To enhance the treatment of relations in biomedical ontologies we advance a methodology for providing consistent and unambiguous formal definitions of the relational expressions used in such ontologies in a way designed to assist developers and users in avoiding errors in coding and annotation. The resulting Relation Ontology can promote interoperability of ontologies and support new types of automated reasoning about the spatial and temporal dimensions of biological and medical phenomena.
In the last fifty years, average overall health status has increased more or less in parallel with a much celebrated decline in mortality, attributed mostly to poverty reduction, sanitation, nutrition, housing, immunization, and improved medical care. It is becoming increasingly clear, however, that these achievements were not equally distributed. In most countries, while some social groups have benefited significantly, the situation of others has stagnated or may even have worsened.If health is a prerequisite to a person functioning as an agent, (...) inequalities in health constitute inequalities in people's capability to function -- a denial of equality of opportunity. So why should a concern with health equity be singled out from the pursuit of social justice more generally? Can existing theories of justice provide an adequate account of health equity? And what ethical problems arise in evaluating health inequalities? These are some of the important questions that this book addresses in building an interdisciplinary understanding of health equity. With contributions from distinguished philosophers, anthropologists, economists, and public-health specialists, it centres on five major themes: what is health equity?; health equity and social justice; responsibilities for health; ethical issues in health evaluation; and anthropological perspectives. (shrink)
This volume provides an overview of issues arising in work on the foundations of decision theory and social choice. The collection will be of particular value to researchers in economics with interests in utility or welfare, but also to any social scientist or philosopher interested in theories of rationality or group decision-making.
This study used fMRI to investigate the neural substrates of moral cognition in health resource allocation decision problems. In particular, it investigated the cognitive and emotional processes that underpin utilitarian approaches to health care rationing such as Quality Adjusted Life Years. Participants viewed hypothetical medical and nonmedical resource allocation scenarios which described equal or unequal allocation of resources to different groups. In addition, participants were assigned to 1 of 2 treatments in which they either did or did not receive advanced (...) instructions about the principles of utilitarianism. In all cases, participants were asked to judged the proposed allocations as “fair” or “unfair.” More brain activity was observed within the superior parietal lobe, angular gyrus, middle temporal gyrus, and bilateral caudate nucleus when participants viewed scenarios depicting equal divisions of resources. Conversely, unequal resource divisions were associated with more activity in the inferior frontal gyrus and insula cortex. Furthermore, instructions about the principles of utilitarianism led to significant activation differences within the inferior frontal gyrus and the middle frontal gyrus. Significant differences in activity were also found within the inferior frontal cortex and anterior insula between medical and nonmedical scenarios. The implications for cognitive control mechanisms and the cognitive and neural bases of utilitarian ethical judgment are discussed. (shrink)
Sen’s capabilities approach offers a radical generalisation of the conventional approach to welfare economics. It has been highly influential in development and many researchers are now beginning to explore its implications for health care. This paper contributes to the emerging debate by discussing two examples of such applications: first, at the individual decision making level, namely the right to die, and second, at the social choice level. For the first application, which draws on Nussbaum’s list of capabilities, it is argued (...) that many capabilities are ambiguously or indirectly related to the right to die, but the ability to form a concept of the good life and plan one’s own life provides a direct justification for such a right. In the second application, the focus is specifically on healthcare rationing and it is argued that, although not committed to age based rationing, the capabilities approach provides a more natural justification of age related access to health care than the fair innings argument, which is often used to justify the alleged ageism inherent in quality adjusted life years maximisation. (shrink)
Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey conducted in 2015–16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of (...) children. A total of 33,422 survey women aged 15–49 were included in the analysis of maternal health care indicators, and 8246 children aged 12–23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children. (shrink)
“Radical The paper provides a survey of arguments for claims that rational agents should have transitive preferences and argues that they are not valid. The presentation is based on a chapter for the forthcoming Oxford Handbook of Rational and Social Choice.
Postulating the subcortical organization of human consciousness provides a critical link for the construal of pain in patients with impaired cortical function or cortical immaturity during early development. Practical implications of the centrencephalic proposal include the redefinition of pain, improved pain assessment in nonverbal humans, and benefits of adequate analgesia/anesthesia for these patients, which certainly justify the rigorous scientific efforts required. (Published Online May 1 2007).
The aim of this report is to present an example of a multidisciplinary Indian-Swedish co-operation on ethics in health care. It is based on a conference held in Asia Plateau, Panchgani, Maharasthra, India in 1998. The emphasis is on ethical values that are important for consumers of health care and professionals, and also for different cultures in developed and developing countries. The importance of human dignity is stressed. Sixteen recommendations are given in an appendix.
This paper uses Castoriadis’s idea of the imaginary and Agnes Heller’s conceptualization of modernity as an interplay of the historical and technological imaginations, to examine how modernity engages with the idea of development to foster a particular vision of the future as always in progression. It uses the examples of Tasmania and Kerala, in Australia and India, respectively, as case studies which challenge the dominant perception of development as a linear and progressive ideology of growth that translates into ‘the development (...) of productive forces and the rational mastery of nature’. The case studies also show how, despite the radically different paths through modernity, it is the same logics of modernity that are at work in both locations. (shrink)
The paper argues against the polarisation of the health economics literature into pro- and anti-QALY camps. In particular, we suggest that a crucial distinction should be made between the QALY measure as a metric of health, and QALY maximisation as an applied social choice rule. We argue against the rule but for the measure and that the appropriate conceptualisation of health-care rationing decisions should see the main task as the integration of competing and possibly incommensurable normative claim types. We identify (...) the main types as consequences, rights, social contracts, individual votes and community values and note situations in which the contribution of each claim type is limited. We go on to show that the integration of (at least some of) these claim types can be formalised within the mathematical framework provided by non-linear programming. (shrink)
The paper compares use of willingness to pay values with multi-attribute utility as ways of modelling social choice problems in the environment. A number of reasons for moving away from willingness to pay are reviewed. The view proposed is that social choice is about the integration of competing claim types (utilities, rights, social contracts and beliefs about due process). However, willingness to pay is only indirectly related to the first of these and assumes an Arrovian approach, namely one in which (...) social choice is regarded as the aggregation of people's preferences. (shrink)
Long-term vegetation dynamics based on paleo-pollen data display transient behaviour, often alternating in phase between predominant determinism and predominant 'turbulence', when viewed as a trajectory in a multivariate phase space. Given this, the metaphor of vegetation dynamics as a 'flowing stream', first introduced by Cooper in his classic 1926 paper entitled "The fundamentals of vegetation change", is re-examined and revealed to be not only useful, but strikingly realistic. Vegetation dynamic theory is reviewed and classic theories are found to reflect reality (...) poorly. It is suggested that vegetation dynamics is a far from equilibrium system, and that the application of nonequilibrium thermodynamic theory is appropriate. (shrink)
This article seeks to provide a characterization of theory prevalent in economics and found in many areas of social and natural science, particularly those that make increasing use of rational choice perspectives. Four kinds of theoretical project are identified in which empirical evidence plays a relatively small role in theory acceptance. The paper associates the minor role of evidence in theory formation and acceptance to a need to answer counterfactual questions and argues that is not necessarily incompatible with accounts of (...) science that emphasise truth in the development of theory. However, this view of economics does highlight factors that play a central role in theory acceptance which have not featured very strongly, if at all, in the philosophy of science literature. The article goes on to discuss four areas of economics that illustrate the consequences of using theory acceptance procedures which give relatively little weight to empirical testing. Benefits and costs of counterfactual science as it has developed in economics are discussed. It is concluded that there are good reasons why scientists may not use evidence in theory acceptance, even if an unintended consequence has been to strip economics of valuable empirical sensibilities still evident in natural sciences. (shrink)
This computational study generates a hypothesis for the coagulation protein whose initial concentration greatly influences the course of coagulation. Many clinical malignancies of blood coagulation arise due to abnormal initial concentrations of coagulation factors. Sensitivity analysis of mechanistic models of blood coagulation is a convenient method to assess the effect of such abnormalities. Accordingly, the study presents sensitivity analysis, with respect to initial concentrations, of a recently developed mechanistic model of blood coagulation. Both the model and parameters to which model (...) sensitivity is being analyzed provide newer insights into blood coagulation: the model incorporates distinct equations for plasma-phase and platelet membrane-bound species, and sensitivity to initial concentrations is a new dimension in sensitivity analysis. The results show that model predictions are most uncertain with respect to changes in initial concentration of factor VIII, and this hypothesis is supported by results from other models developed independently. (shrink)
In the context of multidimensional measures of well-being, a key question for policy is whether particular groups have differing priorities and are therefore likely to react differently to given economic or social shocks. We explore this issue by presenting the results of two related analyses that suggest positive answers on both counts. First, we apply reference class weights to unique data on adult capabilities in the UK and show that relative weights vary across some groupings. Furthermore, in some cases, deprivation (...) rankings of groups vary depending on which weights are used. Second, we explore possible behavioural consequences of different weights by examining the extent to which groups respond differently to three economic and social shocks (unemployment, widowhood and ill health). In this case, we find that weights and responses vary noticeably with age and region and sometimes with gender. We conclude that whilst equal weighting may be practically unavoidable when constructing indices of welfare in the absence of information on weights, their estimation from survey or experimental data is likely to be justified and may change views about policy needs or efficacy. (shrink)
The book offers a novel account of human happiness suitable for the general or popular science reader. Drawing on evidence from psychology and economics, as well as recent thinking in ethics, Happiness Explained addresses two of the most important questions to humankind, namely, what is happiness and how can we take account of this in our everyday lives? The book starts by setting out what is wrong with focussing exclusively on gross national income as a measure of wellbeing and introduces (...) a novel approach developed by Nobel prize-winner Amartya Sen. It then considers evidence relating to different aspects of wellbeing from a wide range of economics and psychological studies. It also examines issues of fairness and wellbeing, the emergence of policies and practice around the world that seek to account for human wellbeing explicitly, and the principles that underpin wellbeing over the life course. (shrink)