Redish et al. propose a constellation of vulnerabilities inherent in the brain's decision-making system. They allow over-attention to cues a minor role in drug addiction. We think this is inadequate. Using the established links among drug cues, dopamine, and novelty, we propose a fuller account of this key feature of addiction, which we call the phenomenon of cue fascination.

In Working Virtue: Virtue Ethics and Contemporary Moral Problems, leading figures in the fields of virtue ethics and ethics come together to present the first ...

Controversial and provocative, To Be Real is a blueprint for the creation of a new political force.

The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The (...) gazette empowers the government to monitor the spread of infection. Despite there being an infrastructure of research ethics committees in almost all hospitals in Bangladesh, a lack of such committees in the clinical setting often forces healthcare professionals to allocate scarce healthcare resources to the task. These personnel are often either influenced by materialistic matters or guided by the emergency policies, without reaching a consensus on how to allocate scarce resources in times of need, especially in the time of the COVID-19 pandemic. Ethical dilemmas often arise when a number of patients with COVID-19, especially in poor and middle-class areas, are denied care while elites are prioritized to receive such scarce resources. Resource allocation in healthcare during the COVID-19 pandemic in Bangladesh appears to be unethical and in direct conflict with the biomedical principles of non-maleficence and procedural justice. The findings of this study suggest that the Act needs substantive changes in the stipulation of policy directing hospitals in the provision of resource allocation framework. Furthermore, parliament should produce guidance outlining how to successfully implement the law with the aim of protecting public health in times of emergency, especially the COVID-19 pandemic. (shrink)

Phase 1 healthy volunteer clinical trials—which financially compensate subjects in tests of drug toxicity levels and side effects—appear to place pressure on each joint of the moral framework justifying research. In this article, we review concerns about phase 1 trials as they have been framed in the bioethics literature, including undue inducement and coercion, unjust exploitation, and worries about compromised data validity. We then revisit these concerns in light of the lived experiences of serial participants who are income-dependent on phase (...) 1 trials. We show how participant experiences shift attention from discrete exchanges, behaviors, and events in the research enterprise to the ongoing and dynamic patterns of serial participation in which individual decision-making is embedded in collective social and economic conditions and shaped by institutional policies. We argue in particular for the ethical significance of structurally diminished voluntariness, routine powerlessness in setting the terms of exchange, and incentive structures that may promote pharmaceutical interests but encourage phase 1 healthy volunteers to skirt important rules. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

This chapter explores two kinds of testimonial trust, what we call ‘evidential trust’ and ‘non-evidential trust’ with the aim of asking how testimonial trust could provide epistemic reasons for belief. We argue that neither evidential nor non-evidential trust can play a distinctive role in providing evidential reasons for belief, but we tentatively propose that non-evidential trust can in some circumstances provide a novel kind of epistemic reason for belief, a reason of epistemic facilitation. The chapter begins with an extensive discussion (...) of standard accounts of both kinds of trust and criticises especially the standard accounts of non-evidential trust. A new account of non-evidential trust is offered that avoids a number of difficulties that plague the standard accounts by rejecting what we call ‘attitude-liability assumptions’. (shrink)

While bioethics as a field has concerned itself with methodological issues since the early years, there has been no systematic examination of how ethics is incorporated into research on the Ethical, Legal and Social Implications of the Human Genome Project. Yet ELSI research may bear a particular burden of investigating and substantiating its methods given public funding, an explicitly cross-disciplinary approach, and the perceived significance of adequate responsiveness to advances in genomics. We undertook a qualitative content analysis of a sample (...) of ELSI publications appearing between 2003 and 2008 with the aim of better understanding the methods, aims, and approaches to ethics that ELSI researchers employ. We found that the aims of ethics within ELSI are largely prescriptive and address multiple groups. We also found that the bioethics methods used in the ELSI literature are both diverse between publications and multiple within publications, but are usually not themselves discussed or employed as suggested by bioethics method proponents. Ethics in ELSI is also sometimes undistinguished from related inquiries. (shrink)

Human beings with diminished decision-making capacities are usually thought to require greater protections from the potential harms of research than fully autonomous persons. Animal subjects of research receive lesser protections than any human beings regardless of decision-making capacity. Paradoxically, however, it is precisely animals’ lack of some characteristic human capacities that is commonly invoked to justify using them for human purposes. In other words, for humans lesser capacities correspond to greater protections but for animals the opposite is true. Without explicit (...) justification, it is not clear why or whether this should be the case. Ethics regulations guiding human subject research include principles such as respect for persons—and related duties—that are required as a matter of justice while regulations guiding animal subject research attend only to highly circumscribed considerations of welfare. Further, the regulations guiding research on animals discount any consideration of animal welfare relative to comparable human welfare. This paper explores two of the most promising justifications for these differences␣between the two sets of regulations. The first potential justification points to lesser moral status for animals on the basis of their lesser capacities. The second potential justification relies on a claim about the permissibility of moral partiality as␣found in common morality. While neither potential justification is sufficient to justify the regulatory difference as it stands, there is possible common ground between supporters of some regulatory difference and those rejecting the current difference. (shrink)

The standard notion of autonomy in medical ethics does not require that autonomous choices not be irrational. The paper gives three examples of seemingly irrational patient choices and discusses how a rational autonomy analysis differs from the standard view. It then considers whether a switch to the rational autonomy view would lead to overriding more patient decisions but concludes that this should not be the case. Rather, a determination of whether individual patient decisions are autonomous is much less relevant than (...) usually considered in determining whether health care providers must abide by these decisions. Furthermore, respect for rational autonomy entails strong positive requirements of respect for the autonomy of the person as a rational decision maker. The rationality view of autonomy is conceptually stronger than the standard view, allows for a more nuanced understanding of the practical moral calculus involved in respecting patient autonomy, and promotes positive respect for patient autonomy. (shrink)

Research uses of human bodies maintained by mechanical ventilation after being declared dead by neurological criteria, were first published in the early 1980s with a renewed interest in research on the newly or nearly dead occurring in about last decade. While this type of research may take many different forms, recent technologic advances in genomic sequencing along with high hopes for genomic medicine, have inspired interest in genomic research with the newly dead. For example, the Genotype-Tissue Expression program through the (...) National Institutes of Health aims to collect large numbers of diverse human tissues with the eventual goal of elucidating the genetic bases of common diseases through a better understanding of the relationship between genetic variation and gene expression. (shrink)

Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

In the United States at present, the death penalty is a possible sentence in 31 out of 50 states, as well as within the military and for federal cases. In the U.S., numbers of executions are declin...

The truth of a myth, your Honor, is not its words but its patterns.Why would a novel want to undermine its own words? Surely, literature is made of words, and any ambitious novel would want to wear its words proudly, declaiming their truth as well as their beauty. Yet we know that novels produced in smaller languages, which possess fewer publishers and fewer readers, have needed to make their words accessible, both to distant audiences and to translators in dominant languages. (...) And some works in dominant languages, when they are produced in spaces far from the centers of publishing, have likewise had to retract idiomatic phrases, alter references to regional languages, and provide glossaries. But why would a.. (shrink)

Imprisonment may sometimes be a justified form of punishment. Yet the U.S. carceral system suffers from appalling problems of justice—in who is put into prisons, in how imprisoned people are treated, and in downstream personal and community health impacts. Medical personnel working in prisons and jails take on risky work for highly vulnerable and underserved patients. They are to be lauded for their professional commitments. Yet at the same time, prison care undercuts the ability of medical personnel to uphold their (...) own professional standards and sometimes fails in even basic health protection. Doctors in prisons are stuck between their commitment to vulnerable patients and complicity in a system that requires their participation to uphold its constitutionality. Medical ethics is frayed in prisons, and the problem deserves our attention. (shrink)

Aestheticians have had a great deal to say recently in praise of (aesthetic) appreciation. This enthusiastic appreciation for appreciation may seem unsurprising given the important role it plays in many of our aesthetic practices, but we maintain that some prominent aestheticians have overstated the role of appreciation (and, perhaps more importantly, understated the role of other elements we will discuss) when it comes to the exercise of aesthetic taste. This is not, of course, to deny the obvious fact that appreciation (...) often plays an important role in our aesthetic practices but merely that it is a mistake to cast it in the role of the sine qua non of aesthetics. (shrink)

New Zealand has an unspoken commandment: ‘thou shalt not be a tall poppy’. A tall poppy is someone who stands out from the crowd, usually by excelling at one or more pursuits. Sadly, many New Zealanders are all too familiar with this phrase as they have been ‘cut down’ by those around them, taunted for their success and discouraged from celebrating their achievements. This social phenomenon of cutting down tall poppies is called Tall Poppy Syndrome and is present in many (...) areas of New Zealand culture, such as sport, academic achievement, and entrepreneurship. Consequently, the church is not immune to this phenomenon. Tall Poppy Syndrome, whether within or outside the church, discourages excellence and prevents flourishing. This article engages Moral Foundations Theory to understand why Tall Poppy Syndrome exists in New Zealand, and then proposes Christian humility as a remedy for Tall Poppy Syndrome within the church. When humility and excellence can co-exist, then Tall Poppy Syndrome will no longer exist; thus the church could have an important role in enabling New Zealand to be a place where tall poppies can freely flourish. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Breathing TogetherRebecca L. Walkowitz (bio)For the first seven years of my career, I taught a very large lecture course once, and sometimes twice, a year in a graded auditorium filled seat-to-seat with as many as 350 undergraduates. The course focused on a cluster of themes that linked art and violence–how art resists violence, how art animates violence, how art expresses violence, how violence spurs art– and traced those themes (...) through the history of British fiction from Joyce, Woolf, and Forster through Barker, Burgess, Ishiguro, and Rushdie. I loved teaching that class. I loved and was sometimes terrified and almost always invigorated by being in that room with those students. Needless to say, no one wore masks. Far from it.I remember the feel of the crowded, anonymous, yet intimate room. Intimate, because a group of 20 or 30 very avid students occupied the first few rows, and I came to value and recognize their attentive faces. I could hear their little sounds as they scratched out notes, adjusted their laptops, whispered to each other, and rustled papers. Intimate, because I was standing at my full, not very substantial height on a stage, and they were looking up at my body and listening to my voice for 50 minutes twice a week. And intimate, in another sense, because they would sometimes forget that we were there together live and behave in ways that I have never experienced in a smaller classroom. One day, two students in the last row, which in the slanted auditorium was directly level with my elevated gaze, spent most of the lecture kissing ardently. I was impressed by their enthusiasm and by the duration of their embrace. At the end of the lecture, I quick-stepped up the aisle to remind them: this is not TV; we are here together. I smiled while I said it, and they apologized for distracting me. I smile as I think about it now.During the COVID lockdown, I missed the embodied experience of large gatherings, including large lectures. The Zoom classroom, for all its affordances, can't replicate the accidental encounters, the risk and energy of embodied presentation, the warmth of individual eye contact, and the shoulder experiences of the class period: what happens in the time just before and the time just after the actual class takes place. The shoulder experiences are truly precious, as any seasoned teacher knows, because [End Page 258] they allow us to shift the scale of encounter up and down, and they allow us to interact in spontaneous and less formal ways than we do when the entire class is gathered as one. Close up and informally, we are more likely to use our faces and our hands: smiling, nodding, tilting, waving, and pressing our palms together to say thank you.There is a kind of social intimacy and a kind of social violence that can only be illustrated in a very large group, and I appreciated my lecture for allowing me to experience that. The most terrifying day of my class each semester was the day I spoke about– and performed!–the shock of involuntary, inchoate expression in E. M. Forster's A Room with a View. Like other Bloomsbury artists, Forster was committed to ushering out traditional ideas of self-restraint and maturity and ushering in greater communication between men and women, between social classes, and between ages about sexuality, desire, and the experiences of the body. The word of the day was "play": life needed more play, more honesty, more curiosity, and less seriousness, less decorum, and less lying to ourselves and others.What does this look like in the classroom? On the day in question, we would talk about the scenes in the novel in which characters are criticized for disruptive actions they cannot or do not control, such as fainting, laughing, bleeding, getting carried away, or expressing sounds in addition to words. I would explain that there are two problems with these actions: they are accidental or unintentional, and they involve an unexpected, unregulated expression of the body in public. Even worse, the actions take place in what our grandparents used to call "mixed... (shrink)

Abstract:AbstractThis essay explores the role affect plays in police use of force. On the one hand, police officers' affect, and more specifically, police officers' fear of African Americans can function as evidence in police shootings. But black fear of police violence is often cast as unreasonable and excessive. In a discussion of the public battles over affective responses to police violence, I argue that the failure that the struggle over perceptions of affect is an essential piece of fight against state (...) violence. (shrink)

This volume is fourth in the series of annuals created under the auspices of The Association for Feminist Ethics and Social Theory. The topics covered herein—from peacekeeping and terrorism, to sex trafficking and women's paid labor, to poverty and religious fundamentalism—are vital to women and to feminist movements throughout the world.

With the help of the current experiment, we wanted to learn more about the impact of visually demanding vs. cognitively demanding secondary tasks on the attention allocation of older pedestrians during the phase of traffic perception within the process of road crossing. For this purpose, we used two different road crossing tasks as well as two different secondary tasks. The road crossing “stop task” was a signal detection task, where an approaching car had to be detected. The road crossing “go (...) task” was a dynamic visual search task, where the resolution of a busy road situation had to be identified. The visual secondary task was a static visual search task and the cognitive secondary task was a 1-back task. One younger group and one older group of participants completed the tasks as single vs. dual-tasks in all possible combinations. Performance was measured through errors and response time; in addition, the subjective workload was assessed via NASA-TLX. Analyses show that the visual secondary task reduces performance in the road crossing more strongly than the cognitive task, while the visual task itself is less impaired by the road crossing tasks than is the cognitive task. Overall, performance diminishes from single to dual-task completion. Results further indicate age effects in terms of increased errors and response time for older compared to younger participants. In addition to these age effects, age-specific dual-task effects emerge for response time in the go task along with the visual task as well as for response time in the cognitive task along with the go task. Subjective workload is higher in the dual-task conditions than in the single tasks. Findings are discussed with regard to theoretical and practical implications. (shrink)

Empirical data can be an extremely powerful and influential tool in bioethical research. However, when researchers or policy makers look for answers to ethical questions by engaging with empirical research, there can be a tendency (conscious or unconscious) to shape, report, and use empirical research in a way that confirms their own preferred ethical conclusions. This skewing effect - what we call ‘normative bias’ - is often so subtle it falls short of clear misconduct and thus can be difficult to (...) call out. However, we argue that this subtle influence of bias has the potential to significantly influence debate and policy around highly sensitive ethical issues and must be guarded against. In this paper we share the lessons we have learned through a journey of self-reflection around the effect that normative bias can have when reporting on and referring to empirical data relating to ethical issues. We use a variety of papers from our area of the ethics of routine prenatal screening to illustrate these subtle but often powerfully distorting effects of bias. Our aim in doing so is not to criticise the work of others, as we recognise our own normative bias, but to improve awareness of this issue, remind the need for reflexivity to guard against our own biases, and introduce a new criterion - the idea of a ‘limitation prominence assessment’ - that can work as a practical way to evaluate the seriousness of the limitations of an empirical study and thus, the risks of the study being misread or misinterpreted through superficial reading. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 61.4 (2000) 561-575 [Access article in PDF] Claude de Seyssel's Translations of Ancient Historians Rebecca Boone Through his seven translations of ancient history Claude de Seyssel played a major role in transmitting knowledge about antiquity to the French. Despite this fact he has received little attention from scholars of the French Renaissance. Perhaps the problem is that Seyssel does not seem to (...) fit neatly into any category. He was neither French nor Italian but a Savoyard, not truly noble but the illegitimate son of a noble family, not truly a historian but a writer of history-based propaganda and a translator of histories. He began his career as a jurist, became a royal councillor, then a bishop, and in the end died as the Archbishop of Turin. Before his death Seyssel left numerous works, his most famous being a political treatise entitled La Monarchie de France, a work contemporaneous with The Prince by Machiavelli, with whom he shared a similar view of the political world. 1Much like Seyssel himself the genre of history translation has been rather neglected by scholars. A notable exception is a recent article by A.C. Dionisotti, which also examines the translations of Seyssel. The article's intention is to continue a project proposed by Arnaldo Momigliano, to collect evidence that "would help us to understand where and on what occasions and by what people books of history were written and read." 2 This essay attempts to continue this project by asking the following questions: Why did Seyssel undertake the translations? For whom were they intended? How did Seyssel conceive his task as translator? Finally, what can be inferred from his technique of translation? [End Page 561]First, the translations must be put in the context of Seyssel's life. The translations were a sideline in his busy career as royal councillor. One of many itinerant scholar-diplomats hired by the states of Europe at that time, Seyssel had been teaching law at the University of Turin when he was called into the service of France by the newly crowned Louis XII in 1498. Seyssel was of value to the court because of his reputation as a jurist as well as his connections with the court of Savoy, the state which held the mountain passes leading to Italy. This was especially important because the conquest of Milan was the main goal of Louis XII throughout his reign. Seyssel played an active role in the French occupational government in several Italian cities. Although Seyssel spent much of his time in Italy, he often followed the king around France or was in transit on diplomatic missions to England, to Flanders, and to the Swiss cantons.It is amazing that Seyssel even found the time to write, but by the end of his life, he had left an astounding variety of written works: legal commentaries, translations, works of propaganda for the French monarchy, a political treatise, and at the end of his life several religious tracts. Despite the copiousness of his written works, however, Seyssel remained outside the circle of writers at the French court. He had no connections either with Budé or with the Grands Rhetoriqueurs, such as Jean Lemaire de Belges, nor did he leave any friendly and eloquent correspondence to other humanists. If Seyssel lived during the budding years of the French renaissance, he showed few signs of appreciating it. As a Savoyard educated in Italy he probably thought of the French in the same way as did many Italians of his age: they were militarily powerful but culturally backward. 3Undoubtedly, Seyssel believed the translations would serve his own interests at court. They were a way to cultivate patronage and to enhance his prestige by building up a reputation as an important scholar. But evidence suggests that their main purpose was to prove to the king, to whom all but one of his translations were dedicated, his utility as a councillor. This was the argument of Paul [End Page 562] Chavy in his study of Seyssel's... (shrink)

Flora Champy shows how Rousseau developed his political philosophy by reference to ancient examples, intertexts, and interlocutors. Her literary methodology involves close readings of published tex...

Sabrina Ebbersmeyer and Sarah Hutton have assembled a rich collection of essays on Elisabeth of Bohemia that were initially presented at a 2018 conference at the Center for the History of Women Phi...

This article examines the conceptual impact of equal pay legislation on Canadian trade unionism. Ambiguous, largely voluntary, legislation poses major challenges to unions negotiating wage parity for their members. Furthermore, the movement finds itself caught between conflicting responsibilities as champion of the underpaid and protector of traditional interests. The authors examine this challenge within the context of the historic development, and fundamental principles of trade unionism. They conclude that many of the conflicts discussed arise directly from established union practices and (...) must, therefore, be resolved by the movement and other affected parties together. (shrink)

The aim of this paper is to summarize key psychoanalytic concepts first developed by Sigmund Freud and apply them to a critical exploration of three terms that are central to nursing's self‐image—empathy, caring, and compassion. Looking to Menzies‐Lyth's work, I suggest that the nurse's strong identification as a carer can be understood as a fantasy of being the one who is cared for; critiques by Freud and others of empathy point to the possibility of it being, in reality, a form (...) of projective identification; reading Lacan and Žižek, I propose that repeated research into caring and repeated complaint about barriers to caring can be understood as manifestations of the death drive first posited by Freud. I conclude that psychoanalytic insights suggest that caring roles can raise profoundly ambivalent issues for those who care but they can also point the way to freedom from painful and self‐destructive symptoms inherent in such work. (shrink)

Postmodernism has been criticized as failing to offer, on the one hand, authoritative explanations for social phenomena that might provide a scientific basis for policy formation or, on the other, the philosophical justification for emancipatory work – its radical scepticism about claims to knowledge leaving its advocates, including many nurses, with little scope to transform oppressive social and political regimes. Various approaches to this important problem have been offered, both philosophical and mediodological. Some critical theorists have rejected certain aspects of (...) postmodernism as dangerous and distracting. Some more accommodating solutions are troubled by unacknowledged inconsistencies. Others embrace post‐modernism's unavoidable ambiguity (towards the Enlightenment for instance) with a lighter heart. In this paper I will review some of the criticism of postmodernism and some proposed solutions to these problems. Using recent research into the impact of managerialism on nursing within the UK National Health Service as an example and drawing on deconstructive literary theory, I conclude by accepting a rhetorical agonistics of undecidability. I take postmodernism as a mandate for causing trouble for those groups who are currently having their say and whose version of truth and rationality has achieved domination over others. I do not take postmodernism as a place from which to champion the cause or privilege the view of any particular group. (shrink)

This chapter explores a potential analogy between mereological principles and laws of nature. Against a backdrop of what Marmodoro has termed ‘power structuralism’ (and a rejection of a Humean worldview), the connection between parthood and modality may be richer than has hitherto been considered. Mereological principles delineate possibilities for parts and wholes, and putting powers at the centre of a discussion about parthood can furnish a novel conception of mereological laws, much as dispositionalism has done so for natural laws; namely, (...) these principles express connections between fundamental dispositional properties. By extending dispositionalism to comprehend mereology in this way, we can help fulfil its promise to provide a foundational, naturalistic metaphysics, as foundational mereological debates then begin to mirror those relating to dispositionalist views of laws of nature: we may treat natural and mereological laws in tandem, as holding either necessarily or contingently, with associated strategies for dealing with supposed counterexamples to one’s preferred set of mereological principles. We can thus bring new life to the debate over whether questions of composition admit of contingent or only necessary answers. (shrink)

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published (...) between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems. (shrink)

The oil crisis, risk and evidence‐based practice Evidence‐based practice has risen to prominence over the last 20 years. Different professions have taken it up in different ways and for different purposes. It has been seen as holding both threats and advantages to professionalising endeavours and professional identity. It has engendered controversy but some criticisms of it have been unconvincing. It is possible to account for its rise as a response to tightening financial constraints on state spending in the west, as (...) a sign of a culture increasingly concerned with risk, distrust of professionals and experts, as well as a way for professionals themselves to maintain control over their activity in the face of growing managerialism. This paper reviews the literature of some of the movement's proponents as well as criticism from various professional groups. It concludes that more useful than either arguing for or against it, is to understand the policy background and sociological reasons for its emergence and spread. (shrink)