M. K.T. Gallagher a entrepris la t^che difficile d'introduirele public philosophique américain dans l'univers de la pensée de Gabriel Marcel. Tâche difficile, non pas tant parce que la mentalité américaine serait plus qu'une autre réfractaire à cette pensée—on pourrait faire remarquer en effet l'influence exercée très tôt sur la formation et l'évolution de la pensée marcellienne par J. Royce—mais en raison de la nature toute particulière de la manière m≖me dont Marcel philosophe.

The article that follows is the second part of a study on Freedom prepared by the author for the International Dictionary of the Basic Terms of Philosophy and political Thought. The first half of the essay appeared in Philosophy Today, Summer 1960, pp. 126-136.

Les conflits sont consubstantiels à l’homme. Pour les régler, recourir à la justice plutôt qu’à la force permet la vie en société. Cependant, la justice étatique, rendue dans de nombreux pays par des juges non indépendants du pouvoir exécutif, est parfois erratique ou partiale, rarement réparatrice et souvent chère et lente. Comme alternative, existent des modes dits alternatifs comprenant les modes amiables (non juridictionnels) et l’arbitrage (mode quasi-juridictionnel), qui peuvent être utilisés séparément, successivement ou en parallèle. Y recourir en dépassant (...) certaines réticences permet d’éviter bien des défauts de la justice étatique, en particulier en raison de l’acceptation par les parties de la solution amiable trouvée. Ces modes alternatifs sont pratiqués le plus souvent par des avocats et ont de plus en plus la faveur des politiques publiques, tant en France qu’à l’étranger. (shrink)

Tort claims have been studied for various reasons. Several studies have found that most tort claims are not related to negligent adverse events and most negligent adverse events do not result in tort claims. Several studies have examined the disposition of tort claims to understand the likelihood of payment once a claim has been made. Still others have proposed that tort-claims trend analysis may help administrators target their quality-improvement efforts and identify problems with quality that would not otherwise be captured.In (...) this article, we conduct a tort-claims analysis to explore areas for quality improvement, specifically for patient safety, in the Veterans Health Administration. Patient safety is an increasingly highlighted aspect of health-care delivery. Failure to assure patient safety can result in bad clinical outcomes, additional costs of care, and a negative organizational image. Filing a tort claim is one way for an individual to express concern about an organization. For our analysis, we draw from resolved tort claims in the Veterans Health Administration from fiscal years 1989 to 2000. (shrink)

Uncertainty about the acceptability of the forest industry and its practices to the citizens of Mississippi provided the impetus for a study of the attitudes and perceptions of eight constituency groups toward the forest industry in the state. This study examines attitudes and perceptions of two of those groups, loggers and two environmentalists/conservationists, and finds similarities and differences. Survey data analysis finds that all groups hold similar perceptions of themes defining the forest industry and forest industry occupations but differ concerning (...) activities the industry does or does not perform well and environmental problems associated with the forest industry. Mississippi Loggers Association members hold more positive attitudes/perceptions, similar to those of the Mississippi Wildlife Federation. Attitudes/perceptions of Mississippi 2020, a small grassroots organization, differ from Mississippi Loggers Association members in all instances and from Mississippi Wildlife Federation members on some issues. (shrink)

In the United States, physicians are Increasingly functioning In the consultative role. This change in role Is undoubtedly a result of a surge in the numbers of specialists, the relative decreasing number of primary care physicians, and the emergence of tertiary care centers as primary treatment providers. This change In the style of practicing medicine has led to role confusion In attending physician-patient-consultant relationships.

Tort claims have been studied for various reasons. Several studies have found that most tort claims are not related to negligent adverse events and most negligent adverse events do not result in tort claims. Several studies have examined the disposition of tort claims to understand the likelihood of payment once a claim has been made. Still others have proposed that tort-claims trend analysis may help administrators target their quality-improvement efforts and identify problems with quality that would not otherwise be captured.In (...) this article, we conduct a tort-claims analysis to explore areas for quality improvement, specifically for patient safety, in the Veterans Health Administration. Patient safety is an increasingly highlighted aspect of health-care delivery. Failure to assure patient safety can result in bad clinical outcomes, additional costs of care, and a negative organizational image. Filing a tort claim is one way for an individual to express concern about an organization. For our analysis, we draw from resolved tort claims in the Veterans Health Administration from fiscal years 1989 to 2000. (shrink)

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)