The prelims comprise: Introduction The Physician and the Provider Organization The Physician and the Payer Organization Dealing with Systems Conclusion Notes References.

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total QualityManagement, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, (...) and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system. (shrink)

The problem is a simple one. A placebo is “a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated” (AMA 2007). 1 But i...

Originally published in 1908, this book contains six essays on various aspects of the Platonic theory of knowledge as expounded in the later dialogues reviewed by Aristotle. The text was written during the author's period as Marion Kennedy Student at Newnham College, Cambridge. Textual notes are also included. This book will be of value to anyone with an interest in Plato, Aristotle and classical philosophy.

In this case, an adolescent with a life-threatening immune disease experiences increased social complexity, child welfare involvement, and placement into foster care, which could disrupt a medical...

This work reviews and critically evaluates contemporary American Catholic moral theological reflections, both non-magisterial and magisterial, from 1975 to the present. It also considers relevant reflections from papal and papally related literature, and from the older tradition. It examines the following: criteria used in distinguishing between "ordinary" and "extraordinary" means, e.g., benefit and burden; miscellaneous elements employed in regard to these means, e.g., treatment and care; definitions given for these means. Based on the results of the foregoing, it proposes original (...) working definitions of these two main types of means. ;This work confirms the need, already recognized by some moral theologians, for a broad foundational criterion on which to base contemporary definitions of and distinctions between "ordinary" and "extraordinary" means. It finds the criteria offered thus far to be suggestive but flawed. Accordingly, its own working definitions are grounded in a foundational criterion of "integral human fulfillment in Jesus," a concept taken from the fundamental moral theological system developed by Germain Grisez. (shrink)

The primary subject of this study is the assessment ofJohann B. Metz’s judgment that Karl Rahner’s transcendental anthropology abstracts from concrete experience and succumbs to a kind of Idealist tautology. Secondarily consideration is given to the broader range of similar criticisms of Rahner’s construal of the God-human relation.

Clinical ethics takes on a special cast in a rehabilitation clinic for psychosis where many patients come from severely disadvantaged backgrounds and many suffer from fluctuating decisional capacity. This paper illustrates several ethical issues—truth telling and partiality, prescribing concealed medication, questionable billing practices, industry collaboration, limits of confidentiality, grounds for abandonment and the primacy of autonomy—in the hope that discussing such matters will lead to a clearer framework for work with this population.

Bioethics, clinical ethics, and professional ethics are mature, well-developed fields of applied ethics that focus on medical research, patient autonomy and patient care, patient–healthcare professional relationships, and issues that arise in clinical and other medical settings. However, despite these developments, little attention has been paid to the organizational aspects of healthcare in these fields. This is surprising, because in the last 30 years healthcare has become more and more institutionalized in provider, management, and insurer organizations. Despite JCAHO's preoccupation with organizational (...) ethics during the last decade, the philosophical underpinnings of their requirements have been less explored in the literature. Clinical ethics remains preoccupied with clinical patient care and professional ethics with individual professional guidelines; even the American College of Healthcare Executives focuses primarily on healthcare managers, not on healthcare organizations. (shrink)

Most organizations and/or their sub-units like ethics programs want to acquire the knowledge, skills and other resources needed to achieve their goals efficiently and effectively. Thus, they want to acquire or develop needed capacity. But there are pre-conditions to building capacity that are often overlooked or forgotten, but which nevertheless, must be in place before capacity can be developed. This essay identifies these pre-conditions and discusses why they are necessary before attempts are made to enhance the capacity of any ethics (...) program. The essay closes by offering a series of questions that ethics program leaders/and or members can asked themselves to assess whether or not these pre-conditions exist. (shrink)

The Supreme Court seems poised to overrule Roe v. Wade and hold that there is no constitutional right to choose abortion. The reversal of Roe seems to run counter to public opinion in the United St...

Chenu, M.-D. Foi, certitude et recherche.--Gilson, É. Réponse à Louis-Marie Régis, On some difficulties of interpretation.--Dubarle, D. Logique et épistémologie du signe chez Aristote et chez les Stoïciens.--Geiger, L.-B. Ce qui est, se dit en plusiers sens.--Owens, J. "Diversificata in diversis."--Cauchy, V. Être et connaître, l'irréductibilité de l'aristotélisme au platonisme.--Joós, E. Maurice Merleau-Ponty, de l'intentio intellectus, à l'intentio rei.--Murin, C. Pour une démystification de la "mort-de-Dieu" nietzschéenne.--Joós, E. Post-scriptum, la nouvelle scolastique de Louis-Marie Régis.--Landry, A.-M. Louis-Marie Régis, O.P., quelques dates (...) et faits marquants de sa vie.--Lettre d'Henri-Irénée Marrou à Louis-Marie Régis. (shrink)

As concern over the use of questionable research practices in academic science has increased over the last couple of decades, some reforms have been implemented and many others have been debated and recommended. While many of these proposals have merit, efforts to improve scientific practices are more likely to succeed when they are responsive to the prevailing views and concerns of scientists themselves. To date, there have been few efforts to solicit wide-ranging input from researchers on the topic of needed (...) reforms. This article is a qualitative report of responses from federally funded scientists to the question of what should be done to address the problem of QRPs in their disciplines. Overall, participants were concerned about how institutional and career-oriented incentives encourage the use of QRPs. Compared to previous recommendations, participants had surprisingly little confidence in the ability of ethics training to improve research integrity. (shrink)

The explanatory value of niche construction can be strengthened by firm footing in semiotic theory. Anthropologists have a unique perspective on the integration of such diverse approaches to human action and evolutionary processes. Here, we seek to open a dialogue between anthropology and biosemiotics. The overarching aim of this paper is to demonstrate that niche construction, including the underlying mechanism of reciprocal causation, is a semiotic process relating to biological development as well as cognitive development and cultural change. In making (...) this argument we emphasize the semiotic mechanisms underlying the niche concept. We argue that the “niche” in ecology and evolutionary biology can be consistent with the Umwelt of Jakob von Uexkull. Following John Deely we therefore suggest that investigations into the organism—environment interface constituting niche construction should emphasize the semiotic basis of experience. Peircean signs are pervasive and allow for flexible interpretations of phenomena in relation to the perceptual and cognitive capacities of the behaving organism, which is particularly pertinent for understanding the relation of proximate/ultimate selective forces as co-productive. Additionally, theoretical work by Kinji Imanishi on the evolution of daily life and Gregory Bateson’s relational view of evolution both support the linkage between proximate and ultimate evolutionary processes of causation necessitated by the niche construction perspective. We will then apply this theoretical framework to two specific examples: 1) hominin evolution, including uniquely human cultural behaviors with niche constructive implications; and 2) the multispecies and anthropocentric niche of human-dog coevolution from which complex cognitive capacities and semiotic relationships emerged. The intended outcome of this paper is the establishment of concrete semiotic mechanisms and theory underlying niche constructive behavior which can then be applied to a broad spectrum of organisms to contextualize the reciprocal relation between proximate and ultimate drivers of behavior. (shrink)

Mary Margaret McCabe; V*—Persistent Fallacies, Proceedings of the Aristotelian Society, Volume 94, Issue 1, 1 June 1994, Pages 73–94, https://doi.org/10.1093/ar.

After the Supreme Court overturned Roe in Dobbs v. Jackson Women’s Health Organization, legal commentators and bioethicists asked whether other constitutional rights were on the chopping block (Coh...

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations (...) of Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)