En hommage à la longévité universitaire du sociologue et philosophe Jacques Leenhardt - professeur à l'École des hautes études en sciences sociales depuis 1966, fondateur des Archives de la critique d'art, créateur et directeur du Centre d'art contemporain de Crestet -, cet ouvrage réunit des contributions de sociologues, philosophes, artistes et écrivains qui retracent plusieurs débats marquants liés aux sciences humaines, à la littérature et aux arts, en France et aux Amériques à partir des années 1970. Le riche parcours du (...) chercheur français, né à Genève, se dessine à travers autant de rencontres intellectuelles et de sensibilités artistiques en partage--Page 4 of cover. (shrink)

Résumé Culture transgénique et art global explore la dimension géopolitique de l’art et certains enjeux actuels de l’interdisciplinarité et de la mondialisation dans le projet « Al Grano » de Pat Badani. Partant de cette capsule complexe qu’est le grain maïs, symbole traditionnel de l’identité nationale mexicaine autant que source de macro-profits de l’industrie agroalimentaire, l’artiste élabore une œuvre étrange, comme génétiquement modifiée, qui constitue une représentation du monde actuel. Le texte analyse ce nouvel hybride que constitue « Al (...) Grano », une œuvre traitant du patrimoine matériel et des vertiges de l’immatérialité et du monde virtuel, dont les contours circonscrivent un environnement « neutralisé ». (shrink)

But still I think some account has to be given of the application of CM to tides and cannon balls etc. etc. It seems to me that Einstein's and Bohr's analysis was essentially correct: we make the connection, and thus apply the mathematical statements of CM to macroscopic features of the world about us, by constructing, within the mathematical framework,. macroscopic conglomerates of the elementary particles and fields that should have the general appearance of tides and billiard, looked at from (...) a distance, and that would respond to the probings of mathematical models of measuring devices, whose "pointers" we can see from afar, in the ways that waves and billiard balls do. I think a look at how CM has been used and applied since the time of Newton and Galileo shows that the mathematical theory is linked into our experiences of the world in this nonproblematic way, and that this correspondence at this nonproblematic level is part of classical mechanics in the broad sense in which it is understood by people who use it. (shrink)

Critical analysis of the commercialization and malpractice current in the profession of medicine.

One of the sub-branches of Central Semitic, Northwest Semitic, contains a number of languages with no established hierarchical relation among them: Ugaritic, Aramaic, Canaanite, Deir Alla, and Samalian. Over the years, scholars have attempted to establish a more accurate sub-branching for Northwest Semitic or to suggest a different genetic affiliation for some languages, usually Ugaritic. In this paper, we will argue that Aramaic and Canaanite share a direct ancestor, on the basis of a number of morphosyntactic features: the fs demonstrative (...) *ðaˀt, the direct object marker *ˀayāt, the development of dative subjects with adjectival predicates, the use of the construct state with prepositions, the G imperfect inflection of geminate verbs, and the plural form of *bayt. We will also address arguments that Ugaritic is a Canaanite dialect, or that Canaanite and Ugaritic are more closely related. This proposal not only outlines a more coherent family tree for Northwest Semitic, but also accounts for numerous “Aramaic”-like features in some Canaanite dialects, primarily Biblical Hebrew, which have thus far been treated as the result of language contact in the early Iron Age. (shrink)

... The purpose of this paper is to try to clarify the extent to which consumers “value” ethical product features when making purchases by utilizing a distinctive methodology – structured choice experiments ( Louviere et al., 2000) – that What Will Consumers Pay ... Jordan J. Louviere ... \n.

Phenomenology has contributed to healthcare by providing resources for understanding the lived experience of the patient and their situation. But within a burgeoning literature on the characteristic features of illness, there has not yet been an account appropriate to describe congenital illnesses: conditions which are present from birth and cause suffering or medical threat to their bearers. Congenital illness sits uncomfortably with standard accounts in phenomenology of illness, in which concepts such as loss, doubt, alienation and unhomelikeness presuppose prior health. (...) These accounts reflect, in different ways, Maurice Merleau-Ponty’s assumption that the ways of living of the ill contain allusions to fundamental, healthy functions. The originality of congenital illness complicates this assumption and demands its own original phenomenology. In this paper, I sketch my personal experience living with a single-ventricle heart condition. While some of this story may reflect my own idiosyncratic experience, I hope that much of it will resonate with the congenital illness experience. I argue that the phenomenological literature on illness, grounded in the notion of loss, does not describe the congenital illness experience. I show how a number of other patient-centred theories of health and illness which have been influential on phenomenology can and cannot elucidate congenital illness. In particular, I consider Georges Canguilhem’s account of the normal and the pathological; debates in disability; and the notion of illness as biographical disruption. I show that congenital illness results in the preadmission of its patients to a paradoxical logic of medical palliation, one product of which is existential maturity. (shrink)

Pat White, John White; David Cooper's Illusions, Journal of Philosophy of Education, Volume 14, Issue 2, 30 May 2006, Pages 239–248, https://doi.org/10.1111/j.1.

The importance of ethical consumerism to many companies worldwide has increased dramatically in recent years. Ethical consumerism encompasses the importance of non-traditional and social components of a company's products and business process to strategic success - such as environmental protectionism, child labor practices and so on. The present paper utilizes a random utility theoretic experimental design to provide estimates of the relative value selected consumers place on the social features of products.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 35.1 (2002) 1-21 [Access article in PDF] Turning Kant Against the Priority of Autonomy: Communication Ethics and the Duty to Community Pat J. Gehrke Communication ethics scholars afford Immanuel Kant significantly less attention than one might expect. This may be because, as Robert Dostal notes, Kant argues that rhetoric merits no respect whatsoever (223). This rejection of rhetoric, Dostal writes, is grounded in the significant emphasis (...) given to Kant's concept of autonomy (232). The focus on autonomy and, hence, rhetoricians' relative neglect of Kant's ethical theory are both connected to the separation of Kant's Critique of Pure Reason (hereinafter CPuR) from his subsequent ethical and moral philosophy. Kenneth Burke writes that Kant's first critique has no ethical implications, "no 'wills,' 'oughts,' 'shoulds,' or 'thou shalt nots'... nothing but an inevitable is, a description of conditions as they necessarily are for human experience" (191; emphasis in original). Such readings lose much of the richness and complexity of Kant's thought and tend instead to produce simple moral duties, such as Mike Markel's assertion that technical communicators must be truthful.Perhaps the most critical element of Kant's work lost in our focus on autonomy is his articulation of a ground for a duty to community. While Kant makes clear the importance of community for his metaphysics in the first critique (CPuR), the importance of community in Kant's moral philosophy often is overlooked. Some scholars claim that an ethical duty to community is either rejected by Kant's emphasis on the autonomy of will or simply ignored. This article combines a reading of Kant's metaphysics of experience with his moral philosophy to articulate a communication ethic grounded in community. This argument is made in three parts: first, the community of objects in experience—the Third Analogy of Experience—is an organizing principle of and a necessary condition for the possibility of all experience; second, this metaphysical principle of community is relevant [End Page 1] to community as developed in Kant's ethical writings; and finally, Kant's own work undermines the primacy of autonomy and better supports a communication ethic grounded in a duty to community.Scholars interested in Jurgen Habermas's theory of communicative action have special reason to take note of Kant's work. Kant is not only a figure that Habermas sees reflected in his own work, 1 but a constant point of contrast. Craig Calhoun writes that much of Habermas's own philosophy emerges by rejecting Kant's epistemology and elements of his metaphysics while still giving credence to Kantian moral philosophy (2). However, like most communication scholars and philosophers, Habermas believes that autonomy governs Kantian ethics: "Formalistic ethics (Kant) binds the criterion of generality of norms to the further criterion of autonomy, that is, independence from contingent motives" (Habermas, Legitimation 89). Since autonomy excludes or represses the contingent, if our readings of Kant give primacy to autonomy we leave little room for any notion of community as manifest in experience. In no small part, it is the criticism of Kant for privileging autonomy that has given Habermasians their break from Kantian ethics. However, if we turn to the first critique to guide our reading of the moral philosophy, there is another way to understand the role of autonomy and community in Kant's thought. By linking Kant's metaphysics with his moral philosophy, this article turns Kant away from the primacy of autonomy and uses Kant's own works to argue that autonomy is but one half of an antinomy that is organized under the principle of community. Thus, this article recuperates the possibility of deploying Kantian metaphysics and moral philosophy together as grounds for a communication ethic that privileges community and recovers the value of rhetoric.For rhetorical scholars, the resistance to the priority of autonomy may be related to the frequent expression of community through appeal to commonality, sameness, or identification. Today, feminist, race, postmodern, and poststructural communication scholars are questioning the value of commonality as a ground for ethics (e... (shrink)

Pat White; Work-place Democracy and Political Education [1], Journal of Philosophy of Education, Volume 13, Issue 1, 30 May 2006, Pages 5–20, https://doi.org/10.

This study uses best–worst scaling experiments to examine differences across six countries in the attitudes of consumers towards social and ethical issues that included both product related issues (such as recycled packaging) and general social factors (such as human rights). The experiments were conducted using over 600 respondents from Germany, Spain, Turkey, USA, India, and Korea. The results show that there is indeed some variation in the attitudes towards social and ethical issues across these six countries. However, what is more (...) telling are the similarities seen and the extent to which individual variation dominates observable demographics and country-based variables. (shrink)

Therapeutic misconception involves the failure of subjects either to understand or to incorporate into their own expectations the distinctions in nature and purpose of personally responsive therapeutic care, and the generic relationship between subject and investigator which is constrained by research protocols. Researchers cannot disregard this phenomenon if they are to ensure that subjects engage in research on the basis of genuine informed consent. However, our presumption of patient autonomy must be sustained unless we have compelling evidence of serious misunderstanding. (...) This article argues that the mere expression of aspects of therapeutic misconception should not necessarily displace the presumption of subject autonomy or undermine ethical inclusion in research for at least three reasons. First, some interpretations of the empirical data do not suggest misunderstanding. Second, assessment of misestimation and optimism are delicate and value-laden, and turn quickly from questions of autonomy to questions of judgment. Third, incomplete understanding may yet be sufficient to allow a subject to engage in a substantially autonomous decision-making process. Our point is not to dismiss the possibility of genuine therapeutic misconception, but to question its frequency and fatality to the consent process. (shrink)

The most plausible type of panpsychism explains high-level consciousness as a compound of basic conscious properties instantiated by basic bottom-level physical objects. Arguments for panpsychism stand little chance in the absence of an account that makes sense of basic bottom-level experience; and explains how basic bottom-level experiences yield high-level experiences. This paper tackles the first task. It develops a method for investigating basic bottom-level experience: it identifies constraints, motivated by scientific and philosophical considerations, that force a unique account. Then it (...) applies this method, using quarks as stand-ins for basic but conscious physical objects. It concludes that quark-consciousness is maximally simple ; multiple ; and internal. (shrink)

Any panpsychism building complex consciousness out of basic atoms of consciousness needs a theory of ‘mental chemistry’ explaining how this building works. This paper argues that split-brain patients show actual mental chemistry or at least give reasons for thinking it possible. The paper next develops constraints on theories of mental chemistry. It then puts forward models satisfying these constraints. The paper understands mental chemistry as a transformation consistent with conservation of consciousness rather than an aggregation perhaps followed by the creation (...) of something in addition. The paper suggests that this kind of mental chemistry alone yields a workable panpsychism. (shrink)

Nearly all studies of consumers’ willingness to engage in ethical or socially responsible purchasing behavior is based on unconstrained survey response methods. In the present article we ask the question of how well does asking consumers the extent to which they care about a specific social or ethical issue relate to how they would behave in a more constrained environment where there is no socially acceptable response. The results of a comparison between traditional survey questions of “intention to purchase” and (...) estimates of individuals willingness-to-pay for social attributes in products reveal that simple survey questions are too “noisy” to provide operationally meaningful information and overstate intentions to a considerable extent. (shrink)

BACON.3 is a production system that discovers empirical laws. Although it does not attempt to model the human discovery process in detail, it incorporates some general heuristics that can lead to discovery in a number of domains. The main heuristics detect constancies and trends in data, and lead to the formulation of hypotheses and the definition of theoretical terms. Rather than making a hard distinction between data and hypotheses, the program represents information at varying levels of description. The lowest levels (...) correspond to direct observations, while the highest correspond to hypotheses that explain everything so for observed. To take advantage of this representation, BACON.3 has the ability to carry out and relate multiple experiments, collapse hypotheses with identical conditions, ignore differences to let similar concepts be treated as equal, and to discover and ignore irrelevant variables. BACON.3 has shown its generality by rediscovering versions of the ideal gas law, Kepler's third law of planetary motion, Coulomb's law, Ohm's law, and Galileo's laws for the pendulum and constant acceleration. (shrink)

Using touch as a medium for exploring the ways in which it is constructed by nurses, the body is here characterized by a plethora of competing and co‐existing terms: disobedient, obedient, mirroring, stigmatized, sinful, post‐mortem, sanitized, angelic, desexualized, dangerous, dominant, dominating, deceitful, submissive, disciplined, postmodern and communicative. We have tried to be provocative by juxtaposing contradictory messages and evoking conflicting emotions, and we hope that the reader will not assume that we believe everything we write, or that everything may be (...) taken only at face value. There are as many messages and meanings in the paper as each reader thinks there are. (shrink)

In this paper, I review two related lines of computational research: discovery of scientific knowledge and causal models of scientific phenomena. I also report research on quantitative process models that falls at the intersection of these two themes. This framework represents models as a set of interacting processes, each with associated differential equations that express influences among variables. Simulating such a quantitative process model produces trajectories for variables over time that one can compare to observations. Background knowledge about candidate processes (...) enables search through the space of model structures and associated parameters to find explanations of time-series data. I discuss the representation of such process models, their use for prediction and explanation, and their discovery through heuristic search, along with their interpretation as causal accounts of dynamic behavior. (shrink)

Pat White; Education, Democracy and the Public Interest, Journal of Philosophy of Education, Volume 5, Issue 1, 30 May 2006, Pages 7–28, https://doi.org/10.1111.

The evolution of reciprocal altruism probably involved the evolution of mechanisms to detect cheating and remember cheaters. In a well-known study, Mealey, Daood, and Krage (1996) observed that participants had enhanced memory for faces that had previously been associated with descriptions of acts of cheating. There were, however, problems with the descriptions that were used in that study. We sought to replicate and extend the findings of Mealey and colleagues by using more controlled descriptions and by examining the possibility of (...) enhanced altruist recognition. We also examined whether individual differences in cheating tendencies were related to cheater and altruist recognition. In the first experiment, 164 undergraduates saw 40 faces that were paired with character descriptions representing the categories of cheater, trustworthy, altruist, or neutral, for individuals who had either low or high social status. One week later participants reported which faces they recognized from the previous week (among 80 faces). Overall, the results failed to replicate the findings of Mealey and her colleagues, as there was no enhanced memory for cheaters. In addition, there was no enhanced memory for altruists, and no effect of participants’ cheating tendencies. A second experiment using a slightly different methodology produced similar results, with some evidence for enhanced memory for altruists. (shrink)

Lectures delivered and papers presented by the author at various seminars; most previously published.

On the concept of Jagannātha, Hindu deity.

Nowhere is current controversy over biological explanations for human behaviour more striking than in debates over violence. New theories are being formulated, and biological markers are being identified in new ways. The terms of discourse and debate are being changed. Violence may be represented as a pathological biological syndrome, or as natural, especially for men. Why the growing interest now in biological explanations of violence? Is the biology of violence suggestive of a new brand of biological determinism? This latter, broader (...) question poses a challenge to the argument that current biological theories of behaviour are different and better than faulty, often racist and eugenicist, theories which have gone before. New theories do not reduce to linear cause-and-effect explanations, and there are no `genes for crime'. Nevertheless, there is a question of geneticism, `the doctrine of the primacy of the genetic make-up in determining every aspect of the human mind, constitution and social behaviour...' (Medawar, 1984: 255). (shrink)

Because psychiatry deals specifically with ‘mental’ suffering, its efforts are always centrally involved with the meaningful world of human reality. As such, it sits at the interface of a number of discourses: genetics and neuroscience, psychology and sociology, anthropology, philosophy, and the humanities. Each of these provides frameworks, concepts, and examples that seek to assist our attempts to understand mental distress and how it might be helped. However, these discourses work with different assumptions, methodologies, values, and priorities. Some are in (...) dispute with one another. At various times in the history of psychiatry, a particular form of understanding has become dominant and worked to marginalize .. (shrink)

Phenomenology has a rich tradition of interpreting technology, medicine, and the life sciences. It has not yet had much to say about the medical devices which have always been central to bioethics. In this chapter, I outline what is meant by medical devices, and connect the sense of intention in made-object design with the notion of intentionality in phenomenology. I survey three basicways of characterising medical devices grounded in the phenomenological literature: Albert Borgmann’s device paradigm, Don Ihde’s human-machine relations, and (...) Merleau-Ponty’s body-subject. Engaging with these approaches could help bring to analyses of medical devices the uniquely whole-of-context view of which phenomenology is capable, and better inform all stakeholders about their phenomenal consequences. (shrink)

Phenomenology has a rich tradition of interpreting technology, medicine, and the life sciences. It has not yet had much to say about the medical devices which have always been central to bioethics. In this chapter, I outline what is meant by medical devices, and connect the sense of intention in made-object design with the notion of intentionality in phenomenology. I survey three basic ways of characterising medical devices grounded in the phenomenological literature: Albert Borgmann’s device paradigm, Don Ihde’s human-machine relations, (...) and Merleau-Ponty’s body-subject. Engaging with these approaches could help bring to analyses of medical devices the uniquely whole-of-context view of which phenomenology is capable, and better inform all stakeholders about their phenomenal consequences. (shrink)

This study uses best–worst scaling experiments to examine differences across six countries in the attitudes of consumers towards social and ethical issues that included both product related issues (such as recycled packaging) and general social factors (such as human rights). The experiments were conducted using over 600 respondents from Germany, Spain, Turkey, USA, India, and Korea. The results show that there is indeed some variation in the attitudes towards social and ethical issues across these six countries. However, what is more (...) telling are the similarities seen and the extent to which individual variation dominates observable demographics and country-based variables. (shrink)

This peer commentary opens with setting the context for decisions on the edge of viability through an autoethnographic account (Bochner and Ellis 2016) of the author’s experience of such a situatio...

In lieu of an abstract, here is a brief excerpt of the content:Feminist Perspectives on Bioethics*Pat Milmoe McCarrick (bio) and Martina Darragh (bio)The literature of feminist bioethics has flourished in the last decade. Women’s health care, women’s role both as patient and health care professional, the many new reproductive technologies, the exclusion of women as research subjects, as well as the broader topic of feminist contributions to ethical theory itself, have all become topics of interest for feminist bioethical writers.Although feminism (...) is anything but a monolithic enterprise, Karen Lebacqz’ essay on feminism in the new, revised Encyclopedia of Bioethics (II A, 1995) says that “all feminists agree that women are oppressed and this oppression is wrong.” Rosemarie Tong refines this statement to include variations of feminism: “... feminist theory is not one, but many theories or perspectives and... each feminist theory or perspective attempts to describe women’s oppression, to explain its causes and consequences, and to prescribe strategies for women’s liberation” (VII, Tong 1989). She describes different feminist views in Feminine and Feminist Ethics (II A, 1993), labelling them liberal, Marxist, radical, psychoanalytic, socialist, existentialist, and postmodern. Alison Jaggar critiques these different forms of feminism in Feminist Politics and Human Nature, and Susan Sherwin applies these perspectives to the field of bioethics in No Longer Patient: Feminist Ethics and Health Care.One of the central activities in current feminist bioethics is a revisitation of ethical theory itself. There is a distinction between “feminine” and “feminist” ethics in this field (II A, Tong 1993). “A feminine approach to ethics consists of observations of how the traditional approaches to ethics fail to fit the moral experiences and intuitions of women. In contrast, a feminist approach to ethics applies a specifically political perspective and offers suggestions of how ethics must be revised if it is to get at the patterns of dominance and oppression as they affect women” (IV, Sherwin 1992). Carol Gilligan’s two books, In a Different Voice and Mapping the Moral Domain, Nel Noddings’s Caring: A Feminine Approach to Ethics and Moral Education, and Virginia Held’s Feminist Morality: [End Page 85] Transforming Culture, Society, and Politics can be thought of as feminine critiques of contemporary ethics.Gilligan’s notion of the “ethics of care” has served as a point of departure for a discussion of a type of relational ethics that focuses on concrete experiences, pairs emotions with reason, and balances justice with care. This “ethics of care” has been both celebrated and criticized. The concept of “care” in ethics dates back to the “cura” tradition of care in ancient Rome and was further developed by philosophers Soren Kierkegaard and Martin Heidegger and psychologists Rollo May and Erik Erikson. Nursing theorists have built on this tradition both in theory and in practice (II A, Reich, Care, Encyclopedia of Bioethics, 1995). “Care” often is discussed in opposition to the liberal notion of “justice” (III, Sterba, Justice, Encyclopedia of Bioethics, 1995).Gilligan’s theory was developed to provide a counter model to Lawrence Kohlberg’s six steps in the development of a human moral nature: (1) acting to avoid punishment, (2) acting to promote reciprocity, (3) conforming to get approbation, (4) respecting authority to maintain social order, (5) acting freely if others are not harmed, and (6) following self-legislated, self-imposed, universal principles of justice, reciprocity, and respect for the dignity of humans as individuals. In contrast, Gilligan holds that the moral self is an individual working with other individuals to identify mutually agreeable solutions to thorny human relations problems. Gilligan called Kohlberg’s the male moral point of view as an ethics of justice and hers the female moral view as an ethics of care. Her levels are (1) inward-directed care, (2) other-directed care subjugating personal wants and needs to others (eventually leading to anger), (3) a philosophy of care that balances egoism and altruism, recognizing the women’s connection to others and theirs to her.According to Jocelyn Downie and Susan Sherwin (IV, 1993), oppression, as used by feminists, is understood as an interlocking series of restrictions and barriers that reduce the options available to members of a group defined by morally insignificant characteristics, here gender. The literature itself can be... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Just Share: Justice and Fairness in Resource Allocation*Pat Milmoe Mccarrick (bio) and Martina Darragh (bio)Each of us has some basic sense of what the words “fair” or “just” or “fairness” or “justice” mean. Each of us probably also has an idea of what is “fair” in health care. The attempt by the state of Oregon in the mid-1980s to quantify this notion made a previously private exercise a (...) public one. This transition has been chronicled in the bioethics literature that focuses on resource allocation. These works examine both theories of justice and concepts of “health”; the fair distribution of health resources has been of continuing interest since the beginning of bioethics in the 1960s. Early writing on justice includes authors Tom L. Beauchamp, Robert H. Blank, James F. Childress, H. Tristram Engelhardt, Paul T. Menzel, Paul Ramsey, and Robert M. Veatch (VII).During the 1980s, bioethicists such as Daniel Callahan and Norman Daniels proposed thinking of health care decisions not as moments of personal crisis but as choices that span a lifetime, possibly involving tradeoffs in other areas of one’s life, e.g., education. The Oregon experience added another dimension to the discussion. The initial rank-ordering of health services by cost produced a skewed list—for example, surgery for life-threatening conditions ranked below minor, elective procedures. For the project to make sense, the ranking algorithm could not be based on cost alone, but rather on a combination of costs and benefits both to individuals and to the community—“concatenations of individual and group goods” (I, Jecker and Jonsen 1995). Various metaphors have been used in the literature to facilitate discussion of this shift from individual to individual/community trade-offs: medical services as a “commons” (I, Asch 1995, Jecker and Jonsen 1995, Michels 1994); resource allocation as a “lifeboat” (I, Campbell 1995; III, Kaveny 1994); medical care as “shares” in a community health (III, Nelson 1992, Ford and Kissick 1995; II, Anderson 1993); and rationing as traveling through the desert with one jug of water for two people (a story from the Halachah literature) (I, Zoloth-Dorfman 1995). [End Page 81]Such metaphors do not promote any one “theory of justice” but rather draw from the work of a number of bioethicists as well as from theological, sociological, economic, and business literature. The five major conceptions of justice that are referenced most frequently are: “(1) a libertarian conception, which takes liberty to be the ultimate political ideal; (2) a socialist conception, which takes equality to be the ultimate political ideal; (3) a welfare liberal conception, which takes contractual fairness or maximal utility to be the ultimate political ideal; (4) a communitarian conception, which takes the common good to be the ultimate political ideal; and (5) a feminist conception, which takes a gender-free society to be the ultimate political ideal” (I, Sterba 1995).The use of new metaphors also draws on expanded concepts of “health.” “As health care is currently practiced, the most powerful symbols for public and professional alike are those that promise the defeat of time” (I, Campbell 1995). When medical care is perceived as an unrelated series of individual cures, the fact that health care resources are finite cannot be addressed.Reflections concerning the difficulties in limiting the use of health care resources have an ancient lineage and reveal a tight bond with the obsession to postpone death at all costs. Plato in Book 3 of the Republic recognizes the quandary of infinite expectations and finite resources that characterizes the challenge of health care choices. (I, Engelhardt 1996)The proliferation of expensive medical technologies and the loss of autonomy by health care professionals further complicates perceptions of the crucial issues at hand. Some have said that Americans place too much emphasis on individualism to address these issues. Daniels et al. believe that this is too pessimistic a view and that the American commitment to protecting equal opportunity for all provides a firm basis for developing a public consensus on what is fair in health care (III, Daniels, Light, and Caplan 1996). Finally, several authors suggest that the nature of all four principles of medical ethics, not justice alone, must be... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managed Health Care: New Ethical Issues for All*Martina Darragh (bio) and Pat Milmoe McCarrick (bio)Changes in the way that health care is perceived, delivered, and financed have occurred rapidly in a relatively short time span. The 50-year period since World War II encompasses enormous growth in medical technology, soaring health care costs, and significant fragmentation of the two-party patient- physician relationship. This relationship first grew to include the third-party (...) payer, the health insurance industry, and now “with great speed and relatively little public awareness, a significant change has occurred in the way some decisions are made about a patient’s medical care” (III, Institute of Medicine 1989).The new means of providing health care bring an increasing number of parties into clinical decision-making processes. With this change, ethical issues that once concerned only health care professionals, the physician or the nurse, have expanded to include the patient and the groups who “manage” care—e.g., health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service groups (POSs), independent practice associations (IPAs), insurance reviewers, hospital administrators, institutional managers, and, the most recent players, purchasers of group health care who base their decisions on competitive pricing.The term “managed care” refers to a variety of continually adapting and developing arrangements that involve four groups. These groups, which have been labeled by the world of business, not health, are the “consumer” (once the patient), the “provider” (the physician and other health care professionals), the “insurer” (the reimburser for any care), and the “purchaser of care” or the primary buyer of health services (the large employer organization). Capitation is a common way to pay for health services in managed care systems. A certain dollar amount is negotiated for health services for a specified number of patients whether the care is delivered or not; the provider shares with the [End Page 189] insurer any financial risk for the actual cost of care (III, Centers for Disease Control 1995).When the Clinton administration’s health care reform movement failed to gain support in the U.S. Congress, the use of managed care to control rising health care costs accelerated. The literature on managed care and its effect on the patient-physician relationship reflects this shift. During the era of health care reform, “debate centered on how managed care could control costs, on the use of technology and patient satisfaction, [and] on access and barriers to care” (IV, Emanuel and Dubler 1995). When managed care organizations began contracting with physicians to provide health care services subject to the plans’ provisions, these plans became agents in clinical decision making on a wide-spread basis. HMO enrollment grew to 51 million persons by 1994 (III, Centers for Disease Control 1995). This “corporatization” of health care has sparked a plethora of articles about the effects of the marketplace on the physician’s ability to do what is best for the patient, and on the patient’s ability to trust the physician to do so.Many authors make it clear that managed care itself is not the problem, but rather the development of for-profit managed care plans by “corporate conglomerates with billions of dollars in assets that compensate their executives as grandly as basketball players” (V, Kassirer 1995) “in a marketplace that is largely unregulated” (I, Zoloth-Dorfman and Rubin 1995). “Some, mostly older plans that were created when cost containment was an unexpected benefit rather than their central purpose, deliver high-quality care economically. Unfortunately, others cut costs by recruiting the healthiest patients, excluding the sickest, rationing care by making it inconvenient to obtain, and denying care by a variety of mechanisms” (V, Kassirer 1995).These cost-containment features now play an intimate role in clinical practice. When a managed care plan contracts with a physician, the doctor becomes a “double agent” with contractual obligations to the plan to provide a preset amount of services and professional responsibilities to each patient to authorize necessary treatment (V, Angell 1993). This duality can undermine the physician’s fiduciary responsibility to the patient wherein the physician “has power over the affairs of [the patient]...and is required by law to act on that person’s... (shrink)

Henry re. your recent reply to Aaron. OK, current physics does not allow us to retreat into a comfortable assumption of Newtonian regularity. However, given the following range of options, I know which I find the 'spookiest'.