Should mental health insurance cover only disorders found in DSM‐IV, or should it be extended to treatment for ordinary shyness, unhappiness, and other responses to life's hard knocks?

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

How can health plans make fair determinations about when “experimental” (and costly) treatments such as high dose chemotherapy with autologous bone marrow transplantation should be covered despite lack of clear clinical consensus about their benefits? Different models for managing “last chance” therapies evolving in some health plans offer promising examples of how issues of fairness and legitimacy in decisionmaking can be addressed.

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Although “rationing” continues to be a dirty word for the public in health policy discourse, Nir Eyal and colleagues handle the concept exactly right in their article in this issue of the Hastings Center Report. They correctly characterize rationing as an ethical requirement, not a moral abomination. They identify the key health policy question as how rationing can best be done, not whether it should be done at all. They make a cogent defense of what they call “rationing through (...) inconvenience” as a justifiable allocational technique. And they wisely call for research on the effectiveness and fairness of this approach and other methods of rationing. I fully agree with their approach to rationing and with their argument that the process they provocatively label “rationing through inconvenience” should not be rejected out of hand. But I believe they have underestimated two ways in which the practical impacts of rationing through inconvenience limit its potential usefulness: the asymmetry of its effect on patients and physicians and the way in which it reduces the capacity of health systems to learn from experience. (shrink)

"Cluster randomized trials," in which groups of patients are randomly assigned to different therapeutic interventions, provide a powerful way of evaluating drugs. CRTs have not been widely used, in good part because of concerns about whether patients must give informed consent to participate in them. A better understanding of how CRTs fit into clinical practice resolves the concerns.

Book reviewed in this article: Animal Experimentation: The Moral Issues. Edited by Robert M. Baird and Stuart E. Rosenbaum.

Book reviewed in this article: Animal Experimentation: The Moral Issues. Edited by Robert M. Baird and Stuart E. Rosenbaum.

One of the contemporary results of Germany’s memorial conundrum is the rise of its “counter-monuments”: brazen, painfully self-conscious memorial spaces conceived to challenge the very premises of their being. On the former site of Hamburg’s greatest synagogue, at Bornplatz, Margrit Kahl has assembled an intricate mosaic tracing the complex lines of the synagogue’s roof construction: a palimpsest for a building and community that no longer exist. Norbert Radermacher bathes a guilty landscape in Berlin’s Neukölln neighborhood with the inscribed light of (...) its past. Alfred Hrdlicka began a monument in Hamburg to counter—and thereby neutralize—an indestructible Nazi monument nearby. In a suburb of Hamburg, Jochen Gerz and Esther Shalev-Gerz have erected a black pillar against fascism and for peace designed to disappear altogether over time. The very heart of Berlin, former site of the gestapo headquarters, remains a great, gaping wound as politicians, artists, and various committees forever debate the most appropriate memorial for this site.4 4. The long-burning debate surrounding projected memorials, to the Gestapo-Gelände in particular, continues to exemplify both the German memorial conundrum and the state’s painstaking attempts to articulate it. For an excellent documentation of the process, see Topographie des Terrors: Gestapo, SS und Reichssicherheitshauptamt auf dem “Prinz-Albrecht-Gelände,” ed. Reinhard Rürup . For a shorter account, see James E. Young, “The Topography of German Memory,” The Journal of Art 1 : 30. James E. Young is assistant professor of English and Judaic studies at the University of Massachusetts, Amherst. He is the author of Writing and Rewriting the Holocaust: Narrative and the Consequences of Interpretation and The Texture of Memory: Holocaust Memorials and Meaning in Europe, Israel, and America , from which this essay is drawn. He is also the curator of “The Art of Memory,” an exhibition at the Jewish Museum of New York. (shrink)

Unchanging God -- Simple God -- Simple God lost -- Eternal creator -- One God, three persons.

The contribution of this work is a classification of corporate social action underlying the Social Ratings Data compiled by Kinder Lydenburg Domini Analytics, Inc. We compare extant typologies of corporate social action to the results of our exploratory factor analysis. Our findings indicate four distinct latent constructs that bear resemblance to concepts discussed in prior literature. Akey finding of our research is that positive and negative social action are both empirically and conceptually distinct constructs and should not be combined in (...) future research. Additionally, we recommend that some prior research results be reconsidered to determine whether these newly derived measures might clarify some previous findings. (shrink)

A contribution to ongoing debates in the philosophy of science, aiming to reconceptualize the orientation of the subject. Mobilizing the literature, the authors seek to transform their insights into a new epistemological and ontological basis for studying the enterprise of science.

This paper discusses global corporate citizenship in the twenty-first century. The primary focus is on the responsibility of managementeducators to foster among students an understanding of the causes and consequences of business activitiy that creates organizationalwealth, including the role of stakeholders. The modern corporation is a stakeholder enterprise: stakeholders enable the business to create wealth and require that it distribute wealth appropriately. The stakeholder enterprise model, which has been so economically successful, also implies corporate citizenship responsibilities. The Clarkson Principles are (...) discussed as a means through which educators and managers can better understand and address the challenges of corporate citizenship in the modern world. (shrink)

We study the I-ultrafilters on ω, where I is a collection of subsets of a set X, usually R or ω 1 . The I-ultrafilters usually contain the P-points, often as a small proper subset. We study relations between I-ultrafilters for various I, and closure of I-ultrafilters under ultrafilter sums. We consider, but do not settle, the question whether I-ultrafilters always exist.

We study the $I$-ultrafilters on $\omega$, where $I$ is a collection of subsets of a set $X$, usually $\mathbb{R}$ or $\omega_1$. The $I$-ultrafilters usually contain the $P$-points, often as a small proper subset. We study relations between $I$-ultrafilters for various $I$, and closure of $I$-ultrafilters under ultrafilter sums. We consider, but do not settle, the question whether $I$-ultrafilters always exist.

The Alexandrian emphasis on smallness, elegance, and slightness at the expense of grand themes in major poetic genres was not preciosity for its own sake: although the poetry was written by and for scholars, it had much larger sources than the bibliothecal context in which it was composed. Since the time of the classical poets, much had changed. Earlier Greek poetry was an intimate part of the life of the city-state, written for its religious occasions and performed by its citizens. (...) But eh conquests of Alexander had altered the structure and the boundaries of the Greek world to an astonishing degree. Alexandria, the center of the poetic culture of the new age, was a city that had not even existed at the time of Euripides; it was in Egypt, not in Greece, and was a huge, polyglot community. As immigrants immersed in a new, impersonal, and bureaucratic society, the poets not unreasonably sought out what was small, intimate, and personal in their verses. The heroes of early Greek poetry are larger than life; those of Alexandrian poetry are life-size. They are human, like us; they have a childhood and an old age; they are afraid or in love or caught in a rainstorm. It was simply one way of reducing the world to more manageable dimensions. At the same time, the new world of Alexandria needed a new poetry. To continue writing epics about a mythology that seemed very far away was senseless; it was impossible to recapture either the style or the immediacy of Homer, lyric poetry, or Attic tragedy. The scholar-poets of Alexandria admired the literature of classical Greece; for them Homer was incomparable and inimitable, to be studied—but not to be copied. Far better, then, to find a new voice on a more manageable scale: instead of oral epic, erudite epyllion; instead of lyric, epigram; instead of tragedy, mime. The poets of an urban and unheroic world might long for but could never re-create the grandeur of the past. James E. G. Zetzel is associate professor of classics at Princeton University and editor of the Transactions of the American Philological Association. He is the author of Latin Textual Criticism in Antiquity and, with Anthony T. Grafton and Glenn W. Most, has translated Friedrich August Wolf’s Prolegomena ad Homerum. (shrink)

Current discussions of business ethics usually only consider deontological and utilitarian approaches. What is missing is a discussion of traditional teleology, often referred to as virtue ethics. While deontology and teleology are useful, they both suffer insufficiencies. Traditional teleology, while deontological in many respects, does not object to utilitarian style calculations as long as they are contained within a moral framework that is not utilitarian in its origin. It contains the best of both approaches and can be used to focus (...) on the individual''s role within an organization. More work is needed in exposing students and faculty to traditional teleology and its place in business ethic''s discussions. (shrink)

In this article, I examine both the problem of so-called postmodern history as it relates to the Holocaust and suggest the ways that Saul Friedlander's recent work successfully mediates between the somewhat overly polemicized positions of "relativist" and "positivist" history. In this context, I find that in his search for an adequately self-reflexive historical narrative for the Holocaust, Hayden White's proposed notion of "middle-voicedness" may recommend itself more as a process for eyewitness writers than as a style for historians after (...) the fact. From here, I look at the ways Saul Friedlander's reflections on the historian's voice not only mediate between White's notions of the ironic mode and middle-voicedness, but also suggest the basis for an uncanny history in its own right: an anti-redemptory narrative that works through, yet never actually bridges, the gap between a survivor's "deep memory" and historical narrative.For finally, it may be the very idea of "deep memory" and its incompatibility to narrative that constitutes one of the central challenges to Holocaust historiography. What can be done with what Friedlander has termed "deep memory" of the survivor, that which remains essentially unrepresentable? Is it possible to write a history that includes some oblique reference to such deep memory, but which leaves it essentially intact, untouched and thereby deep? In this section, I suggest, after Patrick Hutton, that "What is at issue here is not how history can recover memory, but, rather, what memory will bequeath to history." That is, what shall we do with the living memory of survivors? How will it enter the historical record? Or to paraphrase Hutton again, "How will the past be remembered as it passes from living memory to history?" Will it always be regarded as so overly laden with pathos as to make it unreliable as documentary evidence? Or is there a place for the understanding of the witness, as subjective and skewed as it may be, for our larger historical understanding of events?In partial answer to these questions, I attempt to extend Friedlander's insights toward a narrow kind of history-telling I call "received history"-a double-stranded narrative that tells a survivor-historian's story and my own relationship to it. Such a narrative would chart not just the life of the survivor-historian itself but also the measurable effect of the tellings-both his telling and mine-on my own life's story. Together, they would compose a received history of the Holocaust and its afterlife in the author's mind-my "vicarious past.". (shrink)