The current concern with reforming and regulating managed care under the general rubric of “patients' rights” has eclipsed the more fundamental need to legislate the human rights of those without adequate access to any healthcare. To characterize the regulatory activity as a “rights” movement inflates its moral dimension. The concept of “rights” carries a serious and powerful moral force that is currently inappropriately applied to the parochial concerns of a segment of the population privileged to have health insurance coverage. By (...) contrast, the language of “rights” refers to a high level of universality for the most rudimentary of human concerns. If there was a universal right to become a patient equal to other patients, a concept of patients' rights would have legitimacy. As it is, however, the central determinant of this “right” is how much the insurance policy costs and what is covered. To so diminish the meaning of “right” within the miasma of managed care is to lose sight of the real possibilities of applying a positive “right” to healthcare and, in the long run, is to diminish the ethics of healthcare. (shrink)

The rock climber and the law share in a common etymological allusion when each reaches a steep, high, and hard place. The climber “appeals” to the mountain by inching down on a rope and the law's “rappel” is similarly a route to more comfortable footing. Each step in this common process is germane to the eventual resolution, for it is to be found in the rappel process itself and in the meaning of each appeal.

Has the private body of biethics become a microcosm of the body politic? Politics is ethics writ large. Ethics is politics writ small. However we turn it, the practice of bioethics is increasingly attuned to developments in public policy. The establishment of a “Health Policy Watch” in these pages is an invitation for research and reflection on these issues.

The challenge of determining that therapeutic intervention is futile is a recurrent ethical theme in critical care medicine. The process by which that determination is reached often involves demanding collaborative and interdisciplinary conversation and deliberation within the context of hospital policy, including ethics committee guidelines. The subsequent decision as to what happens next depends on resources, such as palliative care services, hospice, other hospital protocols, and, of course, family support.

A common tale of moral cacophony and euphemism on the city streets:Each day, an owner of a small business decides, “once and for all,” how to respond to the “homeless person” panhandling for “spare change” as she makes her way to work in the morning. Today, she looks the other way and holds more tightly to her purse. Nearby, a building contractor waits impatiently for the traffic light to change as his van is approached by a small and shabby band (...) of “street people” demanding to clean his windshield. He turns his wipers on to signal them away. Sometimes this works. At the next light, a woman carrying an infant swaddled to her torso offers a tube of three roses for a dollar. The driver smiles pleasantly, but does not stop. The businesswoman, now close to work, buys two tubes of roses and does not wait for the change from the five-dollar bill she earnestly presses into the mother's hand. (shrink)

Ongoing legislative proposals to overhaul United States immigration policy look very much like a new wave of nativism is sweeping the Congress. The movement, mounted in early 1995, is in full swing to limit immigrant populations from arriving, settling, producing, and benefiting as our parents' generations have done. Legislators and the courts are now considering the most complete antiimmigration social legislation since the decades following the First World War.

The era of managed care has arrived with portents of a new calculus to integrate cost and quality in health services. These devises such as “report cards” and “outcome measures” place performance against expectations and thus are expected to gauge the value of specific elements of healthcare delivery. From such measures and comparisons, the public will be able to better judge the appropriate, effective, and attractive place to seek their medical services. What is now widely used by utilization review, guiding (...) reimbursement decisions and allowances for the length of hospital stays, will soon have a more prosperous future as general guidelines built into the very framework of managed care agreements. (shrink)

The ideal of universal human rights is arguably the most potent moral concept marking the modern world. Its accelerated fruition in the last half of the twentieth century has created a powerful political force, laying the groundwork for future generations to extend and apply. Whereas anything resembling international legal status for human rights had to wait for the post-Nazi era, the bold proclamations of the Universal Declaration of Human Rights (UDHR, 1948) loosened a revolutionary force with endless potential for application (...) to the full range of human endeavors. The roots of this movement can be traced to each and every era in which the vulnerable and powerless sought justification to oppose arbitrary domination. Its roots are, therefore, deep and wide. (shrink)

The classic formulation of situation ethics in the 1960s was the result of the contention that the deductive application of general rules and principles in ethics was inherently flawed by the uniqueness of every situation. Quite often, ethical problems are problems precisely because existing rules do not apply four square to the singular situation at hand. There is a need, the argument ran, to assert the primacy of the special situation and to formulate a resolution of the unsettling circumstances appropriately (...) attuned to it. Situation ethics is, in a sense, a moral theory equivalent to case law in a legal system devoid of rule by law. (shrink)

Was this just another incendiary sound bite, headline news banner attacking the airwaves? Getting it wrong? Overstating some small technicality for the sake of getting attention? No, to all of the above: the most incendiary aspect of the blurb was that it was accurate. And it did get attention.

Jonathan Mann was a pioneer in establishing communication between the world of public health and that of human rights activism. At the very start, he strongly believed that although each of these two fields was in the midst of separate paradigm shifts, these shifts are essential, perhaps causal, to the combined health and human rights movement.

A 68-year-old gentleman is brought into a New York City ER at 2:30 P.M. by the squad in response to a 911 call from his neighbor, who found him unconscious in his bed. The cause of his condition is not known, but the man is unresponsive and requires immediate life support, including intubation, IV fluids, and pressors. Within minutes, his son arrives and attempts to deny permission for the LSMTx, claiming that his father is in end-stage ALS and has an (...) advance directive stipulating that he should not be invaded with LSMTx at this last moment in his life. The copy of the directive he produces is nonspecific in this context, because it qualifies refusal of LSMTx for “ … irreversible conditions …” and no one is sure if this situation is reversible. The advance directive names a daughter as proxy, and she is on her way from Maine, a 10-hour drive. (shrink)

As the concept of universal access to healthcare comes to America, an ethical paradox emerges. “Access” is the code word for being assured that sick people without financial resources get appropriate medical care. There is an ethical imperative to provide care for the sick – whether paying or not – and this value ought to give direction to any reformed system.

In this case, the patient's mother repeatedly asked about the health of any prospective child and whether she would be assured some custodial role. She also questioned the role of the prospective recipient. The committee facilitated obtaining the necessary information, sharing this information with the surrogate, and assisted the surrogate and two of her daughters to share both their feelings and additional information they possessed.

This article recounts the development of the Professional/problem-based Ethics Program, the original physicians’ professional ethics remediation course. Since 1992, more than 1,200 healthcare professionals of many disciplines have been mandated to attend ProBE by licensing boards and other oversight entities. Using a small-group, interprofessional setting, the ProBE Program assists participants to discover and articulate ethical underpinnings violated by their misconduct; appreciate professional responsibilities that are societal, regulatory, and ethical; and recommit to professional ideals. The authors describe the rationale for developing (...) ProBE, its curriculum, participant demographics, and infractions and reconsider medical professionalism in light of two decades of ProBE. (shrink)

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)

" -- Africa Today "The excellence of this book lies in the wealth of perspectives that it brings to the discussion on what constitutes philosophy, rationality, ...

Authors philosophical notes on life, conduct of life from the perspective of a life.

A comprehensive introduction to the ways in which meaning is conveyed in language. Alan Cruse covers semantic matters, but also deals with topics that are usually considered to fall under pragmatics. A major aim is to highlight the richness and subtlety of meaning phenomena, rather than to expound any particular theory. Rich in examples and exercises, Meaning in Language provides an invaluable descriptive approach to this area of linguistics for undergraduates and postgraduates alike.

This book: * assumes no mathematical background and keeps the technicalities to a minimum * explains the most important applications of probability theory to ...

In this entry we provide a critical review of recent work on the nature and ethics of blame, including issues of moral standing.

A record of the words and teachings of Confucius, _The Analects_ is considered the most reliable expression of Confucian thought. However, the original meaning of Confucius's teachings have been filtered and interpreted by the commentaries of Confucianists of later ages, particularly the Neo-Confucianists of the Song dynasty, not altogether without distortion.In this monumental translation by Professor D. C. Lau, an attempt has been made to interpret the sayings as they stand. The corpus of the sayings is taken as an organic (...) whole and the final test of the interpretation rests on the internal consistency it exhibits. In other words, _The Analects_ is read in the light of _The Analects._This results in a truer understanding of Confucius' thought than the traditional interpretation and paves the way for a re-assessment of its importance in the history of Chinese thought and its relevance to the present day world.This volume also contains an introduction to the life and teachings of Confucius, and three appendices on the events in the life of Confucius, on his disciples, and on the composition of _The Analects._. (shrink)

The Greeks have long been regarded as innovators across a wide range of fields in literature, culture, philosophy, politics and science. However, little attention has been paid to how they thought and felt about novelty and innovation itself, and to relating this to the forces of traditionalism and conservatism which were also present across all the various societies within ancient Greece. What inspired the Greeks to embark on their unique and enduring innovations? How did they think and feel about the (...) new? This book represents the first serious attempt to address these issues, and deals with the phenomenon across all periods and areas of classical Greek history and thought. Each chapter concentrates on a different area of culture or thought, while the book as a whole argues that much of the impulse towards innovation came from the life of the polis which provided its setting. (shrink)

Abstract:Contemporary common sense holds that authenticity is an ethical ideal: that there is something bad about inauthenticity, and something good about authenticity. Here we criticize the view that authenticity is bad because it detracts from the wellbeing of the inauthentic person, and propose an alternative moral account of the badness of inauthenticity, based on the idea that inauthentic behaviour is potentially misleading.

The verb 'imagine' admits of perspectival modification: we can imagine things from above, from a distant point of view, or from the point of view of a Russian. But in such cases, there need be no person, either real or imagined, who is above or distant from what is imagined, or who has the point of view of a Russian. We call this the puzzle of perspectival displacement. This paper sets out the puzzle, shows how it does not just concern (...) language, but also states of imagining themselves, and then presents a solution. The solution draws on the idea that many reports of imagining conceal a distinctive kind of question, and such concealed questions have an extra argument place for (what we will call) an experiencer from whose perspective things are imagined. This solution has a range of advantages over other proposals in the literature, and helps to advance two debates concerning perspectival engagement with fiction. (shrink)

In Rationalities in history, the distinguished historian David d'Avray writes a new comparative history in the spirit of Max Weber. In a strikingly original reassessment of seminal Weberian ideas, d'Avray applies value rationality to the comparative history of religion and the philosophy of law. Integrating theories of rational choice, anthropological reflections on relativism, and the recent philosophy of rationality with Weber's conceptual framework, d'Avray seeks to disengage 'rationalisation' from its enduring association with Western 'modernity.' This mode of analysis is contextualised (...) through the examples of Buddhism, Imperial China, and sixteenth-century Catholicism--in the latter case building upon unpublished archival research. This ambitious synthesis of social theory and comparative history will engage social scientists and historians from advanced undergraduate level upwards, stimulating interdisciplinary discourse, and making a significant contribution to the methodology of history. D'Avray explores the potential of this new Weberian analysis further in his companion volume, Medieval religious rationalities"--Provided by publisher. (shrink)

The theme of the relationship between art and society is certainly not a central topic in the aesthetic reflection of Italian neo-idealism. Neither in Croce nor in Gentile it is ever discussed at length, and the few writings in which it is addressed are brief and polemically oriented. This essay, however, proposes to discuss the few hints present in Croce and Gentile on this subject. First, the debate on the materialistic interpretation of history will be examined, to which both Croce (...) and Gentile made important contributions at the end of the 19th century. Secondly, Croce’s own way of doing the history of literature will be discussed, showing the differences that distance him from the Desanctisian model and also from the model derived from the Hegelian Aesthetics. Croce’s way of making history of literature, indeed, aroused harsh criticism after World War II and provoked a request for a “return to De Sanctis”.Finally, but the theme will be only hinted at in the essay, a brief reference will be proposed to the opinions of Antonio Gramsci and his reading of Croce. (shrink)

1. cahier. Logique et mathématique: Thèmes unitaires et crise de l'unité dans la mathématique, par G. Bouligand. Les techniques logiques et l'unite des mathématiques, par D. Dubarle. Chronique de logique, par F. Russo. Physique: Le renouvellement des idées en physique par les théories quantiques et relativistes, par O. Costa de Beauregard. A la recherche d'une physique cohérente, par F. Russo. Sciences de l'homme et de la vie: La paléontologie, par H. Alimen. La biologie et l'homme nouveau, par R. Collin. Précisions (...) sur la notion d'évolution, par R. Lavocat. Pensée religieuse et esprit scientifique, par A.-M. Dubarle. (shrink)