In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the provider-patient (...) relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

In this paper I discuss William Lane Craig’s response to problems faced by Molinists who hold that an eternal hell exists and that most people who fail to accept Christ during their earthly lives end up there. Craig suggests that it is plausible to suppose that most people who fail to accept Christ suffer from transworld damnation, and that the fact that they do ensures that it is fair that they end up in hell regardless of whether they hear the (...) Gospel message. I argue that whether this suggestion-which I call ‘Craig’s contentious suggestion’-is true depends on how transworld damnation is understood. I present four interpretations of transworld damnation, and argue that on three of the interpretations Craig’s suggestion is clearly unacceptable, but that it may be acceptable on the fourth. (shrink)

Volume 20, Issue 10, October 2020, Page 96-98.

This is a new edition of a classic textbook in health care ethics, one that offers an alternative to the principle-based approach from Beauchamp and Childress (Principles of Biomedical Ethics, now in its seventh edition from OUP) and traditional Catholic approaches of Ashley and O'Rourke. In the early chapters Devettere spells out the meaning of ethics and the importance of prudential reasoning in seeking the good life. The rest of the book deals with issues and cases, including determinations of life (...) and death, reproduction and research and genetics, and the distribution of health care. In this fourth edition Devettere updates all chapters and adds new cases and new sections on the following: neuroscience, social psychology, overriding advance directives, studies on the fetus, the palliative care movement, cardiopulmonary resuscitation, pharmacists and reproductive issues, prenatal life and abortion, neonatal testing and mandatory vaccinations, the US governments' STD research in Guatemala, the emergence of biobanks, facial transplantations, genetic testing, legal issues around the Affordable Care Act, and more. This is an accessible and comprehensive textbook covering all aspects of the field. (shrink)

The Belmont Report’s distinction between research and the practice of accepted therapy has led various authors to suggest that these purportedly distinct activities should be governed by different ethical principles. We consider some of the ethical consequences of attempts to separate the two and conclude that separation fails along ontological, ethical, and epistemological dimensions. Clinical practice and clinical research, as with yin and yang, can be thought of as complementary forces interacting to form a dynamic system in which the whole (...) exceeds the sum of its parts. Just as effective clinical practice cannot exist without clinical research, meaningful clinical research requires the context of clinical practice. We defend this thesis by triangulation, that is, by outlining how multiple investigators have reached this conclusion on the basis of varied theoretical and applied approaches. More confidence can be placed in a result if different methods/viewpoints have led to that result. (shrink)

Judges in Street Clothes provides an historical, theoretical, and practical analysis of the ethical restrictions placed on the public lives of judges. The State’s interest in maintaining an independent and impartial judiciary is considered against a judge’s right to engage in educational, religious, charitable, civic, and professional activities.

Introduction. During the past two decades philosophers of psychology have considered a large variety of computational models for philosophy of mind and more recently for cognitive science. Among the suggested models are computer programs, Turing machines, pushdown automata, linear bounded automata, finite state automata and sequential machines. Many philosophers have found finite state automata models to be the most appealing, for various reasons, although there has been no shortage of defenders of programs and Turing machines. A paper by Arthur Burks (...) convinced me long ago that “all natural human functions” are, or can be fruitfully modeled to be, finite state automata with output. Further work in the field has reinforced this conviction. There is room, however, for the use of any of the above models in philosophy of mind and in the ongoing development of cognitive science. (shrink)

I shall argue the likelihood that Vergil took Aeacus’ speech as his model for Charon's, as part of Aeneas’ newly created journey through Vergil's expanded topography of Hades.The four Greek verses just quoted, addressed by Aeacus to Heracles, and Heracles’ reply in twelve, were first published separately by Rabe, and then inserted by Page as verses 16–19 and 20–31 between surviving frs. 1 and 2 of P.Oxy. 2078, to be ascribed in all likelihood to the lost Pirithous of Euripides, rather (...) than to the slightly later Critias. (shrink)

In this paper it is argued that certain stimulus-response learning models which are adequate to represent finite automata (acceptors) are not adequate to represent noninitial state input-output automata (transducers). This circumstance suggests the question whether or not the behavior of animals if satisfactorily modelled by automata is predictive. It is argued in partial answer that there are automata which can be explained in the sense that their transition and output functions can be described (roughly, Hempel-type covering law explanation) while their (...) behaviors are in principle not predictable short of possession of their complete histories or of information concerning present internal states by indirect observation. (shrink)

. The seemingly disparate systems of philosophical Taoism and modern biological science are compared. A surprising degree of similarity is found in their views on death, reversion , complementary interactions of dichotomous systems, and the place of humans in the universe. The thesis is advanced that these similarities arise quite naturally, since both systems base their knowledge upon objective observation of natural phenomena. Substantial differences between the two systems are recognized and examined regarding verbal argument, machinery, and experimentation. The Taoists' (...) relationship to Chinese alchemy and the biologists' to technology are claimed to mitigate their attitudes toward experimentation. (shrink)

Calcium ions act as modulators of many fundamental processes in eukaryotic cells. Although these processes apparently involve initial interactions between calcium ions and cell membranes, the identity of the putative membrane Ca2+‐binding proteins has until recently been obscure. This article describes a recently discovered family of mammalian membrane proteins, of perhaps ancient origin, that may fulfil this function.