E. C. Tolman's 'purposive behaviorism' is commonly interpreted as an attempt to operationalize a cognitivist theory of learning by the use of the 'Intervening Variable' (IV). Tolman would thus be a counterinstance to an otherwise reliable correlation of cognitivism with realism, and S-R behaviorism with operationalism. A study of Tolman's epistemological background, with a careful reading of his methodological writings, shows the common interpretation to be false. Tolman was a cognitivist and a realist. His 'IV' has been systematically misinterpreted by (...) both behaviorists and antibehaviorists. For this reason, Tolman's alliance with modern cognitivism and his influence on its development have been underestimated. (shrink)

The quantitative problem of old evidence is the problem of how to measure the degree to which e confirms h for agent A at time t when A regards e as justified at t. Existing attempts to solve this problem have applied the e-difference approach, which compares A's probability for h at t with what probability A would assign h if A did not regard e as justified at t. The quantitative problem has been widely regarded as unsolvable primarily on (...) the grounds that the e-difference approach suffers from intractable problems. Various philosophers have proposed that 'Bayesianism' should be rejected as a research strategy in confirmation theory in part because of the unsolvability of this problem. I develop a version of the e-difference approach which overcomes these problems and possesses various advantages (but also certain limitations). I develop an alternative 'theistic' approach which handles many cases that my development of the e-difference approach does not handle. I conclude with an assessment of the significance of the quantitative problem for Bayesianism and argue that this problem is misunderstood in so far as it is regarded as unsolvable, and in so far as it is regarded as a problem only for Bayesians. (shrink)

Every healthcare organisation enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.Using, as an example, the controversy about patient’s refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency.Policy writing for morally (...) controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO’s obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy. (shrink)

This essay explores a tragic event that happened in China, which garnered much attention, the Li case: a young woman who was nine months pregnant and her baby died as a result of the failure to receive a medically necessary c-section due to the hospital having failed to secure her family's consent for the c-section. Differing from some critiques, this essay argues that the Li case should not be used to blame the Confucian family-determination model that has been applied in (...) Chinese society for thousands of years. Based on summarizing the reasons supporting the model, this essay indicates that it is an integral part of the model that, in emergency or special cases, the physician must take medical action to save the patient, without the need to secure the consent of a family member. In order to prevent tragic cases like the Li case from happening, we recommend that relevant Chinese laws be further developed and specified and that, most importantly, Chinese physicians must cultivate the Confucian virtue of benevolence in their practice of taking care of patients in a virtuous way, along with patients’ families. (shrink)

The healthcare crisis that has developed in the last two decades during China's economic reform has caused healthcare and hospital financing reforms to be largely experienced by patients as a crisis in the patient–healthcare professional relationship (PPR) at the bedside. The nature and magnitude of this crisis were epitomized by the "Harbin Scandal"—an incident that took place in August 2005 in a Harbin teaching hospital in which the family of an elderly patient hospitalized in the intensive care unit (ICU) for (...) 66 days paid over RMB ¥6 million. The news was publicized globally and ended in the firing of six top hospital administrators including the hospital president and the ICU director. This paper seeks to show that the Chinese healthcare crisis is ultimately linked to a conflict of interests between patients and healthcare professionals (HCPs), which is inherent in the reformed healthcare system of China. Hence the crisis is, at its core, a crisis of fidelity and confidence that must be restored to the PPR. At the "macro" level, it is simplistic to blame the crisis on the failure of the market system, and at the "micro" level, it is naïve to expect that a contractual understanding of the PPR will effectively restore the confidence of patients. This paper will show that the fiduciary relationship and medical professionalism share similar attributes, with fidelity being the core value of both. It concludes that the loss of medical fidelity implies the dissolution of the PPR and the demise of the medical profession and challenges Chinese HCPs to keep their fidelity as a means to both protect their patients’ interests and to preserve their profession's survival. (shrink)