The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment—a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range (...) from worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed. (shrink)

Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a (...) misuse of finite health resources. In this paper, we argue in favour of permitting sub-optimal choices on the basis of value pluralism, uncertainty, patient autonomy and responsibility. There are diverse views about how to evaluate treatment options, and patients’ right to self-determination and taking responsibility for their own lives should be respected. We introduce the concept of cost-equivalence, as a way of defining the boundaries of permissible pluralism in publicly-funded healthcare systems. As well as providing the most effective, available treatment for a given condition, publicly-funded healthcare systems should provide reasonable suboptimal medical treatments that are equivalent in cost to the optimal treatment. We identify four forms of cost-equivalence, and assess the implications of CE for decision-making. We evaluate and reject counterarguments to CE. Finally, we assess the relevance of CE for other treatment decisions including requests for potentially superior treatment. (shrink)

Allocating on the basis of need is a distinguishing principle in publicly funded health care systems. Resources ought to be directed to patients, or the health program, where the need is considered greatest. In Sweden support of this principle can be found in health care legislation. Today however some domains of what appear to be health care needs are excluded from the responsibilities of the publicly funded health care system. Corrections of eye disorders known as (...) refractive errors is one such domain. In this article the moral legitimacy of this exception is explored. Individuals with refractive errors need spectacles, contact lenses or refractive surgery to do all kinds of thing, including participating in everyday activities, managing certain jobs, and accomplishing various goals in life. The relief of correctable visual impairments fits well into the category of what we typically consider a health care need. The study of refractive errors does belong to the field of medical science, interventions to correct such errors can be performed by medical means, and the skills of registered health care professionals are required when it comes to correcting refractive error. As visual impairments caused by other conditions than refractive errors are treated and funded within the public health care system in Sweden this is an inconsistency that needs to be addressed. (shrink)

Since 2000, 11 human uterine transplantation procedures (UTx) have been performed across Europe and Asia. Five of these have, to date, resulted in pregnancy and four live births have now been recorded. The most significant obstacles to the availability of UTx are presently scientific and technical, relating to the safety and efficacy of the procedure itself. However, if and when such obstacles are overcome, the most likely barriers to its availability will be social and financial in nature, relating in particular (...) to the ability and willingness of patients, insurers or the state to pay. Thus, publicly funded healthcare systems such as the UK9s National Health Service (NHS) will eventually have to decide whether UTx should be funded. With this in mind, we seek to provide an answer to the question of whether there exist any compelling reasons for the state not to fund UTx. The paper proceeds as follows. It assumes, at least for the sake of argument, that UTx will become sufficiently safe and cost-effective to be a candidate for funding and then asks, given that, what objections to funding there might be. Three main arguments are considered and ultimately rejected as providing insufficient reason to withhold funding for UTx. The first two are broad in their scope and offer an opportunity to reflect on wider issues about funding for infertility treatment in general. The third is narrower in scope and could, in certain forms, apply to UTx but not other assisted reproductive technologies (ARTs). The first argument suggests that UTx should not be publicly funded because doing so would be inconsistent with governments’ obligations to prevent climate change and environmental pollution. The second claims that UTx does not treat a disorder and is not medically necessary. Finally, the third asserts that funding for UTx should be denied because of the availability of alternatives such as adoption and surrogacy. (shrink)

This article defends the public funding of abortion in the Canadian health care system in light of objections by opponents of abortion that the procedure should be denied public funding. Abortion opponents point out that women terminate their pregnancies most often for social reasons, that the Canadian health care system only requires funding for medically necessary procedures, and that abortion for social reasons is not medically necessary care. I offer two lines of response. First, I briefly present an (...) argument that characterizes abortion sought for social reasons as medically necessary care, directly contesting the anti-abortion position. Second, and more substantially, I present a justice argument that shows that even if abortion is not regarded as medically necessary care, the reasons that typically motivate women to seek abortion are sufficiently weighty from the moral perspective that it would be unjust to deny them public funding. I finish by drawing the more general conclusion that health care funding decisions should be guided by a broader concept of necessary care, rather than by a narrow concept of specifically medical necessity. A broad concept of necessary care has been debated in health care policy in the Netherlands, and I suggest that such a concept would be a more just and defensible guide for funding decisions than the concept of medical necessity. (shrink)

Irecall vividly my initial excitement at the accomplishments of the Human Genome Project. That excitement was short-lived and diminished steadily over the next decade as I came to realize that the HGP was just another nail to be hit by the metaphoric hammer of genome-sequencing technology. To this day, I see this trend in many other spheres of public health and biomedical science. I take responsibility for using this same approach of "hammer" and "nail" in my own research program, where (...) I use complex systems modeling to address pressing public health issues, such as adverse birth outcomes, food insecurity, and the opioid epidemic. But I am slowly yet surely shifting my ways by explicitly and slowly... (shrink)

Background Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of therapies on future reproductive autonomy are a major concern. While a few options are open to post-pubertal patients, the only immediate option currently open to pre-pubertal girls is cryopreservation of ovarian tissue and subsequent transplantation. The aim of the study was to address a current gap in knowledge regarding the offer (...) of fertility preservation by Ovarian Tissue Cryopreservation for prepubescent girls with cancer, and to explore current practices and attitudes of Canadian, French and Moroccan pediatric heme oncologists. The comparative perspective is relevant since legal frameworks surrounding fertility preservation and funding offered by the healthcare system vary greatly. Methods An online survey was sent to the 45 pediatric oncology centers in Canada, France and Morocco. Results A total of 39 centers responded. OTC is offered by almost all pediatric heme oncologists in France, very few in Canada, and none in Morocco. For pediatric hematologists/oncologists who do not propose fertility preservation in Canada, the reasons are: the technique is still experimental, it is not available locally and cost of the technique for the family. 97% of Canadian and 100% of Moroccan pediatric hematologists/oncologists think OTC should be funded by the healthcare system as it is in France and in the province of Quebec in Canada. Conclusions The results of this study show tremendous diversity in the provision of OTC across countries, whereby its offer is correlated with legislation and funding. We argue that the current reality, in which this technology is often not offered to families, raises ethical issues related to justice and equity of access, as well as informed consent and future reproductive autonomy. (shrink)

Asking pregnant women to pay for non-invasive prenatal testing out of pocket leads to unequal access across socioeconomic strata. To avoid these social justice issues, first-trimester prenatal screening should be publicly funded in countries such as the Netherlands, with universal coverage healthcare systems that offer all other antenatal care services and screening programmes free of charge. In this reply, we offer three additional reasons for public funding of NIPT. First, NIPT may not primarily have medical utility for women (...) and children, but rather offers relevant information and reproductive options, and thus serves important autonomy interests of women. Second, public funding of NIPT can be justified because it results in a reduction of collectively borne costs associated with care and support for children with chromosomal abnormalities. It is important to note that this is not an argument for individual women to take part in screening or to terminate an affected pregnancy. However, it is a legitimate argument in policy making regarding funding arrangements for screening programmes. Finally, public funding would help to amend current misunderstandings among pregnant women, and thus to support informed consent for first-trimester prenatal screening. (shrink)

In the Canadian health care system, the Government is responsible for allocating scarce resources in a fair and equitable manner. A proposal to implement managed care as a method of reimbursing physicians in Alberta, Canada, needs careful ethical consideration, because physicians are not well prepared, and should not be asked, to make the resulting difficult allocation decisions. The Government must continue to be held responsible for ensuring that all citizens have equal access to necessary medical services, and we must (...) find ways to encourage the public to become more involved in deciding how resources are best allocated. Health professionals other than physicians must take an interest and enter into this debate. (shrink)

As stewards of public money, government funding agencies have the obligation and responsibility to uphold the integrity of funded research. Despite an increasing amount of empirical studies examining research-related misconduct, a majority of these studies focus on retracted publications. How agencies spot funding-relevant wrongdoing and what sanctions the offenders face remain largely unexplored. This is particularly true for public funding agencies in emerging science powers. To amend this oversight, we retrieved and analyzed all publicized investigation results from China’s largest (...) basic research funding agency over the period from 2005 to 2021. Our findings reveal that both the “police patrol” and “fire alarm” approaches are used to identify misconduct and deter funding-related fraud in China. The principal triggers for investigations are journal article retractions, whistleblowing, and plagiarism detection software. Among the six funding-related misconduct types publicized and punished, the top three are: (1) fraudulent papers, (2) information fabrication and/or falsification in the research proposal, and (3) proposal plagiarism. The most common administrative sanctions are debarment and reclamation of grants. This article argues that more systematic research and cooperation among stakeholders is needed to cultivate research integrity in emerging science powers like China. Specific training and education should be provided for young scientists to help them avoid the pitfall of academic misconduct. (shrink)

Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses (...) a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions ], we argue that the patient needs to experience some degree of suffering, which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development. (shrink)

Our article attempts to provide some clarity to the debate about the proper relationship between science and public policy by drawing on the philosophical field of logic. We argue that based on an analysis of the most fundamental ways that empirical and evaluative truth claims can be used together in arguments, the tendency to conceive of this relationship either in dual terms of “pure” vs. “applied” or complex “multi-disciplinary” or “multi-cultural” systems of categorization should be rejected in favor a basic (...) four-part division. A significantly improved understanding of the connection between science and public policy can be based on an examination of the four most basic kinds of logical connection between empirical and evaluative statements. One such improvement is a better understanding of how funding should be divided between state and private interests. (shrink)

A friend, correspondent and intellectual successor to David Ricardo, John Ramsay McCulloch forged his reputation in the emerging field of political economy by publishing deeply researched articles in Scottish periodicals and the Encyclopaedia Britannica. From 1828 he spent nearly a decade as professor of political economy at the newly founded University of London, thereafter becoming comptroller of the Stationery Office. Perhaps the first professional economist, McCulloch had become internationally renowned by the middle of the century, recognised for sharing his ideas (...) through lucid lecturing and writing. The present work, first published in 1845, has been hailed as 'the first systematic account of the theory and policy of public finance'. After a general introductory chapter, the book discusses direct and indirect taxation, before considering national debt and how to deal with it. Several other works written or edited by McCulloch are also reissued in the Cambridge Library Collection. (shrink)

Private funding of life sciences has been extensively criticized as lacking objectivity (e.g., Bekelman et al. 2003). However, it is also important to point out that public funding of life sciences faces many objections. In order to improve the system of publicly funded life sciences and its ability to respond to global health challenges such as the COVID-19 pandemic, we should focus on several aspects. First of all, providing existential stability for researchers, in turn, could result in (...) the decrease of academic misconduct. Secondly, COVID-19 vaccines come from all parts of the world and have to be distributed throughout the world, which is a strong argument in favor of the positive stimulation of global science conducted at less-known research institutions and throughout all countries. This brings us to the quest of working on epistemic decolonization and inclusion in contrast to the current elitist paradigm in science. Finally, publicly funded research, which is at the moment mainly focused on foundational questions, should also be extended to applied ones. Public funding of applied research would lead to its development independently of private financial interests. (shrink)

While vaccination rates in the United States are high — generally over 90 percent — rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes (...) a case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials. (shrink)

In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. (...) I conclude that economist and philosopher John Broome’s writing provides the framework for an answer: a healthcare system in a democracy should do as much good as possible, although sometimes we should sacrifice some overall good for the sake of fairness. This leaves open some detailed questions about what in practice we consider to be good and fair, and about when some good should be traded off in order to be fair. The answers to these questions depend on our values, or as explained by systems theory, our weltanschauung. How policy decisions should be made when citizens’ values differ is a subject of extensive academic debate. However, it is a separate question. Representative democracies have mechanisms for resolving such debates. (shrink)

There has been a sharp rise in private funding of medical research, especially in relation to patentable products. Several serious problems with this are described. A solution involving the elimination of patents and public funding administered through extended national health care systems is proposed.

Department of Economics, University of Calgary, 2500 University Dr NW, Calgary AB, T2N 1N4, Canada. Tel.: +1403220 5861; Fax: +1403220 5861; Email: ahollis{at}ucalgary.ca ' + u + '@' + d + ' '//--> . Abstract The Health Impact Fund has been proposed as an optional, comprehensive advance market commitment system offering financial payments or ‘prizes’ to patentees of new drugs, which are sold globally at an administered low price. The Fund is designed to offer payments based on the therapeutic (...) impact of the drugs or vaccines, so that innovators will have efficient incentives to develop drugs that maximize health gains. Consumers would have improved access to such drugs because of low prices. CiteULike Connotea Del.icio.us What's this? (shrink)

BackgroundThe increasing emphasis on research, development and innovation for health in providing solutions to the high burden of diseases in the African Region has warranted a proliferation of studies including clinical trials. This changing public health landscape requires that countries develop adequate ethics review capacities to protect and minimize risks to study participants. Therefore, this study assessed the readiness of national ethics committees to respond to challenges posed by a globalized biomedical research system which is constantly challenged by new (...) public health threats, rapid scientific and technological advancements affecting biomedical research and development, delivery and manufacture of vaccines and therapies, and health technology transfer.MethodsThis is a descriptive study, which used a questionnaire structured to elicit information on the existence of relevant national legal frameworks, mechanisms for ethical review; as well as capacity requirements for national ethics committees. The questionnaire was available in English and French and was sent to 41 of the then 46 Member States of the WHO African Region, excluding the five Lusophone Member States. Information was gathered from senior officials in ministries of health, who by virtue of their offices were considered to have expert knowledge of research ethics review systems in their respective countries.ResultsThirty three of the 41 countries responded. Thirty of respondent countries had a national ethics review committee ; 79 % of which were established by law. Twenty-five NECs had secretarial and administrative support. Over 50 % of countries with NECs indicated a need for capacity strengthening through periodic training on international guidelines for health research ethics; and allocation of funds for administrative and secretariat support.ConclusionsDespite the existing training initiatives, the Region still experiences a shortage of professionals trained in health research ethics/ethicists. Committees continue to face various capacity needs especially for evaluating clinical trials, for monitoring ongoing research, database management and for accrediting institutional ethics committees. Given the growing number of clinical trials involving human participants in the African Region, there is urgent need for supporting countries without NECs to establish them; capacity strengthening where they exist; and creation of a regional network and joint ethical review mechanisms, whose membership would be open to all NECs of the Region. (shrink)

In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. (...) I conclude that economist and philosopher John Broome’s writing provides the framework for an answer: a healthcare system in a democracy should do as much good as possible, although sometimes we should sacrifice some overall good for the sake of fairness. This leaves open some detailed questions about what in practice we consider to be good and fair, and about when some good should be traded off in order to be fair. The answers to these questions depend on our values, or as explained by systems theory, our weltanschauung. How policy decisions should be made when citizens’ values differ is a subject of extensive academic debate. However, it is a separate question. Representative democracies have mechanisms for resolving such debates. (shrink)

The way research is, and should be, funded by the public sphere is the subject of renewed interest for sociology, economics, management sciences, and more recently, for the philosophy of science. In this contribution, I propose a qualitative, epistemological criticism of the funding by lottery model, which is advocated by a growing number of scholars as an alternative to peer-review. This lottery scheme draws on the lack of efficiency and of robustness of the peer-review based evaluation to argue that (...) the majority of public resources for basic science should be allocated randomly. I first differentiate between two distinct arguments used to defend this alternative funding scheme based on considerations about the logic of scientific research. To assess their epistemological limits, I then present and develop a conceptual frame, grounded on the notion of “system of practice”, which can be used to understand what precisely it means, for a research project, to be interesting or significant. I use this epistemological analysis to show that the lottery model is not theoretically optimal, since it underestimates the integration of all scientific projects in densely interconnected systems of conceptual, experimental, or technical practices which confer their proper interest to them. I also apply these arguments in order to criticize the classical peer-review process. I finally suggest, as a discussion, that some recently proposed models that bring to the fore a principle of decentralization of the evaluation and selection process may constitute a better alternative, if the practical conditions of their implementation are adequately settled. (shrink)

This article presents the dual conception of legal regulation of funding of political parties. In general, funding of political parties is considered as part of public law, however, this article explains that it also could be understood as an institute of private law. When funding of political parties is analysed not only through the conception of public law, but also taking into consideration the idea of private law, it is possible to apply different (than usual) principles of legal regulation of (...) such relations. Those principles are followed in this article in order to reveal different practical problems pertaining to legal regulation of political party funding. A conclusion is made that the legal provisions on funding of political parties form an integral system that consists of both public law and private law provisions. The relations when natural and legal persons assign property to political parties are considered as part of private law and those property relations that are based on state subsidies to political parties or other financial support by the state are the object of public law regulation. In the case of Lithuania, all such relations are regulated by the Law on Funding of, and Control Over Funding of Political Parties and Political Campaigns, which is an act of private law and also a source of public law. The legal regulation that stems from this law is supplemented by the Civil Code of the Republic of Lithuania and other related laws. The legislator, while regulating the legal relations pertaining to the funding of political parties, and the courts, when dealing with disputes related to those relations, are advised to take into consideration the general principles of civil law. It is important to point out that some legal provisions of the Law on Funding of Political Parties that are in force as of 1 January 2012 are against those principles. A prohibition for legal persons and limitations for natural persons to fund political parties should be critically considered, since those restrictions limit the possibilities for private persons to dispose their property and for political parties – to acquire it. Moreover, it is important to point out that such restrictions can be circumvented by assigning property through a third party and by other legal means. In order to avoid such cases, it is recommended to provide an opportunity for natural and legal persons to fund political parties, but with reasonable limitations for such donations. (shrink)

Publicly-funded health systems, including those national health services and social or National Health Insurances, are institutionalized solidarity in health. In Europe, solidarity originated from the legacies of labor movements, the Judeo-Christian traditions, and nationalist sentiments in the re-construction Era after the WWII. In middle-to-high income East Asian countries, such as Japan, Taiwan, Korea, the health systems were built on different grounds and do not have such ethical origins of solidarity. As health systems in Europe and East Asia are (...) both facing sustainability crises due to aging population, stagnant economy, changing boundaries, and advancing medical technologies, how those systems with the European solidaristic ethical traditions can be revived and how those without the European traditions could survive become a matter of theoretical interests and an urgent policy problem to be addressed. Drawing on contemporary theories of solidarity, this essay analyzes the boundary problem and its impact on the sustainability of the health system in Taiwan. It then considers two plausible origins of solidarity in Taiwan. One is the re-emerged civic nationalism, and the other is an ethos of common life. It is argued that after years of implementation, the National Health Insurance in Taiwan might have shaped the social values and people’s habits and formed an ethos of common life. Such ethos could be an ethical origin of solidarity in non-western societies and help the health systems endure the prolonged sustainability crises. (shrink)

The public purse is responsible for funding almost all autism spectrum disorders (ASD) research in Canada (as per Canadian Institutes of Health Research [CIHR]) and for providing some of the existing services and supports for this population. In this article, we consider various reasons why Canada should be concerned to ensure a more equitable distribution of relevant public funding for ASD research than is currently the case to meet the express needs and interests of the diversity of autism stakeholders. As (...) such, we report data to show that CIHR-supported ASD research from the period of 2000–2010 demonstrates a bias focussed on the aetiology of the condition revealing a disproportionate emphasis on only two (Biomedical and Clinical) out of the four research pillars avowed by CIHR, with a comparative lack of fiscal resources committed to Health Systems and Services and Population and Public Health research. We advance certain normative and prudential reasons for funding more Health Systems and Services and Population and Public Health ASD research in Canada. In our view, this would seem to follow from CIHR’s official mandate ‘as a flexible mechanism that will continually align health research funding with changes in the manner in which health problems and opportunities are identified, understood and addressed’. (shrink)

Funding is an important mechanism for exercising influence over ever more parts of academic systems. In order to do so, funding agencies attempt to export their functional and normative prerequisites for financing to new fields. One essential requirement for fundees is then to construct research processes in the form of a project beforehand, one that is limited in time, scope and content. This article demonstrates how the public funding of doctoral programs expands this model of project research from experienced academics (...) to the socialization process for the new academic generation. This process of “projectification” underlies funding-driven institutional changes in doctoral training. A multi-level comparative study of German policies, funding mechanisms and organizational frameworks for doctoral training demonstrates the emergence of a specific model of predefined PhD projects. The investigation of doctoral training practices reveals that socio-epistemic preconditions regulate whether research fields adopted or rejected this demanding model. This result contradicts widespread claims about a radical change in doctoral training and suggests focusing on the actual practices of field-specific doctoral research. (shrink)

This book addresses one of the most urgent questions in American society today, one that is currently in the spotlight and hotly debated on all sides: Who shall rule the schools--parents or educators? _School Choice or Best Systems: What Improves Education?_ presents an overview of research and practical applications of innovative--even radical--school reforms being implemented across the United States. These fall along a continuum ranging from "parental choice" to "best systems." At the one extreme are schools of choice, which allow (...) parents to choose and even govern schools for their children. These include charter schools, traditional private and parochial schools, schools that are privately governed but publicly funded through vouchers, and those that are funded by private scholarships provided by both corporations and wealthy individuals. At the other extreme are centralized state or district systems, based on reform initiatives and new systems of education that have been developed in response to views of citizens and legislators that schools can do much better. These schools, which specify uniform goals, policies, and programs for each school, are highly innovative systems based on research or representing advanced thinking about "what works," and have attracted wide interest. Important questions related to schools of choice and best systems are addressed: How can we choose among schools of choice and best systems? Among the various approaches within each of these alternatives? How can we understand their guiding principles and operational practices? What results do they produce? How can we evaluate their claims? In choosing among the alternatives, how should issues of student achievement, accountability, costs, feasibility, and equity be factored in? This volume brings together leading researchers and education leaders who have carried out the latest studies and advances in the field, providing a forum for them to set forth the arguments and evidence that will be most helpful in making choices for tomorrow's schools. It does not provide a single "right" answer--values and preferences differ across parents, schools, districts, and states. However, there are benefits for all from seeing the rigorous research, challenging thinking, and alternate points of view this volume presents. (shrink)

The development of new effective but expensive medical treatments leads to discussions about whether and how such treatments should be funded in solidarity-based healthcare systems. Solidarity is often seen as an elusive concept; it appears to be used to refer to different sets of concerns, and its interrelations with the concept of justice are not well understood. This paper provides a conceptual analysis of the concept of solidarity as it is used in discussions on the allocation of healthcare resources (...) and the funding of expensive treatments. It contributes to the clarification of the concept of solidarity by identifying in the literature and discussing four uses of the concept: (1) assisting patients in need, (2) upholding the solidarity-based healthcare system, (3) willingness to contribute and (4) promoting equality. It distinguishes normative and descriptive uses of the concept and outlines the overlap and differences between solidarity and justice. Our analysis shows that the various uses of the concept of solidarity point to different, even conflicting, ethical stances on whether and how access to effective, expensive treatments should be provided. We conclude that the concept of solidarity has a role to play in discussions on the accessibility and funding of newly approved medical treatments. It requires, for instance, that healthcare policies promote and maintain both societal willingness to contribute to the care of others and the value of providing care to vulnerable patients through public funding. (shrink)

The development of new effective but expensive medical treatments leads to discussions about whether and how such treatments should be funded in solidarity-based healthcare systems. Solidarity is often seen as an elusive concept; it appears to be used to refer to different sets of concerns, and its interrelations with the concept of justice are not well understood. This paper provides a conceptual analysis of the concept of solidarity as it is used in discussions on the allocation of healthcare resources (...) and the funding of expensive treatments. It contributes to the clarification of the concept of solidarity by identifying in the literature and discussing four uses of the concept: (1) assisting patients in need, (2) upholding the solidarity-based healthcare system, (3) willingness to contribute and (4) promoting equality. It distinguishes normative and descriptive uses of the concept and outlines the overlap and differences between solidarity and justice. Our analysis shows that the various uses of the concept of solidarity point to different, even conflicting, ethical stances on whether and how access to effective, expensive treatments should be provided. We conclude that the concept of solidarity has a role to play in discussions on the accessibility and funding of newly approved medical treatments. It requires, for instance, that healthcare policies promote and maintain both societal willingness to contribute to the care of others and the value of providing care to vulnerable patients through public funding. (shrink)

More recent advancements in digital technologies have significantly alleviated the dissemination of new scientific ideas as well as the storing, searching and retrieval of large amounts of published research findings. While not denying the benefits of this novel ‘economy of memory,’ this paper endeavors to shed light on the ways in which the use of digital technologies may be linked to a distortion of the system of formal publications that facilitates the effective dissemination and collaborative building of scientific knowledge. (...) Through combining three different strands of discussion that are often left separate – those pertaining to the cognitive effects of new technological memory systems, those pertaining to citation and publishing practices, and those regarding the effects of formalizing modes of research governance – it is also shown that this distortion is not merely a consequence of technological developments alone. Rather, such a distortion is inseparable from and potentially aggravated by the spreading of increasingly dysfunctional, formalizing research governance mechanisms. It is argued that these mechanisms run the risk of fostering the proliferation of knowledge practices that are characterized by an increasing degree of superficiality as well as the strategic publication of research that is of a decreasing degree of originality. If left unaddressed, this may pose a serious threat to the efficiency and effectiveness of the formal record of scientific knowledge as a tool for the dissemination of original research. By extension, this may in the long run seriously undermine the capacity of the publicly funded research system more generally. (shrink)

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

Publication date: 2 May 2019 Source: Author: Zoran Mastilo Aim of this paper is to, by means of comparative analysis, demonstrate that contemporary pension systems are limitation factors of development of the Republic of Srpska, and that they should be reformed and improved. Ultimately, pension systems should be the basis for development of the Republic of Srpska. They should significantly improve strengthening of financial markets, enhancement of capital markets, higher growth rates of the Republic of Srpska, idecrease of unemployment. Private (...) pension funds are to change the habits and ideas of every future insurance holder, aiming to make the pension rights a matter of concern of every individual, instead being the obligation and ballast of the society. Today, stabile financing of pension systems and their funds is becoming increasingly questionable. A gap is emerging between the area of rights gained by law and financial possibilities for their implementation. Pay-as-you-go systems, i.e. systems of inter-generation solidarityare particularly endangered. Adequate systematization of gathered data, i.e. evidence, should provide conclusions that pension systems are a limitation todevelopment of national economy. This claim is present in underdeveloped and developing countries, with developed economies also facing grave problems. (shrink)

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference (...) to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the ‘right’ to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to ‘their clients’ is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to ‘your’ patients in certain circumstances. (shrink)

BackgroundDespite the recognition that developing artificial intelligence (AI) that is trustworthy is necessary for public acceptability and the successful implementation of AI in healthcare contexts, perspectives from key stakeholders are often absent from discourse on the ethical design, development, and deployment of AI. This study explores the perspectives of birth parents and mothers on the introduction of AI-based cardiotocography (CTG) in the context of intrapartum care, focusing on issues pertaining to trust and trustworthiness.MethodsSeventeen semi-structured interviews were conducted with birth parents (...) and mothers based on a speculative case study. Interviewees were based in England and were pregnant and/or had given birth in the last two years. Thematic analysis was used to analyze transcribed interviews with the use of NVivo. Major recurring themes acted as the basis for identifying the values most important to this population group for evaluating the trustworthiness of AI.ResultsThree themes pertaining to the perceived trustworthiness of AI emerged from interviews: (1) trustworthy AI-developing institutions, (2) trustworthy data from which AI is built, and (3) trustworthy decisions made with the assistance of AI. We found that birth parents and mothers trusted public institutions over private companies to develop AI, that they evaluated the trustworthiness of data by how representative it is of all population groups, and that they perceived trustworthy decisions as being mediated by humans even when supported by AI.ConclusionsThe ethical values that underscore birth parents and mothers’ perceptions of trustworthy AI include fairness and reliability, as well as practices like patient-centered care, the promotion of publicly funded healthcare, holistic care, and personalized medicine. Ultimately, these are also the ethical values that people want to protect in the healthcare system. Therefore, trustworthy AI is best understood not as a list of design features but in relation to how it undermines or promotes the ethical values that matter most to its end users. An ethical commitment to these values when creating AI in healthcare contexts opens up new challenges and possibilities for the design and deployment of AI. (shrink)

Different kinds of medical technologies and biotechnologies have all been developed for “therapeutic purposes,” but the possible uses of these technologies are not restricted to therapy. These possibilities give rise to a number of questions. This chapter discusses whether mood enhancement is a legitimate goal of medicine when medical resources are limited and the medical enterprise is publicly funded. It focusses on the case of mood enhancement through so‐called cosmetic psychopharmaceuticals. It suggests that we should give absolute priority (...) to those who suffer most; we should give equal weight to all improvements in well‐being, regardless of where on the scale they occur; the better a person feels, the less is the value of a certain improvement; once a certain level of subjective well‐being is achieved, further improvement is worth nothing from a medical perspective, and an improvement beyond normal mood still has value, but it is worth less. (shrink)

Although successive generations of digital technology have become increasingly powerful in the past 20 years, digital democracy has yet to realize its potential for deliberative transformation. The undemocratic exploitation of massive social media systems continued this trend, but it only worsened an existing problem of modern democracies, which were already struggling to develop deliberative infrastructure independent of digital technologies. There have been many creative conceptions of civic tech, but implementation has lagged behind innovation. This article argues for implementing one such (...) vision of digital democracy through the establishment of a public corporation. Modeled on the Corporation for Public Broadcasting in the United States, this entity would foster the creation of new digital technology by providing a stable source of funding to nonprofit technologists, interest groups, civic organizations, government, researchers, private companies, and the public. Funded entities would produce and maintain software infrastructure for public benefit. The concluding sections identify what circumstances might create and sustain such an entity. (shrink)

Healthcare counts as a morally relevant good whose distribution should neither be left to the free market nor be simply imposed by governmental decisions without further justification. This problem is particularly prevalent in the current boom of anti-ageing medicine. While the public demand for medical interventions which promise a longer, healthier and more active and attractive life has been increasing, public healthcare systems usually do not cover these products and services, thus leaving their allocation to the mechanisms of supply and (...) demand on the free market. This situation raises the question on which basis the underlying preferences for and claims to a longer, healthier life should be evaluated. What makes anti-ageing medicine eligible for public funding? In this article, we discuss the role of anti-ageing medicine with regard to the scope and limits of public healthcare. We will first briefly sketch the basic problem of justifying a particular healthcare scheme within the framework of a modern liberal democracy, focusing on the challenge anti-ageing interventions pose in this regard. In the next section, we will present and discuss three possible solutions to the problem, essentialistic, transcendental, and procedural strategies of defining the scope of public healthcare. We will suggest a procedural solution adopting essentialistic and transcendental elements and discuss its theoretical and practical implications with regard to anti-ageing medicine. (shrink)

The contribution of food and diet to health is much disputed in the background culture in the US. Many commercial or ideological advocates make claims, sometimes with health as a primary goal, but often accompanied by commercial or ideological interests. These compete culturally with authoritative recommendations made by publicly funded groups. For public policy concerning diet and health to be legitimate, not only should it not be inconsistent with the scientific evidence, but also it should not be inconsistent (...) with the political environment. Healthy Eating Policy and Political Philosophy (HEPPP), by Barnhill and Bonotti (2022), addresses how policy in this complex area might be justified. In the present essay I highlight some important strengths of their work and also make some points about how it might be clarified or enlarged in scope. The great strength of HEPPP is that it emphasizes the role of a political philosophy in evaluating the legitimacy of public policy. They presume a well-off liberal democratic state, and specifically they draw on Rawls’ political liberalism, as developed in Political Liberalism (PL). One of several interlocking technical concepts developed in this book, public reason speaks to the boundaries of what should be acceptable in public deliberation about constitutional essentials and basic justice. HEPPP explores the application of an extension of public reason to the justification of policies related to “healthy eating.“ Public reason has two components, both of which pertain to a common understanding among citizens: (1) a common understanding of the principles and ideals that are the foundation of the political society, and (2) a common understanding of the standards that govern reason and evidence, including common sense. HEPPP argues that even though for diet and health the complexity of the scientific evidence goes far beyond anything like common sense for a typical citizen, the technical idea of “accessibility” of the scientific evidence justifies reliance on it within the concept of public reason. I question this accessibility argument about scientific evidence and public reason because the nature of the population-level epidemiological evidence about diet and health is that it often includes judgments that are based on arguable interpretations, framing incidence in terms of risk and prevention; thus the issue is more than one of potential accessibility of scientific evidence. Nevertheless, evaluation and consideration of the scientific evidence is of obvious practical importance in policy deliberation concerning policy related to what Rawls call “ordinary legislation.“ Even though public reason applied to healthy eating policy may not be as pertinent as it is for constitutional essentials and basic justice, and even though it is unlikely to result in a “correct outcome,“ invoking reasons based on political values and principles held in common has important value even in these deliberations about more ordinary questions. That value applies not to the specifics of the particular issue, but to the larger context for the particular policy being deliberated, as a potential contribution to an overlapping consensus that is stable for the right reasons. If this vision of political liberalism were achieved, then contentious debate about health eating policy and its scientific basis could occur within that context and be resolved within the basic political structure. Because public health and political liberalism have a common concern for a good at the population level, they have an underlying affinity. Healthy eating policies could be evaluated in two not-unrelated ways: based on their instrumental contribution to the good of the public body of citizens as population-level health, and according to their stabilizing contribution to an overlapping consensus among citizens. In this latter way a policy would contribute to a conditional integral common good a la Sulmasy, one that has the prospect of conditioning a political system, and by doing so create the conditions of the possibility of a constitutive integral common good that is constituted on the right reasons for allegiance to an overlapping consensus. To conclude with reference to HEPPP, public reason may play an important function with respect to the political common good, even as debates about the weight and meaning of scientific evidence from epidemiology play out in deliberation of ordinary legislation concerning healthy eating. (shrink)

Zakat is a monetary form of religious worship that establishes a bridge between a rich and a poor, helps those who are in need and contributes to peace and tranquillity within a society. When zakat is collected properly under a government control and transmitted to those who deserve, it helped to decrease the gap between the poor and the rich, supported activities of social solidarity and revived the economy as well. Malaysia after its independence in 1957 has developed an interest (...) in Islamic practices by drawing attention to a distinctive practice with the public zakat system. Even though a national- central system of zakat could not be established due to the federal structure of the country, the collection and distribution of zakat has been centralized on a state level. Parts of the practice are being criticized, reviewed and new regulations are introduced. Unlike Malaysia, the zakat practice in Turkey is out of state control, thus it hinders zakat from achieving its real purpose. There is a need to make use of the well-functioning zakat systems around the world and establish a public zakat system in our country so that we can make the most of the benefits that zakat has for individuals and societies. This article aims to be a step in that direction. -/- SUMMARY Zakat is one of the main forms of worship and is at the same time one of the main sources for the state budget in Islam. It aims at making sure that the rich –those with higher wealth and income– protects the poor and the powerless and through this it contributes to the peace in the society. In the Islamic creed wealth in reality belongs to Allah; therefore, those who live an affluent life should not attribute their wealth to themselves alone and help those who, for whatever reason, are unable to meet their needs. Because there is a social dimension to this form of worship, it is the duty of the head of state to collect the zakat and distribute it to the right people. Historically this duty has taken different forms and today, many Muslim countries sustain this collection and redistribution under state supervision. Malaysia is a country where zakat is collected and distributed officially at the state level. In each state, there is an Islamic council responsible for taking care of activities related to Islam and is semi-independent from the government that organizes the zakat process. Some of these do the collection and distribution together, some do it separately. In some states, the process has been totally privatized. Constitutionally, each state is dependent on its own sultan in religious affairs, thus each has its own mufti and partially different zakat practices and eac collect and distributes its zakat within that state. Because religious affairs have been codified as the privilege of the sultans of each state in the constitution during Malaysia’s foundation, there is no attempt at centralizing religious affairs and a centralization of zakat practices; the establishment of an institution to achieve this is not possible. Moreover, the secular character of the federation does not seem yet compatible with making zakat obligatory. However, due to the dominant Shafi‘i tradition and the convention in the country, people see it as imperative to hand over the charity and tithe to state institutions. Furthermore, there are local fatwas – which are considered as legal regulations in Malaysia – that require people with an income over a certain amount to pay zakat. Those who have the most are expected to give it voluntarily. In the 19th century, when wealth sources such as palm oil, cacao, rubber, tin were discovered, Malaysian officials were not able to extend the tithe to these; however, in the last twenty-five years, based on fatwas that income should be taxable under zakat has led to a boom in zakat. In all states, the largest portion of zakat is collected through income, usually automatically deducted from payroll. An influential factor in this outcome is that individually paid zakat can be deducted from income tax. From 2005 on, there have been other regulations to make it possible for legal personalities to deduct zakat from taxes. To increase zakat payment, especially publications have been produced to inform and encourage people, and modern opportunities to make payment easy have been developed. The most often used method is direct deduction from payroll. The second most common method is payment through zakat machines in different parts of the city by cash, check, Islamic credit card and, debit card. In addition to these, online, internet banking, telephone banking, ATM machines, post offices, kiosk machines, sms-zakat options are all available. The distribution of zakat differs from year to year and state to state. In general, there is an observable effort to pay all groups from zakat, but because there are no slaves in some states no payment is done under this category. There are both direct transfers and indirect transfers, such as through the construction of houses for poor people. There have been cases where poor people who had projects were supported with funds and those later returned in zakat. There is support for students in terms of scholarships through fuqarā’, fī sabīl allāh and ibn al-sabīl classes. For the muallafa al-qulūb class, there is a foundation to encourage local people to convert to Islam and help them for food, shelter, clothes and education. For Muslims who suffer as minorities in other countries help is provided through the riqāb, muallafa al-qulūb, fī sabīl allāh and ibn al-sabīl classes. In the ghārimīn class, especially victims of natural disasters such as flood and earthquake are supported. For those who have a right to receive zakat be able to receive it, the state has to side with the powerless and help zakat fulfill its social and individual functions. The way zakat is spent requires state policy and will. For this reason, zakat should be institutionalized and all activities should be organized by a single institution with state power behind it. Determining the recipients and the zakat-payers, and using the funds efficiently is easier with the coordination of state institutions. Extensive zakat councils that include state institutions should consider the ijtihāds in the area of zakat anew and make decisions to create a just and consistent zakat system. For these decisions to be applicable, the question of what kind of a system could be founded in our country should be on the agenda in these councils. Once an institution – official or autonomous but with state power behind it- is created, solutions can be found as they arise in the way. (shrink)

This is a contribution to construction of a research roadmap for future cognitive systems, including intelligent robots, in the context of the euCognition network, and UKCRC Grand Challenge 5: Architecture of Brain and Mind. -/- A meeting on the euCognition roadmap project was held at Munich Airport on 11th Jan 2007. This document was in part a response to discussions at that meeting. An explanation of why specifying requirements is a hard problem, and why it needs to be done, along (...) with some suggestions for making progress, can be found in this presentation: http://www.cs.bham.ac.uk/research/projects/cosy/papers/#pr0701 "What's a Research Roadmap For? Why do we need one? How can we produce one?" Working on that presentation made me realise that certain deceptively familiar words and phrases frequently used in this context (e.g. "robust". "flexible", "autonomous") appear not to need explanation because everyone understands them, whereas in fact they have obscure semantics that needs to be elucidated. Only then can we understand what the implications are for research targets. In particular, they need explanation and analysis if they are to be used to specify requirements and research goals, especially for publicly funded projects. -/- First draft analyses are presented here. In the long term I would like to expand and clarify those analyses, and to provide many different examples to illustrate the points made. This will probably have to be a collaborative research activity. (shrink)

I Several years ago, when the Carter administration announced that it would support congressional action to end the public fund ing of abortions, the President was asked at a press conference whether he thought that such a policy was unfair; he responded, "Life is unfair." His remarks provoked a storm of controversy. For other than those who, for principled reasons, opposed abor tion on any grounds, it seemed that the President's comments were cruel, violating what was thought to be an (...) American com mitment to providing equal access to health services to all citi zens, regardless of their capacity to pay. Those sentiments had, in fact, been reflected in public opinion polls that had, for at least three decades, indicated that Americans supported the propo sition that the government should guarantee health care to all. Ultimately, those beliefs had been translated into the oft-ex 1 pressed political demand for a one-class system of health care. This commitment to equality is rather remarkable. American society evidences a striking willingness to tolerate vast inequal ities with regard to income and wealth. While it guarantees ed ucation to all children, there is not even a pretense that the children of the wealthy and the children of the poor ought to get precisely the same kind of schooling. While some commitment 'Hazel Erskine. "The Polls: Health Insurance," Public Opinion Quarterly, XXXIX (Spring, 1975), 128-143. (shrink)

The current public debate about the role and place of religion in Australia's education system feels very much like deja vu. The Religious Freedom Review2 may be new, but we've been here before. Religious schools have regularly been at the forefront of the evolving relationship between the state and religion in Australia, from the creation and collapse of the Church and Schools Corporation in the 1830s, and the implementation of the dual board system in the 1840s, to the (...) removal of all government funding for religious schools in the 1860s-90s, and then its reintroduction in the 1960s and '70s.3 The current debate about the extent to which religious schools will continue to be permitted to discriminate against students, staff and contractors in line with the religious ethos of the school is therefore just the latest reiteration of an ongoing narrative. (shrink)

Over the past three decades, two separate federal regulatory structures have emerged, each seeking to assure separate aspects of the integrity and ethics of research conducted using federal funding. One set of regulations is described in the Public Health Service Policies on Research Misconduct and relates to research misconduct, defined as consisting of fabrication of data or results, falsification of data and results, or plagiarism, in accordance with the federal‐wide definition adopted by the Office of Science and Technology Policy. The (...) second set of regulations, set forth in the Department of Health and Human Services regulations on the protection of human subjects (known as the “Common Rule”), prescribes a set of ethical and procedural protections for research involving human subjects.These two sets of research regulations are distinguished from each other by having different foci of enforcement, priorities of protection, oversight officials, oversight procedures, seizure of evidence, standards of proof, expectations of privacy, and appeal procedures for researchers who are subject to adverse findings and penalties. These differences are significant and fundamental. They complicate the process of compliance for institutions and researchers, who are expected to adhere to both sets of standards for the same federally funded research activities in research with human subjects. Compliance is especially complicated when suspected violations of both sets of standards must be investigated and resolved concurrently. This document represents an effort to provide institutions and individuals with practical suggestions as they try to comply with both sets of regulations. (shrink)

In the wake of recent corporate scandals, this paper traces the growing power of pension funds to provide managerial oversight of the firms they hold in their investment portfolios. Increasingly pension funds are exercising their legitimate rights as owners to raise the corporate governance standards of the firms they invest in. Within corporate governance generally, pension funds are shifting their attention away from managerial accountability and toward measures that increase transparency in firm-level decision-making. Pension funds use transparency to ensure that (...) shareholders are the primary interest being served by the firm. Transparency not only aligns managers and owners, it also raises issues of firm behaviour that allow other stakeholders to engage the corporation more broadly. I contend that secrecy is economically inefficient. When organizations are opaque and interests are secret, decision-making can and does distort efficiency. I examine recent pension fund corporate governance campaigns with particular reference to the California Public Employees Retirement System. (shrink)

Neglected and tropical diseases, pervasive in developing countries, are important contributors to global health inequalities. They remain largely untreated due to lack of effective and affordable treatments. Resource-poor countries cannot afford to develop the public health interventions needed to control neglected diseases. In addition, neglected diseases do not represent an attractive market for pharmaceutical industry. Although a number of international commitments, stated in the Millennium Development Goals, have been made to avert the risk of communicable diseases, tropical diseases still remain (...) neglected due to delays in international assistance. This delay can be explained by the form international cooperation has generally taken, which is limited to promoting countries’ national interests, rather than social justice at a global level. This restricts the international responsibility for global inequalities in health to a humanitarian assistance. We propose an alternative view, arguing that expanding the scope of international cooperation by promoting shared health and economic value at a global level will create new opportunities for innovative, effective and affordable interventions worldwide. It will also promote neglected diseases as a global research priority. We build our argument on a proposal to replace the patenting system that currently regulates pharmaceutical research with a global fund to reward this research based on actual decreases in morbidity and mortality at a global level. We argue that this approach is beneficent because it will decrease global health inequalities and promote social justice worldwide. (shrink)

Public funding institutions are able to influence what aspects researchers take into account when they consider the future impacts of their research. On the basis of a description of the evaluation systems that public research funding institutes in the Netherlands (STW and SenterNovem) use to estimate the quality of engineering science, this article shows that researchers are now predominantly required to reflect on the intellectual merit of their research and on the usability and marketability of the technology it contributes to. (...) In addition, SenterNovem also mandates reflection on sustainability. Here it is argued that these requirements do not suffice. Funding institutions should also do more to enhance reflection during the research process on the “soft impacts” of technologies, which refer to the alterations that technologies may bring about in the quality of human life. To do this it is suggested that it is helpful to engage a specifically trained ethicist to monitor the research process and create a feedback loop from the ethicist to the funding institution. (shrink)

A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in (...) tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls’s original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy. (shrink)

Thomas Alured Faunce, College of Law, Fellows Road, Acton, Canberra ACT 0200, Australian National University, Fax: 61 2 61253971, Email: Thomas.Faunce{at}anu.edu.au ' + u + '@' + d + ' '//-->This paper sets out to analyse three different academic proposals for addressing the needs of the poor in relation to new, rather than ‘essential’ medicines. It focuses particularly on research and development prize funds, a health impact fund system and a multilateral treaty on health technology cost-effectiveness evaluation and competitive (...) tender. It compares the extent to which each responds to the ‘market fundamentalist’ philosophy and begins to analyse their respective strengths and weaknesses. CiteULike Connotea Del.icio.us What's this? (shrink)

The Turning Point Initiative is an initiative for which the Robert Wood Johnson and W.K. Kellogg foundations partnered in order to fund a group of states and a number of communities within each of those states to work through a planning process to look at ways to strengthen their public health systems at the state and local levels. Out of that process, the states and communities would come together at the national level to talk about what they had been learning (...) and what the issues were. There were a number of issues that resonated with all of the states. (shrink)

The Turning Point Initiative is an initiative for which the Robert Wood Johnson and W.K. Kellogg foundations partnered in order to fund a group of states and a number of communities within each of those states to work through a planning process to look at ways to strengthen their public health systems at the state and local levels. Out of that process, the states and communities would come together at the national level to talk about what they had been learning (...) and what the issues were. There were a number of issues that resonated with all of the states. (shrink)

A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in (...) tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy. (shrink)