Coggon’s remarks on a previous paper on active and passive euthanasia elicit a clarification and an elaboration of the argument in support of the claim that there is a moral difference between killing and letting die. The relevant moral duties are different in nature, strength and content. Moreover, not all people who are involved in the relevant situations have the same moral duties. The particular case that is presented in support of the claim that to kill is not the same (...) as to let die is based upon a rejection of consequentialism. (shrink)

The nature and significance of equity and equality in relation to health and healthcare policy is discussed in the light of a recent article by Culyer. Culyer makes the following claims: the importance of equity in relation to the provision of health care derives from the human need for health in order to flourish; and for the sake of equity, equality of health among the members of particular political jurisdictions should be the aim of health policy. Both these claims are (...) challenged in this paper.The argument put forward is that it is only when needs arise and are met in particular contexts that need and equity are fused. The state and its agents and agencies should distribute what it distributes impartially, whatever it distributes. Whether or not equity applies to the distribution of healthcare services depends on how they are provided and not on their nature as “primary goods”. Contrary to what Culyer suggests, a policy of trying to produce the outcome of health equality would be inequitable. It would not be impartial and it would fail to treat persons as persons ought to be treated. (shrink)

This is a continuation of and a development of a debate between John Keown and me. The issue discussed is whether, in Britain, an unpaid system of blood donation promotes and is justified by its promotion of altruism. Doubt is cast on the notions that public policies can, and, if they can, that they should, be aimed at the promotion and expression of altruism rather than of self-interest, especially that of a mercenary sort. Reflections upon President Kennedy's proposition, introduced into (...) the debate by Keown, that we should ask not what our country can do for us but what we can do for our country is pivotal to this casting of doubt. A case is made for suggesting that advocacy along the lines which Keown presents of an exclusive reliance on a voluntary, unpaid system of blood donation encourages inappropriate attitudes towards the provision of health care. Perhaps, it is suggested, and the suggestion represents, on my part, a change of mind as a consequence of the debate, a dual system of blood provision might be preferable. (shrink)

Now, we can draw a conclusion on the matter of the necessity of angādhikāra in Pā $$ \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{n}$$ ini's grammar. We have seen that angādhikāra constitutes a very important section of the grammar where the relation of the suffixes and their bases is crucial. We also have observed that the concept of anga cannot be separated from Pā $$ \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{n}$$ ini's system due to its being a part of many sūtras as well as many paribhā $$\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{s}$$ ās. We have also (...) seen that at least three exclusive prayojanas exist for the justification of angādhikāra. Another justification can be given in the form of preventing the double samprasāra $$ \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{n}$$ a in forms like vavraś which we discussed while determining the limit of angādhikāra. We saw that three important paribhā $$\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{s}$$ ās, which are accepted by Patañjali, depend on angādhikāra. Finally we saw that an alternative suggested by Patañjali for angādhikāra is in no way better, but actually defective.Kātyāyana's use of angādhikāra in other sections to counter some objections has been shown too. Patañjali's apparent rejection of angādhikāra on the basis of Kātyāyana's vārtika on ‘angasya’ (6-4-1) is not supported by his own treatment of the subject in other places. So, we conclude that Patañjali did not really intend to refute the angādhikāra and the view which appears in his commentary on 6-4-1 should not be taken as his siddhānta on this matter. Tasmād angādhikāra iti bhagavato gūdho 'bhisandhir iti bhāvah. Naitāni ity ādi grantha $$\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{h}$$ ekadeśyuktir iti tātparyam. Nāgeśa, ‘Uddyota’, MB, Vol. 5, p. 273.Thus the necessity of angādhikāra in Pā $$ \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{n}$$ ini's A $$\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{s}$$ $$\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\cdot}$}}{t}$$ ādhyāyī is established. (shrink)

Death of motor neurones following invasion of the central nervous system by poliovirus may result in paralysis of specific muscles. Virulence may be tested by injection into monkeys by routes which bypass natural infection. Transmissibility is also very important, but cannot be measured, only inferred. An infection may lead to immunity or paralysis. In epidemics, the highest incidence among children 0-2 years was 2% and among those over 10 years was 25%: these figures fit a model of genetic susceptibility of (...) homozygotes and heterozygotes with phenotypic susceptibility increasing with age. Hypogamma-globulinemics, some neonates and pregnant women are more susceptible than others. Intra-muscular injections may increase the risk of paralysis. Strenuous exercise and IM injections given when poliovirus has already reached the spinal cord can increase the severity of paralysis or convert a non-paralytic attack to paralysis. Although vaccines reduced polio in temperate countries, polio was thought to be no problem in the tropics. Since 1977 polio has been recognised as a massive problem in the third world: because it affects babies and very young children, it is properly infantile paralysis. (shrink)

In his paper , Culyer talks about “values” and “value judgments” in relation to equity.1 He says: “The focus is on equity in the allocation of health care resources .... These are value laden questions because any idea of “equity” must embody value judgments about what it is that makes for a good society”. He says too: “Equity in health care policy, as in other arenas of policy, is a question of ethics and therefore of values”.I disagree with this way (...) of talking: it suggests a sort of “postmodernist” moral relativism. It sounds as if there might be, say, socialist beliefs which were vouched for by socialist values while …. (shrink)

Julian Le Grand's case for saying that it would be equitable if smokers and smokers alone were to pay the costs of smoking-related health care is considered and found to be deficient.

A study of the place of human sexuality in religious systems indicates a possible universal stress on sexual attraction. This could be explained by using the theories of Richard Dawkins and other sociobiologists: the philandering male and the coy female express the best strategies for the survival of the “selfish gene.” Closer analysis of four religious systems throws doubt on these theories. In some systems the strategies are contradicted while in others there is stress on cooperative restraint rather than on (...) survival through selfish propagation. The principal objection to the sociobiological approach is its assumption of conflict between the sexes. (shrink)

The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral (...) entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies. (shrink)

The author defends himself against an attack by Smith and Bopp on his views on smoking and taxation. The theory that, on the grounds of equity and/or fairness, smokers should pay via taxation on tobacco for the health care costs of treating smoking-related medical conditions is discussed and shown to be defective. It is argued that the fundamental mistake that Smith and Bopp make is to confuse and conflate the separate issues of whether particular taxes are fair and whether they (...) are justifiable. The conclusion is reached that an excise duty on tobacco is a good tax. It is a non-fair or even an unfair tax but it is justified on grounds other than fairness. (shrink)