Drawing on a survey of over 4000 students and 1300 faculty members at the University of Maryland Global Campus, we find evidence for a reconceptualization of the use of commercialized websites offering access to “tutors” or “study help” as a type of collaborative cheating. Past studies have examined this behavior as an extension of contract cheating, but we find that students perceive the use of these sites very differently than they perceive contract cheating behaviors. In this paper we will discuss (...) how “tutor” or “study helper” websites combine the phenomena of collaborative cheating with internet-driven shifts in cultural and social perceptions to create a new type of cheating behavior that is viewed differently by students and faculty. (shrink)

This study examines how the self-reported cheating behaviors of students from a single large institution serving primarily adult students in online courses differ from those previously reported in large-scale studies of academic integrity among traditional-age college students. Specifically, the research presented here demonstrates that students at a large online university are no more likely to engage in most forms of cheating than the traditional-age students in residential institutions studied by Donald McCabe in his seminal research on academic integrity. Relatedly, our (...) study finds that students’ age decreases the likelihood of engaging in cheating behaviors. Moreover, traditional-age undergraduates in our study were no more likely to engage in cheating behaviors than the undergraduate students McCabe surveyed. Our study offers a unique contribution to the extant literature on academic integrity, as we believe this is the largest survey of student attitudes, beliefs, and behaviors from a single institution. The research presented here confounds the common perception that cheating is more prevalent and easier to accomplish in online learning and assessment. (shrink)

Making sense of religion in a world where Christianity seems to have forgotten the message of Jesus.

Introduction: nativism, exceptionalism, emics, and etics -- Kokugaku, nativism, and "exceptional" Japan -- Sonnō jōi : nativism and Bakumatsu Japan -- Proving uniqueness and asserting superiority : the history of exceptionalism -- Seventeenth-century Tokugawa exceptionalism -- From exceptionalism to nativism : Mitogaku and nineteenth-century Japan -- Conclusion : transcending Confucian hierarchy with a logocentric binary.

In his critique of preparedness theory, Davey does not address the limitations of adaptationism. The purpose of this commentary is to outline problems that arise when one assumes that mental illness (e.g., phobic disorder)musthave had adaptive significance for it to have survived the vicissitudes of natural selection.

This commentary describes some extensions of the Phillips & Singer model of contextual interactions to cater for the contrast- and extent-dependency of surround facilitation and suppression. I also comment briefly on some semantic problems with what exactly the role of synchronization might be: input preprocessing or output postprocessing?

Moral philosophy and psychology have sought to define the nature of right and wrong, and good and evil. The industrial turn of the twentieth century fostered increasingly technological approaches that conjoined philosophy to psychology, and psychology to the natural sciences. Thus, moral philosophy and psychology became ever more vested to investigations of the anatomic structures and physiologic processes involved in cognition, emotion and behavior - ultimately falling under the rubric of the neurosciences. Since 2002, neuroscientific studies of moral thought, emotions (...) and behaviors have become known as – and a part of – the relatively new discipline of neuroethics. Herein we present Part 2 of a bibliography of neuroethics from 2002–2013 addressing the “neuroscience of ethics” – studies of putative neural substrates and mechanisms involved in cognitive, emotional and behavioral processes of morality and ethics. (shrink)

The shortage of organs for transplantation has led researchers to look for new techniques to expand the donor pool. Preconditioning strategies have the potential to protect organs from transplant associated injury or may improve the function of substandard organs so that they become suitable for transplantation. Translating this type of technology to the clinical setting raises ethical issues, particularly relating to the deceased donor. It is important that society has the opportunity to discuss the issues raised by implementation of preconditioning (...) strategies before they are implemented rather than as a reaction to them. (shrink)

This paper considers whether a physician is criminally liable for administering a dose of painkillers that hastens a patient's death. The common wisdom is that a version of the doctrine of double effect legally protects the physician. That is, a physician is supposedly acting lawfully so long as the physician's primary purpose is to relieve suffering. This paper suggests that the criminal liability issue is more complex than that. Physician culpability can be based on recklessness, and recklessness hinges on whether (...) a physician has taken an unjustifiable risk of hastening death. The authors identify three conditions of justifiability. Their analysis helps to explain the distinction between euthanasia, which is legally banned, and the use of risky analgesics, which is permitted in limited circumstances. (shrink)

This article responds to two problems confronting social and human sciences: how to relate to digital data, inasmuch as it challenges established social science methods; and how to relate to life sciences, insofar as they produce knowledge that impinges on our own ways of knowing. In a case study of proteomics, we explore how digital devices grapple with large-scale multiples – of molecules, databases, machines and people. We analyse one particular visual device, a cluster-heatmap, produced by scientists by mining data (...) from a large number of experiments on human blood plasma proteins. These proteins make up a myriad multiple whose identity shifts in many ways. Rather than displaying data about proteins, the heatmap constructs a view of the differences and similarities between experiments. We find this attempt to construct a view on many things at once instructive in thinking about multiples more generally. Instead of flattening molecular ‘life itself’, this visual device superimposes layers of digital devices and techniques from a wide variety of disciplines. This layering suggests a different way of relating to the life sciences more generally: rather than what they know, how they know might be of use to social and human sciences when attending to multiplicities. (shrink)

This paper extends the dialogue of educational philosophy to the experience of beginners entering the teaching profession. Rather than impose the ideas of any specific philosopher or theorist, or indeed official standard, the exploration presented here owes its origins to phenomenology and the use of grounded theory. Working from a narrative data base and focussing on the knowing of name in the first instance, the authors develop their emergent ideas on self and identity in relation to children taught, through connection (...) to a wider literature that includes reference to Giddens, Illeris, Deleuze and Heidegger, for example. The paper is thus also an exercise in suggesting that research on practice by academics working in professional education, who are non-philosophers, can lead to constructive and relevant engagement with philosophy in developing theory from and about about practice, even though the approach, in the initial stages, may well be serendipitous and eclectic in nature. (shrink)

This paper extends the dialogue of educational philosophy to the experience of beginners entering the teaching profession. Rather than impose the ideas of any specific philosopher or theorist, or indeed official standard, the exploration presented here owes its origins to phenomenology and the use of grounded theory. Working from a narrative data base and focussing on the knowing of name in the first instance, the authors develop their emergent ideas on self and identity in relation to children taught, through connection (...) to a wider literature that includes reference to Giddens, Illeris, Deleuze and Heidegger, for example. The paper is thus also an exercise in suggesting that research on practice by academics working in professional education, who are non‐philosophers, can lead to constructive and relevant engagement with philosophy in developing theory from and about about practice, even though the approach, in the initial stages, may well be serendipitous and eclectic in nature. (shrink)

I address the question whether Dummetts manifestation challenge to semantic realism can be disarmed by reflection on the compositionality of meaning. Building on work of Dummett and Wright, I develop in §§12 what I argue to be the most formidable version of the manifestation challenge. Along the way I review attempts by previous authors to deploy considerations about compositionality in realisms favour, and argue that they are unsuccessful. The formulation of the challenge I develop renders explicit something which I argue (...) to be implicit in Dummetts and Wrights presentations: that the challenge depends on a contention about the constitution of speakers states of declarative sentence understanding: i.e., that many such states incorporate abilities to recognize whether the associated sentences truth conditions are satisfied. In §3 I argue that reflection on the compositionality of meaning reveals, first, that this contention must be rejected by the realist, and second, that it is unmotivated. This result does not settle the debate over the manifestation challenge, but it implies that the onus of argument does not currently rest with the realist. (shrink)

The paper addresses a prima facie tension between two popular views about concepts. The first is the doctrine that some concepts are constitutively perceptual/experiential, so that they can be possessed only by suitably experienced subjects. This is a classic empiricist theme, but its most conspicuous recent appearance is in literature on phenomenal concepts. The second view is anti-individualism: here, the view that concept possession depends not only on a thinker’s internal states and relations to the concepts’ referents, but also on (...) certain of her relations to sociolinguistic peers. In recent works, Derek Ball and Michael Tye have in effect argued that the doctrines are incompatible, and their conclusion is that no concepts depend on experience. In reply, Bénédicte Veillet endorses those authors’ incompatibilism, but argues that it is anti-individualism that we should reject. I develop an approach to reconciliation that is more promising than any considered by these theorists. Against Veillet, I defend a version of anti-individualism about phenomenal concepts, but against Ball and Tye, I argue that they can be possessed only by suitably experienced thinkers. (shrink)

Color adjectives have played a central role in work on language typology and variation, but there has been relatively little investigation of their meanings by researchers in formal semantics. This is surprising given the fact that color terms have been at the center of debates in the philosophy of language over foundational questions, in particular whether the idea of a compositional, truth-conditional theory of natural language semantics is even coherent. The challenge presented by color terms is articulated in detail in (...) the work of Charles Travis. Travis argues that structurally isomorphic sentences containing color adjectives can shift truth value from context to context depending on how they are used and in the absence of effects of vagueness or ambiguity/polysemy, and concludes that a deterministic mapping from structures to truth conditions is impossible. The goal of this paper is to provide a linguistic perspective on this issue, which we believe defuses Travis’ challenge. We provide empirical arguments that color adjectives are in fact ambiguous between gradable and nongradable interpretations, and that this simple ambiguity, together with independently motivated options concerning scalar dimension within the gradable reading accounts for the Travis facts in a simpler, more constrained, and thus ultimately more successful fashion than recent contextualist analyses such as those in Szabó (Perspectives on semantics, pragmatics and discourse: A festschrift for Ferenc Kiefer, 2001) or Rothschild and Segal (Mind Lang, 2009). (shrink)

:This essay investigates the relationships among scripts, schemata, and social norms. The authors examine how social norms are triggered by particular schemata and are grounded in scripts. Just as schemata are embedded in a network, so too are social norms, and they can be primed through spreading activation. Moreover, the expectations that allow a social norm’s existence are inherently grounded in particular scripts and schemata. Using interventions that have targeted gender norms, open defecation, female genital cutting, and other collective issues (...) as examples, the authors argue that ignoring the cognitive underpinnings of a social norm can hamper the effectiveness of behavioral interventions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.1 (2002) 103-113 [Access article in PDF] Scope Note Update Searching Across Boundaries: National Information Resource on Ethics and Human Genetics* While indeed an historical moment, the announcement of the mapping of the human genome has been treated in the literature as a beginning—a new way to think about biology and the ways in which biological concepts are applied to medicine. Issues of both (...) Science and Nature magazines celebrated the event by establishing interdisciplinary websites where readers can access essays on aspects of genome mapping and directly link to databases to search for more information on the topics (IV. Genome Gateway 2001; The Human Genome 2001). Since 1994, the National Information Resource on Ethics and Human Genetics (NIREHG), a special project of the National Reference Center for Bioethics Literature (NRC), has been providing such an integrated information service on ethics and genetics. Designed to enable a wide range of users to go from annotated bibliographies (Scope Notes) and brief essays (called "enotes") to database searching, NIREHG fosters an interdisciplinary approach to research on ethics and genetics. Links are provided between and among Scope Notes and enotes to information maintained on the NIREHG site as well as to sources found throughout the Internet. In providing the following annotations added to NIREHG materials since 1997, the Kennedy Institute of Ethics Journal (in its online presence through Project Muse) becomes an additional forum for NIREHG links. "It is a rare and wonderful moment when success teaches us humility, and this, I argue, is precisely the moment at which we find ourselves at the end of the twentieth century" (IV. Keller 2000, p. 7). It is with both joy and humility that we celebrate the mapping of the human genome. [End Page 103] I. Genetic Testing Andrews, Lori B. Future Perfect: Confronting Decisions About Genetics. New York: Columbia University Press, 2001. 264 p.Noting the wide impact of genetic testing, Andrews discusses patient self concept, reproduction decisions, confidentiality, discriminations in health insurance and employment, the need for competent counseling, and the legal, ethical, and social regulations she deems important to help solve dilemmas arising from the tests and their ensuing ramifications. She describes three models, pointing out both advantages and problems: a medical model with physician gatekeepers, a public health model that could provide education as well some testing for those unable to afford tests, and a fundamental rights model that could give greater weight to individuals decisions about the use of health care services. The book has 85 pages of footnotes.American Society of Human Genetics. Social Issues Subcommittee on Familial Disclosure. Professional Disclosure of Familial Genetic Information. American Journal of Human Genetics 62 (2): 474-83, February 1998.The ASHG statement outlines points to consider: the general rule of confidentiality, exceptional circumstances that permit disclosure, and the ethical duty to inform patients about familial implications. Background discussion includes: ethical frameworks for disclosure of otherwise confidential information, the duty to warn under law, and international trends and positions.Boetzkes, Elisabeth. Genetic Knowledge and Third-Party Interests. Cambridge Quarterly of Healthcare Ethics 8 (4): 386-92, Summer 1999.Protection from the interests of insurers or prospective employers are discussed from the point of view of the ethical basis of the professional obligation to confidentiality as well as the right to privacy of those tested. However, the author supports family members, saying that "first-party resistance to disclosure may be overcome by weighty third-party claims."Chadwick, Ruth; Shickle, Darren; ten Have, Henk; and Wiesing, Urban, eds. The Ethics of Genetic Screening. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1999. 255 p.Twenty-one chapters and 23 authors provide views of genetic testing/screening in different European countries and offer brief discussions of sociological perspectives, moral and philosophical issues, privacy, reconciling liberty and the common good, and questions raised in genetic testing of children.Clayton, Ellen Wright. Genetic Testing in Children. Journal of Medicine and Philosophy 22 (3): 233-51, June 1997.Clayton argues that there is room for... (shrink)

BackgroundNeuroethics describes several interdisciplinary topics exploring the application and implications of engaging neuroscience in societal contexts. To explore this topic, we present Part 3 of a four-part bibliography of neuroethics’ literature focusing on the “ethics of neuroscience.”MethodsTo complete a systematic survey of the neuroethics literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U.S. National Library of Medicine. A Python code was used to eliminate duplications in the final bibliography.ResultsThis bibliography (...) consists of 1137 papers, 56 books, and 134 book chapters published from 2002 through 2014, covering ethical issues in neuroimaging, neurogenetics, neurobiomarkers, neuro-psychopharmacology, brain stimulation, neural stem cells, neural tissue transplants, pediatric-specific issues, dual-use, and general neuroscience research issues. These works contain explanations of recent research regarding neurotechnology, while exploring ethical issues in future discoveries and use. (shrink)

The goal of this short paper is to show that esthetic adjectives—exemplified by “beautiful” and “elegant”—do not pattern stably on a range of linguistic diagnostics that have been used to taxonomize the gradability properties of adjectives. We argue that a plausible explanation for this puzzling data involves distinguishing two properties of gradable adjectives that have been frequently conflated: whether an adjective’s applicability is sensitive to a comparison class, and whether an adjective’s applicability is context-dependent.

Many contemporary physicalists concede to dualists that conscious subjects have distinctive “phenomenal concepts” of the phenomenal qualities of their experiences. Indeed, they contend that idiosyncratic characteristics of these concepts facilitate responses to influential anti-physicalist arguments. Like some some other critics of this approach, James Tartaglia maintains that phenomenal concepts express contents that conflict with physicalism, but as a physicalist, the moral he distinctively draws from this is that phenomenal concepts misrepresent. He contends further that the contemporary physicalists’ account cannot accommodate (...) this feature, and that in consequence, physicalists should abandon phenomenal concepts and return to the identity theory championed by Place and Smart in the 1950s. I respond to Tartaglia by identifying lacunae in his interpretation of contemporary physicalism and arguing that phenomenal concepts as conceived by the contemporary physicalists do not express content... (shrink)

The nature of moral judgments, and, more specifically, the question of how they relate, on the one hand, to objective reality and, on the other, to subjective experience, are issues that have been central to metaethics from its very beginnings. While these complex and challenging issues have been debated by analytic philosophers for over a century, it is only relatively recently that more interdisciplinary and empirically-oriented approaches to such issues have begun to see light. The present chapter aims to make (...) a contribution of that kind. We will present the results of an empirical – specifically, corpus linguistic – study that offers evidence that moral predicates exhibit hallmarks of subjectivity at the linguistic level, but also, that they differ significantly from paradigmatically subjective predicates. (shrink)

Arguing About Language presents a comprehensive selection of key readings on fundamental issues in the philosophy of language. It offers a fresh and exciting introduction to the subject, addressing both perennial problems and emerging topics. Classic readings from Frege, Russell, Kripke, Chomsky, Quine, Grice, Lewis and Davidson appear alongside more recent pieces by philosophers or linguists such as Robyn Carston, Delia Graff Fara, Frank Jackson, Ernie Lepore & Jerry Fodor, Nathan Salmon, Zoltán Szabó, Timothy Williamson and Crispin Wright. Organised into (...) clear sections, readings have been chosen that engage with one another and often take opposing views on the same question, helping students to get to grips with the key areas of debate in the philosophy of language, including: sense and reference definite descriptions linguistic conventions language and behaviour descriptivism and rigidity contextualism vagueness rule-following and normativity fictional discourse. Each article selected is clear, thought-provoking and free from unnecessary jargon. The editors provide lucid introductions to each section in which they give an overview of the debate and outline the arguments of the papers. Arguing About Language is an ideal reader for students looking for a balanced yet up-to-date introduction to the philosophy of language. Darragh Byrne is lecturer in philosophy at the University of Birmingham, UK. Max Kölbel is ICREA Research Professor at the University of Barcelona, Spain. He is the author of Truth without Objectivity (Routledge, 2002) and co-editor of Wittgenstein's Lasting Significance (Routledge, 2004) with Bernhard Weiss, as well as Relative Truth (Oxford, 2008) with Manuel García-Carpintero. (shrink)

Even-like particles have widely been analyzed as inducing scalar and additive presuppositions (cf. Horn 1969; Karttunen & Peters 1979; Rooth 1992; Gast & van der Auwera 2011). However, the additivity of even has been controversial since at least Horn 1992 and increasingly called into question (see Greenberg & Umbach 2021 for references); Greenberg specifically argues that scalar even-like particles can vary in additivity. This claim is surprising in light of the typological study in Gast & van der Auwera 2011, which (...) subsumes even and similar expressions under a larger class of additive particles. Against this background, we present an analysis of Italian addirittura, which with perfino has been described as scalar-additive (Visconti 2005) – but only optionally so – and is chosen preferentially over perfino precisely in those contexts that Greenberg takes to challenge the additivity of even. We argue, drawing on observations in Atayan 2017, that addirittura contrasts with perfino in deriving its scalar alternatives from rhetorical structure rather than focus structure. Once this is recognized we can view addirittura as additive, after all, in a rhetorical sense we describe below. (shrink)

1 I shall mainly concentrate on Loar (1997, 1999), Tye (1999), Papineau (1998, 2002), Levine (1998, 2001) and Chalmers (2003). Only the first three of these authors endorse the claim that the proposal supports materialism. Levine.

The first half of Mark Quentin Gardiner’s recent book, Semantic Challenges to Realism: Dummett and Putnam, is a sustained, systematic, and, for the most part, novel attempt to demolish the case against semantic realism instigated by Michael Dummett. In this article I reply on the anti-realist’s be-half. I aim to demonstrate that none of Gardiner’s main anti-Dummettian arguments are successful, and moreover that his errors are, in the main, consequences of serious misconstruals of vital aspects of the semantic realist and (...) anti-realist positions. (shrink)

Abstract Empiricist philosophers of mind have long maintained that the possession conditions of many concepts include recognitional abilities. One of Jerry Fodor's recent attacks on empiricist semantics proceeds by attempting to demonstrate that there are no such, ?recognitional? concepts. His argument is built on the claim that if there were such concepts, they would not compose: i.e., they would exhibit properties which are not in general ?inherited? by complex concepts of which they are components. Debate between Fodor and his critics (...) on this issue has focused on his construal of compositionality, the critics in effect advocating a weaker conception than that assumed by Fodor. I argue that the critics' contention is under-motivated, and in the current context ad hoc. But there is something else wrong with Fodor's argument. He misidentifies the notion of recognitionality in which the empiricist should trade. A proper understanding of recognitionality allows us to disarm Fodor's argument without resolving the question about compositionality that divides Fodor and his critics. I end with two very general remarks. First a contention about the motivation for empiricist semantics, and second, a suggestion that my proposal about recognitionality may be extended to disarm a more familiar and influential type of concern about their viability. (shrink)

Among semanticists and philosophers of language, there has been a recent outburst of interest in predicates such as delicious, called predicates of personal taste (PPTs, e.g. Lasersohn 2005). Somewhat surprisingly, the question of whether or how we can distinguish aesthetic predicates from PPTs has hardly been addressed at all in this recent work. It is precisely this question that we address. We investigate linguistic criteria that we argue can be used to delineate the class of specifically aesthetic adjectives. We show (...) that there are, in fact, good motivations for keeping PPTs and aesthetic predicates apart: the semantic structure of the former, but not the latter, entails an experiencer. There are many adjectives whose semantic structure arguably also entails an experiencer, yet which are readily used in expressing aesthetic judgments. Adjectives such as provocative or moving are a case in point, since as adjectives they arguably maintain the experiencer argument from the verb they are derived from. Nevertheless, when we describe, say, a sculpture as provocative, or a theater performance as moving, we clearly make aesthetic judgments. The difficult question, then, is to articulate the relationship between an aesthetic predicate (of which beautiful and ugly are paradigms) and other predicates that just happen to be used in making an aesthetic judgment. Tightly related to this point is the more general question of the relationship between an evaluative predicate and a predicate that occurs in an evaluative judgment. One of our aims is to make some progress in addressing these questions. (shrink)

Obsessive-compulsive disorder (OCD) is a deeply enigmatic psychiatric condition associated with immense suffering worldwide. Efficacious therapies for OCD, like exposure and response prevention (ERP) are sometimes poorly tolerated by patients. As many as 25 percent of patients refuse to initiate ERP mainly because they are too anxious to follow exposure procedures. Accordingly, we proposed a simple and tolerable (immersive yet indirect) low-cost technique for treating OCD that we call “multisensory stimulation therapy.” This method involves contaminating a rubber hand during the (...) so-called “rubber hand illusion” (RHI) in which tactile sensations may be perceived as arising from a fake hand. Notably, Jalal and Ramachandran (2015), showed that such fake hand contamination during the RHI provokes powerful disgust reactions in healthy volunteers. In the current study, we explored the therapeutic potential of this novel approach. OCD patients (n = 29) watched as their hidden real hand was being stroked together with a visible fake hand; either synchronously (inducing the RHI) (i.e., the experimental condition; n = 16) or asynchronously (i.e., the control condition; n = 13). After 5 minutes of tactile stimulation, the rubber hand was contaminated with fake feces, simulating conventional exposure therapy. Intriguingly, results suggested sensory assimilation of contamination sensations into the body image via the RHI: patients undergoing synchronous stimulation did not report greater contamination sensations when the fake hand was initially contaminated relative to asynchronous stroking. But contrary to expectations, they did so after the rubber hand had been contaminated for 5 minutes; as assessed via disgust facial expressions (a secondary outcome) and in vivo exposure (upon discontinuing the illusion). Further to our surprise, synchronous and asynchronous stroking induced an equally vivid and fast emerging illusion, which helps explain why both conditions initially (5 minutes after initiating tactile stimulation) provoked contamination reactions of equal magnitude. This study is the first to suggest heightened malleability of body image in OCD. Importantly, it may pave the way for a tolerable technique for the treatment of OCD—highly suitable for poorly resourced and emergency settings, including low-income and developing countries with minimal access to high-tech solutions like virtual reality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Public Health Ethics: Health by the NumbersMartina Darragh (bio) and Pat Milmoe McCarrick (bio)Hippocrates had nothing to say about public health. Rather, the idea that a government should protect its citizens from disease by maintaining sanitary conditions has its origin in Renaissance humanities texts, and the notion that physicians have public health responsibilities emerged in the works of such Enlightenment authors as Johann Peter Frank, Benjamin Rush, and (...) John Gregory (II, Coughlin and Beauchamp 1996). When the spread of infectious diseases such as typhoid and cholera accompanied the growth of the Industrial Revolution, England was the first to respond by passing the Public Health Act of 1848. The motivation for this reform was not based in humanitarian concerns but in the realization that unsanitary conditions were costly to industry. “... [The] founders of the public health movement were guided by nineteenth century utilitarian moral theories... the greatest good for the greatest number... accompanied by a growing appreciation for the innate value and dignity of mankind... however, the rights and autonomy of individuals have not always been respected in pursuing these important objectives” (I, Coughlin 1995, p. 1).Public health projects have dramatically improved global health status. One measure of their success is that “... most poor people now live longer, on average, than the wealthiest people a century ago” (I, Beaglehole and Bonita 1997, p. 13) These projects are not limited to such activities as disinfecting sewers. “Public health is what we, as a society, do to collectively assure the conditions in which people can be healthy. This requires that continuing and emerging threats to the health of the public be successfully countered. These threats include immediate crises, such as the AIDS epidemic; enduring problems, such as injuries and chronic illness; and impending crises foreshadowed by such developments as the toxic by-products of a modern economy” (I, Institute of Medicine (IOM) 1988, p. 1) The practice of public health has embraced this IOM challenge and includes the subspecialties of epidemiology, health promotion and education, public health administration, international health, maternal and child health, biostatistics, environmental health, and nutrition. This annotated bibliography focuses on epidemiology, [End Page 339] health promotion and education, and public health administration, and includes a wide variety of opinions on each topic.EpidemiologyAt first glance, it is hard to see what ethical issues could arise in population studies of the causes and control of illness. Disclosure of risk information in the clinical encounter is complicated by issues of uncertainty with regard to the data itself. Causation and causal inference may be affected by “wish bias,” leading to studies that use the same data but reach widely varying conclusions (II, Weed 1997). Given the complexity of the statistical calculations used to validate public health recommendations, and mass media’s portrayal of them, the public may be unintentionally deceived by population-based recommendations (V, Seedhouse 1997; II, Lupton 1995). With the addition of genetic screening, another layer of statistical complexity is added to this mix (VI, Stone and Steward 1996).Health Promotion and EducationIncreased life expectancy brought about by advances in public health has raised a new set of problems. With the realization that illness can be promoted in part by individual life-style choices, population-based recommendations about risk factors become important in the clinical encounter. This shift is not without difficulties; one author notes that he has yet to receive any risk information from his physicians, even when he asks “the experts” (V, Dugdale 1998). This may be due in part to the fact that “... public health lacks a vocabulary with which to speak about and identify commonalities among health problems experienced by very different populations” (IV, Mann 1997, p. 8). Furthermore, the mix of disciplines informing health promotion activities (sociology, psychology, recreation medicine, and the like) creates an illusion of shared ethics where none exists, which in turn leads to programs based on value systems that may not be meaningful for the populations they serve (V, Seedhouse 1997).Given these factors, a number of authors are skeptical of introducing public health measures into the clinical encounter. “We might do well to encourage people to live lives of modified hedonism so that they might... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managed Health Care: New Ethical Issues for All*Martina Darragh (bio) and Pat Milmoe McCarrick (bio)Changes in the way that health care is perceived, delivered, and financed have occurred rapidly in a relatively short time span. The 50-year period since World War II encompasses enormous growth in medical technology, soaring health care costs, and significant fragmentation of the two-party patient- physician relationship. This relationship first grew to include the (...) third-party payer, the health insurance industry, and now “with great speed and relatively little public awareness, a significant change has occurred in the way some decisions are made about a patient’s medical care” (III, Institute of Medicine 1989).The new means of providing health care bring an increasing number of parties into clinical decision-making processes. With this change, ethical issues that once concerned only health care professionals, the physician or the nurse, have expanded to include the patient and the groups who “manage” care—e.g., health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service groups (POSs), independent practice associations (IPAs), insurance reviewers, hospital administrators, institutional managers, and, the most recent players, purchasers of group health care who base their decisions on competitive pricing.The term “managed care” refers to a variety of continually adapting and developing arrangements that involve four groups. These groups, which have been labeled by the world of business, not health, are the “consumer” (once the patient), the “provider” (the physician and other health care professionals), the “insurer” (the reimburser for any care), and the “purchaser of care” or the primary buyer of health services (the large employer organization). Capitation is a common way to pay for health services in managed care systems. A certain dollar amount is negotiated for health services for a specified number of patients whether the care is delivered or not; the provider shares with the [End Page 189] insurer any financial risk for the actual cost of care (III, Centers for Disease Control 1995).When the Clinton administration’s health care reform movement failed to gain support in the U.S. Congress, the use of managed care to control rising health care costs accelerated. The literature on managed care and its effect on the patient-physician relationship reflects this shift. During the era of health care reform, “debate centered on how managed care could control costs, on the use of technology and patient satisfaction, [and] on access and barriers to care” (IV, Emanuel and Dubler 1995). When managed care organizations began contracting with physicians to provide health care services subject to the plans’ provisions, these plans became agents in clinical decision making on a wide-spread basis. HMO enrollment grew to 51 million persons by 1994 (III, Centers for Disease Control 1995). This “corporatization” of health care has sparked a plethora of articles about the effects of the marketplace on the physician’s ability to do what is best for the patient, and on the patient’s ability to trust the physician to do so.Many authors make it clear that managed care itself is not the problem, but rather the development of for-profit managed care plans by “corporate conglomerates with billions of dollars in assets that compensate their executives as grandly as basketball players” (V, Kassirer 1995) “in a marketplace that is largely unregulated” (I, Zoloth-Dorfman and Rubin 1995). “Some, mostly older plans that were created when cost containment was an unexpected benefit rather than their central purpose, deliver high-quality care economically. Unfortunately, others cut costs by recruiting the healthiest patients, excluding the sickest, rationing care by making it inconvenient to obtain, and denying care by a variety of mechanisms” (V, Kassirer 1995).These cost-containment features now play an intimate role in clinical practice. When a managed care plan contracts with a physician, the doctor becomes a “double agent” with contractual obligations to the plan to provide a preset amount of services and professional responsibilities to each patient to authorize necessary treatment (V, Angell 1993). This duality can undermine the physician’s fiduciary responsibility to the patient wherein the physician “has power over the affairs of [the patient]...and is required by law to act on that person’s... (shrink)

Emerging parallel to long-standing, academic and policy inquiries on personal responsibility for health is the empirical assessment of lay persons’ views. Yet, previous studies rarely explored personal responsibility for health among lay persons as dynamic societal values. We sought to explore lay persons’ views on personal responsibility for health using the Fairness Dialogues, a method for lay persons to deliberate equity issues in health and health care through a small group dialogue using a hypothetical scenario. We conducted two 2-h Fairness (...) Dialogues sessions (n = 15 in total) in Nova Scotia, Canada. We analyzed data using thematic analysis. Our analysis showed that personal choice played an important role in participants’ thinking about health. Underlying the concept of personal choice was considerations of freedom and societal debt. In participants’ minds, personal and social responsibilities co-existed and they were unwilling to determine health care priority based on personal responsibility. The Fairness Dialogues is a promising deliberative method to explore lay persons’ views as dynamic values to be developed through group dialogues as opposed to static, already-formed values waiting to be elicited. (shrink)