Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S. counterparts who increasingly have their practices micromanaged. The Affordable Care Act illustrates the ways that managerial strategies and a market model of health care have shaped the financing and delivery of health care in the U.S., often with little or no (...) evidence of their effectiveness. (shrink)

This essay describes how longstanding conceptions of professionalism in American medical care came under attack in the decades since the enactment of Medicare in 1965 and how the reform strategy and core provisions of the 2010 Affordable Care Act illustrate the weakening of those ideas and the institutional practices embodying them.The opening identifies the dominant role of physicians in American medical care in the two decades after World War II. By the time Medicare was enacted in 1965, associations of American (...) physicians were almost completely in charge of medical education, specialist certification, and the enforcement of professional norms on their members. Who could be a doctor, what education and training would be required, and what collegial oversight was operative was first a professional matter and only secondly implicated the state through malpractice or major corporations via the employment of physicians. (shrink)

Many business and government institutions appear to have failed in meeting society’s expectations of them. Continuing scandals and failures, as well as an increasingly obvious lack of responsibility to customers, have caused communities to question the probity and operation of these organisations. Consequently, “social licence to operate” is becoming an increasingly common process and one which demands a change in management philosophy and behaviour in our institutions. Improving the quality of responsible management practice is a critical element in this new (...) management philosophy, and which demands an intense focus on including ethical considerations in the core management competence of decision-making. We draw on a combined 100-plus years of international consulting experience, “C“ and senior executive work experience, and academic research to present a practical framework for responsible management practice which, we believe, can also form the foundation for the required organisational cultural transformation required of many existing organisations. (shrink)

Many business and government institutions appear to have failed in meeting society’s expectations of them. Continuing scandals and failures, as well as an increasingly obvious lack of responsibility to customers, have caused communities to question the probity and operation of these organisations. Consequently, “social licence to operate” is becoming an increasingly common process and one which demands a change in management philosophy and behaviour in our institutions. Improving the quality of responsible management practice is a critical element in this new (...) management philosophy, and which demands an intense focus on including ethical considerations in the core management competence of decision-making. We draw on a combined 100-plus years of international consulting experience, “C“ and senior executive work experience, and academic research to present a practical framework for responsible management practice which, we believe, can also form the foundation for the required organisational cultural transformation required of many existing organisations. (shrink)

This article offers an historical-materialist account of the coup in Honduras on 28 June 2009, which ousted democratically elected President Manuel Zelaya. It draws on over two dozen interviews with members of theFrente Nacional de la Resistencia Popular[National Front of Popular Resistance, FNRP], and participation in numerous marches and assemblies over two periods of fieldwork – January 2010, and June–July 2011. The paper steps back in time to provide an historical cartography of the basic material structures of the Honduran economy (...) and its integration into the world market, as well as the geopolitical role it played as a launching pad for Ronald Reagan’s counter-insurgency campaigns against guerrilla forces elsewhere in the region during the 1980s. We show how the defeat of mass guerrilla insurgencies in Guatemala and El Salvador, as well as the triumph over the Sandinista government in Nicaragua by 1990, allowed for the neoliberal pacification of Central America as a whole, including Honduras. We further demonstrate how the centre-leftist Manuel Zelaya, elected to the Honduran presidency in 2006, modestly encroached upon neoliberal orthodoxy and forged geopolitical alliances with left and centre-left governments elsewhere in the region, laying the bases for his violent overthrow. Finally, the paper traces the origins, trajectory, and heterogeneity of the resistance that emerged almost immediately after the coup had been carried out. (shrink)

This book explores the richness of contemporary philosophical reflection in Eastern and Central Europe. Philosophers from Poland, Russia, the Czech Republic, and the United States discuss the status of democracy, nationalism, language, economics, education, women, and philosophy itself in the aftermath of communism. Fresh ideas are combined with renewed traditions as poignant problems are confronted.

This book engages in critical discussion of the role of reason and rationality in philosophy, the human mind, ethics, science, and the social sciences. Philosophers from Poland, Germany, and the United States examine reason in the light of emotion, doubt, absolutes, implementation, and interpretation. They throw new light on old values.

_Philosophy and Vision_ argues that clear thinking and imaginative understanding are necessary qualities as we try to deal with the problems that confront us in our daily life. The book discusses history, the environment, religion, personal and corporate morality, freedom, the concept of person, poetry, and post-modernism attempts to show that as a philosophic vision is brought to bear on all of these, we will grasp them more completely and more constructively. The issues which challenge most of us seldom have (...) straightforward answers, but they require some answers, some response other than failing out of our emotions. Attempting to see these philosophically, to adopt a philosophic vision, is no panacea, but it may make the difference between being overwhelmed and being able to cope. The book has a crisp enjoyable style, and while it is a philosophical work it draws upon movies, fiction, poetry, and life's experiences in developing its arguments. (shrink)

Research on bias in peer review examines scholarly communication and funding processes to assess the epistemic and social legitimacy of the mechanisms by which knowledge communities vet and self-regulate their work. Despite vocal concerns, a closer look at the empirical and methodological limitations of research on bias raises questions about the existence and extent of many hypothesized forms of bias. In addition, the notion of bias is predicated on an implicit ideal that, once articulated, raises questions about the normative implications (...) of research on bias in peer review. This review provides a brief description of the function, history, and scope of peer review; articulates and critiques the conception of bias unifying research on bias in peer review; characterizes and examines the empirical, methodological, and normative claims of bias in peer review research; and assesses possible alternatives to the status quo. We close by identifying ways to expand conceptions and studies of bias to countenance the complexity of social interactions among actors involved directly and indirectly in peer review. (shrink)

Business Ethics, the Environment & Responsibility, EarlyView.

Robust stakeholder engagement in health research requires broad communicative integration, not only of patients but also other stakeholders such as health system leaders, clinicians, and researcher...

The purpose of this study was to describe the extent to which nurses perceive the ethical dimensions of clinical practice situations involving patients, families and health care professionals. Using the composite theory of basic moral principles and the professional standard of care established by legal custom as a framework, situations involving ethical dilemmas were gleaned from the nursing literature. They were reviewed for content validity, clarity and representativeness in a two-stage process by expert panels. The situations were presented in a (...) written format to a convenience sample of nurses (n = 125), who were primarily staff nurses (65.6%). Respondents' judgements about whether the main issue of each situation concerned ethics ranged from a low of 0.8% to a high of 40%. From analyses of the categories into which the majority of subjects placed each situation, it was concluded that these nurses generally perceived ethics as the main issue in situations that directly involve patients' autonomy. Analysis yielded unanticipated findings about the themes in ethical situations to which nurses in practice may respond. (shrink)

This book explores the richness of contemporary philosophical reflection in Eastern and Central Europe. Philosophers from Poland, Russia, the Czech Republic, and the United States discuss the status of democracy, nationalism, language, economics, education, women, and philosophy itself in the aftermath of communism. Fresh ideas are combined with renewed traditions as poignant problems are confronted.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 36.1 (2003) 1-21 [Access article in PDF] Did Habermas Cede Nature to the Positivists? Gordon R. Mitchell Jürgen Habermas's "colonization of the lifeworld" thesis (1987, 332-73) posits that many of society's pathologies are due to the tendency of institutions to convert social issues that ought to be sorted out by a debating citizenry into technical problems ripe for resolution by expert bureaucracies, thus pre-empting important (...) public discussion. Habermas has attempted to lay bare the pernicious effects of this colonization process in his analysis of public opinion polling, welfare policy, education, German reunification, immigration, and other social issues (see Habermas 1997, 1994, and 1970; Holub 1992). In each of these contexts, Habermas has publicly challenged the encroachment of scientistic modes of decision-making into spheres where joint communicative action by deliberating citizens would yield more appropriate and legitimate judgments. This critical impulse is also evident in Habermas's methodological reflections on the proper role of academic scholarship, where he has argued vigorously against attempts to graft "objectivating" methods of natural scientific inquiry onto research projects in the social sciences (1971, 304-17).From all of this, one might gather that Habermas's commitment to rolling back the influence of technical forms of reasoning is connected to some intrinsic quarrel he has with the natural sciences. Yet such a sweeping generalization is hard to sustain in light of the fact that Habermas does not oppose technical reasoning per se; he recognizes that the daunting complexity of social life in late capitalism requiresthat certain "steering" tasks be delegated to systems that utilize largely instrumental logics to co-ordinate action. Likewise, he acknowledges that the disciplines of the natural sciences necessarily play important supporting roles in such steering projects.One normative presupposition of Habermas's colonization thesis is that there exists some proper boundary demarcating where the sphere of technical reasoning ends and the realm of communicative rationality begins. [End Page 1] On one side of this boundary, Habermas has provided many details on what he sees as the essential qualities of a properly functioning "public sphere," where "new social movements" continuously reweave the threads of communicative fabric holding society together (1996, 359-87), and where "historico-hermeneutic" academic study reflects on public life, sluicing insight back into the capillaries of democratic deliberations (1987, 374-403).What lies on the other side of the boundary is murkier. The proper role of natural scientific investigation has received relatively scant attention in Habermas's critical theory of society, and this has led to some confusion regarding his account of the natural sciences, as well as debate over whether this account has political purchase. One would think that sympathetic commentators, such as Helen Longino (who bases much of her own coherence theory of scientific truth on Habermas), would have reassuring things to say on this point. Yet her lukewarm assessment that, "in trying to clear a space for an autonomous social and critical theory, [Habermas] has ceded nature to the positivists" (1990, 202), raises questions about the flexibility and scope of Habermas's theory of communicative action as a basis for critique of scientific practice.One way to test Habermas's account of the natural sciences on this count is to put his views in conversation with science studies commentators who share a similar commitment to the idea that dialogue and argumentation are constitutive elements of scientific practice. Such an approach recasts the "ceding to positivism" question into a moment of controversy over the role of dialogue, not only as an essential motor driving the scientific enterprise, but also as a vehicle for democratic decision-making on issues related to the purpose and direction of scientific inquiry in society.Part one of this essay locates discursive norms embedded pragmatically in the notion of scientific objectivity. By bringing a modified version of Habermas's theory of communicative action into conversation with other approaches to science studies that foreground intersubjective dialogue as the key motor driving the scientific enterprise, I develop a foundation for robust criticism of systematically distorted scientific communication. Specific strategies of... (shrink)

In a critical discussion, interlocutors can strategically maneuver by shading their expressed degree of standpoint commitment for rhetorical effect. When is such strategic shading reasonable, and when does it cross the line and risk fallacious derailment of the discussion? Analysis of President George W. Bush’s 2002–2003 prewar commentary on Iraq provides an occasion to explore this question and revisit Douglas Ehninger’s distinction between argumentation as coercive correction and argumentation as a person-risking enterprise. Points of overlap between Ehninger’s account and pragma-dialectical (...) argumentation theory suggest avenues for harmonization of rhetorical and dialectical perspectives on argumentation. Out of this conceptual convergence comes theoretical resources for understanding strategic maneuvering, by accounting for ways that discussants exploit gaps between their externalized and actual discussion attitude. As such higher-order strategic maneuvering played a major role in the 2003 Iraq prewar discourse failure, perspicacious understanding of this particular argumentative maneuver carries practical, as well as theoretical import. (shrink)

While many "benchtop-to-bedside" research pathways have been developed in "Type I" translational medicine, vehicles to facilitate "Type II" and "Type III" translation that convert scientific data into clinical and community interventions designed to improve the health of human populations remain elusive. Further, while a high percentage of physicians endorse the principle of citizen leadership, many have difficulty practicing it. This discrepancy has been attributed, in part, to lack of training and preparation for public advocacy, time limitation, and institutional resistance. As (...) translational medicine and physician-citizenship implicate social, political, economic and cultural factors, both enterprises require "integrative" research strategies that blend insights from multiple fields of study, as well as rhetorical acumen in adapting messages to reach multiple audiences. This article considers how argumentation theory's epistemological flexibility, audience attentiveness, and heuristic qualities, combined with concepts from classical rhetoric, such as rhetorical invention, the synecdoche, and ethos, yield tools to facilitate translational medicine and enable physician-citizenship. (shrink)

The contention that cognitive psychology and radical behaviorism yield equivalent accounts of decision making and problem solving is examined by contrasting a framework of cognitive interpretation, Dennett's intentional stance, with a corresponding interpretive stance derived from contextualism. The insistence of radical behaviorists that private events such as thoughts and feelings belong in a science of human behavior is indicted in view of their failure to provide a credible interpretation of complex human behavior. Dennett's interpretation of intentional systems is an exemplar (...) of the interpretive stance radical behaviorism requires; a corresponding interpretive position can be based initially on a radical behaviorist view of human behavior and its determinants. This "contextual stance" is ontologically and methodologically distinct from the intentional stance over the range of explanations for which scientific psychology, cognitive or behaviorist, is responsible. (shrink)

In 2000, US Secretary of Health and Human Services Secretary Tommy Thompson mobilized the US public health infrastructure to deal with escalating trends of excess body weight. A cornerstone of this effort was a report entitled The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. The report stimulated a great deal of public discussion by utilizing the distinctive public health terminology of an epidemic to describe the growing prevalence of obesity in the US population. We suggest (...) that the ensuing controversy was fueled in part by the report's ambiguous usage of the evocative term “epidemic.” In some passages, the report seems to use “epidemic” in a literal sense, suggesting that rising prevalence of excess body weight should be defined technically as a disease outbreak. Other passages of the report present the same key term metaphorically, leaving readers with the impression that the epidemic language is invoked primarily for rhetorical effect. Here, we explore dynamics and implications of both interpretations. This analysis sheds light on the ongoing public argument about the appropriate societal response to steadily increasing body sizes in the US population; likewise, it capitalizes on the accumulated knowledge that the field of public health has garnered from combating diverse historic epidemics. Our interdisciplinary approach deploys critical tools from the fields of rhetoric, sociology and epidemiology. In particular, we draw from metaphor theory and public address scholarship to elucidate how the Call to Action frames public deliberation on obesity. We turn to the applied public health literature to develop a reading of the report that suggests a novel approach to the problem—application of the Epidemic Investigation protocol to streamline the public health response and reframe the public argument about obesity. (shrink)

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor (...) evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation. (shrink)