This is a time of change in American healthcare. Market forces are restructuring local delivery systems around competing managed care networks. Many leading proposals for healthcare reform intend a reshaping of the national healthcare marketplace itself. Periods of change create an opportunity to reassess traditional values and practices. Such reassessments can be used to help insure that current innovations and proposed reforms preserve and strengthen the best in the traditions of medicine. A legitimate focus of concern in the medical and (...) medical ethics community has been the effect of these delivery system changes on the physician-patient relationship. For example, will the future American healthcare system support and encourage compassion by physicians? Suppose it does not. Would something of significant moral value have been lost? More pointedly, would a system that undervalued or frustrated physician compassion be incompatible with the moral obligations of physicians? In order to address these questions, we examine the meaning of compassion and the role it should play in the physician-patient relationship. We argue that compassion is a duty of all physicians. Because this is so, we believe that changes in the healthcare system must be judged, in part, by how well they protect and encourage compassionate conduct by physicians. (shrink)

The purpose of this paper is to review the rising influence of commercialism in American medicine and to examine some of the consequences of this trend. Increased competition subverts physician collegiality, draws hospitals into for-profit ownership and behavior, and leads clinical investigators into secrecy and possibly into bias and abuse. Medicine faces a deprofessionalization evidenced in loss of control over the clinical setting and over self-regulation. Health care becomes a commodity relying on cultivation of desires instead of satisfaction of needs, (...) even as many basic needs go unmet. Patients become consumers empowered with lawsuits and the connection of medicine to the relief of suffering is attenuated. Medical encounters are increasingly impersonal, dominated by specialization, technology, and bureaucracy. Patients are losing their physician-advocates to new conflicts of interests, physicians are losing their impulse to charity, and trust in the doctor-patient relationship and in medicine generally is eroding. (shrink)

Identifying what the differences are or ought to be between Catholic health care organizations and their non-Catholic counterparts is the subject of great debate. The author responds to the essays in this volume by Dennis Brodeur, Clarke E. Cochran and Christopher J. Kauffman, each of which represents a different perspective in the discussion of what is unique about Catholic health care.

DRGs may contain costs, but they threaten to restrict access to health care, to compromise its quality, and to impede the development of new medical technologies. Immediate corrections are necessary to ensure that hospitals continue to serve the poorest and sickest.

Pressures to contain budgets and provide cost‐effective care are widespread in the American health care system, no less in psychiatry than elsewhere. The ethical implications of such economically motivated trends, however, become even more important in the area of psychiatric medicine.

Since the publication of Husserl's Logische Untersuchungen at the outset of this century, the notion of phenomenology has had a long and important history on the European continent. Of the many claims made on its behalf perhaps the most interesting is that phenomenology is able to ground philosophical assertions in a manner which is neither purely formal nor purely empirical, i.e., that phenomenology as a method is capable of transcending this very distinction. For example, phenomenologists argue that their reduction of (...) essences provides a way of knowing which is neither analytic nor synthetic but both. Having reached such an eidetic intuition phenomenologists claim to have attained a non-trivial universality and necessity. (shrink)

Two models of the relationship between individual behaviour and health status are examined. On the Freedom Model, the individual is presumed to be capable of free choices including many that have important health consequences. Freedom entails accountability. Thus individuals can be held responsible for health conditions that result from choices they have made. To hold otherwise—to refuse to acknowledge the freedom and responsibilities of individuals—is bad faith. On the Facticity Model, behaviour is a result of facts—genetic and environmental—beyond an individual's (...) control. There is little or no freedom; people are the bodies and roles they inherit. Important among these facts is socio-economic position since it determines much of behaviour and resulting health status. Many people who are poor and lack education also suffer from poor health. To blame their poor health on their behaviour is to blame people already victimised by their circumstances. The relationships of these two models to health promotion are explored. Though conflicting in theory, some justice can be done to each model in the practical world of health promotion by appealing to the freedom in individuals in health education and to the facts that shape individuals in other health promotion and health care contexts. (shrink)

Should engineering ethics be taught? Despite the obvious truism that we all want our students to be moral engineers who practice virtuous professional behavior, I argue, in this article that the question itself obscures several ambiguities that prompt preliminary resolution. Upon clarification of these ambiguities, and an attempt to delineate key issues that make the question a philosophically interesting one, I conclude that engineering ethics not only should not, but cannot, be taught if we understand “teaching engineering ethics” to mean (...) training engineers to be moral individuals (as some advocates seem to have proposed). However, I also conclude that there is a justification to teaching engineering ethics, insofar as we are able to clearly identify the most desirable and efficacious pedagogical approach to the subject area, which I propose to be a case study-based format that utilizes the principle of human cognitive pattern recognition. (shrink)

Despite its importance, the linkage between genetic and cultural evolution has until now been little explored. An understanding of this linkage is needed to extend evolutionary theory so that it can deal for the first time with the phenomena of mind and human social history. We characterize the process of gene-culture coevolution, in which culture is shaped by biological imperatives while biological traits are simultaneously altered by genetic evolution in response to cultural history. A case is made from both theory (...) and evidence that genetic and cultural evolution are inseverable, and that the human mind has tended to evolve so as to bias individuals toward certain patterns of cognition and choice rather than others. With the aid of mathematical models we trace the coevolutionary circuit: The genes prescribe structure in developmental pathways that lay down endocrine and neural systems, imposing regularities in the development of cognition and behavior; these regularities translate upward into holistic patterns of culture, which can be predicted in the form of probability density distributions ; natural selection acts within human history to favor certain epigenetic rules over others; and the selection alters the frequencies of the underlying genes. The effects of genetic and cultural changes reverberate throughout the circuit and are consequently tested with the passage of each life cycle. In addition to modeling gene-culture coevolution, we apply methods from island biogeography and information theory to examine the cultural capacity of the genes, the factors determining the magnitude of cultural diversity, and the possible reasons for the uniqueness of the human achievement. (shrink)

Ownership rights influence thought and behavior in relation to the physical world and in relation to other people. We review recent research examining the nature of ownership rights, and how young children and adults conceive of them. This research examines issues such as the rights ownership is assumed to confer; whether ownership rights reflect principles specific to ownership or instead depend on more general moral principles; and whether ownership rights are inventions of law and culture, or whether they have a (...) more natural basis. (shrink)

This volume sets Berkeley's philosophy in its historical context by providing selections from: firstly, works that deeply influenced Berkeley as he formed his main doctrines; secondly, works that illuminate the philosophical climate in which those doctrines were formed; and thirdly, works that display Berkeley's subsequent philosophical influence. The first category is represented by selections from Descartes, Malebranche, Bayle, and Locke; the second category includes extracts from such thinkers as Regius, Lanion, Arnauld, Lee, and Norris; while reactions to Berkeley, both positive (...) and negative, are drawn from a wide range of thinkers - Leibniz, Baxter, Hume, Diderot, Voltaire, Reid, Kant, Herder, and Mill. (shrink)