The corporatization of U.S. health care has directed cost containment efforts toward scrutinizing the clinical decisions of physicians. This stimulated a variety of new utilization management interventions, particularly in hospital and managed care settings. Recent changes in fee-for-service medicine and physicians' traditional agency relationships with patients, purchasers, and insurers are examined here. New information systems monitoring of physician ordering behavior has already begun to impact on physician autonomy and the relationship of physicians to provider organizations in both for-profit and not-for-profit (...) sectors. As managed care practice settings proliferate, serious ethical questions will be raised about agency relationships with patients.This article examines health system dynamics altering the historical agency relationship between the physician and patient and eroding the traditional autonomy of the medical profession in the United States. The corporatization of medicine and the accompanying information systems monitoring of physician productivity is seen to account of such change, now posing serious ethical dilemmas. (shrink)

Theological determinism can make good sense of petitionary prayer. Answered prayers are a good thing, so God has reasons to create them. Thus, when a supplicant prays, she gives God a reason to create an answer to her prayer. When he does answer a prayer, he creates the prayed-for results as a means to the fulfillment of the petition. In this way, the prayed-for results are genuinely answers to prayer, even as God has also determined the supplicant to make the (...) request. This result holds whether or not God would have had sufficient reason to bring about the prayed-for result, had the petition not occurred. Thus, the theological determinist can hold all of: a) when a prayer is answered, it is always at least partly answered because of the prayer, b) God would have brought about some prayed-for results whether or not anyone prayed for them, and c) God would not have brought about some prayed-for results, if someone had not prayed for them. (shrink)