Providing health care in the most cost-effective way has become a priority in recent years. This book tackles the important issue of the potential conflict between economic expediency and the welfare of individual patients. Contributors examine different attitudes to this complex problem, along with a variety of legal and historical perspectives. The book addresses particular aspects of health care, such as medical expert systems, general practice, medical education, and clinical decision-making where the direct involvement of doctors in allocating scarce and (...) expensive resources is perhaps most obvious. (shrink)

This book comprises an attempt to examine how we might set about an- swering the question: How much is society prepared to pay to reduce mortality: Or more brutally, what is the value of human life? The justification for attempting to answer such questions lies in the de- sirability of injecting increased explicitness and rationality into decision-making in those areas of the public sector which are con- cerned with life saving. Given that resources are already being de- ployed to such (...) activities as crash-barriers on motorways, helicopters for air-sea rescue, kidney machines and other life-saving measures - although such activities result only in a reduction in risk of death, not itsillimination, in the policy fields affected - this means that already at the present time, at least by implication, values are be- ing placed by decision-makers on the saving of life. (shrink)

Effectiveness, efficiency and equity in health care are discussed in this article against the background of concerns that cost containment may lead to reductions in quality of care. It is suggested that effectiveness is best seen from the patient's point of view and that it relates to more than simply improved health status. Efficiency and equity are better viewed from a societal stance.The paper discusses the role of the medical profession in effectiveness, efficiency and equity and argues that the role (...) of medical doctors needs to be constrained. (shrink)

Most of the debate surrounding standards in medical care, issues of medical audit and what constitutes benefit from health care assumes that what is obtained from health care is health and only that. This is an assumption which most health economists at least implicitly appear to endorse. This paper questions that assumption. There are various outcomes beyond health and there are various processes involved in health care about which patients are not indifferent. This paper calls for a fuller investigation as (...) to what it is that patients want from their health services and the adoption of a more pluralistic conception of health care benefits. It is further argued that the objectives of health care systems are those in which citizensqua citizens also have interests and which may be different from those of patients. It is yet less likely that citizens’ interests in health care will be restricted to health. (shrink)

This study is part of a programme to elicit and examine community preferences for health care in different contexts. Data were obtained from a group of predominantly Australian health care decision-makers. A short questionnaire contained six valuation questions and four demographic questions. The six valuation questions posed choices where equal health gains were to be allocated to different population groups based upon: age; sex; current health; socio-economic status; across time; and across different numbers of individuals. The results provide some evidence (...) that respondents were prepared to discriminate between health gains derived in different contexts especially where health gains were to be allocated between groups of different health status and over time. Further research is planned and the possible implications for health policy, and in particular for resource allocation in health care, are briefly discussed. (shrink)

Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than ignored. The notionof individual autonomy in the (...) context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities. (shrink)

This paper argues that there is a need to move yet further than has already been suggested by some from the individual to the collective as a base for public health. A communitarian approach is one way to achieve this. This has the advantage of allowing not only the community’s voice to have a say in setting the values for public health but also more formally the development of a constitution on which public health might then be built. It also (...) sees public health as a social institution which can be valued in its own right. (shrink)

This paper introduces this mini-series on vertical equity in health care. It reflects on the fact that by and large equity policies in health care have failed and that there is a need for positive discriminationto promote equity better in future. This positive discrimination is examined under the heading of`vertical equity'. The paper considers Varian's notion of 'envy' as a basis for equity in health care but concludes that this is not a helpful route to go down. Better it would (...) seem to pursue the idea from Sen of 'freedoms' and 'communitarian claims' (as raised previously by this author). While it is argued that procedural justice is to be preferred in the longer run as a basis for equity there are gains in adopting a short run goal of promoting distributive justice. Some preliminary evidence is presented on the weighting of health gains to reflect such vertical equity concerns. (shrink)

This book addresses an intruiging question: What do we mean by justice in health care? It concentrates on the social level of decision-making rather than the individual decisions which are more commonly the subject of medical ethics.

The notion of whether people focus on the past, present or future, and how it shapes their behaviour is known as Time Perspective. Fundamental to the work of two of its earliest proponents, Zimbardo and Boyd (2008), was the concept of balanced time perspective and its relationship to wellness. A person with balanced time perspective can be expected to have a flexible temporal focus of mostly positive orientations (past-positive, present-hedonistic, and future) and much less negative orientations (past-negative and present-fatalistic). This (...) study measured deviation from balanced time perspective (DBTP: Zhang, Howell, and Stolarski, 2013) in a sample of 243 mature adults aged 45 to 91 years and explored relationships to Retirement Planning, Depression, Anxiety, Stress, Positive Mood, and Negative Mood. Results indicate that DBTP accounts for unexplained variance in the outcome measures even after controlling for demographic variables. DBTP was negatively related to Retirement Planning and Positive Mood and positively related to Depression, Anxiety, Stress and Negative Mood. Theoretical and practical implications regarding balanced time perspective are discussed. (shrink)

Understanding terrestrial carbon metabolism is critical because terrestrial ecosystems play a major role in the global carbon cycle. Furthermore, humans have severely disrupted the carbon cycle in ways that will alter the climate system and directly affect terrestrial metabolism. Changes in terrestrial metabolism may well be as important an indicator of global change as the changing temperature signal. Improving our understanding of the carbon cycle at various spatial and temporal scales will require the integration of multiple, complementary and independent methods (...) that are used by different research communities. Tools such as air sampling networks, inverse numerical methods, and satellite data allow us to study the strength and location of the global- and continental-scale carbon sources and sinks. Bottom-up studies provide estimates of carbon fluxes at finer spatial scales and examine the mechanisms that control fluxes at the ecosystem, landscape, and regional scales. Bottom-up approaches include comparative and process studies that provide the necessary mechanistic information to develop and validate terrestrial biospheric models. An iteration and reiteration of top-down and bottom-up approaches will be necessary to help constrain measurements at various scales. We propose a major international effort to coordinate and lead research programs of global scope of the carbon cycle. (shrink)

The issue of assessing priorities is one that has become the subject of much debate in the National Health Service particularly in the wake of various documents on priorities from central Government. It has become even more so with the prospect of real cuts in expenditure. Economists claim that their science, or perhaps more accurately art can assist in determining not only how best to achieve various ends but also whether and to what extent competing objectives should be pursued. Such (...) choices cannot be made in the absence of some ethical considerations and it is important that health service decision makers (and in particular the medical profession) are aware if the relationship between economics (and especially cost-benefit analysis) and medical ethics. (shrink)

Recent theoretical developments in economic theory have attempted to relax the assumption that human behavior is guided by “tight calculation” of profit-maximization. Harvey Liebenstein's notion of X-efficiency is a particularly important development in this regard. This article argues, however, that X-efficiency theory does not go far enough in relaxing the assumptions of economic theory. The understanding of human behavior requires a recognition of variability in the ends or goals of action as well as variability in the means which are utilized (...) in the pursuit of these diverse ends. Max Weber's concepts of formal rationality and substantive rationality recognize this variability in the ends toward which action is oriented as well as the intrusion of habit or routine in the “calculatedness” of social and economic action. C. Wright Mills' ideal of craftship is used to represent a type of substantive rationality which contrasts with the formal rationality of calculation toward profit-maximization. The case is made that craftship is a particularly significant substantive rationality in American agriculture. It is argued that, among family farmers, other values, such as autonomy in one's work, often constitute alternative ends toward which action may be directed. Such ends may, in fact, conflict with the goal of profit-maximization. It is concluded that agricultural policy analysis and prescription which fails to consider the significant role of substantive rationalities, such as craftship, are likely to reproduce and enhance the conditions from which the present crisis in agriculture has developed. (shrink)

Contemporary understanding of the mechanisms of disease increasingly points to examples of “genetic diseases” with an infectious component and of “infectious diseases” with a genetic component. Such blurred boundaries generate ethical, legal, and social issues and highlight historical contexts that must be examined when incorporating host genomic information into the prevention, outbreak control, and treatment of infectious diseases.

Many studies have argued for distinct but complementary contributions from each hemisphere in the control of movements to visual targets. Investigators have attempted to extend observations from patients with unilateral left- and right-hemisphere damage, to those using neurologically-intact participants, by assuming that each hand has privileged access to the contralateral hemisphere. Previous attempts to illustrate right hemispheric contributions to the control of aiming have focussed on increasing the spatial demands of an aiming task, to attenuate the typical right hand advantages, (...) to try to enhance a left hand reaction time advantage in right-handed participants. These early attempts have not been successful. The present study circumnavigates some of the theoretical and methodological difficulties of some of the earlier experiments, by using three different tasks linked directly to specialized functions of the right hemisphere: bisecting, the gap effect, and visuospatial localization. None of these tasks were effective in reducing the magnitude of left hand reaction time advantages in right handers. Results are discussed in terms of alternatives to right hemispheric functional explanations of the effect, the one-dimensional nature of our target arrays, power and precision given the size of the left hand RT effect, and the utility of examining the proportions of participants who show these effects, rather than exclusive reliance on measures of central tendency and their associated null hypothesis significance tests. (shrink)

In a famous debate on jurisprudence held in 1958 between H. L. A. Hart and Lon Fuller, the protagonists argued about the nature of the law. On one side was H. L. A. Hart, who was a staunch defender of two ideas, first, that law was to be separated from morals, and secondly, that law as it is should be separated from law as it ought to be. These two ideas are subtly different. On the other side, is Fuller, who (...) argues that law cannot be understood apart from its reason for being formulated in the first place. In relation to Hart's two ideas, the paper shows how both rest upon an unstated hidden motivating assumptions, clues to which can be found in both "Positivism and the Separation of Law and Morals" and 'The Concept of Law'. This assumption is that Hart is committed to a distinctively liberal account of morality which finds expression in the rule of law. The paper argues that the project of finding a purely descriptive account of law is impossible in the Hartian sense since the descriptive/evaluative dichotomy is a false dichotomy. This is achieved by means of the Kovesian analysis of concept formation. (shrink)

Preliminary research on the Edition of One (EO1) project, "W(h)ither the Avant-garde?" Includes a report on the art-world ca.2006-2010.

On Humour and the Comic in the Hebrew Bible. Edited by Y. T. Radday and A. Brenner.The Trouble With Kings: The Composition of rhe Book of Kings in the Deuteronomistic History. By Steven L. McKenzie.Sacred Space: An Approach to the Zheology of the Epistle to the Hebrews. By Marie E. Isaacs.Fourth Ezra: A Commentary on the Book of Fourth Ezra. By Michael Edward StonePaul the Convert: iShe Apostolate and Apostasy of Saul the Pharisee. By Alan F. Segal.Creative Biblical Exegesis: Christian (...) and Jewish Hermeneutics through the Centuries. Edited by Benjamin Uffenheimer and Henning Graf Reventlow.The Hope of the Early Church: A Handbook of Patristic Escharology. By Brian E. Daley.The Emergence of the Laity in the Early Church. By Alexandre Faivre, translated by David Smith.Pastoral Life and Practice in the Early Church. By Carl A. Volz.The Making of the Creeds. By Frances Young.La correzione fratenia in s. Agosrino. By Agostino Clerici.Beaup and Revelation in the Thought of St Augustine. By Carol Harrison.Grace, Politics and Desire. Edited by Hugo Meynell.Boerhius and Aquinas. By Ralph McInerny.The Weight of Glory. A Vision and Practice for Christian Faith: The Future of Liberal Theology. Edited by D. W. Hardy and P. H. Sedgwick.Atonenrent and Incarnation. By Vernon White.Tragic Method and Tragic Theology: Evil in Contemporary Drama and Religious Thought. By L. D. Bouchard.Parmenides of Elea, Fragments: A Text and Translation, with an Introduction. By David Gallop.Language, Thought and Falsehood in Ancient Greek Philosophy. By Nicholas Denyer.Weakness of the Will. By Justin Gosling.Knowledge and the Sciences in Medieval Philosophy. Vol. I, edited by Monica Asztalos, John E. Murdoch and Ilkka Niiniluoto.Episcopal Power and Norenrine Sociev. 1000–1320. By George W. Dameron.Matins, Lauds and Vespers for St David's Day. By Owain Tudor Edwards.More's ‘Utopia’. By Dominic Baker‐Smith.Frontiers of Heresy: The Spanish Inquisitionfrom the Basque Lands to Sicily. By William Monter.Inquisition and Society in the Kingdom of Valencia, 1478–1834, By Stephen Haliczer.The Fear of Hell: Images of Damnation and Salvation in Early Modern Europe. By Piero Camporesi, translated by Lucinda Byatt.Lucrecia's Dreams: Politics and Prophecy in Sixteenth‐Centun Spain. By Richard L. Kagan.Heresy and Mysticism in Sixteenth‐Century Spain: The Alumbrados. By Alastair Hamilton.Japan's Encounter with Christianiry: The Catholic Mission in Pre‐Modern Japan. By Neil S. Fujita.Galileo, Bellannine and the Bible. By Richard J.Augustine Baker's Inner Light: A Study in English Recusant Spirituality. By James Gaffney.The Prorestarit Evaqelical Awakening. By W. R. Ward.The Study of Anglicanism. Edited by Stephen Sykes and John Booty.The Anglican Tradition: A Handbook of Sources. Edited by G. R. Evans and J. Robert Wright.The Restoration Church of England, 1646‐1689. By John Spurr.Awash in a Sea of Faith: Christianizing the American People. By Jon Butler.A Woman Styled Bold: The Life of Cornelia Connelly, 1809–1879. By Radegunde Flaxman.Cane Ridge: America's Pentecost. By Paul K. Conkin.Revivalism and Social Change: Christianio, Nation Building and the Market in the Nineteenth‐Century United States. By George M. Thomas.Church and State: The English Experience. By Adrian Hastings.Evelyn Underhill: Artist of the Infinite Life. By Dana Greene.Northern Ireland: Fairh and Faction. By Maurice Irvine.The Tragedy of Belief: Division, Politics, arid Religion in Ireland. By John Fulton.Shattered Vows: Exodus from the Priesthood. By David Rice.Making Saints: Inside the Vatican: Who Become Saints, Who Do Not, and Why. By Kenneth L. Woodward.Ecclesiae Memoria: Miscellanea in onorr del R. P. Josef Metzler, O. M. I. Edited by Willi Henkel. (shrink)

Professor Bonnie Steinbock writes ‘… I am not going to discuss rights, important as the issue is’; but she adds, en passant , ‘According to the view of rights held by H. L. A. Hart and S. I. Benn, infants do not have rights, nor do the mentally defective, nor do the insane, in so far as they all lack certain minimal conceptual capabilities for having rights’.

Book Reviws in this ArticleThe Human Body and the Law, 2nd edition by D.W. Meyers, Edinburgh University Press, 1990Classic Cases in Medical Ethics by Gregory E. Pence. New York: McGraw‐Hill Publishing Co. 1990Changing Values in Medical and Health Care Decision Making, edited by Uffejuul Jensen and Gavin Mooney. Chichester: John Wiley & Sons, 1990IVF and Justice by Teresa Iglesias, London: The Linacre Centre For Health Care Ethics, 1990The Practical, Moral and Personal Sense of Nursing: A Phenomenon‐ological Philosophy of (...) Practice by Anne H. Bishop and John R. Scudder, Jr. New York: State University of New York Press, 1990A Companion to Ethics, edited by Peter Singer. Oxford and Cambridge, Mass: Basil Blackwell, 1991.Ethics and Law in Health Care and Research edited by Peter Byrne, Chichester, UK: 1990The Human Embryo edited by G.R. Dunstan, Exeter: Exeter University Press, 1990Everyday Ethics: Resolving Dilemmas in Nursing Home Life by Rosalie A. Kane and Arthur L. Caplan. N.Y.: Springer Publishing Company, 1990Psychiatric Ethics, 2nd edition, edited by S. Bloch and P. Chodoff. Oxford, Oxford University Press, 1991Health Care and Gender by Charlotte Muller. New York: Russell Sage Foundation, 1990. (shrink)

The author joins the discussion on selection of patients in the face of life-saving resources initiated in the Journal by Parsons and Lock, Mooney and the editorial in the December 1980 issue. In this article several selection systems are discussed. The author is in favour of a `criteria-system'. The criteria for such a system are elaborated. On the basis of a sequence of values a sequence of criteria is proposed. Attention is also given to the procedural aspects.

The arguments used by Gavin Mooney in his scornful response to Castigating QALYs, are examined. In spite of the rhetoric there is a broad measure of agreement about the deficiencies of QALYs as a means of distributing scarce resources. The main area of conflict is that John Rawles favours compaigning for more resources while Gavin Mooney, constrained by his remit as a health economist, favours acceptance of the present level of funding and better methods of distributing (...) resources. (shrink)

The phasalist solution to the puzzle of the statue and the piece of clay claims that being a statue is a phase sortal property of the piece of clay, just like being a child is a phase sortal property of a human being. Some philosophers reject this solution because it cannot account for cases where the statue seems to gain and lose parts that the piece of clay does not. I rebut this objection by arguing, contrary to the prevailing view, (...) that the piece of clay is not mereologically constant and might even be highly mereologically flexible. (shrink)

We argue that the evil-god challenge is not an additional challenge for theists above and beyond the (much older) gap problem. One version of the evil-god challenge is merely a specific instance of the gap problem, and another is dependent on that specific instance of the gap problem. Therefore, the various solutions to the gap problem that theists have developed double as responses to the evil-god challenge, placing the evil-god challenge in a more vulnerable position than has been supposed.

Scholars have long been captivated by the parallels between birdsong and human speech and language. In this book, leading scholars draw on the latest research to explore what birdsong can tell us about the biology of human speech and language and the consequences for evolutionary biology. They examine the cognitive and neural similarities between birdsong learning and speech and language acquisition, considering vocal imitation, auditory learning, an early vocalization phase, the structural properties of birdsong and human language, and the striking (...) similarities between the neural organization of learning and vocal production in birdsong and human speech. After outlining the basic issues involved in the study of both language and evolution, the contributors compare birdsong and language in terms of acquisition, recursion, and core structural properties, and then examine the neurobiology of song and speech, genomic factors, and the emergence and evolution of language. Contributors: Hermann Ackermann, Gabriël J.L. Beckers, Robert C. Berwick, Johan J. Bolhuis, Noam Chomsky, Frank Eisner, Martin Everaert, Michale S. Fee, Olga Fehér, Simon E. Fisher, W. Tecumseh Fitch, Jonathan B. Fritz, Sharon M.H. Gobes, Riny Huijbregts, Eric Jarvis, Robert Lachlan, Ann Law, Michael A. Long, Gary F. Marcus, Carolyn McGettigan, Daniel Mietchen, Richard Mooney, Sanne Moorman, Kazuo Okanoya, Christophe Pallier, Irene M. Pepperberg, Jonathan F. Prather, Franck Ramus, Eric Reuland, Constance Scharff, Sophie K. Scott, Neil Smith, Ofer Tchernichovski, Carel ten Cate, Christopher K. Thompson, Frank Wijnen, Moira Yip, Wolfram Ziegler, Willem Zuidema. (shrink)

One of the standard puzzles in ordinary-object metaphysics concerns what happens when an object and one of its undetached parts apparently begin to coincide. I distinguish two versions of this puzzle: the problem of extraordinary undetached parts and the problem of ordinary undetached parts. Then I present a novel phasalist solution to the problem of ordinary undetached parts. My solution is designed to supplement the recently-defended view that ordinary undetached parts exist but extraordinary ones do not.

It is widely held that the classic reassembly model of resurrection faces intractable problems. What happens to someone if God assembles two individuals at the resurrection which are equally good candidates for being the original person? If two or more people, such as a cannibal and the cannibal’s victim, were composed of the same particles at their respective deaths, can they both be resurrected? If they can, who gets the shared particles? And would an attempt to reassemble a long-gone individual (...) result in a genuine resurrection, or merely an intrinsic duplicate of the original person? In this paper, I argue that the first of these problems has, in effect, been solved by defenders of a rival view; I propose a novel solution to the second problem; and I show that the third can be solved by upgrading the naïve reassembly model to a novel variety of reassembly model. (shrink)

The notion of repression as active forgetfulness already found in Nietzsche and systematised by Freud and his successors is employed in a distinctive manner by Merleau-Ponty in Phenomenology of Perception. By showing how we appropriate our environment towards outcomes and respond to other people, he contends, we can unearth hidden modes of operative intentionality. Two such modes are the motor intentional projection of action and the anonymous intercorporeality that includes touching and being touched. Each of these is an aspect of (...) a past that was never a present. Merleau-Ponty does have something to say about pasts that were once present and that linger on in human life. Yet he shows little interest in the unconsciousness of psychoanalysis for its own sake. Psychoanalytic accounts of repression are assimilated into his theory of the body itself, serving merely as means for illustrating the latter. I suggest that this move follows on a conception of an integrated existent whose past acquisitions are remarkably enabling and untroubling. (shrink)