Volume 20, Issue 7, July 2020, Page 6-8.

Those who advocate higher out-of-pocket spending, especially high deductibles, to keep health care costs better controlled without losing quality use market language to talk about how people should think about health care. Consumers—that is, patients—should hunt for bargains. Clip coupons. Shop around. Patients need to have more “skin in the game.” Consumer-patients will then choose more carefully and prudently and use less unnecessary health care. Unfailingly, “skin” refers to having money at stake. Usually, those arguing for high deductibles express dismay (...) or frustration that patients do not face the full cost of the health services they receive. Unfortunately, a lack of price transparency, the need to unbundle bundled groups of services to discover total price, and the challenge of validly and reliably measuring and disclosing quality make shopping for health care a challenge for even the savviest patient. Urgency, fear, and sickness that impairs peak cognitive function and other aspects of emotionally laden decision-making, even when “shared” with a physician, add obstacles to coupon clipping and tire kicking. Who has more at stake in health decisions than patients? Whose flesh is literally, not just figuratively, at risk? (shrink)

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including (...) residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

usually brings to mind images of picket signs held by laborers striking for better wages and benefits. Collective action, however, need not be limited to the withholding of labor. Nor need it involve only the working or middle classes, as airline pilots have recently demonstrated. Finally, collective action need not have as its only purpose the self-interest of the group. Collective action does, however, always involve a joining together of individuals united by common goals or interests in order to consolidate (...) power for the purpose of negotiating with another group or entity. Examples of collective action obviously include striking, other withholding labor actions, and slowdowns, but can also include many other activities. for example, have been threatened or used by house officer organizations in the past. In a paper strike, patient care continues but without documentation, and thus, the institution suffers from absent or delayed financial remuneration. (shrink)

Though trust is essential to relationships between people, including that between patient and clinician, its role in organizational ethics is largely unexplored. Nonetheless, trust is also ideally a part of the relationship between patient and health care institution, both because it is desirable in and of itself, and because it makes for better medical care.

Health care and public health programs increasingly rely on, and often even require, organizational action, which is facilitated, if not dependent on, trust. Case examples in this essay highlight trust, trustworthiness, and distrust in public and private organizations, providing insights into how trust in health‐related organizations can be betrayed, earned, and justified and into the consequences of organizational trust and trustworthiness for the health of individuals and communities. These examples demonstrate the need for holistic assessments of trust in clinicians and (...) trust in organizations and for organizations, public health, and the medical profession to address questions concerning their own trustworthiness. Normative and empirical assessments of trust and trustworthiness that capture the experiences of those treated within the walls of a health care organization, as well as the care of those outside, will contribute to more trustworthy systems of care. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 62-63, August 2011.

The American Journal of Bioethics, Volume 11, Issue 7, Page 1-2, July 2011.

The American Journal of Bioethics, Volume 11, Issue 12, Page 13-16, December 2011.

Volume 19, Issue 12, December 2019, Page 57-60.

Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need (...) for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness, while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government. (shrink)

Jecker makes three major points in her article, “A Broader View of Justice” (2008). First, she argues that justice in healthcare relates to justice in the broader social conditions of society as th...

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of (...) six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors’empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners. (shrink)

How does sign language compare with gesture, on the one hand, and spoken language on the other? Sign was once viewed as nothing more than a system of pictorial gestures without linguistic structure. More recently, researchers have argued that sign is no different from spoken language, with all of the same linguistic structures. The pendulum is currently swinging back toward the view that sign is gestural, or at least has gestural components. The goal of this review is to elucidate the (...) relationships among sign language, gesture, and spoken language. We do so by taking a close look not only at how sign has been studied over the past 50 years, but also at how the spontaneous gestures that accompany speech have been studied. We conclude that signers gesture just as speakers do. Both produce imagistic gestures along with more categorical signs or words. Because at present it is difficult to tell where sign stops and gesture begins, we suggest that sign should not be compared with speech alone but should be compared with speech-plus-gesture. Although it might be easier (and, in some cases, preferable) to blur the distinction between sign and gesture, we argue that distinguishing between sign (or speech) and gesture is essential to predict certain types of learning and allows us to understand the conditions under which gesture takes on properties of sign, and speech takes on properties of gesture. We end by calling for new technology that may help us better calibrate the borders between sign and gesture. (shrink)

Most people, including philosophers, tend to classify human motives as falling into one of two categories: the egoistic or the altruistic, the self-interested or the moral. According to Susan Wolf, however, much of what motivates us does not comfortably fit into this scheme. Often we act neither for our own sake nor out of duty or an impersonal concern for the world. Rather, we act out of love for objects that we rightly perceive as worthy of love--and it is (...) these actions that give meaning to our lives. Wolf makes a compelling case that, along with happiness and morality, this kind of meaningfulness constitutes a distinctive dimension of a good life. Written in a lively and engaging style, and full of provocative examples, Meaning in Life and Why It Matters is a profound and original reflection on a subject of permanent human concern. (shrink)

The first systematic exposition of all the central topics in the philosophy of logic, Susan Haack's book has established an international reputation for its accessibility, clarity, conciseness, orderliness, and range as well as for its thorough scholarship and careful analyses. Haack discusses the scope and purpose of logic, validity, truth-functions, quantification and ontology, names, descriptions, truth, truth-bearers, the set-theoretical and semantic paradoxes, and modality. She also explores the motivations for a whole range of non-classical systems of logic, including many-valued (...) logics, fuzzy logic, moddal and tense logics, and relevance logics. Persupposing only an elementary knowledge of formal logic, this book includes many useful summary tables and diagrams, as well as a helpful glossary of technical terms. Wide-ranging, informative, and eminently readable, this book has proven a valuable resource for generations of students and scholars in a variety of disciplines outside philosophy needing guidance on the philosophy of logic. (shrink)

(From the book cover in 2007) The Blackwell Companion to Consciousness is the most thorough and comprehensive survey of contemporary scientific research and philosophical thought on consciousness currently available. Its 55 newly commissioned, peer-reviewed chapters combine state-of-the-art surveys with cutting edge research. Taken as a whole, these essays by leading lights in the philosophy and science of consciousness create an engaging dialog and unparalleled source of information regarding this most fascinating and mysterious subject.

An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change—both are common pool resource challenges that require massive, long-term political commitments—the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for (...) AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support. (shrink)

Moral naturalism, as I use the term here, is the view that there are moral facts in the natural world – facts that are both natural and normative – and that moral claims are true or false in virtue of their corresponding or not to these natural facts. Moral naturalists argue that, since moral claims are about natural facts, we can establish the truth about moral claims through empirical investigation. Moral knowledge, on this view, is a form of empirical knowledge.One (...) objection to this metaethical view is that even if moral naturalists are correct in their claims about truth, they cannot answer the question of normativity. Jean Hampton, for instance, argues that it is not enough to explain the conduct's wrongness by showing it to be a property that necessarily supervenes on natural properties. For nothing in this analysis explains the relationship between these properties andus.The question is why should peoplecareabout these properties. Christine Korsgaard claims that moral realists take the normative question to be one about truth and knowledge. (shrink)