The ethical implications of the growth of for-profit health care institutions are complex. Two major moral criticisms of for-profit medicine are analyzed. The first claim is that for-profit health care institutions fail to fulfill their obligations to do their fair share in providing health care to the poor and so exacerbate the problem of access to health care. The second claim is that profit seeking in medicine will damage the physician-patient relationship, creating conflicts of interest that will diminish the quality (...) of care and erode patients' trust in their physicians and the public's trust in the medical profession. The authors conclude that while the continued expansion of for-profit health care may exacerbate in some respects problems of access, trust and conflicts of interest, it is a mistake to consider these problems as unique to for-profit health care; they are problems for not for-profit health care as well. Though these issues justify continuing moral concern, they do not at this time provide decisive grounds for substantially curbing or eliminating for-profit enterprise in health care. (shrink)

In the study reported here we examined the impact of population size and two proxies of risk of resource failure on the diversity and complexity of the food-getting toolkits of hunter–gatherers and small-scale food producers. We tested three hypotheses: the risk hypothesis, the population-size hypothesis, and a hypothesis derived from niche construction theory. Our analyses indicated that the toolkits of hunter–gatherers are more affected by risk than are the toolkits of food producers. They also showed that the toolkits of food (...) producers are more affected by population size than are the toolkits of hunter–gatherers. This pattern is inconsistent with the predictions of both the risk hypothesis and the population-size hypothesis. In contrast, it is consistent with the predictions of the niche construction hypothesis. Our results indicate that niche construction has affected the evolution of technology in small-scale societies and imply that niche construction must be taken into account when seeking to understand technological variation among food producers and the technological changes that occurred in association with the various transitions to farming that have occurred over the last 10,000 years. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The (...) book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late nineteenth and early twentieth centuries. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science. (shrink)

This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The (...) book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late nineteenth and early twentieth centuries. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science. (shrink)

The attitude of the American classical scholar Basil L. Gildersleeve toward the English may be taken as typical of Americans over the period of his long life. A native of Charleston, South Carolina, a city with deep economic and cultural ties to England, he found his youthful admiration for British scholarship offset by the sufferings of his ancestors in the Revolution and the War of 1812. At mid-century the allegiance of many American intellectuals had switched from England to Germany, viewed (...) idealistically as a place of pure intellectual discovery and artistic creativity. British amateurism held little interest for those who were building the first American research institutions in the 1880s, but as the FirstWorldWar approached, the deficiencies of the German system and the exciting work being done by those around Jane Harrison and Gilbert Murray brought Gildersleeve back to the respect for humane British scholarship that he had learned in his youth in Charleston. (shrink)