This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative—related to a strand in public choice theory—is to (...) model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines. (shrink)

Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying (...) ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia. (shrink)

Valérie Chevassus-Marchionni, Raymond Lemieux et François Nault.

◆ Writing is per se already violence: the rupture there is in each fragment, the break, the splitting, the tearing of the shred—acute singularity, steely point. And yet this combat is, for patience, debate. The name wears away [s'use], the fragment fragments, erodes.There is much talk today but little speech, or rather, little speech that could be received and responded to absent the vows of the unavowable community of its speakers. There is combat but debate is foreclosed by the absence (...) of asignifying absence. To avow that a community is unavowable—when the name wears away—is not to say that it has been disavowed, subjected, though in many cases this is so, for often the name names sovereignly.... (shrink)

Now in a third edition, Introduction to Philosophy: Classical and Contemporary Readings is a highly acclaimed, topically organized collection that covers five major areas of philosophy--theory of knowledge, philosophy of religion, philosophy of mind, freedom and determinism, and moral philosophy. Editor Louis P. Pojman enhances the text's topical organization by arranging the selections into a pro/con format to help students better understand opposing arguments. He also includes accessible introductions to each chapter, subsection, and individual reading, a unique feature for an (...) anthology of this depth. While the book focuses on a compelling sampling of classical material--including selections from Plato, Aristotle, Descartes, Locke, Berkeley, Hume, and Kant--it also incorporates some of philosophy's best twentieth-century and contemporary work, featuring articles by Bertrand Russell, Richard Taylor, John Searle, Thomas Nagel, and others. This third edition contains an expanded glossary, more extensive section introductions, and twelve new selections: Karl Popper: "Epistemology without a Knowing Subject" Richard Rorty: "Dismantling Truth: Solidarity Versus Objectivity" Daniel Dennett: "Postmodernism and Truth" Bruce Russell: "The Problem of Evil: Too Much Suffering" David Chalmers: "Against Materialism: Can Consciousness Be Reductively Explained?" Baron Paul Henri d'Holbach: "A Defense of Determinism" Michael Levin: "A Compatibilist Defense of Moral Responsibility" Plato: Socratic Morality: "Crito" Herodotus: "Custom Is King" J. L. Mackie: "The Subjectivity of Values" Louis P. Pojman: "A Critique of Mackie's Theory of Moral Subjectivism" Thomas Nagel: "Moral Luck". (shrink)

In ”Skepticism,” Peter Klein distinguishes between the “Academic Skeptic” who proposes that we cannot have knowledge of a certain set of propositions and the “Pyrrhonian Skeptic” who refrains from opining about whether we can have knowledge. Klein argues that Academic Skepticism is plausibly supported by a “Closure Principle‐style” argument based on the claim that if x entails y and S has justification for x, then S has justification for y. He turns to contextualism to see if it can contribute to (...) the discussion between one who claims that we can have knowledge about some epistemically interesting class of propositions and the Academic Skeptic. He outlines the background of Pyrrhonian Skepticism, pointing out that the Pyrrhonist withholds assent concerning our knowledge‐bearing status because reason cannot provide an adequate basis for assent. He assesses three possible patterns of reasoning, and concludes that the Pyrrhonist view, that reason cannot resolve matters concerning the nonevident, is vindicated. (shrink)

Two approaches to the study of diagnostic thinking are compared, one mainly propositional, namely that of Patel and Groen (1986), the other mainly semantic, that of Lemieux and Bordage (1986). Patel and Groen analyzed the linear dimension of cardiologists' discourses while solving a case of acute bacterial endocarditis, that is, the before and after propositional rules. A secondary analysis of two of their pothophysiological protocols is done using structural semantic techniques from Lemieux and Bordage where the vertical dimension (...) of the discourses is analyzed, that is, the levels of meaning or semantic axes. Contrary to Patel and Groen's position, making an accurate diagnosis is not explained in terms of pure forward reasoning through networks of causal rules, but by means of networks of semantic qualities abstracted from the symptoms and signs. The semantic qualities operate in the clinician's mind in terms of binary oppositions (e.g., sudden-gradual, unilateral-bilateral) whereby each pair of properties constitutes a semantic axis (e.g., sudden-gradual). The successful diagnosticians are those who use the most diversified and pertinent set of semantic axes and, therefore, have a deeper representation of the problem. (shrink)

First published in 1987. Routledge is an imprint of Taylor & Francis, an informa company.

First published in 1987. Routledge is an imprint of Taylor & Francis, an informa company.

: This essay is a collection of my experiences of and reflections on being pregnant and choosing to place the child for open adoption. The piece was started late in the term of my pregnancy and completed about a week before the birth.

Raymond Lemieux | Résumé : Entre le discours du maître et le discours magistériel, la proximité est évidente. Pourtant le magis formant leur élément commun peut aussi bien s’avérer un facteur d’abrutissement, un producteur d’esclave, qu’un porteur d’émancipation. Comment le discours magistériel, qui se veut émancipateur, peut-il gérer cette ambiguïté ? Comment le maître peut-il être un maître de liberté ? L’article interroge tour à tour les pratiques éducatives et les pratiques psychanalytiques qui affrontent le même type d’aporie. Il (...) met de l’avant l’importance de l’interdiction faite à l’éducateur tant qu’à l’analyste de jouir de l’élève ou de l’analysant, c’est-à-dire de faire de leur apparente position de sujet assujetti un profit personnel. Qu’est-ce qu’éduquer à la liberté ? Qu’en est-il du magistère, dont le discours se veut émancipateur ? |: The semantic closeness between the discourse of the master and the magisterial teaching of the Church is obvious. However, the common root magis may be displayed as an enslavement process as well as a liberating one. How can this ambiguousness be removed from the teaching of the Church ? How can this one be an education to liberty ? In order to find some practical way of answering this question, the paper briefly examines contemporary educational and psychoanalytic challenges which confront such a logical and practical deadlock. It stresses the importance of the interdiction, for the educator as well as the psychoanalyst, of taking any personal advantage, pleasure or profit from the apparent position of subject which is that of the other. What does mean to educate with the purpose of liberty ? How the magisterial discourse of the Church can be an emancipatory one ? (shrink)

Une sourde appréhension hante aujourd’hui les consciences : « Le christianisme survivra-t-il à la modernité ? ». S’il a été un facteur historique de civilisation, sa pertinence est-elle caduque quand cette civilisation se transforme, comme cela est le cas dans le monde contemporain ? De quelles quêtes, de quelles souffrances, les regards portés sur lui, de l’intérieur comme de l’extérieur, sont-ils symptômes ? Quels en sont les dynamismes fondamentaux ? À quelles conversions l’expérience chrétienne est-elle appelée ?Pour baliser des pistes (...) de réponses à ces questions, nous questionnerons ici l’institution culturelle du christianisme, c’est-à-dire les modes selon lesquels, dans son histoire, il a soutenu du sens et se trouve, aujourd’hui, confronté à une conjoncture inédite. Cette institution culturelle comprend davantage que la vie interne et l’action des Églises qui à la fois la débordent et en dépendent. Des actes de foi l’animent, certes, sans s’y confiner non plus. Par christianisme, nous entendons donc saisir les modes variés par lesquels se sont inscrites, historiquement, « des nappes de produit relatives à des systèmes de production » en transactions constantes avec le « monde ». A vague apprehension haunts many minds today: “Will Christianity outlive modernity?” Although Christianity was a historical factor in the development of civilisation, will its pertinence be bypassed when this civilisation is transformed, as seems to be the case in the contemporary world? What is the re-examination applied to it from inside and out symptomatic of – of what searching and what suffering? What are the fundamental dynamics underlying this? What sorts of conversion is the Christian experience called upon to undertake?In order to outline some approached to responding to these questions, we shall examine the cultural institution of Christianity, that is, the ways in which it underwrote meaning and today stands at a new crossroads in its history. This cultural institution comprises more than its internal life and the action of the Churches, which both go beyond it and depend upon it. Acts of faith are vital to this process, obviously, but also reach beyond it. By “Christianity”, we mean discerning the various modes through which “the layers of products related to systems of production” in constant interplay with the “world” are inscribed in a historical process. (shrink)

Sous le thème de la « méthode », l’auteur se propose de formuler une éthique de la lecture à partir de Gilles Deleuze. L’analyse est fondée sur un dédoublement de la lecture : d’abord la lecture qu’a fait De-leuze de David Hume tel qu’exprimé dans Empirisme et subjectivité (1953) et celle de Henri Bergson dans Le bergsonisme (1966), ensuite par la lecture que l’auteur fait de ces deux livres de Deleuze. Par l’entremise de l’empirisme (Hume) et de l’intuition (Bergson), l’auteur (...) conclut que la lecture que Deleuze a faite est performative en ce sens qu’elle fait ce qu’elle énonce. Une éthique de la lecture correspondante se voudra donc, de même, performative : elle dépassera le donné à tra-vers le délire, s’ouvrira à l’inhumain et au surhumain à travers le vir-tuel. (shrink)

Sous le thème de la « méthode », l’auteur se propose de formuler une éthique de la lecture à partir de Gilles Deleuze. L’analyse est fondée sur un dédoublement de la lecture : d’abord la lecture qu’a fait De-leuze de David Hume tel qu’exprimé dans Empirisme et subjectivité (1953) et celle de Henri Bergson dans Le bergsonisme (1966), ensuite par la lecture que l’auteur fait de ces deux livres de Deleuze. Par l’entremise de l’empirisme (Hume) et de l’intuition (Bergson), l’auteur (...) conclut que la lecture que Deleuze a faite est performative en ce sens qu’elle fait ce qu’elle énonce. Une éthique de la lecture correspondante se voudra donc, de même, performative : elle dépassera le donné à tra-vers le délire, s’ouvrira à l’inhumain et au surhumain à travers le vir-tuel. (shrink)

Un État idéal pourrait intervenir efficacement pour articuler l’interface entre les médias classiques et les médias sociaux. L’État réel, par contre, ne dispose pas de l’information nécessaire et ses acteurs ne sont pas soumis aux incitations requises. De plus, il n’existe pas d’intérêt public dont l’État puisse se réclamer. Il faut se demander si découlerait du laissez-faire une situation meilleure que celle que produit la coercition des processus politiques et bureaucratiques.

Laziness is a borderline phenomenon. It may cause the withdrawal from any commitment or allow the human being a space and a time for reflexing the conditions of his actions. If it is undoubtedly a capital sin when source of mindless, could not it be also a tool for the self-construction of life and identity? Then how could it play such a role? The paper intends to clarify the possible misunderstanding hidden under this dilemma. For this purpose, it proposes a (...) survey of the heroic conditions of modern life in which social ideals are more and more demanding and, consequently, force to choose between enactment and truth, conformist or genuine achievements. It stresses then the question of authenticity as a stake for desire. (shrink)