Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H-2-antihistamines by general practitioners, internists and "astroenterologists were obtained from the Belgian (...) national health insurance database (1997-2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the Iona term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care. (shrink)
Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices, knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in Flanders, (...) Belgium. Nurses, care assistants and allied care staff completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels, as part of a cluster randomized controlled trial. Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated. After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations and documented advance care planning ; differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses ; 95% confidence interval 0.08–0.17; p < 0.001) and allied staff scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)
International Rules brings together exemplary works from the most prominent approaches to international rules of International Law and International Relations disciplines. Included are chapters on Natural Law, Legal Positivism, Classical Realism, the New Haven School, Institutionalism, Structural Realism, the New Stream, and Feminist Voices. Each of the eight chapters begins with a brief overview, offers a representative work or works, and concludes with a selected bibliography. From Hugo Grotius to David Kennedy, from George Kennan to Robert Keohane, the featured (...) authors provide valuable insights into their common subject: international rules. Despite divergent methods and objectives, they address fundamentally the same questions: What is the nature of such rules? What is their purpose? How do they originate? What role, if any, do they play in politics? Framing the selections assembled are two original chapter-length essays. The first chapter of this volume assesses the prospects for interdisciplinary collaboration; the final one suggests a direction for future research. (shrink)
Oxford Studies in Ancient Philosophy is an annual publication which includes original articles, which may be of substantial length, on a wide range of topics in ancient philosophy, and review articles of major books. Contributors to this volume; Paul A. Vander Waerdt, Christopher Rowe, Rachel Rue, Paula Gottlieb, Robert Bolton, and John M. Cooper.
The relationship between love/care and justice was one of the key tensions from which care ethics originated; to this very day it is subject of debate between various streams of thought within care ethics. With some exceptions most approaches have in common the belief that care and justice are mutually exclusive concepts, or at least as so different that their application is situated on different levels. Hence, both are complementary, but distinct, so that there is no real interaction. This paper (...) aims to investigate whether, and if so, how, a deeper understanding of Ricoeur’s thoughts on this matter enriches the relationship between care and justice with respect to care ethics. This connection suggests itself from Ricoeur’s interpretation of the relationship as a dialectical one in which the logic of superabundance and the logic of equivalence meet. Care enables people to see the face and individuality of the one, ‘le chacun,’ within the anonymous structures of justice that tend to reduce all human beings to the anonymous each, ‘le on’; justice in its turn is the precondition for love to become incarnated and made real. What may this view—of care and justice standing in close connection, in which they correct and strengthen each other—add to the understanding of concrete practices of care? (shrink)
Drawing on Aristotle’s notion of “ultimate responsibility,” Robert Kane argues that to be exercising a free will an agent must have taken some character forming decisions for which there were no sufficient conditions or decisive reasons.<sup>1</sup> That is, an agent whose will is free not only had the ability to develop other dispositions, but could have exercised that ability without being irrational. To say it again, a person has a free will just in case her character is the product (...) of decisions that she could have rationally avoided making. That one’s character is the product of such decisions entails ultimate responsibility for its manifestations, engendering a free will. (shrink)
Several themes of David Lewis's theory of counterfactuals, especially their sensitivity to context, pave the way for a viable theory of non-trivial counterpossibles. If Lewis was successful in defending his account against the early objections, a semantics of counterpossibles can be defended from similar objections in the same way. The resulting theory will be extended to address 'might' counterfactuals and questions about the relative "nearness" of impossible worlds.
Drawing on Aristotle’s notion of “ultimate responsibility,” Robert Kane argues that to be exercising a free will an agent must have taken some character forming decisions for which there were no sufficient conditions or decisive reasons. That is, an agent whose will is free not only had the ability to develop values and beliefs besides those that presently make up her motives, but could have exercised that ability without being irrational. An agent wills freely, on this view, by beingultimately (...) responsible for how she is currently disposed to act. Kane needs, then, to show how an agent could be responsible for decisions that her deliberations did not guarantee. He must also explain how a decision for which there is no decisive reason could yet be rational, assuming that the responsibility engendering decisions forming the basis of a free will would be rational. I shall argue here that Kane has achieved neither of these goals. (shrink)
Whether certain objects compose a whole at a given time does not seem to depend on anything other than the character of those objects and the relations between them. This observation suggests a far-reaching constraint on theories of composition. One version of the constraint has been explicitly adopted by van Inwagen and rules out his own answer to the composition question. The constraint also rules out the other well-known moderate answers that have so far been proposed.
[Robert Stalnaker] Saul Kripke made a convincing case that there are necessary truths that are knowable only a posteriori as well as contingent truths that are knowable a priori. A number of philosophers have used a two-dimensional model semantic apparatus to represent and clarify the phenomena that Kripke pointed to. According to this analysis, statements have truth-conditions in two different ways depending on whether one considers a possible world 'as actual' or 'as counterfactual' in determining the truth-value of the (...) statement relative to that possible world. There are no necessary a posteriori or contingent a priori propositions: rather, contingent a priori and necessary a posteriori statements are statements that are necessary when evaluated one way, and contingent when evaluated the other way. This paper distinguishes two ways that the two-dimensional framework can be interpreted, and argues that one of them gives the better account of what it means to 'consider a world as actual', but that it provides no support for any notion of purely conceptual a priori truth. /// [Thomas Baldwin] Two-dimensional possible world semantic theory suggests that Kripke's examples of the necessary a posteriori and contingent a priori should be handled by interpreting names as implicitly indexical. Like Stalnaker, I reject this account of names and accept that Kripke's examples have to be accommodated within a metasemantic theory. But whereas Stalnaker maintains that a metasemantic approach undermines the conception of a priori truth, I argue that it offers the opportunity to develop a conception of the a priori aspect of stipulations, conceived as linguistic performances. The resulting position accommodates Kripke's examples in a way which is both intrinsically plausible and fits with Kripke's actual discussion of them. (shrink)
For most of the problems that economists consider, the assumption that agents are self-interested works well enough, generating predictions that are broadly consistent with observation. In some significant cases, however, we find economic behavior that seems to be inconsistent with self-interest. In particular, we find that some public goods and some charitable ventures are financed by the independent voluntary contributions of many thousands of individuals. In Britain, for example, the lifeboat service is entirely financed by voluntary contributions. In all rich (...) countries, charitable appeals raise large amounts of money for famine relief in the Third World. The willingness of individuals to contribute to such projects is an economic fact that requires an explanation. (shrink)
Among moral attributes true virtue alone is sublime. … [I]t is only by means of this idea [of virtue] that any judgment as to moral worth or its opposite is possible. … Everything good that is not based on a morally good disposition … is nothing but pretence and glittering misery. 1.
Neither the existence of God nor the nature of God is apparent or obvious. If God exists, why is it not entirely clear to everyone that this is so? How can theists explain God's hiddenness, and how plausible are their explanations? God, if God exists, is an omnipotent, morally good, omnipresent being, than whom none greater can be conceived. Surely it is well within the abilities of God to let God's existence and nature be known to us. Why isn't the (...) existence and nature of our Heavenly Father as apparent as, say, the existence of our various earthly fathers? (shrink)
Plausibly, no agent ever performs an action without some desire to perform that action. If so, a regress argument shows that, given incompatibilism, we are only rarely free. The argument sidesteps recent objections to this thesis.
Robert Owen was one of the most extraordinary Englishmen who ever lived and a great man. In a way his history is the history of the establishment of modern industrial Britain, reflected in the mind and activities of a very intelligent, capable and responsible industrialist, alive to the best social thought of his time. The organisation of industrial labour, factory legislation, education, trade unionism, co-operation, rationalism: he was passionately and ably engaged in all of them. His community at New (...) Lanark was the nearest thing to an industrial heaven in the Britain of dark satanic mills; he tried to found a rational co-operative community in the USA. In everything he contemplated, he saw education as a key. This selection of his writings on education illustrates his rationalist concept of the formation of character and its implications for education and society; also his growing utopian concern with social reorganisation; and third, his impact on social movements. Silver's introduction shows Owen's relationship to particular educational traditions and activities and his long-term influence on attitudes to education. (shrink)
The contemporary explosion of information makes intellectual responsibility more needed than ever. The uncritical tend to believe too much that is unsubstantiated; the overcritical tend to believe too little that is true. A central problem for this paper is to formulate standards to guide an intellectually rigorous search for a mean between excessive credulity and indiscriminate skepticism. A related problem is to distinguish intellectual responsibility for what we believe from moral responsibility for what we do. A third problem is how (...) to square intellectual responsibility in retaining our views with the realization that peers we respect disagree with us. Much of the paper is directed to articulating principles for dealing with such disagreements. (shrink)
A standard objection to act utilitarian theories is that they are not helpful in deciding what it is morally permissible for us to do when we actually have to make a choice between alternatives. That is, such theories are worthless as decision procedures. A standard reply to this objection is that act utilitarian theories can be evaluated solely as theories about right-making characteristics and, when so evaluated, their inadequacy as decision procedures is irrelevant. Even if somewhat unappealing, this is an (...) effective reply to the standard objection. (shrink)
A recently advanced argument for purgatory hinges on the need for complete sanctification before one can enter heaven. The argument has a modal gap.The gap can be exploited to fashion a competing account of how sanctification occurs in the afterlife according to which it is in part a heavenly process.The competing account usefully complicates the overall case for purgatory and raises questions about how the notion ought to be understood.
A significant feature of John Stuart Mill's moral theory is the introduction of qualitative differences as relevant to the comparative value of pleasures. Despite its significance, Mill presents his doctrine of qualities of pleasures in only a few paragraphs in the second chapter of Utilitarianism, where he begins the brief discussion by saying: utilitarian writers in general have placed the superiority of mental over bodily pleasures chiefly … in their circumstantial advantages rather than in their intrinsic nature.… [B]ut they might (...) have taken the … higher ground with entire consistency. It is quite compatible with the principle of utility to recognize the fact, that some kinds of pleasure are more desirable and more valuable than others. It would be absurd that while, in estimating all other things, quality is considered as well as quantity, the estimation of pleasures should be supposed to depend on quantity alone. (shrink)
Formal axiology is based on the logical nature of meaning, namely intension, and on the structure of intension as a set of predicates. It applies set theory to this set of predicates. Set theory is a certain kind of mathematics that deals with subsets in general, and of finite and infinite sets in particular. Since mathematics is objective and a priori, formal axiology is an objective and a priori science; and a test based on it is an objective test based (...) on an objective standard.1. (shrink)
The situationist challenge to global character traits claims that on the basis of findings in social psychology, we should only accept at most the existence of local or context-sensitive traits. In this article I explore a neglected area of J. S. Mill's work to outline an account of context-sensitive traits. This account of traits, coupled with a sophisticated consequentialist ethical framework, suggests an interesting view on which persons govern the circumstances of their actions in order to best promote overall well-being.
Robert Kane provides a critical overview of debates about free will of the past half century, relating this recent inquiry to the broader history of the free will issue and to vital currents of twentieth century thought. Kane also defends a traditional libertarian or incompatibilist view of free will, employing arguments that are both new to philosophy and that respond to contemporary developments in physics and biology, neuro science, and the cognitive and behavioral sciences.
In his paper ‘Miracles: metaphysics, physics, and physicalism’, 1 Kirk McDermid appears to have two primary goals. The first is to demonstrate that my account of how God might produce a miracle without violating any laws of nature is radically flawed. The second is to suggest two alternative accounts, one suitable for a deterministic world, one suitable for an indeterministic world, which allow for the occurrence of a miracle without violation of the laws of nature, yet do not suffer from (...) the defects of what McDermid terms the ‘Larmerian’ model. I briefly describe my model, reply to McDermid's criticism of it, and evaluate his alternative accounts. (shrink)
The best arguments for possible worlds as states of affairs furnish us with equally good arguments for impossible worlds of the same sort. I argue for a theory of impossible worlds on which the impossible worlds correspond to maximal inconsistent classes of propositions. Three objections are rejected. In the final part of the paper, I present a menu of impossible worlds and explore some of their interesting formal properties.
A companion volume to In the Realm of Organization, this book explores in detail the intricate relationships that exist between technology, representation and organization from a diversity of perspectives, relocating the study of organization in wider social theory.
I have been arguing, for almost thirty years now, that emotions have been unduly neglected in philosophy. Back in the seventies, it was an argument that attracted little sympathy. I have also been arguing that emotions are a ripe for philosophical analysis, a view that, as evidenced by the Manchester 2001 conference and a large number of excellent publications, has now become mainstream. My own analysis of emotion, first published in 1973, challenged the sharp divide between emotions and rationality, insisted (...) that we reject the established notion that the emotions are involuntary, and argued, in a brief slogan, that ‘emotions are judgments.’ Since then, although the specific term ‘judgment’ has come under considerable fire and my voluntarist thesis continues to attract incredulousness the general approach I took to emotions has been widely accepted in both philosophy and the social sciences. When Paul Griffiths took on what he misleadingly characterized as ‘propositional attitude’ theories of emotion as the enemy of all that was true and scientifically worthy, I knew that we had made it. Such ferocious abuse is surely a sign that we had shifted, in Kuhnian terms, from being revolutionary to becoming the ‘normal’ paradigm. The current counter-revolution of affect programmes and neuro-reductionism says a lot about who we are and how far we have come. (shrink)
Maximizing want-satisfaction per se is a relatively unattractive aspiration, for it seems to assume that wants are somehow disembodied entities with independent moral claims all of their own. Actually, of course, they are possessed by particular people. What preference-utilitarians should be concerned with is how people's lives go—the fulfilment of their projects and the satisfaction of their desires. In an old-fashioned way of talking, it is happy people rather than happiness per se that utilitarians should be striving to produce.