Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

There have always been medical standards of care in the American health-care sector. However, never before have they been so deeply incorporated in the delivery of health care as they are today. With the increased delivery of care through integrated delivery systems, as well as the development of the computerized patient record, medical standards of care are now used in innovative ways by providers and health plans in delivering health care to individual patients. There is great potential for even more (...) innovative uses of medical standards of care in the future.This article first presents a taxonomy of the medical standards of care that are involved in health-care delivery today Next, the article traces the historical evolution of medical standards of care since the early 1980s. Included in this discussion are the origins of the standard-setting movement as well as the developments that led to the way standards of care are currently used by large institutional providers and managed care plans to improve the quality of their health-care services. The article concludes with a brief analysis of the key legal issues that affect how standards of care can be used to improve the health care of patients. (shrink)

There have always been medical standards of care in the American health-care sector. However, never before have they been so deeply incorporated in the delivery of health care as they are today. With the increased delivery of care through integrated delivery systems, as well as the development of the computerized patient record, medical standards of care are now used in innovative ways by providers and health plans in delivering health care to individual patients. There is great potential for even more (...) innovative uses of medical standards of care in the future.This article first presents a taxonomy of the medical standards of care that are involved in health-care delivery today Next, the article traces the historical evolution of medical standards of care since the early 1980s. Included in this discussion are the origins of the standard-setting movement as well as the developments that led to the way standards of care are currently used by large institutional providers and managed care plans to improve the quality of their health-care services. The article concludes with a brief analysis of the key legal issues that affect how standards of care can be used to improve the health care of patients. (shrink)

Today, public health regulation at all levels faces unprecedented challenges both at home and abroad. The September 11, 2001 attacks on New York and Washington, D.C., by the Al Qaeda terrorist network and the anthrax bioterrorism that followed shortly thereafter have put public health regulation at the forefront of homeland security. The anthrax scare, in particular, has greatly tested the American public health system, calling into question whether the United States and its component states and localities are prepared to handle (...) a major outbreak of infectious disease, such as smallpox, in a future bioterrorist action. While the response of public health agencies was commendable, especially in light of the magnitude of the assaults, it is manifestly clear that the American public health system will be hard pressed to meet similar challenges that may lie ahead.The events of fall 2001 follow a period of major challenges for public health. The AIDS pandemic has killed millions of people throughout the globe, especially in Africa and other parts of the developing world. (shrink)

Today, public health regulation at all levels faces unprecedented challenges both at home and abroad. The September 11, 2001 attacks on New York and Washington, D.C., by the Al Qaeda terrorist network and the anthrax bioterrorism that followed shortly thereafter have put public health regulation at the forefront of homeland security. The anthrax scare, in particular, has greatly tested the American public health system, calling into question whether the United States and its component states and localities are prepared to handle (...) a major outbreak of infectious disease, such as smallpox, in a future bioterrorist action. While the response of public health agencies was commendable, especially in light of the magnitude of the assaults, it is manifestly clear that the American public health system will be hard pressed to meet similar challenges that may lie ahead.The events of fall 2001 follow a period of major challenges for public health. The AIDS pandemic has killed millions of people throughout the globe, especially in Africa and other parts of the developing world. (shrink)

With the North American Free Trade Agreement , the health care sectors of the United States, Canada, and Mexico are becoming more economically integrated. NAFTA poses major challenges to the realization of the international human right. These include: Cross Border Trade in Medical Products, Cross Border Trade in Medical Services, and the attendant investment protections, Portability and Comparability of Health Insurance Coverage, and Protection of Public Health Insurance Programs. The United States, Mexico, and Canada all provide public health insurance programs (...) either to the entire population as in Canada or to vulnerable groups as in the United States. In none of these countries have private, for-profit providers and insurers been able to provide universal and affordable health coverage and care in a truly free market. Private insurers and for-profit providers should not profit from the care of the healthy and wealthy in ways that compromise the public programs that serve the poor and seriously ill. Nor should they be allowed to use NAFTA processes to compromise public programs. Policy makers must consider implications of NAFTA and move toward assuring access to affordable health care for all people on the North American continent. (shrink)

During World War II, the Allies created the United Nations and its associated international institutions to stabilize the post-war world. The Allies envisioned a coordinated world in which human rights for all were respected, economic and social progress for all promoted, and global warfare prevented. This was a phenomenally fantastic vision that seemed unattainable in the wake of the most devastating global war in history.Today, the world is witnessing some of the fruits of these mid-20th century events and aspirations, especially (...) since the collapse of Communism in 1989. Economic integration and free trade has become much more prevalent as exemplified by astounding developments such as the European Union. And there is a greater appreciation of human rights, including the international human right to health. This article examines the evolution of trade policy and the impact of free trade policies on the health care sectors of the three countries of North America and the realization of the human right to health in North America. (shrink)

The key to wealth in health care is the physician, who certifies to third-party payers that health care items and services are necessary for patient care. To compete more effectively for this wealth, physician specialists are organizing their practices into for-profit corporations and employing other physicians. Focusing on neonatology, this article describes the prevailing business model of these for-profit medical groups as controlling employed physicians through restrictive employment contract provisions, e.g., non-compete and mandatory arbitration clauses. With this business model and (...) because of deficiencies in current law, for-profit medical groups eliminate competition from other physician specialists to the detriment of patients and consumers. (shrink)

With new, effective, and expensive health care services, the American health care sector has become an even greater source of business and wealth opportunities. All kinds of health care providers and suppliers are competing for patients and dollars. The key to wealth in today’s health care sector is the physician. Only physicians can certify to third-party payers that health care services, medical devices, or pharmaceutical products are necessary for patient care. That certification initiates the process by which the item, service, (...) or treatment modality is ordered, delivered, and paid for. Thus, organizations that can exert control over physicians stand to gain financially. (shrink)

Does telling a story imply a fictional world in which that story takes place? In contemporary philosophy, “fictional worlds” are one solution to the problem of how there can be true and false judgments about fictional characters. Fictional-world accounts generally disregard whether facts are explicitly stated in the story or not; it is enough for them to be logically implied. And yet, as Ruth Lorand has observed, whether a fact is stated or merely implied changes the meaning of a story. (...) “Imagine that the original text contains the following sentence: ‘Daisy Miller is human and as such she was born to human parents.’ Wouldn’t.. (shrink)

There is a sense in which poetry can re-inscribe humans in their natural surroundings, but language—even poetic language—is also always problematic. In conversation with and in response to recent works by David Abram, I will delineate at least two ways in which poetic language separates and distinguishes humans from nature. I also argue for the importance of what is implicit or invisible (as opposed to tangible and sensuous). Language is a mode of human responsibility for the world, not just a (...) sign or result of being part of it. (shrink)

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, (...) and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature. (shrink)

Computational models of relevance in case-based legal reasoning have traditionallybeen based on algorithms for comparing the facts and substantive legal issues of aprior case to those of a new case. In this paper we argue that robust models ofcase-based legal reasoning must also consider the broader social and jurisprudentialcontext in which legal precedents are decided. We analyze three aspects of legalcontext: the teleological relations that connect legal precedents to the socialvalues and policies they serve, the temporal relations between prior andsubsequent (...) cases in a legal domain, and the procedural posture of legal cases,which defines the scope of their precedential relevance. Using real examples drawnfrom appellate courts of New York and Massachusetts, we show with the courts' ownarguments that the doctrine of stare decisis (i.e., similar facts should lead to similar results) is subject to contextual constraints and influences. For each of the three aspects of legal context, we outline an expanded computational framework for case-based legal reasoning that encompasses the reasoning of the examples, and provides a foundation for generating a more robust set of legal arguments. (shrink)

Pandemics challenge the law and often highlight its strengths or expose its limits. The novel strain of influenza A virus that emerged in the spring of 2009 and rapidly spread around the globe was no exception. The H1N1 pandemic prompted the first significant application of a number of international legal and policy mechanisms that have been developed in the last decade to respond to this kind of event. Furthermore, it presented a considerable test for public health systems at all levels, (...) from global to local.Although initial predictions forecasting high morbidity and mortality from this virus overestimated its eventual impact, the human toll of the pandemic was nevertheless significant. The World Health Organization reported approximately 1.5 million people were infected worldwide in 214 countries, resulting in over 25,000 confirmed deaths, but the actual health impact of the outbreak was certainly much higher. (shrink)

Pandemics challenge the law and often highlight its strengths or expose its limits. The novel strain of influenza A virus that emerged in the spring of 2009 and rapidly spread around the globe was no exception. The H1N1 pandemic prompted the first significant application of a number of international legal and policy mechanisms that have been developed in the last decade to respond to this kind of event. Furthermore, it presented a considerable test for public health systems at all levels, (...) from global to local.Although initial predictions forecasting high morbidity and mortality from this virus overestimated its eventual impact, the human toll of the pandemic was nevertheless significant. The World Health Organization reported approximately 1.5 million people were infected worldwide in 214 countries, resulting in over 25,000 confirmed deaths, but the actual health impact of the outbreak was certainly much higher. (shrink)

Growth mindset is an important aspect of children’s socioemotional development and is subject to change due to environmental influence. Orchestral music education may function as a fertile context in which to promote growth mindset; however, this education is not widely available to children facing economic hardship. This study examined whether participation in a program of orchestral music education was associated with higher levels of overall growth mindset and greater change in levels of musical growth mindset among children placed at risk (...) by poverty. After at least 2 years of orchestral participation, students reported significantly higher levels of overall growth mindset than their peers; participating students also reported statistically significant increases in musical growth mindset regardless of the number of years that they were enrolled in orchestral music education. These findings have implications for future research into specific pedagogical practices that may promote growth mindset in the context of orchestral music education and more generally for future studies of the extra-musical benefits of high-quality music education. (shrink)

A musical phrase, or, for that matter, a musical unit of any size or shape, becomes an image whenever we imagine it to be invested with a content whose origins lie outside music. Such a content, according to the theory developed here, constitutes the image's conventional significance; it accounts for whatever strikes us about the image as having a common and familiar ring. That being so, the origins in question must be coincident with the fundamental ideas--the archetypes--that have been traditionally (...) represented as underlying and unifying Western culture. As the theoretical constructs they are, arehctypes are never encountered directly. It is in the form of their local variants that we make contact with the archetypes, and it is at this local level that the present book sets its sights: style, the typical or shared element in the musical imagery of a time and place, is studies as a function of Zeitgeist, the complex of beliefs, values, and ideals of a community. The approach is both thematic and historical, in keeping with a key objective of archetypal criticism. Far from repudiating the popular notion that music expresses the human emotions, this study attempts to recast emotion theory by examining musical images for kinds of behavior from which we may infer not only emotion (pathos, effectus) but also personality (ethos). Ethical and affective distinctions are very sharply drawn, in an effort to clarify and widen the vocabulary of musical commentary, as well as to provide cultural and historical backing for contents long considered the cliches of musical expression. (shrink)

Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics”, that is, national ethical guidelines, Institutional Review Boards, and research stakeholder’ ethical attitudes and behaviors. We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data (...) on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity. (shrink)

We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to those in (...) need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature. (shrink)

Ethics networks have emerged over the last few decades as a mechanism for individuals and institutions over various regions, cities and states to converge on healthcare-related ethical issues. However, little is known about the development and nature of such networks. In an effort to fill the gap in the knowledge about such networks, a survey was conducted that evaluated the organizational structure, missions and functions, as well as the outcomes/products of ethics networks across the country. Eighteen established bioethics networks were (...) identified via consensus of three search processes and were approached for participation. The participants completed a survey developed for the purposes of this study and distributed via SurveyMonkey. Responses were obtained from 10 of the 18 identified and approached networks regarding topic areas of: Network Composition and Catchment Areas; Network Funding and Expenses; Personnel; Services; and Missions and Accomplishments. Bioethics networks are designed primarily to bring ethics education and support to professionals and hospitals. They do so over specifically defined areas—states, regions, or communities—and each is concerned about how to stay financially healthy. At the same time, the networks work off different organizational models, either as stand-alone organizations or as entities within existing organizational structures. (shrink)

Ce recueil offre à ses lecteurs diverses pistes d’interprétation. Elles se distinguent tant par le contenu de ses chapitres que par la question plus large de la place essentielle des études touchant à l’éducation. L’ouvrage, véritablement interdisciplinaire, remet en question la relation entre l’éducation et le genre grâce aux contributions d’historiens, de spécialistes en science de l’éducation, de sociologues, de psychologues et d’enseignants allant de la maternelle à l’université. Le livre...

Dans ce volume collectif, J. Albisetti, J. Goodman et Rebecca Rogers nous emmènent dans un tour européen du développement de l’enseignement secondaire pour les filles. Les contributeurs proposent deux pistes principales : une vue d’ensemble des histoires nationales de l’enseignement des filles ; et une présentation des pistes de recherche à suivre. Bien que Girls’ Secondary Education in the Western World soit organisé par pays, les directeurs et les auteurs soulignent les multiples connexions...

I look at the ‘flavour-oscillation clocks’ proposed by D. V. Ahluwalia and two of his arguments suggesting that such clocks might behave in a way that threatens the geometricity of general relativity (GR). The first argument states that the behaviour of these clocks in the vicinity of a rotating gravitational source implies a non-geometrical element of gravity. I argue that the phenomenon is best seen as an instance of violation of the ‘clock hypothesis’ and therefore does not threaten the geometrical (...) nature of gravitation. Ahluwalia’s second argument, for the ‘incompleteness’ of general relativity, involves the idea that flavour-oscillation clocks can detect constant gravitational potentials. I argue that the purported ‘incompleteness-establishing’ result is in fact one that applies to all clocks. It is entirely derivable from general relativity, does not result in the observability of the potential, and is not at odds with any of general relativity’s foundations. (shrink)

We review here the data indicating a role for epidermal growth factor receptor (EGF receptor) signalling in early mouse development. Embryonic development of the metazoan embryo generally begins with the formation of a cystic structure and epithelial layers that subsequently form anlagen of the definitive body parts and organs. For the mammalian embryo, this cystic structure is a blastocyst whose wall consists of trophectoderm, the first epithelium to develop during mammalian embryogenesis. The onset of expression and function of EGF receptors (...) is coincident with the onset of trophectoderm development. Modulating EGF receptor expression and function modulates trophectoderm differentiation, leading to the hypothesis that functional EGF receptors participate in the induction of trophectoderm development and perhaps of other embryonic epithelial derivatives such as nervous tissues. (shrink)

Many of the reforms being required or recommended to ensure that for-profit companies achieve greater transparency and more effective governance are similarly being promoted for adoption by nonprofit health care organizations. The demands are coming from a variety of sources - government officials, donors, business partners, companies that provide directors and officers (D&O) liability insurance, the media, and directors themselves. To meet these demands, nonprofit health care boards and executives need to assess whether they have the right number, mix, and (...) caliber of board members, and to modify their recruitment and/or retention strategies where they don't. -/- The following discussion is another in an ongoing Inquiry series called "Dialogue," a collaboration with the Alliance for Advancing Nonprofit Health Care to provide a variety of voices on current, major issues in the nonprofit health care sector. (shrink)