Tort law and liability insurance have a complex interaction in which each shapes the evolution and effects of the other. This interaction and its many forms and facets in different international contexts must be comprehended to understand fully the ethical responsibilities of liability insurers. This essay builds on previous scholarship on the tort law–liability insurance interaction through a series of observations from the perspective of a global reinsurer. It seeks in part to extend previous analyses of this interaction (...) by also considering issues in the developing world. It seeks to make some normative questions and stances explicit concerning this interaction, as well as to identify some empirical questions that still need to be answered. The responsibility of liability insurers includes ethically shaping the responsibility of others in interaction with tort law in countless diverse situations. (shrink)

This essay discusses unlimited insurance subrogation (UIS) as a means of improving the deterrence and compensation results of medical malpractice law. Under UIS, health care insureds could assign their entire potential medical malpractice claims to their first-party commercial and government insurers. UIS should improve deterrence by establishing first-party insurers as plaintiffs to confront liability insurers on the defense side, leading to more effective prosecution of meritorious claims and reducing meritless and unnecessary litigation. UIS should improve (...) compensation outcomes by converting litigation cost- and risk- laden “tort insurance” into cheaper and enhanced first-party insurance. UIS also promises dynamic benefits through further reforms by contract between the first-party and liability insurers that would take charge of system. No UIS-related costs are apparent that would outweigh these benefits. (shrink)

This volume is an exploration of the ethical issues raised by health insurance, which is particularly timely in the light of recent advances in medical research and political economy. Focusing on a wide range of areas, such as AIDS, genetic engineering, screening and underwriting, new disability legislation and the ethics of private and public health insurance, this comprehensive and sometimes controversial book provides an essential survey of the key issues in health insurance. Divided into two parts, the (...) first considers the ethics of underwriting, risk assessment and the acceptance and refusal of insurance risk by insurers. Discussing the unjust treatment of high-risk applicants, the authors identify sources of unfairness to both parties of the insurance contract, indicating how reasonable trade-offs can be made. The second part considers the argument for a mix of public and private insurance for acute and long-term care, offering recommendations for changes in the balance of social insurance, and discussing the shift toward long-term contracts in private health care and pension insurance. (shrink)

Recent discussions of genetic information have highlighted the need for ethical disclosure guidelines. For instance, the (Canadian) Royal Commission on New Reproductive Technologies points out the range of third-party interests in genetic information and the lack of clear ethical and professional guidelines governing its dissemination. Among the more worrying interests are those of insurance companies and prospective employers. However, also worrisome is the problem of negotiating the first-party interest in privacy (from which the professional obligation of (...) confidentiality arises) and strong third-party claims from family members. The survey by Knoppers and Laberge of consent forms currently used in DNA testing in Canada shows that fewer than half mention access by family members, and only three out of 20 alert subjects to the possibility of finding nonpaternity. Both the Royal Commission and the Knoppers research group recommend integrated, national consent standards, with the Knoppers group explicitly approving a standard of disclosure. While endorsing the call for integrated consent guidelines, in this paper I intend to raise some doubts about the adequacy of the reasonable person standard in light of gender differences in reproductive burden and risk perception. (shrink)

On March 23, 2010, President Obama signed into law the nation's first comprehensive health care reform bill, the Patient Protection and Affordable Care Act. Within weeks, twenty states filed lawsuits challenging the constitutionality of its most politically charged feature—an individual purchase mandate. By 2014, the bill requires most individuals to have health insurance. With certain exceptions (pertaining to income level and religious objections), individuals without qualifying coverage will pay an annual tax penalty. If anything, the tax penalty is (...) too low compared with the cost of insurance, so it may not provide sufficient incentive for healthy individuals to purchase insurance. But it remains controversial because it compels people to purchase coverage they choose not to have, raising the question whether Congress can lawfully and ethically require individuals to contract with, and transfer money to, a private party. (shrink)

This volume is an exploration of the ethical issues raised by health insurance, which is particularly timely in the light of recent advances in medical research and political economy. Focusing on a wide range of areas, such as AIDS, genetic engineering, screening and underwriting, new disability legislation and the ethics of private and public health insurance, this comprehensive and sometimes controversial book provides an essential survey of the key issues in health insurance. Divided into two parts, the (...) first considers the ethics of underwriting, risk assessment and the acceptance and refusal of insurance risk by insurers. Discussing the unjust treatment of high-risk applicants, the authors identify sources of unfairness to both parties of the insurance contract, indicating how reasonable trade-offs can be made. The second part considers the argument for a mix of public and private insurance for acute and long-term care, offering recommendations for changes in the balance of social insurance, and discussing the shift toward long-term contracts in private health care and pension insurance. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Can They Do This?” Dealing with Moral Distress after Third–Party Termination of the Doctor–Patient RelationshipSusan McCammonNot so long ago, a storm badly damaged the tertiary care hospital in which I practice surgical oncology. In the aftermath of the storm, the institution determined it was no longer able to provide unreimbursed cancer care, and many of my patients were terminated by a form letter from the hospital. The helplessness (...) and outrage that I experienced when I was first handed one of these letters, crumpled from the damp fist of one of my patients, was immense, and frightening in its unfamiliarity: “Can they do this?” I asked repeatedly, ascending a hierarchy of authority, which was increasingly reticent and then elusive. In short, the answer was “yes.”While this decision was made by the administration, its enactment was delegated to the physicians. Thus, not only were the physicians not involved in the decision to terminate their patients, they shouldered the burden of telling their patients that they would no longer be treated. The reason given—storm devastation—was contradicted by the orderly flow of insured patients in and out of unaffected clinics and hospitals.In those months, when the operating rooms were closed, I took to the road and learned about hospice and palliative care medicine on the ground. I drove from city to smaller city to the devastated countryside, locating my patients and providing all the care that I could with only my hands and mind and heart. I struggled with the limitations of the health care system and worked to rebuild a sustainable infrastructure at my own institution, all while trying to come to terms with bioethicist Haavi Morreim’s (1995) caution that “... it is not the physician who owes the resources at all. He cannot owe what others own and control, because moral obligations can only be assigned to those capable of fulfilling them” (p. 87).In considering my experience of moral distress over this period of time, I have reflected on the different connotations of the word, “practice.” I grappled with the philosophical terms “practice,” “praxis,” and “phronesis,” and I questioned their relevance to the word, as used in my professional life. However, in struggling to understand my moral obligations after the storm, when I was learning to do what I could, even when I couldn’t do what I felt like I should, I reconsidered. The elements of immersion, repetition, particularity, and utility that pervade this language of philosophers and artists turned out to be what preserved my ability [End Page 109] to practice medicine in a space holding only patient and practitioner.Many of the patients that I take care of are very poor. Many more are working but uninsured. This is a result of both their risk factors and the demographics and resources in my geographic catchment area. Their access to care was disrupted after a natural disaster and concerted efforts to reestablish it have not succeeded. Since then, I have learned how to tell people that they will die of cancer because they don’t have enough money. This is not a skill I was taught in medical school. I can talk about death, imminent or not, feared or anticipated. I can talk about unresectable tumors, treatments that have more risk than benefit (or no benefit at all), suffering beyond what has yet been experienced or imagined, helplessness, futility and grief. I could be neither surgeon nor oncologist without some facility with these. But I was unprepared for this move from medical to economic “can’t,” the nexus where an institutional “won’t” becomes a personal “can’t.”I should say here that I was not blind to the expense and technological hype of the American medico–industrial complex or our systematic marginalization of public health or the ever–present cries for health care reform. I understood that I was a steward and that I served both the individual and the society and had at my disposal what I was told were limited resources. These values, however, were only just being incorporated into the training of medical professionals; certainly they played no role in my own education. Morreim’s (1995) conclusion... (shrink)

Microinsurance is the provision of insurance services to the poor, usually in developing countries. One of the key criteria of poverty is vulnerability even to minor events. In such cases, even micro coverage can make a major difference, yet still be funded by an affordable contribution by the insured. Like any kind of insurance, microinsurance can cover different risks to life, health, farming, property among other things. Our paper sketches how one could address and develop microinsurance business ethics. (...) First, we introduce microinsurance to the business ethics community and business ethics to the microinsurance community. Our draft of microinsurance ethics is then developed from two angles: as a holistic understanding of ideals and possible ethical conflicts in key stakeholder relationships and by distinguishing eight challenges when targeting the poor and when marketing microinsurance. As an open ending, the article suggests a three-stage action research design focusing on how microinsurance could (and should) internalize ethics, respecting rather than neglecting national- and local-cultural conditions. (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)

Third-party property insurance (TPPI) protects insured drivers who accidentally damage an expensive car from the threat of financial ruin. Perhaps more importantly though, TPPI also protects the victims whose losses might otherwise go uncompensated. Ought responsible drivers therefore take out TPPI? This paper begins by enumerating some reasons for why a rational person might believe that they have a moral obligation to take out TPPI. It will be argued that if what is at stake in taking responsibility is (...) the ability to compensate our possible future victims for their losses, then it might initially seem that most people should be thankful for the availability of relatively inexpensive TPPI because without it they may not have sufficient funds to do the right thing and compensate their victims in the event of an accident. But is the ability to compensate one's victims really what is at stake in taking responsibility? The second part of this paper will critically examine the arguments for the above position, and it will argue that these arguments do not support the conclusion that injurers should compensate their victims for their losses, and hence that drivers need not take out TPPI in order to be responsible. Further still, even if these arguments did support the conclusion that injurers should compensate their victims for their losses, then (perhaps surprisingly) nobody should to be allowed to take out TPPI because doing so would frustrate justice. (shrink)

This article investigates whether the doctrine of social Darwinism had any bearing on the Labour Party’s decision to support Britain’s participation in the First World War. Many socialist intellect...

Insurance fraud and abuse—international concerns—are inherent in the proposition of insurance and prevalent in insurer–insured interactions. While the subject of considerable industry and regulatory attention, this little-researched area of consumer behavior and consumer ethics represents persistent social policy questions and problems at multiple levels. This article addresses the issue by first defining insurance fraud and its origins in contract, as well as consumer- and insurer-management. The authors conclude by re-envisioning the problem as one of co-creation by (...) the consumer-insured and insurer personnel, proposing a framework for its study and resolution. (shrink)

Catastrophe insurance differs from regular insurance in that individual claims are correlated and insurers have to pay more clients at once, which creates a liquidity strain. In this paper, I show two related findings: first, that when customers know their claims are correlated, this correlation can cause positive-sloping demand at low prices, and second, that because of this, a catastrophe insurance market can fail. Market failure is a stable equilibrium, which provides a better understanding of the (...) frequent failures in catastrophe insurance markets. (shrink)

Experimental research has studied the emergence of fairness criteria such as merit and equality at increasingly younger ages. How much does the recognition and practice of these principles depend on the influence of central aspects of Western educated and industrialized societies? In an attempt to answer these questions, this article provides evidence regarding the choices of children in the Kogi indigenous community of the Sierra Nevada de Santa Marta, a traditional society living in the mountains of Northern Colombia that practices (...) swidden agriculture, cattle-raising, and enjoys a special cultural status granted by the Colombian Constitution. Two groups of 6–7 and 10–11 year olds were tested on a modified dictator game and several scenarios from a resource distribution task including different fairness criteria. Our results point to the lack of focality of the idea of merit among Kogi children at these ages when deciding on third-party allocation tasks, even when the design prevented equal distribution. (shrink)

In the 1990s, large insurance companies failed in virtually every major market, prompting a fierce and ongoing debate about how to better protect policyholders. Drawing lessons from the failures of four insurance companies, When Insurers Go Bust dramatically advances this debate by arguing that the current approach to insurance regulation should be replaced with mechanisms that replicate the governance of non-financial firms.Rather than immediately addressing the minutiae of supervision, Guillaume Plantin and Jean-Charles Rochet first identify a (...) fundamental economic rationale for supervising the solvency of insurance companies: policyholders are the "bankers" of insurance companies. But because policyholders are too dispersed to effectively monitor insurers, it might be efficient to delegate monitoring to an institution--a prudential authority. Applying recent developments in corporate finance theory and the economic theory of organizations, the authors describe in practical terms how such authorities could be created and given the incentives to behave exactly like bankers behave toward borrowers, as "tough" claimholders. (shrink)

Modern democracy is impossible without political parties. They are necessary in the process of the construction of the political class and building of relations between politicians and ‘ordinary people’. So, in Poland in the twentieth and the twenty-first centuries the significance of parties is also very important. Their history is older than the history of the reborn Poland. Especially in Galicia, an autonomous province of the Hapsburg empire, we can see the activities of many politicians. A part of them (...) in 1895 declared the birth of the Popular Party which is a constant element of the Polish political scene. The second traditional current is the socialistic movement, which is also always legally active in Poland. These two camps represent, in simplification, the ‘two Polands’—the first more traditional, conservative and provincial, and the second more progressive, ‘European’ and urban. Actually, in the typical consciousness of a Polish citizen, the political representation of the ‘black’ country is the party Law and Justice of Jarosław Kaczyński, and the ‘red’ country admires the Citizen Platform with Donald Tusk as a leader. But probably the idea of a twoparty system, like in the Anglo-Saxon world, is still very distant to reality, because in the European continent, the tradition of pluralism in a policentric version is still very significant. In Poland, even in the period of the ‘real socialism’ this conception of the organization of political life was realized, though naturally in the specific version. There were three legal parties and the Polish United Workers’ Party (the PUWP) was the most important. From 1976, the PUWP in the light of the Constitution had the official hegemony in the Republic. It is possible to compare this situation with the period 1926–39, when, after the coup d’état by Marshal Piłsudski, the Government still won in the election and the official elite wanted to create a stable political force with a perspective of permanent rule. But we must remember that between the wars opposition always was legal. In our times of demoliberalism, this is quite normal (though under the Constitution, unconstitutional parties, for example, communist or fascist, are unacceptable); however, interesting is the fact that when you observe sine ira et studio the evolutional trend of the Polish political system, you easily find the tendency of the ‘stabilization’ of the party system in the way of legal operations. From 1997, the laws concerning political parties have changed the possibilities of the conquest of seats in the Seym. Actually, only the parties having 5 per cent (or 8 per cent in coalition) of votes can gain the representation in the Diet. So it is possible to claim that the little parties today are in a more complicated situation than in the first years after the ‘operation of Round Table’ in 1989. The contemporary system is maybe more stable, but less liberal. There are theoreticians who note the danger of the alienation of the political class in the situation of the renewal of the alienation of the political elite, which de facto is more connected with the state than with the society. Many theoreticians emphasize that in the future the role and the character of political structures will be profoundly different from today. Maybe they are prophets, but we can expect that the Polish political parties or ‘post-parties’ and also political structure as a whole will have many similarities with their actual equivalents, because the mentality of the Polish nation, including the politicians, is more or less enduring. (shrink)

In September 2009, the First Circuit Court of Appeals decided Blue Cross & Blue Shield v. AstraZeneca Pharmaceuticals LP, part of the class action suit known as In re Pharmaceutical Industry Average Wholesale Price Litigation. The First Circuit upheld a Massachusetts District Court finding that AstraZeneca violated Massachusetts’ consumer protection laws by manipulating the “average wholesale price” of its physician-administered injectable cancer drug Zoladex, leading to overpayment by the government, third-party payers, and consumers. This case, which highlights (...) the persistent tension between pharmaceutical pricing flexibility and consumer protection, has important implications for similar pending class actions.Between 1991 and 2003, Medicare, as well as many private insurance companies, pegged reimbursement for certain pharmaceutical products to a national “average wholesale price” for each drug. Although the amended 1991 Medicare Part B regulations3 that introduced the term “average wholesale price” failed to define it explicitly, there is some indication in the legislative history that AWP was intended to refer to the prices that physicians and pharmacists actually pay to the drug manufacturers. (shrink)

The aim of this paper is to explore and understand the Albanian Party System. The analysis will cover the period from the collapse of the communist regime in 1991 until 2014. It will try to investigate what forces drive the battle of the parties, what cleavages 'divide' society and consequently the party system as well as which are the parties that count the most. in order to assess this, the paper will focus on the parliamentary parties and will (...) relay on various theoretical concepts of the contemporary literature on political parties. First it will draw on Sartori's concept of 'relevance' in order to understand whether all the parliamentary parties over the course of twenty four years of pluralism are important or not and what weight do they have. Then it will use the Laakso - Taagepera index of the Effective Number of Parties to understand how power is distributed within the parliament. (shrink)

With their intensive use of data to classify and price risk, insurers have often been confronted with data-related issues of fairness and discrimination. This paper provides a comparative review of discrimination issues raised by traditional statistics versus machine learning in the context of insurance. We first examine historical contestations of insurance classification, showing that it was organized along three types of bias: pure stereotypes, non-causal correlations, or causal effects that a society chooses to protect against, are thus (...) the main sources of dispute. The lens of this typology then allows us to look anew at the potential biases in insurance pricing implied by big data and machine learning, showing that despite utopic claims, social stereotypes continue to plague data, thus threaten to unconsciously reproduce these discriminations in insurance. To counter these effects, algorithmic fairness attempts to define mathematical indicators of non-bias. We argue that this may prove insufficient, since as it assumes the existence of specific protected groups, which could only be made visible through public debate and contestation. These are less likely if the right to explanation is realized through personalized algorithms, which could reinforce the individualized perception of the social that blocks rather than encourages collective mobilization. (shrink)

According to US law, insurance companies can lawfully differentiate individual health insurance premiums on the basis of non-genetic medical information, but not on the basis of genetic information. The article reviews the case for such genetic exceptionalism. First, I critically assess some standard justifications. Next, I scrutinize an argument appealing to the view that genetically based premium differentiation expresses that persons do not all merit equal concern and respect. In the final section, I argue that even if (...) genetic exceptionalism is unjustified, there is a forceful luck egalitarian argument against basing premiums on genetic risks, to wit, that this tends to make some individuals worse off than others as a result of the bad brute luck involved in having a genetically determined, above-average risk of developing health problems. (shrink)

In September 2009, the First Circuit Court of Appeals decided Blue Cross & Blue Shield v. AstraZeneca Pharmaceuticals LP, part of the class action suit known as In re Pharmaceutical Industry Average Wholesale Price Litigation. The First Circuit upheld a Massachusetts District Court finding that AstraZeneca violated Massachusetts’ consumer protection laws by manipulating the “average wholesale price” of its physician-administered injectable cancer drug Zoladex, leading to overpayment by the government, third-party payers, and consumers. This case, which highlights (...) the persistent tension between pharmaceutical pricing flexibility and consumer protection, has important implications for similar pending class actions.Between 1991 and 2003, Medicare, as well as many private insurance companies, pegged reimbursement for certain pharmaceutical products to a national “average wholesale price” for each drug. Although the amended 1991 Medicare Part B regulations3 that introduced the term “average wholesale price” failed to define it explicitly, there is some indication in the legislative history that AWP was intended to refer to the prices that physicians and pharmacists actually pay to the drug manufacturers. (shrink)

BackgroundIn many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholic beverages, and ever stricter smoke-free policies. Such interventions can enhance healthier behaviour, but when they become too intrusive, an unfree society can emerge. Which lifestyle interventions that use pressure or coercion are justifiable and which are not? We tried to develop an assessment model that can be used for answering this question, (...) on a generally acceptable way, for all sorts of lifestyle interventions.MethodsThe intended assessment model was developed in three phases. In the first phase the model was theoretically developed on the basis of literature study and reasoning. In the second phase the model was empirically tested by assessing two detailed cases from everyday practice using the model. The model was improved again and again. In the third phase the 10th version of the model was developed while writing this article.ResultsAn assessment model for the justification of intrusive lifestyle interventions. It comprises three components: 12 assessment criteria ; an assessment structure with three filters ; a way of assessing.ConclusionsWe have developed an assessment model for the justification of lifestyle interventions that use pressure or coercion to promote health. The correctness, completeness and practicality of the model are likely. Important principles for the justification are the logic and completeness of the underlying argumentation and the proper use of the available scientific information. Parties for and against a particular intervention could use the model to test and strengthen their argumentation and to improve the quality of the intervention. (shrink)

This paper addresses two examples of overconfident presentations of utilitarian moral conclusions. First, there is Peter Singer’s widely discussed claim that if the consequences of a medical experiment are sufficiently good to justify the use of animals, then we should be prepared to perform the experiment on human beings with equivalent mental capacities. Second, I consider defences of infanticide or after-birth abortion. I do not challenge the soundness of these arguments. Rather, I accuse those who seek to translate these (...) conclusions into moral advice of a dangerous overconfidence. This paper offers an insurance policy that protects against some of the costs of mistaken moral reasoning. An interest in moral insurance is motivated by the recognition that, in the event that overconfident ethicists have reasoned incorrectly, some actions recommended by their conclusions are not just bad, but very bad. We should reject suggestions that we conduct medical experiments on humans or kill newborns. (shrink)

My topic is the parallels between attacks on free speech by the U.S. war party, and attacks on free speech by what Charles Alan Kors and Harvey Silverglate have called “the shadow university”; and the blindness to these parallels of that part of the left and right that is not libertarian on free speech and due process.

In lieu of an abstract, here is a brief excerpt of the content:THE PARTY'S OVER (ALMOST): TERMINAL CELEBRATION IN CONTEMPORARY FILM Tony Bartlett Syracuse University Movies are a universal language, and as we approach more and more integrated levels of global economy and communication they increasingly become a universal symbol system. At these levels a modern movie from China orNigeria will display swiftly recognizable sensibilities and situations to any viewer in Europe or the USA, and vice versa. But should (...) we not, therefore, also feel prompted to indicate a universal de-symbolization, if movies along with the modern world reflect constitutive elements of decomposition and collapse. For I would like to suggest in this essay that not only do movies constitute a kind ofplanetary envelope, literally a "film" of collective imaginai references wrapped around the world, but that this "film" is peculiarly apt to dismemberment, to breaking up before our eyes even as it still holds together, to abuilt-in "crisis" that is part ofits very nature. The two films that form a background to these remarks, Natural Born Killers and Pulp Fiction, are, I suggest, movies that set out actively to represent this cinematic crisis. In Adam Smith's The Wealth ofNations (Bk. 2, Vol. 5, 795-97), the grandfather ofmodern capitalism discusses the fate ofthe laborer who leaves arural village in which he is known and his life observed, or "attended to," by others. He moves to a great city where promptly "he is sunk in obscurity and darkness." Smith's concern is not directly to remedy this misery ofthe worker forced to seek employment in the anonymity ofthe city, but to avoid a possible course ofaction he might take. He wishes to divert him from the possibility of joining "a small religious sect," in whose company the newly depersonalized worker will achieve "a degree of consideration which he never had before." 2 Tony Bartlett Adam Smith does not relish the prospect ofthe mushroom growth ofclosed, "unsocial" religious factions within the heart of industrialized political economies, and he proposes two remedies by which the state, "without violence," might correct these tendencies. His proposals are remarkable both for their conjunction ofcertain themes and their prescience. The first is a plan for the imposition of the study of science and philosophy on the middle ranks ofthe poor, for science is "the great antidote to the poison of enthusiasm and superstition." Next to this classic Enlightenment nostrum comes the following: The second ofthose remedies is the frequency and gaiety of publick diversions. The state, by encouraging, that is by giving entire liberty to all those who for their own interest would attempt, without scandal or indecency, to amuse and divert the people by painting, poetry, musick, dancing; by all sorts ofdramatic representations and exhibitions, would easily dissipate, in the greater part of them, that melancholy and gloomy humour which is almost always the nurse ofpopular superstition and enthusiasm. Publick diversions have always been the object of dread and hatred, to all the fanatical promoters ofthose popular frenzies. Here are the movies before the fact. Adam Smith in his charter for emergent industrial capitalism sketches an alliance between education and entertainment that together will prevent any reversion to the darkness ofsmallscale society and its ready excrescence of religious fanaticism. All of the components of cinema aesthetic are assembled in Smith's prophetic vision: cinematography, script, score, choreography, plot, spectacle. The only thing lacking was the technology to capture them together on film, and with the release ofinventive energies attending division oflabor that would only be a matter of time. Cinema is the born ally ofrational modernity, and is in itself the child of industrial alienation and the need to find a mass aesthetic to substitute for the control exercised by the sacred in a traditionally local setting. But, ofcourse, there are several levels ofirony that are not lost on us here. First, Smith says explicitly that the state has a direct interest in such mass entertainment. What then is the relationship between the much prized freedom ofthe creative artist and the very concrete concern for self-preservation on the part ofthe state? He specifies that the people's entertainment must be without scandal or indecency: what now should be said when political leaders... (shrink)

In 1992, Israel underwent a major constitutional reform, which provided Israel, for the first time in its history, with an effective system of separation of powers between the political branches of government. This reform was not intentional but, rather, a byproduct of the voluntary adoption by the two major political parties of open primaries as the method for choosing candidates on their lists for election to parliament. The adoption of the primaries system produced two major changes in the Israeli (...) constitutional and political order. First, it transformed the Knesset into an independent body and, hence, for the first time in Israel’s history, provided for a functioning system of checks and balances between the legislature and the executive. Second, it shifted power from the Jewish religious minority to the secular majority and even contributed to the increase in the relative power of the Arab parties. On a more general level, the Article demonstrates the impact different modalities of pre-selection of party candidates can have not only on the outcome of the elections and on the relative power relations among the parties, but, more importantly, on the structure and the functioning of the political system. Once proven, this impact requires public attention: legislative regulation of the pre-selection process may be required, indeed even constitutionally mandated, to ensure political checks and balances. (shrink)

Step therapy is an insurance company policy whereby patients must try a less costly treatment and fail-first before the insurer will cover another, more costly treatment. This article argues that there are relevant and well-established principles of medical ethics—the duty to practice evidenced-based medicine and the duty to consider cost-effectiveness when treating patients—that constrain and guide physician behavior with respect to step therapy; clinical practice guidelines promulgated by authoritative physician groups attempt to incorporate and reconcile the competing demands (...) of evidenced-based and cost-effective medicine, although it is unclear whether they do so in a manner that appropriately considers all relevant ethical factors relating to cost-effectiveness; and despite the potential shortcomings of CPGs, the ethical principles guiding and constraining physician behavior can help demarcate the ethical boundaries for other actors in the drug prescribing and reimbursement matrix, including insurance companies and benefit managers. (shrink)

How should policymakers respond to the risk of technological unemployment that automation brings? First, I develop a procedure for answering this question that consults, rather than usurps, individuals’ own attitudes and ambitions towards that risk. I call this the insurance argument. A distinctive virtue of this view is that it dispenses with the need to appeal to a class of controversial reasons about the value of employment, and so is consistent with the demands of liberal political morality. Second, (...) I appeal to the insurance argument to show that governments ought not simply to provide those who are displaced by machines with unemployment benefits. Instead, it must offer re-training programmes, as well as enact more general macroeconomic policies that create new opportunities for employment. My contribution is important not only because it helps us to resolve a series of urgent policy disputes—disputes that have been discussed extensively by labour market economists and policymakers, but less so by political philosophers—but also because my analysis sheds light on more general philosophical controversies relating to risk. (shrink)

Political parties have only recently become a subject of investigation in political theory. In this paper I analyse religious political parties in the context of John Rawls’s political liberalism. Rawlsian political liberalism, I argue, overly constrains the scope of democratic political contestation and especially for the kind of contestation channelled by parties. This restriction imposed upon political contestation risks undermining democracy and the development of the kind of democratic ethos that political liberalism cherishes. In this paper I therefore aim to (...) provide a broader and more inclusive understanding of ‘reasonable’ political contestation, able to accommodate those parties (including religious ones) that political liberalism, as customarily understood, would exclude from the democratic realm. More specifically, I first embrace Muirhead and Rosenblum’s (Perspectives on Politics 4: 99–108 2006) idea that parties are ‘bilingual’ links between state and civil society and I draw its normative implications for party politics. Subsequently, I assess whether Rawls’s political liberalism is sufficiently inclusive to allow the presence of parties conveying religious and other comprehensive values. Due to Rawls’s thick conceptions of reasonableness and public reason, I argue, political liberalism risks seriously limiting the number and kinds of comprehensive values which may be channelled by political parties into the public political realm, and this may render it particularly inhospitable to religious political parties. Nevertheless, I claim, Rawls’s theory does offer some scope for reinterpreting the concepts of reasonableness and public reason in a thinner and less restrictive sense and this may render it more inclusive towards religious partisanship. (shrink)

The paper by Susan M. Wolf and Jeffrey P. Kahn published in this issue of the Journal of Law, Medicine & Ethics notes that we are members of the Working Group on Genetic Testing in Disability Insurance and that the members of the Working Group do not necessarily subscribe to its recommendations. Although we agree with some of Wolf and Kahn's recommendations, we do not agree with recommendations 1, 3, 4, and 5 for individual disability insurance and recommendations (...) 1, 2, and 3 for group disability insurance. We use this paper to delineate our areas of disagreement, but we do not discuss areas such as employment law as they are not our areas of expertise.First, understanding our roles on the Working Group is important. As members, we provided technical expertise on disability insurance. Our input to the Working Group represents our individual opinions. (shrink)

Conceptually, entrepreneurship is seen as the engine that drives a robust economy, promotes a favorable quality of life, and assures the availability of the attributes needed for meaningful living. However, like many popular concepts in this world, its limitations are normally not well acknowledged. A grouping of entrepreneurial ventures which has recently come into existence deals with the personal fiscal issues associated with the end-of-life phase of the human cycle. While generally praised as humanitarian services for society, that are assuredly (...) within legal bounds, these activities have potentially significant negative implications. When examined from an ethical perspective, some questionable practices became apparent. Three such undertakings in particular have to do with the terminally ill and are examined in this paper. The first, viatical transactions, is defined as the transfer of a life insurance policy's ownership to someone who does not have an insurable interest in the life of the insured individual. The second, creative tax shelters for wealthy people involved in estate planning, involves hiring unrelated parties, particularly those who are young and in failing health, to do the dying for the principal. The third, mind games, involves curtailing the use of medical resources for the dying. The justification for this is rationing scarce medical resources. (shrink)

In researching the biomedically-engineered drug Neulasta, a breast cancer patient becomes aware of the extent to which knowledge about the development and marketing of drugs influences her decisions with regard to treatment. Time spent on understanding the commercial interests of insurers and pharmaceutical companies initially thwarts but ultimately aids the healing process. This first-person narrative calls for physicians to recognize that the alignment of commercial interests transgresses the patient’s humanity.

It is almost a truism that political development is synonymous with the building of integrative institutions. The most important of these institutions is the political party. The political parties generally perform many manifest functions. Firstly, parties act as brokers of ideas, programmes and policies. In doing so, they articulate as well as aggregate the diverging interests of the country and help resolve cleavages within the nation. Secondly, they recruit support from all parts of the country and help elect political (...) office-bear ere. By developing machinery for the resolution of infra-party disputes, the parties help unite the people froth various regions from which they recruit their support arid develop a sense of identity among its supporters. She critical latent effect of these manifest functions of political parties is the creation of a high level of consensus and development and fostering of a national political culture. (shrink)

: Four principal arguments have been offered in support of requiring public and private third-party payers to help fund medical research: (1) many of the costs associated with clinical trial participation are for routine care that would be reimbursed if delivered outside of a trial; (2) there is a need to promote scientific research and medical progress and lack of coverage is an impediment to enrollment; (3) to cover the costs of trials expands health care and treatment options for (...) the sick; and (4) it is beneficial for private insurers to cover the costs associated with cancer clinical trials because doing so makes such companies more attractive to consumers. Although many see third-party-payer coverage as a victory for patients and for the future of research, requiring coverage of services provided in a trial beyond those that would be provided to a comparable patient outside the research context raises a number of concerns. (shrink)

Conventional narratives hold that parties are “the orphans of political philosophy” and that systematic normative justifications of parties and partisanship have emerged only in recent years in the West. This article aims to show that when antiparty sentiments were prevalent in late nineteenth- and early twentieth-century Western societies, a systematic justification of party politics existed in China. Western antipartyism in that time shifted from an older accusation that parties were divisive and subversive to a “progressive antipartyism” that portrayed parties (...) as elitist and antidemocratic “machines.” In China, however, although proparty intellectuals faced the first type of antipartyism, the “progressive” type was relatively absent, as there weren’t any mature party machines in the first place. Far from being a hindrance to democracy, parties comprised of public-spirited elites were justified as an instrument for political founding: transforming passive subjects under an imperial despotism into modern active citizens in a constitutional democracy. (shrink)

The grip of political parties of central government actors in Belgium was most striking in the 1970s and 1980s. In this period Belgium, like Italy, constitutes a very strong case of partitocracy. Yet, white the Italian partitocrazia collapsed brusquely in the early 1990s, the Belgian particratie underwent a number of gradual modifications, which prevented the complete collapse of the partitocratic system and to some degree restored the governability of the country.This article presents for each sector of central government first (...) the main features as they were under full partitocratic rule during the 1970s and 1980s. Second, it indicates which corrections were introduced, that reduced the the grip of political parties on central government actors, structures and processes. Finally, it discusses the problem of the public debt and policy inertia. (shrink)

The reform of the health care system will include a mandate: Individuals are required to purchase health insurance provided that affordable options are available. But what is affordable health insurance? Three accounts of affordability of health coverage have been advanced. The first two accounts are empirical. The third account is needs-based. All three accounts are inadequate. I propose a fourth, the reasonable tradeoff account, according to which individuals should only be required to make reasonable tradeoffs in order (...) to pay for their health coverage. That is, health insurance is affordable if in order to pay for it one does not to have to sacrifice other benefit(s) that are comparable in importance to the benefits of health coverage. (shrink)

The policy projected by the Eighth Congress of the Socialist Unity Party of Germany rests on two cornerstones. First, there is the task of further raising the material and cultural living standard of the people on the basis of the higher rates of development of socialist production which result from increased efficiency, scientific-technological progress, and a rise in labor productivity. Second, there is the foreign policy task decided jointly with the Soviet Union and other fraternal socialist countries: "to (...) create favorable external conditions for the building of socialism, to further the strengthening of the community of socialist states, to strengthen international solidarity with peoples fighting for their freedom, to realize the Leninist principles of peaceful coexistence between states having different social systems, and to struggle actively against aggressive imperialism." (1. (shrink)

The Belgian scientific literature dealing with political parties has four main characteristics. First it pays great attention to party doctrines and to parliamentary struggle. Indeed, in the nineteenth century political parties do not strike by their organization, which is still undeveloped, nor by their functions, which are still limited, but by the public debate they are stimulating in Parliament and in the press. Only from the end of the century, when the suffrage is extended, the organization of the (...) parties wilt get more articulated and their functions more complicated. Secondly the literature pays great attention to the legitimation of the political parties, which are still controversial particularly because they should threaten the national union. The authors exert oneselves to prove that parliamentary government is by definition a party government. They distinguish parties from factions in order to make the first acceptable. Thirdly the literature deals with the party system.The Belgian authors take the two party system which exists in Great Britain as example and try to prove that the alternation of two parties, the party of conservation and the party of progress, is necessary for the good working of the institutions. Fourthly, the literature, particularly the historica!, is rather descriptive and is characterized by a lack of comparisons, generalizations and hypothesis.Two periods can be distinguished in the literature. In the first period, 1830-1894, the suffrage is limited and the political scene is dominated by two parties.This period is marked by the publications of Emile de Laveleye, one of the most prolific writers of the second half of the nineteenth century. In the second period, 1894-1914, the advent of the socialist party disturbs the working of the classical party government. Maurice Vauthier is the main author of this period. He tries to establish the characteristics of the party government and its chances in the future. (shrink)

In this paper, I do several things. First, I present a definition of ‘corruption’ as ‘abuse of power that builds or maintains the abuser’s power’, arguing that this definition is more generally applicable than other definitions offered in the literature and that it highlights a crucial property of corruption, namely its tendency to metastasise, presenting a more and more serious danger to society. To defend the emphasis I place on this tendency, I then argue that corruption (as commonly understood) (...) frequently produces three mechanisms pushing it to reproduce: self-perpetuation by the corrupt actors to protect themselves, formation of networks between corrupt actors which ensnare new participants, and normalisation of specific kinds of abuse of power in the corrupt actors’ social environments. From here, I turn to political parties, arguing that they present fertile soil for the mechanisms just described. In their stead, I argue for sortition—a system whereby legislators are randomly selected from the population at large. I make the case that each of the three metastatic mechanisms I have described would have much more difficulty taking root in a sortitional-democratic system than in an electoral-democratic one, before concluding by responding to a major potential objection to such a proposal’s feasibility—namely, that sortitional juries would be less competent than elected legislatures—and presenting a sketch of a sortitional-democratic system setting out how it could discharge the government’s executive functions, in addition to the legislative functions already covered. The paper as a whole, in addition to its explicit arguments, may be considered to make an implicit case for non-ideal over ideal theory, in that it attempts to show the importance of that quintessentially non-ideal factor, corruption, to the nature of any political order. (shrink)

In 1807 the first life insurance society was established in The Netherlands. In the second half of the century, life insurance societies underwent considerable expansion. During the intervening period, the lines had to be laid along which this new phenomenon was to develop in the future: between 1827 and 1830, the government started discussing the nature of its responsibility in this field and the kind of policy to be developed, and in 1830, a book on the organization (...) of life insurance societies, the calculation of life annuities and widows' fund premiums was published, written by the mathematician Rehuel Lobatto. This book played an important role in the government's discussion. Royal Decrees which prescribed government approval for the establishment of life assurance societies were promulgated in 1830, 1833 and 1840. In 1832, Lobatto became the government's scientific adviser on the assessment of the calculations performed by these societies, and in the same year, he was also appointed adviser to the first life insurance society. From 1832 until his death in 1866 he advised the company on the use of life tables for life as well as for reversionary annuities, and he calculated the premiums based on these life tables. Another decree was promulgated in 1864 prescribing exactly which life tables were to be used. Because Lobatto probably played a part in this decree, he was responsible for a very ‘conservative’ government policy, which was no longer adequate in the second half of the century. (shrink)

This paper argues that the best interpretation of Ronald Dworkin’s hypothetical insurance scheme is a holistic one that allows the parties to make choices between the policies that are available. This interpretation contrasts with the hypothecated and insurance-focused aspects that are traditionally understood as part of the procedure. The paper argues that the holistic interpretation better fits with the ideal of resource egalitarianism that people should have as much choice as possible from an equal starting point. It does (...) so by allowing people a choice over the policies that will be used to achieve their insurance preferences. (shrink)

This article explores the impact of the VASKhNIL conference upon the cultural policy of the Italian Communist Party (PCI) and Italian communist biology, with particular attention to the period between 1948 and 1951. News of the Moscow session did not appear in the Italian news media until October, 1948, and for the next three years party biologists struggled over whether to translate the official transcript of the proceedings, The Situation in Biological Science, into Italian. This struggle reveals the (...) complex efforts of the PCI to confirm the ideological and political connection with the Soviet Union, without completely alienating significant milieus of the democratic and antifascist culture in Italy. The apparent impossibility of doing both is indicated by the fact that the project was finally abandoned in March-April, 1951. The article is divided into three sections, each focused on different actors and their response to Lysenkoism. The first section outlines the features of the PCI's pro-Lysenko campaign, with particular regard to the intellectual militancy and organizational commitment of Emilio Sereni, head of PCI's Cultural Commission between 1948 and 1951. The second section analyzes the reaction of the three most important figures in Italian communist biology during this period, Massimiliano Aloisi, Franco Graziosi and Emanuele Padoa. The third section interprets the decision not to publish a translation of The Situation in Biological Science as a consequence of the conflicts between PCI cultural program and the editorial policy of the left-wing publishing house Giulio Einaudi Editore. (shrink)

This article presents two interlocking arguments for epistemic political egalitarianism. I argue, first, that coping with multidimensional social complexity requires the integration of expertise. This is the task of political parties as collective epistemic agents who transform abstract value judgments into sufficiently coherent and specific conceptions of justice for their society. Because parties thus severely lower the relevant threshold of comparison of political competence, citizens have reason to regard each other as epistemic equals. Drawing on the virulent “peer disagreement (...) debate,” I then analyze the epistemic significance of political disagreement. I contend that citizens ought to pursue epistemic conciliation, an idea I contrast to the ideals of compromise and of consensus. Subsequently, I introduce insights from public choice theory and empirical findings which show that and why multi-party electoral competition coupled with equal rights to participation tends to produce conciliatory outcomes. We thus have reason to endorse political egalitarianism on epistemic grounds. (shrink)

Although the technology for telemedicine existed before the Covid‐19 pandemic, the need to provide medical services while minimizing the risk of contagion has encouraged its more widespread use. I argue that, although telemedicine can be useful in certain situations, physicians should not consider it an adequate substitute for the office visit. I first provide a narrative account of the experience of telemedicine. I then draw on philosophical critiques of technology to examine how telemedicine has epistemic and ethical effects that (...) make some of the goods of medicine unavailable. Telemedicine rules out an embodied encounter between physician and patient, in which the sense of touch has special importance. The individualized attention facilitated by the in‐person visit may better sustain a caring physician‐patient relationship. Physicians should criticize attempts by administrators, insurers, or other parties to incentivize the wholesale replacement of traditional office visits with telemedicine. (shrink)