Responding to mounting public concern about the shift to managed care, legislation to grant patient protections has dominated the health policy agenda over the past two years. Although some policies, such as laws on maternity length of stay, can be easily dismissed as “body part by body part” micromanagement of medical practice, other initiatives offer substantive, new rights to patients across the spectrum of care. At both the state and the federal levels, the right of enrollees to appeal a denial (...) of treatment or to file grievances about other plan decisions has emerged as a centerpiece of patient protection legislation. Grievance and appeal rights have been embraced as a way to empower patients, to enhance access to treatment, and to improve the quality of care by providing an external mechanism to review treatment denials. (shrink)

From computerized medical records to databases of pharmacological interactions and automated provisional EKG readings, the emergence of information technology has significantly altered the practice of medicine. Information technology has been widely used to enhance diagnosis and treatment and to improve communication between providers. The advent of the Internet also brings far-reaching implications for patient–physician communication, challenging physicians, patients, and policymakers to consider its impact on the delivery of medical care and the therapeutic relationship. A new set of practices by patients (...) and physicians is unfolding in cyberspace, ranging from the use of e-mail to communicate between physicians and patients in an existing relationship to one-to-one consultations with an anonymous physician and ongoing online treatment, such as psychotherapy. These practices are emerging in both the for-profit and not-for-profit spheres. (shrink)

Recently, debate about the distribution of scarce organs for transplantation has focused on whether patients should have the right to place themselves on waiting lists at several transplant centers, thereby gaining an advantage over other potential recipients. This article explores the social and ethical issues raised by multiple listing, contrasting policies adopted at the national level with those implemented in New York State. It concludes by examining the implications of the debate for broader questions about entitlement and access to health (...) care. (shrink)

On November 8, 1994, Oregon became the first state in the nation to legalize assisted suicide. Passage of Proposition 16 was a milestone in the campaign to make assisted suicide a legal option. The culmination of years of effort, the Oregon vote followed on the heels of failed referenda in California and Washington, and other unsuccessful attempts to enact state laws guaranteeing the right to suicide assistance. Indeed, in 1993, four states passed laws strengthening or clarifying their ban against assisted (...) suicide. No doubt, Proposition 16 is likely to renew the effort to legalize assisted suicide at the state level.The battle over assisted suicide is also unfolding in the courts. Litigation challenging Proposition 16 on the grounds that it violates the equal protection clause is ongoing in Oregon. More significantly, three cases, two in federal courts and one in Michigan state court, have been brought to establish assisted suicide as a constitutionally protected right. (shrink)

"The book as a whole seeks to reinvigorate an academic discipline (philosophy of religion) which has fallen on hard times, and to do so by building a bridge between philosophy and empirical-historical studies of religion. The topic is both significant and timely. Too long the empiricists have been inadequately sophisticated philosophically and too long the philosophers have ignored historical data both in its breadth and depth. In not only calling for bridges between these disciplines, but actually building some, the work (...) makes a significant contribution to both." -- Alan Miller "This book is useful because it provides some insights both into the ways scholars think about various aspects of religious behavior, and also information about important features of such behavior. Both myth and philosophy are topics of great significance, and have been discussed by many philosophers and historians of religions and some anthropologists. An interesting set of questions about the nature of religion, and nature of philosophy and their relationships (and also about the nature of myth and its relationship to philosophy) is emerging at the forefront of academic discussions in departments of religion, departments of philosophy, and departments of anthropology. It contains some well-written and conceptually interesting essays." -- E. Thomas Lawson. (shrink)

Visual representation of instruments and musical practice has long been integral to the study of the iconology and archaeology of early music. Critical to any assessment of such evidence is an understanding of the authority of the artist, and his/her knowledge and degree of participation in musical culture. Contemporary sources reveal that music played a variety of roles in the lives and public perception of the Renaissance artists. Its most tangible manifestation was that of the artist-musician, of whom Leonardo da (...) Vinci is one of the best-known examples. An association with courtliness was one of several markers of status conferred by musical practice. This chapter investigates the domestic setting of the artist, whether in a courtly environment or in a republic, to develop themes of the social elevation of the artist, entertainment and performance, as well as creativity. (shrink)

Friesen et al. (2023) article explores tensions within institutional review boards (IRBs) when they aim both to protect participants from harm and to include under-represented populations in clinic...

Mill's discussion of ‘the internal sanction’ in chapter III of Utilitarianism does not do justice to his understanding of internal sanctions; it omits some important points and obscures others. I offer an account of this portion of his moral psychology of motivation which brings out its subtleties and complexities. I show that he recognizes the importance of internal sanctions as sources of motives to develop and perfect our characters, as well as of motives to do our duty, and I examine (...) in some detail the various ways in which these sanctions give rise to motivating desires and aversions. (shrink)

Quantum field theories containing massless particles are divergent not just in the ultraviolet but also in the infrared. Infrared divergences are typically regarded as less conceptually problematic than ultraviolet divergences because there is a cancellation mechanism that renders measurable physical observables such as decay rates and cross-sections infrared finite. In this article, I scrutinize the restriction to measurable physical observables that is required to arrive at infrared finite results. I argue that the restriction does not necessitate a retreat to operationalism (...) about the meaning of the theory, but it does call attention to underappreciated features of the infrared regime. (shrink)

In a well-known passage in chapter V of On Liberty, J. S. Mill notes that while economic competition is generally socially beneficial and should be permitted, this “Free Trade” doctrine does not follow from the liberty or harm principle because “trade is a social act.” In a largely overlooked passage in chapter IV of the same essay, however, Mill contends that for society to coercively prohibit the practice of piecework – paying workers by the unit rather than by the hour (...) or day – does violate this principle. In this short note, I demonstrate that Mill's reasoning in these two passages is contradictory. (shrink)

In the fourteenth paragraph of the fifth chapter of Utilitarianism, J. S. Mill writes that ‘We do not call anything wrong, unless we mean to imply that a person ought to be punished in some way or other for doing it; if not by law, by the opinion of his fellow-creatures; if not by opinion, by the reproaches of his own conscience.’ I criticize the attempts of three commentators who have recently presented act-utilitarian readings of Mill – Roger Crisp, David (...) Brink, and Piers Norris Turner – to accommodate this passage. (shrink)

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it (...) does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers. (shrink)

This timely book examines the complex and varied relations between educational institutions and societies at war. Drawn from the pages of the _Harvard Educational Review_, the essays provide multiple perspectives on how educational institutions support and oppose wartime efforts. As the editors of the volume note, the book reveals how people swept up in wars “reconsider and reshape education to reflect or resist the commitments, ideals, structures, and effects of wartime. Constituents use educational institutions to disseminate and reproduce dominant ideologies (...) or to empower and inspire those marginalized.” A wide-ranging volume that addresses issues of vital importance within the United States and throughout the world, _Education and War_ fills a crucial void in our understanding of education and its critical role in society. (shrink)

[The Catcher in the Rye's] catalogue of characters, incidents, expressions could be extended indefinitely, all of them suggesting that Holden's sickness of soul is something deeper than economic or political, that his revulsion at life is not limited to social and monetary inequities, but at something in the nature of life itself - the decrepitude of the aged, the physical repulsiveness of the pimpled, the disappearance and dissolution of the dead, the terrors of sex, the hauntedness of human aloneness, the (...) panic of individual isolation. Headlines about Korea, Dean Acheson, and the cold war seem, if not irrelevant, essentially wide of the mark - if we define the mark as the heart and soul of Catcher. James E. Miller, Jr., author of "Henry James in Reality" and numerous books and articles on American literature, responds in this essay to Carol and Richard Ohmann's "Reviewers, Critics, and The Catcher in the Rye. The Ohmann's answer will appear in our summer issue. (shrink)

ABSTRACTIn two experiments, we explored whether anecdotal stories influenced how individuals reasoned when evaluating scientific news articles. We additionally considered the role of education level and thinking dispositions on reasoning. Participants evaluated eight scientific news articles that drew questionable interpretations from the evidence. Overall, anecdotal stories decreased the ability to reason scientifically even when controlling for education level and thinking dispositions. Additionally, we found that article length was related to participants' ratings of the news articles. Our study demonstrates that anecdotes (...) can discourage scientific reasoning while also pointing to the potential influence of article length on judgements of quality. (shrink)

This Companion offers a state-of-the-art survey of the work of John Stuart Mill – one which covers the historical influences on Mill, his theoretical, moral and social philosophy, as well as his relation to contemporary movements. Its contributors include both senior scholars with established expertise in Mill’s thought and new emerging interpreters. Each essay acts as a ‘go-to’ resource for those seeking to understand an aspect of Mill’s thought or to familiarise themselves with the contours of a debate within the (...) scholarship. The Companion is a key reference on Mill’s theory of liberty and utilitarianism, but also provides a valuable resource on lesser-known aspects of his work, including his epistemology, metaphysics, and philosophy of language. The volume is divided into six sections. Part I covers Mill’s life, his immediate posthumous reputation, and his own telling of his life-story. Part II brings together an accessible and comprehensive summary of the various influences on Mill’s thought. Part III offers an account of the foundations of Mill’s philosophy and his thought on key philosophic topics. Parts IV and V tackle issues from Mill’s moral and social philosophy. Part VI concludes with a treatment of the broader aspects of Mill’s thought, tracing his relation to major movements in philosophy. (shrink)

In working his way through his complex conception of the relation of fiction and reality, [Henry] James thus found the unconscious moral dimension inextricably embedded within "realism" itself. In following the threads of realism back to consciousness itself, James invariably found there intertwined with its roots those aspects and elements that other theorists kept carefully separate. By exploring experience to its source, he found imagination. By following objective life from "out there" to conception, he found individual vision. By following the (...) seeming oneness of the passing show back to perception, he found infinite variation and multiplicity. By following the uncolored flux and flow of events to their embodiment in the fictional medium, he found coloration of personality. And by following the "felt life" back to the artist's "prime sensibility", James found there the "moral sense" and the "enveloping air of the artist's humanity"—that which gives "the last touch to the worth of a work." James E. Miller, Jr., professor of English at the University of Chicago, is the author of A Critical Guide to Leaves of Grass; Walt Whitman; F. Scott Fitzgerald: His Art and His Technique; J.D. Salinger; Theory of Fiction: Henry James; and numerous articles on American literature and education. He contributed "Catcher In and Out of History" to Critical Inquiry, Spring 1977. (shrink)

Recruiting research participants based on genetic information generated about them in a prior study is a potentially powerful way to study the functional significance of human genetic variation, but it also presents ethical challenges. To inform policy development on this issue, we conducted a survey of U.S. institutional review board chairs concerning the acceptability of recontacting genetic research participants about additional research and their views on the disclosure of individual genetic results as part of recruitment. Our findings suggest there is (...) unlikely to be a “one-size-fits-all” solution, but rather several ethically acceptable approaches to genotype-driven recruitment, depending on context. Disclosures made during the consent process for the original study and the clinical validity of the results are key considerations. Researchers must be prepared to communicate and answer questions in clear lay language about what is known and not known regarding the role of genetics in their proposed area of research. (shrink)

This report describes the rationale, approaches, organization, and resource development leading to a large-scale deletion bin map of the hexaploid wheat genome. Accompanying reports in this issue detail results from chromosome bin-mapping of expressed sequence tags representing genes onto the seven homoeologous chromosome groups and a global analysis of the entire mapped wheat EST data set. Among the resources developed were the first extensive public wheat EST collection. Described are protocols for sequencing, sequence processing, EST nomenclature, and the assembly of (...) ESTs into contigs. These contigs plus singletons were used for selection of distinct sequence motif unigenes. Selected ESTs were rearrayed, validated by 5′ and 3′ sequencing, and amplified for probing a series of wheat aneuploid and deletion stocks. Images and data for all Southern hybridizations were deposited in databases and were used by the coordinators for each of the seven homoeologous chromosome groups to validate the mapping results. Results from this project have established the foundation for future developments in wheat genomics. (shrink)