Research studies demonstrate wide variation in how physicians diagnose and treat patients with similar medical conditions and suggest that at least some of the variation reflects inefficiencies and unnecessary medical costs. Health care researchers are actively examining ways to reduce variations in practice through standardization of medicine to reduce the cost of treatment and ensure the quality of outcomes. The most widely accepted form of this standardization is Evidence Based Best Practices. Furthermore, financial health care providers such as hospitals (...) and managed care organizations are investigating methods to tie resource usage to medical protocols in their efforts to monitor and control health care costs. Such proposals are contentious because they report on physicians' medical practice behaviors and such reports could potentially be used to influence their clinical behaviors. The intent of this exploratory study was to examine physicians' perceptions about linking a standard costing system to EBBP guidelines. The authors interviewed nine practicing physicians asking each physician to respond to the question, 'As a physician working in a hospital environment, what are your reactions to and concerns with combining standard costing techniques with EBBP?' The interviews were in-depth and free form in nature. The physicians' responses were recorded and analyzed using Grounded Theory Methodology. Using this methodology the field data was categorized into two major themes. The most important theme centered on ethics and the second theme was concerned with the implementation and use of a standard cost system in regard to EBBP. If physicians' worries about ethical dilemmas and implementation issues are not resolved, then it is likely that doctors would be unwilling to participate in any efforts to develop or use a standard cost-reporting system in medicine. While this study was exploratory in nature, it should provide future guidance to accountants, health care researchers and health care providers about physicians' issues with the use of standard costing methods in medicine. (shrink)

Research studies demonstrate wide variation in how physicians diagnose and treat patients with similar medical conditions and suggest that at least some of the variation reflects inefficiencies and unnecessary medical costs. Health care researchers are actively examining ways to reduce variations in practice through standardization of medicine to reduce the cost of treatment and ensure the quality of outcomes. The most widely accepted form of this standardization is Evidence Based Best Practices. Furthermore, financial health care providers such as hospitals (...) and managed care organizations are investigating methods to tie resource usage to medical protocols in their efforts to monitor and control health care costs. Such proposals are contentious because they report on physicians’ medical practice behaviors and such reports could potentially be used to influence their clinical behaviors. The intent of this exploratory study was to examine physicians’ perceptions about linking a standard costing system to EBBP guidelines. The authors interviewed nine practicing physicians asking each physician to respond to the question, ‘As a physician working in a hospital environment, what are your reactions to and concerns with combining standard costing techniques with EBBP?’ The interviews were in-depth and free form in nature. The physicians’ responses were recorded and analyzed using Grounded Theory Methodology. Using this methodology the field data was categorized into two major themes. The most important theme centered on ethics and the second theme was concerned with the implementation and use of a standard cost system in regard to EBBP. If physicians’ worries about ethical dilemmas and implementation issues are not resolved, then it is likely that doctors would be unwilling to participate in any efforts to develop or use a standard cost-reporting system in medicine. While this study was exploratory in nature, it should provide future guidance to accountants, health care researchers and health care providers about physicians’ issues with the use of standard costing methods in medicine. (shrink)

This article uses institutional ethnography to investigate how accounting texts mediate the reshaping of managerial practice in the educational sector. The community college system in Ontario is currently undergoing an extensive process of restructuring. Operating grants have been reduced; government spending policies increasingly pull colleges into market relations. In this context, college administrators are working to develop new ways of "doing business." Integral to this are accounting procedures that play a powerful role in organizational restructuring by creating new (...) patterns of organizational visibility. One such, program costing, calculates the profitability rate of an academic department's various program offerings. As deans, department chairpersons, faculty and union representatives orient to this new visibility, the changes they introduce into their work routines bring market relevances into the local sites of college activity. (shrink)

This article critically engages with Mandeville et al.'s case discussion of using social networking services for the purposes of contact tracing in infectious disease outbreaks. It will be argued that their discussion may be overstating the utility of such approaches, while simultaneously underestimating the ethical concerns that arise from this method of contact tracing. The article separates between ethical and technological concerns and suggests that due to the particular design of networking sites such as Facebook and the usage patterns of (...) subscribers, the positive effect of contact tracing through such services may be overstated. At the same time, using social networking sites raises serious concerns regarding the privacy of patients and the ownership of information posted online. (shrink)

This article presents two related challenges to the idea that, to ensure policy evaluation is comprehensive, all costs and benefits should be aggregated into a single, equity-weighted wellbeing metric. The first is to point out how, even allowing for equity-weighting, the use of a single metric limits the extent to which we can take distributional concerns into account. The second challenge starts from the observation that in this and many other ways, aggregating diverse effects into a single metric of evaluation (...) necessarily involves settling many moral questions that reasonable people disagree about. This raises serious questions as to what role such a method of policy evaluation can and should play in informing policy-making in liberal democracies. Ultimately, to ensure comprehensiveness of policy evaluation in a wider sense, namely, that all the diverse effects that reasonable people might think matter are kept score of, we need multiple metrics as inputs to public deliberation. (shrink)

Progress in medicine and the subsequent extension of health coverage has meant that health expenditure has increased sharply in Western countries. In the United States, this rise was precipitated in the 1980s, compounded by an increase in drug consumption which prompted the government to re-examine its financial support to care delivery, most notably in hospital care and emergencies services. In California for example, 50 emergency service providers were closed between 1990 and 2000, and nine in 1999–2000 alone. In that State, (...) only 355 hospitals (out of 568) have maintained emergency services departments (Darves, WebMB, 2001). Reforming hospital Emergency Department (ED) operations requires caution not only because the media pay a lot of attention to ED operations, but also because it raises ethical issues: this became more apparent with the enactment of the EMTALA which stipulates that federally funded hospitals are required to give emergency aid in order to “stabilize” a patient suffering from an “emergency medical condition” before discharging or transferring that patient to another facility. While in essence the law aims to preserve patient access to care, physicians assert that the EMTALA leads to more patients seeking care for non-urgent conditions in EDs (GAO, Report to Congressional Committees, 2001), leading to overcrowding, delayed care for patients with true emergency needs, and forcing hospitals to divert ambulances to other facilities resulting in further delays in urgent care. Also, fewer physicians are willing to be on-call in emergency departments because the EMTALA law requires on-call physicians to provide uncompensated care. Thus there is a need to find a balance between appropriate care to be provided to ED patients, and low costs since uncompensated care is not covered by state or federal funds. This concerns, first and foremost, hospitals that provide a greater amount of uncompensated care (e.g. hospitals serving communities with a higher population of illegal immigrants). Looking at the intrinsic causes of high ED costs, the paper first explains why costs of care provided in EDs are high, and look at a major cause of high ED costs: overcrowding and ED users’ characteristics. This is followed by a discussion on a much-debated factor: the use of EDs for non-emergency conditions, a practice which has often been accused of disproportionately raising costs. We look at various mechanisms used either to divert or prevent the patient from using ED: these include triage services; and the role of HMOs in the ED chain of care: though the US government has increasingly relied on Managed Care organizations to contain costs (e.g. Medicaid and Medicare Managed Care), do HMOs make a difference when it comes to ED costs? Of particular interest is the family physician acting as a gatekeeper, and the legislation that was enacted to protect those who bypass the referral system. We then look at the other end of the ED chain (i.e. the recipient): the financial responsibility of ED users has increased. Alternative providers such as walk-in clinics are increasingly common. EDs also attempt to reengineer their operations to curb costs. While the data are mostly applicable to a private health care system (e.g. the US), the article, using a critical assessment of the existing literature, has implications for other EDs generally, wherever they operate, since every ED faces similar funding problems. (shrink)

The purpose of the study is to present the author's accounting mechanisms in relation to the transaction costs of a manufacturing enterprise in relation to the financial, managerial and strategic aspects of this process. The scientific novelty of the research lies in the fact that the paper systematizes views on the existing accounting and analytical support in relation to transaction costs, offers various options for constructing accounting, management and strategic accounting of transaction costs, depending on the (...) assessment available for reflection. As a result, the recommended accounting approaches using accounting, management and strategic accounting of transaction costs are presented on the example of an industrial company. Since transaction costs occupy a significant share in the cost structure of business units engaged in production, it is necessary to organize their reflection using modern accounting principles. The complexity of the monetary assessment of such costs causes the complexity of the management process associated with their accounting. This publication is devoted to the problems of accounting, management and strategic accounting of transaction costs at a manufacturing enterprise. The use of an integrated approach based on accounting principles makes it possible to ensure control over transaction costs for solving urgent tasks of management and owners. (shrink)

Questions of social justice and health-care costs are some of the concerns of society. The cost caused by cardiovascular diseases can have an enormous impact, and it is important to know what patients think about illness costs when they are hospitalized. Two interviews were realized in a longitudinal study, in a sample of 106 patients submitted to expensive techniques in Cardiology (Portugal), to understand the patients’ perception about the health costs and behavior changes based on awareness. We can conclude (...) that cardiovascular diseases are a global phenomenon that generally affects all social groups. From those interviewed, 83% of the patients agree about getting information concerning the treatments and intervention costs during hospitalization because the information about costs can bring the necessary tools for improvement in patients and health resources; 70.8% of the patients say that this information could bring awareness to the patient’s life, enhancing responsibility and personal autonomy. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

According to a popular line of thought, being excluded from interpersonal life is to be exempted from accountability, and vice versa. In ordinary life, this is most often illustrated by the treatment of people with serious psychological disorders. When people are excluded from valuable domains on the basis of their arbitrary characteristics (such as race and sex), they are discriminated against, prevented from receiving the benefits of participation in those domains for morally irrelevant reasons. Exemption from accountability—via exclusion from the (...) interpersonal domain—seems to prevent exempted parties from receiving crucial human goods for morally irrelevant reasons. This chapter discusses two widely deployed ways of trying to ameliorate morally costly disabilities. Both fail to apply viably to various psychopathologies. The solution involves disentangling accountability and interpersonality in a way that also provides insights into our shared human nature. (shrink)

We suggest that policies will be less popular when individuals personally have to pay for them rather than when others have to pay (i.e., a Not Out of My Bank Account or NOMBA effect). Dual process models of persuasion suggest that personally having to pay would motivate scrutiny of persuasive messages making it essential to use effective science communication tactics when using climate science to support climate change policies. A pilot experiment (N = 186) and main study (N = 758) (...) support a NOMBA effect with less policy support (Pilot study) and lower recommended fees (Main study) for a policy that would require participants, rather than another group, to pay a fee for community solar panels. Consistent with dual process models and suggesting systematic processing, only when participants would have to pay the fee, messages using strong (vs. weak) science communication tactics increased support for policies (Pilot study), increased the favorability of thoughts about the policy (Main study) and these thoughts subsequently predicted policy support (Main study). Inconsistent with propositions that information about expert sources would be a heuristic or bolster science messages, expert consensus information did not influence thoughts or policy support in any study condition. Efforts to understand climate change policy support would benefit from attending to research on dual process models of persuasion, including understanding how different types and degree of outcome relevance can alter how people process science information used to bolster support for climate change policies. (shrink)

Although the sunk‐cost effect is a well‐documented psychological phenomenon in monetary investments, existing literature investigating behavioral investments (e.g., time, effort) has not replicated this effect except when such investments relate to monetary values. The current explanation for this discrepancy proposes that purely behavioral sunk‐cost effects are unlikely to be observed because they are difficult to book, track, and balance in a mental account. Conversely, we argue that, through an effort‐justification mechanism, people account for the amount of behavioral resources (...) invested when selecting an alternative, in which case they may fall prey to purely behavioral sunk‐cost effects. The results of two experiments support this prediction. Because many decisions involve behavioral investments, behavioral sunk‐cost effects should be pervasive psychological phenomena. (shrink)

Kerr coined the term ‘HARKing’ to refer to the practice of ‘hypothesizing after the results are known’. This questionable research practice has received increased attention in recent years because it is thought to have contributed to low replication rates in science. The present article discusses the concept of HARKing from a philosophical standpoint and then undertakes a critical review of Kerr’s twelve potential costs of HARKing. It is argued that these potential costs are either misconceived, misattributed to HARKing, lacking evidence, (...) or that they do not take into account pre- and post-publication peer review and public availability to research materials and data. It is concluded that it is premature to conclude that HARKing has led to low replication rates. (shrink)

BackgroundA recent paper presents an argument and mechanism for the possible stopping of clinical trials early based on opportunity costs.DiscussionAlthough we agree that the costs and opportunity costs of clinical trials need to be reduced wherever possible, we raise concerns about the motivation and mechanism for stopping clinical trials early raised by Lavery et al.SummaryWe argue that there are already enough acceptable criteria and actors in the clinical trials arena to justify early stoppage of clinical trials, and argue that factors (...) other than efficacy need to be carefully considered, especially in developing country contexts. (shrink)

According to Cushman, rationalization occurs when a person has performed an action and then concocts beliefs and desires that would have made it rational. We argue that this isn't the paradigmatic form of rationalization. Consequently, Cushman's explanation of the function and usefulness of rationalization is less broad-reaching than he intends. Cushman's account also obscures some of rationalization's pernicious consequences.

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers (...) distribute scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

Cost-benefit analysis is commonly understood to be intimately connected with utilitarianism and incompatible with other moral theories, particularly those that focus on deontological concepts such as rights. We reject this claim and argue that cost-benefit analysis can take moral rights as well as other non-utilitarian moral considerations into account in a systematic manner. We discuss three ways of doing this, and claim that two of them (output filters and input filters) can account for a wide range of rights-based (...) moral theories, including the absolute notions of moral rights proposed by Hayek, Mayo, Nozick, and Shue. We also discuss whether the use of output filters and input filters can be generalized to cover other non-utilitarian theories, such as Kantian duty ethics and virtue ethics. (shrink)

Many people who claim to genuinely care about nature still seem reluctant to ascribe intrinsic value to it. Environmentalists, nature friendly people in general, and even environmental activists, often hesitate at the idea that nature possesses value in its own right—value that is not reducible to its importance to human or other sentient beings. One crucial explanation of this reluctance is probably the thought that such value—at least when attached to nature—would be mysterious in one way or another, or at (...) least very difficult to account for. In addition, Bryan Norton’s influential convergence hypothesis states that, from a practical point of view, it makes no or little difference whether we ascribe intrinsic value to nature, given the depth and variety of instrumental value it possesses. In this paper, I argue that people who genuinely care about nature cannot avoid ascribing intrinsic value (in a certain sense) to it, if they want to be able to consistently defend the kind of claims about protecting nature they arguably want to make, i.e., claims to the effect that we ought to protect for instance nature areas and species. The cost of denying intrinsic value in nature is the cost of giving up a crucial resource to philosophically defend such claims. (shrink)

The information on extra costs of disability among developingcountries, including Malaysia, is lacking and the issue seems neglected. As aresult, an appropriate amount of monetary assistance that should be providedto the disabled community in Malaysia could not be determined. This paperundertakes a preliminary analysis of the extra costs of having a disability,by taking the staff of International Islamic University Malaysia asthe sample as to calculate the extra costs of having a disability. The standardof living approach is adopted, and the extra (...) costs are calculated by dividingthe estimated coefficient of disability variables by the estimated coefficientof income. This paper analyses the extra costs among households containingone person with disabilities, and also across different severity levels, types ofdisability, according to gender, and residential area. Overall,a household containing one person with disabilities accounted 27.5 per cent outof their monthly income to fulfil disability-related needs. (shrink)

BackgroundA recent paper presents an argument and mechanism for the possible stopping of clinical trials early based on opportunity costs.DiscussionAlthough we agree that the costs and opportunity costs of clinical trials need to be reduced wherever possible, we raise concerns about the motivation and mechanism for stopping clinical trials early raised by Lavery et al.SummaryWe argue that there are already enough acceptable criteria and actors in the clinical trials arena to justify early stoppage of clinical trials, and argue that factors (...) other than efficacy need to be carefully considered, especially in developing country contexts. (shrink)

People high in depressive or anxious symptom severity show repetitive negative thinking, including worry and rumination. They also show various cognitive phenomena, including probability, cost, and interpretation biases. Since there is conceptual overlap between these cognitive biases and repetitive negative thinking – all involve thinking about potential threats and misfortunes – we wondered whether repetitive negative thinking could account for (mediate) these cognitive biases’ associations with depressive and anxious symptom severity. In three studies, conducted in two languages and cultures, (...) cost bias and (in two studies) interpretation bias only predicted symptom severity via worry and repetitive negative thinking; this suggests these biases are actually associated with repetitive negative thinking, rather than with symptoms. In contrast, probability bias showed direct relationships with depressive (all studies) and anxious (two studies) symptom severity, suggesting its relationships with symptoms are partly independent of repetitive negative thinking. These results show the value of studying relationships among the various cognitive features of psychopathology. Furthermore, new interventions which target cognitive biases in depression or anxiety must show that they can improve upon cognitive behavioural therapy, which is already widely available, targets both repetitive negative thinking and probability bias, and is highly effective. (shrink)

A first-person account of some victims of the virus, the author puts faces and circumstances to the tragedy of the Covid-19 pandemic. Told from a chaplain’s point of view, these narratives will take the reader beyond the numbers and ask questions like: What is the cost of keeping families separated at the end of life, and, if patient/family centered care is so central to healthcare these days, why was it immediately discarded? Is potentially saving human lives worth the risk (...) of damaging them beyond repair? (shrink)

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers (...) distribute scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

Many clinicians believe that allowing costs to influence clinical decisions is unethical. They are mistaken in this belief, because it cannot be ethical to ignore the adverse consequences upon others of the decisions you make, which is what 'costs' represent. There are, however, some important ethical issues in deciding what costs to count, and how to count them. But these dilemmas are equally strong with respect to what benefits to count and how to count them, some of which expose ethically (...) untenable assumptions about such widely-used clinical criteria as survival rates. One of the advantages of systematic cost-effectiveness analysis is that it exposes these hidden assumptions, and requires explicit judgements to be made about which ethical position is appropriate in a particular policy context. This should have the important incidental benefit of improving the accountability of policy-makers to the community they are serving. (shrink)

Tax compliance has been extensively researched. Yet, the classic question ‘why do people pay taxes?’ remains unanswered. In Jordan, tax evasion is widespread. The state and citizens have been trapped in a continuous hide-and-seek game, which has taken the form of a virtuous cycle. This paper investigates tax evasion along with the most noticeable features of the Jordanian tax system. It also highlights how the virtuous cycle of tax evasion has been established and what could possibly be a way out (...) of it. We argue that sociocultural values are the most prominent cause for tax evasion. That is, the procedures of state formation and functionality in Jordan have created mutual distrust between the state and its citizens. Having been raised in a community characterized by deep distrust, tax evasion is no longer considered immoral by substantial numbers of the Jordanian population. We argue that successive governments need to create a high-trust-based culture and formulate strategies that serve to acquire normative ethical values in order to enhance voluntary compliance. The way to accomplish this necessity is through enforcing the state’s transparency and accountability. The taxation system needs to concentrate on income tax rather than raise tax rates on essential commodities to collect substantial tax revenues. Thus, further reform of the taxation system along with a reduction in tax incentives need to be considered. Moreover, lowering the exceptionally high personal income tax threshold would bring Jordan in line with its peers, expand the base, and introduce more progressivity. There would also be a scope to introduce a minimum tax based on sales as a tool to address tax evasion. (shrink)

This article discusses interactive minimum cost spanning tree problems and argues that the standard approach of using a transferable utility game to come up with a fair allocation of the total costs has some flaws. A new model of spillover games is presented, in which each player’s decision whether or not to cooperate is properly taken into account.

INCONTINENCE, HONOURING SUNK COSTS AND RATIONALITY According to a basic principle of rationality, the decision to engage in a course of action should be determined solely by the analysis of its consequences. Thus, considerations associated with previous use of resources should have no bearing on an agent’s decision-making process. Frequently, however, agents persist carrying on an activity they themselves judge to be nonoptimal under the circumstances because they have already allocated resources to that activity. When this is the case, agents (...) are said to be honouring sunk costs. Honouring sunk costs is thus typically viewed as irrational economic behaviour. Two striking findings of the psychological literature on the sunk cost effect are that it is, in general, not lessened by having taken previously courses in economics, and that agents who did take such courses and that do honour sunk costs seem to be frequently aware of a cognitive dissonance in their behaviour. Davidson’s account of the possibility conditions of incontinent action renders continent action materially unfeasible. The very idea of incontinent action becomes thus a hollow one. I’ll present an alternative description of these possibility conditions that renders continent action materially feasible, and both, continent and incontinent action, cognitively plausible. In a nutshell, my proposal rests upon the drawing of an essential cognitive contrast between explicit processes of deliberative reasoning and lower level heuristic procedures. I conclude the paper arguing that my redescription of incontinent action accounts for the above mentioned cognitive dissonance effect better than the alternatives and that viewing at least an important subset of behaviours of honouring sunk costs as incontinent actions will enable us to consider them as peculiar manifestations of a more general and meaningful pattern in human behaviour. (shrink)

This paper addresses how to think about the permissibility of introducing deadweight costs on candidate recipients of goods in order to attain better outcomes. The paper introduces some distinctions between different kinds of value dimensions that should be taken into account when such judgements are made and draws from the literature on comparisons across different value dimensions in order to canvas what sort of situations one might arguably face when evaluating ordeals. In light of the distinctions drawn and the possibilities (...) canvassed, the paper proceeds to outline what circumstances indicate which of the possible situations one is in. (shrink)

This article develops a detailed, empirically driven analysis of the nature of the transition costs incurred in becoming disabled. Our analysis of the complex nature of these costs supports the claim that it can be wrong to cause disability, even if disability is just one way of being different. We also argue that close attention to the nature of transition costs gives us reason to doubt that well-being, including transitory impacts on well-being, is the only thing that should determine the (...) wrongness of causing or removing disability. Non-welfare considerations also defeat the claim that it is always wrong to cause disability. The upshot of these conclusions is that closer attention to the nature of transition costs supports disabled people who strenuously contest the assumption that their well-being is lower than nondisabled people. It also suggests that, in addition, disabled people should contest their opponents’ narrow account of how we should make ethical decisions regarding causing or failing to prevent disability. (shrink)

A familiar part of debates about supererogatory actions concerns the role that cost should play. Two camps have emerged: one claiming that extreme cost is a necessary condition for when an action is supererogatory, while the other denies that it should be part of our definition of supererogation. In this paper, I propose an alternative position. I argue that it is comparative cost that is central to the supererogatory and that it is needed to explain a feature (...) that all accounts agree is central to the very notion of supererogation: optionality. Perhaps because of this agreement on its importance, few attempts have been made to clarify and explain the notion of optionality. I argue that giving an account of the optionality of supererogatory requires drawing a line between doing the bare minimum permissible and going beyond the bare minimum and that this line ought to be drawn based on comparative cost of alternative permissible acts. Having outlined my account and motivated it, I discuss and reject two concerns that might be raised: firstly, that it is extreme cost, not comparative cost, that matters and, secondly, that in fact no cost is needed for an act to be supererogatory. (shrink)

Theories of citizenship have largely focused on the provision of rights by law and policy measures, as if rights are universally beneficial and cost-free and the invitations of rights will be accepted once offered. I challenge this assumption and highlight the need to empirically address how people negotiate with the benefit and cost of claiming rights. Based on ethnographic research in South Korea, this article delves into the everyday lives of migrant women in two feminized sectors of migration—cross-border (...) marriage and sexual commerce—to situate the act of claiming rights in relation to the gendered pursuit of moral respect. I show that feminist groups in South Korea relied on the discourse of victimization and trafficking in pressuring the South Korean state to account for the human rights of migrant wives and migrant hostesses, while reinforcing the moral hierarchy that renders problematic migrant women’s work and intimate relationships. I argue that the distinctive material and moral costs that accompanied human rights–based provisions compelled migrant wives and hostesses to pursue divergent paths in seeking alternate bases to citizenship that would support their inclusion as moral equals. (shrink)

Jaegwon Kim’s causal inheritance principle says that the causal powers of a mental property instance are identical with the causal powers of its particular physical realizer. Sydney Shoemaker’s subset account of realization is at odds with Kim’s principle: it says that a mental property instance has fewer causal powers than Kim’s principle entails. In this paper, I argue that the subset account should be rejected because it has intolerable consequences for mental causation, consequences that are avoided by accepting causal inheritance. (...) I develop my argument in part by drawing on one of the central debates that has arisen regarding the extended mind hypothesis defended by Andy Clark and David Chalmers. (shrink)

Consequentializers suggest that for all non‐consequentialist moral theories, one can come up with a consequentialist counterpart that generates exactly the same deontic output as the original theory. Thus, all moral theories can be “consequentialized.” This paper argues that this procedure, though technically feasible, deprives consequentialism of its potential for normative justification. By allowing purported counterexamples to any given consequentialist moral theory to be accommodated within that theory’s account of value, consequentializers achieve a hollow victory. The resulting deontically equivalent consequentalist counterpart (...) that results from absorbing originally non‐consequentialist moral intuitions can now no longer explain, in a theoretically illuminating way, why certain actions are wrong and others right. The paper explains why traditional consequentialist theories did not embrace the procedure, and sketches how consequentialism can consequentialize without incurring the same cost. (shrink)

This book uses an incidence approach to look at the economic repercussions of birth defects. The authors investigate eighteen of the most clinically significant birth defects affecting 35,000 newborns each year in our country. Their assessments suggest that the annual cost of these eighteen birth defects, together, is more than eight billion dollars . The authors describe in detail their methodology and data sources while providing thorough accounts of each of the eighteen birth defects. Waitzman, Scheffler, and Romano break (...) new ground by using reports from the California Birth Defects Monitoring Program in order to provide cost estimates. They illustrate to the reader how cost estimates of specific birth defects can be used to justify prevention interventions and strategies. In chapter seven, they provide an important example, showing cost-benefit analysis of a program of folate supplementation of food to prevent neutral tube defects. Contents: List of Tables; Preface; Acknowledgements; Introduction; The Application of Cost-of-Illness Methodology To Birth Defects; The Direct Medical Costs of Birth Defects; Nonmedical Direct Costs of Birth Defects: Developmental Services and Special Education; The Indirect Costs of Birth Defects; Premature Mortality and Heightened Morbidity; An Assessment of Total Costs and Policy Implications; Description of Birth Defects; Description of Major Data Sources; Index. (shrink)

The issue of communicated accountability is particularly important in Faith-Based Charity Organisations as the donated funds and use of those funds are often meant to fulfil religious obligations for the well-being of society. Integrating Stewart’s (1984) ladder of accountability with the Statement of Recommended Practice guidance for charities, this paper examines communicated accountability practices of Muslim and Christian Charity Organisations in England and Wales. Our content analysis results indicate communicated accountability to be generally limited, focusing on providing basic descriptive information (...) rather than judgement-based information. Our interviews with trustees and preparers of Trustee Annual Reports in Muslim Charity Organisations identified the reasons being due to high donor trust and consequently weak demand by stakeholders for the latter type of information, as well as internal organisational issues related to the organisational structure and culture, lack of internal professional expertise and high accountability cost. (shrink)

Women currently earn 77 cents for every dollar earned by men. Explanations abound for why, exactly, this wage gap exists. One of the more potent justifications attributes this pay differential to the unequal effects of marriage on the sexes: the marital asymmetry hypothesis. However, even when marital status is accounted for, a small but significant residual gap remains. This article argues that this is the result of social factors. Entrenched societal sexism causes all of us to harbor unconscious bias about (...) the capabilities and proper gender roles of women. This bias, in turn, leads us to discount work completed by females, especially in professional environments. Employers are not immune from this effect, and the undervaluation of female ability affects hiring practices, leading to the residual wage gap. (shrink)

By Belief Revision it is understood a system that logically explains the rational process of changing beliefs by taking into account a new piece of information. The most influential approach in this field of study, the AGM system, proposed by Alchourrón, Gärdenfors, and Makinson, postulates rationality criteria for different types of belief change. In this paper I shall assess the relationship between those criteria and argue for an opposition between the principles of Information Economy and Consistency. Furthermore, I shall argue (...) that Paraconsistent Belief Revision manages to minimise this friction in the best possible way. (shrink)

This paper uses the controversy over the denial of care on futility grounds as a window into the broader issue of the role of cost in decisions about treatment near the end of life. The focus is on a topic that has not received the attention it deserves: the difference between refusing medical treatment and demanding it. The author discusses health care reform and the ethics of cost control, arguing that we cannot achieve universal access to quality care (...) at affordable care without better public understanding of the moral legitimacy of taking cost into account in health care decisions, even decisions at the end of life. (shrink)