treatment means his father will be ignored. A physician orders another course of chemotherapy because she cannot bear for this patient to die. The patient, fearing he will painfully suffocate to death, agrees. Paying attention to emotions and bringing to light the beliefs and values behind them can only enhance the care and consideration of all involved. (shrink)

In this paper, I want to look at Deleuze’s philosophical heritage in two different senses. In the first part of the paper, I explore his relationship to perhaps the most influential philosopher of the twentieth century, Martin Heidegger. Heidegger plays a central role in Deleuze’s early philosophy, and even when in his later collaborations with Guattari their explicit references to Heidegger are dismissive, Heidegger’s influence can clearly be detected, particularly in their critiques of other philosophers. In the second part of (...) the paper, I look at Deleuze’s own contribution to philosophy, and to see how this contribution has been assessed by one of the most influential contemporary French philosophers, Alain Badiou. For Heidegger, Deleuze, and Badiou, perhaps the central problem for philosophy emerges from thinking about totality. For all three, the traditional metaphysical view of totality, derived from Aristotle’s concept of paronymy, occludes rather than solves the problem of how we characterise our most general concepts. As we shall see, Heidegger’s diagnosis of metaphysics, as constituted by what he calls onto-theology, is shared by all three philosophers, while their responses to this diagnosis differ. Deleuze and Badiou both reject Heidegger’s poetics of being in favour of the language of mathematics, but the question I want to explore in the final part of the paper is, which mathematics? The mathematics of the continuous, or the mathematics of the discrete? (shrink)

A definitive theory for ethical decision making in nursing is still only conjecture. The literature confirms that there have been numerous examinations of ethical decision making in nursing, with most proposing either the justice or the care orientation, or a combination of both. In the absence of a definitive theory, this exploratory work sets out, via grounded theory, to shed some light on the methods used every day by nurses to make ethical decisions in the clinical area. The data show (...) that some factors, such as doctors, colleagues and the organization, profoundly influence ethical decision making. The informants used both care and justice to formulate decisions, which is known as the combined approach. As a result of these findings, this article concludes with tentative suggestions and recommendations for practice. (shrink)

The number of admissions to hospitals of patients without a proxy decision maker is rising. Very often these patients need fairly immediate medical intervention for which informed consent—or informed refusal—is required. Many have recommended that there be a process in place to make these decisions, and that it include a variety of perspectives. People are particularly wary of relying solely on medical staff to make these decisions. The University Hospitals Case Medical Center recruits community members from its Ethics Committee to (...) serve on a subcommittee, the Patients Without Proxies (PWP) Committee, which works with medical staff during the decision-making process for these patients. Generally, the community members go to the bedside to observe patients. This article looks at how those unused to observing hospitalized patients who are sick and/or dying are affected, comparing them to mock jurors in a research study who are exposed to graphic photographs related to a fabricated crime scene. Judgments made by the mock jurors are affected by viewing such images. The personal experience of witnessing unfamiliar and shocking scenes affects their subsequent judgments. While it may be difficult to tease out whether observing patients causes PWP members to be benefited or harmed, they are affected by what they see. If a variety of perspectives is desirable to reduce possible bias or error, this article argues that at least one community member should refrain from seeing the patient in order to add a different and valuable voice to the decision-making process. Members of the subcommittee base their judgments on the various kinds of information available. Sometimes the things they see, hear, or feel may affect them particularly deeply, and affect their judgments as well. In this article I explore the idea that something like this may be happening in a particular kind of clinical ethics case consultation. (shrink)

This essay examines the symbolic significance of blood in the twentieth century and its role in determining the composition of a national community along racial lines. By drawing parallels between Nazi notions of blood and racial purity and historically contemporaneous U.S. policies regarding blood and blood products, Polsky reveals a disturbing proximity in discourse and policy. While the Nazis attempted to locate Jewish racial essence and inferiority in blood and instituted eugenic measures and laws forbidding racial admixture, similar policies existed (...) in the U.S. based on the so-called one drop rule that systematically discriminated against African Americans. (shrink)

Why should we seek and tell the truth? Does anyone know what truth is? Many are skeptical about the relevance of truth. Truth Matters endeavours to show why truth is important in a world where the very idea of truth is contested. Putting philosophers in conversation with educators, literary scholars, physicists, political theorists, and theologians, Truth Matters ranges across both analytic and continental philosophy and draws on the ideas of thinkers such as Aquinas, Balthasar, Brandom, Davidson, Dooyeweerd, Gadamer, Habermas, Kierkegaard, (...) Plantinga, Ricoeur, and Wolterstorff. Some essays attempt to provide a systematic account of truth, while others wrestle with the question of how truth is told and what it means to live truthfully. Contributors address debates between realists and anti-realists, explore issues surrounding relativism and constructivism in education and the social sciences, examine the politics of truth telling and the ethics of authenticity, and consider various religious perspectives on truth. Most scholars agree that truth is propositional, being expressed in statements that are subject to proof or disproof. This book goes a step farther: yes, propositional truth is important, but truth is more than propositional. To recognize how it is more than propositional is crucial for understanding why truth truly matters. Contributors include Doug Blomberg (ICS), Allyson Carr (ICS), Jeffrey Dudiak (King’s University College), Olaf Ellefson (York University), Gerrit Glas (VU University Amsterdam), Gill K. Goulding (Regis College), Jay Gupta (Mills College), Clarence Joldersma (Calvin College), Matthew J. Klaassen (ICS), John Jung Park (Duke University), Pamela J. Reeve (St. Augustine’s Seminary), Amy Richards (World Affairs Council of Western Michigan), Calvin Seerveld (ICS), Ronnie Shuker (ICS), Adam Smith (Brandeis University), John Van Rys (Redeemer University College), Darren Walhof (Grand Valley State University), Matthew Walhout (Calvin College), and Lambert Zuidervaart (ICS). (shrink)

Medical Assistance in Dying (MAiD) in Canada has had a tumultuous social and legal history. In the 6 years since assisted dying was decriminalized by the Canadian Parliament in June 2016, the introduction of this practice into the Canadian healthcare system has been fraught with ethical challenges, practical hurdles and grass-roots innovation. In 2021, MAiD accounted for approximately 3.3% of all Canadian deaths annually, and more patients are seeking MAiD year over year as this option becomes more widely know. Unfortunately, (...) some patients who want MAiD are unable to access it in a timely manner because of a lack of willing MAiD providers. This introduction describes statistics about the uptake of MAiD in Canada and the challenges presented by Canadians’ rapid acceptance of this end of life care option. In this special edition of HEC Forum about the implementation of MAiD in Canada, authors depict a range of ethical challenges and strategies to address issues related to MAiD access and quality, organizational engagement, clinician recruitment and retention, and support for a morally diverse workforce. In each article, the authors reflect on the question: What are the practical ethics involved in introducing assisted dying into a new healthcare context, and how can ethicists and ethics resources collaborate with stakeholders to ensure the integration of ethical considerations as this practice continues to evolve? (shrink)

For the last fifty years, the United States healthcare system has done an extremely poor job of delivering healthcare in a just and fair manner. The United States holds the dubious distinction of being the only industrialized nation in the world lacking provisions to ensure universal coverage. We attempt to provide some of the reasons this dysfunctional system has persisted and show that healthcare should not be a commodity. We begin with a brief historical overview of healthcare delivery in the (...) United States since WWII. This is followed by a critical analysis of the for-profit model including reasons to support the view that healthcare should not be a free market commodity. We also demonstrate how special interest groups have been able to win support for their practices based on propaganda rather than fact. A brief analysis of the Affordable Care Act is offered along with critical comments regarding its ineffectiveness. We conclude with a brief overview of international approaches that have resulted in universal coverage and suggest the United States ought to adopt an approach similar to those outlined so that it no longer stands as the only industrialized nation to ignore the glaring problems that exist. (shrink)

The interventionist account of causal explanation, in the version presented by Jim Woodward, has been recently claimed capable of buttressing the widely felt—though poorly understood—hunch that high-level, relatively abstract explanations, of the sort provided by sciences like biology, psychology and economics, are in some cases explanatorily optimal. It is the aim of this paper to show that this is mistaken. Due to a lack of effective constraints on the causal variables at the heart of the interventionist causal-explanatory scheme, as presently (...) formulated it is either unable to prefer high-level explanations to low, or systematically overshoots, recommending explanations at so high of a level as to be virtually vacuous. (shrink)

Both realist and anti-realist accounts of natural kinds possess prima facie virtues: realists can straightforwardly make sense of the apparent objectivity of the natural kinds, and anti-realists, their knowability. This paper formulates a properly anti-realist account designed to capture both merits. In particular, it recommends understanding natural kinds as ‘categorical bottlenecks,’ those categories that not only best serve us, with our idiosyncratic aims and cognitive capacities, but also those of a wide range of alternative agents. By endorsing an ultimately subjective (...) categorical principle, this view sidesteps epistemological difficulties facing realist views. Yet, it nevertheless identifies natural kinds that are fairly, though not completely, stance-independent or objective. (shrink)

David Lewis's influential work on the epistemology and metaphysics of objective chance has convinced many philosophers of the central importance of the following two claims: First, it is a serious cost of reductionist positions about chance (such as that occupied by Lewis) that they are, apparently, forced to modify the Principal Principle--the central principle relating objective chance to rational subjective probability--in order to avoid contradiction. Second, it is a perhaps more serious cost of the rival non-reductionist position that, unlike reductionism, (...) it can give no coherent explanation for why the Principal Principle should hold. I argue that both of these claims are fundamentally mistaken. (shrink)

The United States Court of Appeals for the Third Circuit held that when quitam relators file a multi-claim complaint under the Fraudulent Claims Act, their share of the proceeds must be based on an individual analysis of each claim. More importantly, the court held that relators are not entitled to any portion of the settlement of a specific claim if that claim was subject to dismissal under section 3730 Relator Merena filed a quitam suit against his employer, SmithKline Beecham, claiming, (...) among other things, that SKB defrauded the government by billing for laboratory tests that were not performed, paying illegal kickbacks to health care providers, and participating in an “automated chemistry” scheme. Soon thereafter, additional relators filed suit. (shrink)

The United States Court of Appeals for the Third Circuit held that when quitam relators file a multi-claim complaint under the Fraudulent Claims Act, their share of the proceeds must be based on an individual analysis of each claim. More importantly, the court held that relators are not entitled to any portion of the settlement of a specific claim if that claim was subject to dismissal under section 3730 Relator Merena filed a quitam suit against his employer, SmithKline Beecham, claiming, (...) among other things, that SKB defrauded the government by billing for laboratory tests that were not performed, paying illegal kickbacks to health care providers, and participating in an “automated chemistry” scheme. Soon thereafter, additional relators filed suit. (shrink)

Rationing health care is not new. As governments world wide struggle to contain the costs of health care, health policy analysts debate how rationing should be done. However, they too often neglect how the mechanisms for funding and allocating health care resources are themselves vehicles for rationing treatment. In the UK, where health care rationing debates currently abound, there has been no formal evaluation of the role of the market in allocating scarce health care resources.The market in health care has (...) increased administration, fragmented services, eroded local accountability, and decreased choice.This fragmentation, and the associated competition between purchasers and providers, means that resource allocation can no longer be monitored and evaluated in a national context. The loss of a population focus has left a vacuum in planning. Services cannot be planned rationally, and so are not able consistently to avoid duplication or to respond cogently to estimates of need.The loss of accountability means that decisions about the allocation of health care resources are no longer open to scrutiny by local people. Increasingly, especially in social and long term care the cost of care is being transferred to the individual. The new mechanisms for resource allocation are distributing resources unfairly: away from the poor, the sick and the elderly.The great myth of the market is that it has enabled decision-making to become explicit. This is not the case. To make health care resource allocation appear rational and acceptable to the public, health authorities have resorted to exercises in consumer consultation, and value laden guidelines where clinical cloaks are used to disguise political decisions on funding. In the UK, until the true role of the internal market is acknowledged, myths and subterfuge will conceal the winners and losers in the new system of rationing health care. (shrink)