Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

Following other contributions about the MAX accidents to this journal, this paper explores the role of betrayal and moral injury in safety engineering related to the U.S. federal regulator’s role in approving the Boeing 737MAX—a plane involved in two crashes that together killed 346 people. It discusses the tension between humility and hubris when engineers are faced with complex systems that create ambiguity, uncertain judgements, and equivocal test results from unstructured situations. It considers the relationship between moral injury, principled outrage (...) and rebuke when the technology ends up involved in disasters. It examines the corporate backdrop against which calls for enhanced employee voice are typically made, and argues that when engineers need to rely on various protections and moral inducements to ‘speak up,’ then the ethical essence of engineering—skepticism, testing, checking, and questioning—has already failed. (shrink)

In his long and illuminating paper [1] Joe Barback defined and showed to be non-vacuous a class of infinite regressive isols he has termed “complete y torre” isols. These particular isols a enjoy a property that Barback has since labelled combinatoriality. In [2], he provides a list of properties characterizing the combinatoria isols. In Section 2 of our paper, we extend this list of characterizations to include the fact that an infinite regressive isol X is combinatorial if and only if (...) its associated Dekker semiring D satisfies all those Π2 sentences of the anguage LN for isol theory that are true in the set ω of natural numbers. of the various function and relation symbols of LN via the “lifting ” to D of their Σ1 definitions in ω coincide with their interpretations via isolic extension.) We also note in Section 2 that Π2-correctness, for semirings D, cannot be improved to Π 3-correctness, no matter how many additional properties we succeed in attaching to a combinatoria isol; there is a fixed equation image sentence that blocks such extension. In Section 3, we provide a proof of the existence of combinatorial isols that does not involve verification of the extremely strong properties that characterize Barback's CT isols. (shrink)