Prevention neuroscience investigates the brain basis of attitude and behavior change. Over the years, an increasingly structurally and functionally resolved “persuasion network” has emerged. However, current studies have only identified a small handful of neural structures that are commonly recruited during persuasive message processing, and the extent to which these (and other) structures are sensitive to numerous individual difference factors remains largely unknown. In this project we apply a multi-dimensional similarity-based individual differences analysis to explore which individual factors—including characteristics of (...) messages and target audiences—drive patterns of brain activity to be more or less similar across individuals encountering the same anti-drug public service announcements (PSAs). We demonstrate that several ensembles of brain regions show response patterns that are driven by a variety of unique factors. These results are discussed in terms of their implications for neural models of persuasion, prevention neuroscience and message tailoring, and methodological implications for future research. (shrink)

Health communication is increasingly being held to higher moral standards. No longer do noble goals outweigh ethical concerns. This content analysis examines ethical frames and primes in health public service announcements so we may begin to address the most prevalent of the problematic ones and find more ethical alternatives. In this study, 80% of the PSAs conveyed messages that individuals were to blame. Negative emotion, such as fear, was the second most frequent frame. Stereotypes of women were (...) the primes most prevalent in the visuals, and visual and verbal messages were vastly different for some of these primes. The ethical implications of each are addressed. (shrink)

A large number of scholars have conducted detailed studies on the effectiveness of commercial advertising by using neuroimaging methods, but only a few scholars have used this method to study the effectiveness of public service announcements. To research the relationship between the effectiveness of PSAs and the audience’s implicit awareness, functional near-infrared spectroscopy was employed to record the neural activity data of participants in this study. The results showed that there was a correlation between activation of dorsolateral (...) prefrontal cortex and the effectiveness of PSAs; The activation of the dlPFC could also be used as an indicator to represent the appeal of advertising content. The results means that neuroimaging tool can also be used to investigate the effectiveness of PSAs, not just commercial advertisements and a few PSAs study, and that neural activity can predict and improve the effectiveness of PSAs before they are released. (shrink)

As media companies test and implement newsroom "convergence," growing numbers of journalists are producing content not only for their own employer but also for other media outlets with which that employer has a business relationship. This article, based on case studies in 4 converged news markets, explores journalists' perceptions of normative pressures in this new media environment, particularly in relation to the overarching concept of public service. The findings suggest that although journalists do not see convergence itself as (...) posing significant ethical problems, they do raise concerns related to specific components of public service, including a devotion to accuracy, an avoidance of sensationalism, and independence from economic pressures. (shrink)

In September 2020, Helsinki and Amsterdam announced the launch of their open AI registers—the first cities in the world to offer such a service. The AI registers describe what, where, and how AI applications are being used in the two municipalities; how algorithms were assessed for potential bias or risks; and how humans use the AI services. Examining issues of security and transparency, this paper discusses the potential for implementing AI in an urban public service setting and (...) how this might be harnessed to improve services and citizens’ experiences. -/- . (shrink)

We develop intuitionistic public announcement logic over intuitionistic \({\textbf{K}}\), \({{\textbf{K}}}{{\textbf{T}}}\), \({{\textbf{K}}}{{\textbf{4}}}\), and \({{\textbf{S}}}{{\textbf{4}}}\) with distributed knowledge. We reveal that a recursion axiom for the distributed knowledge is _not_ valid for a frame class discussed in [ 12 ] but valid for the restricted frame class introduced in [ 20, 26 ]. The semantic completeness of the static logics for this restricted frame class is established via the concept of pseudo-model.

The State against Public Service ? the Hidden Side of Endogenous Growth Models of endogenous growth are generally considered to be endowed with the following properties : 1. A macro-dynamisation of the general Walrasian equilibrium ; 2. A rupture with the Solow paradigm ; 3. A capacity to identify the forces which are currently driving technical progress and growth, by way of an increase in externalities and yields ; 4. A rehabilitation of state-intervention, particularly in the social field (...) ; 5. A capacity to effect a rapprochement between the neo-classical and heterodox paradigms. The article, arguing that such positions, which have given rise to a consensus, are seriously flawed, casts light on the latter’s « hidden side », in particular the ambiguities lurking at the heart of its redefinition of the role of the State. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.1 (2002) 103-113 [Access article in PDF] Scope Note Update Searching Across Boundaries: National Information Resource on Ethics and Human Genetics* While indeed an historical moment, the announcement of the mapping of the human genome has been treated in the literature as a beginning—a new way to think about biology and the ways in which biological concepts are applied to medicine. Issues of both (...) Science and Nature magazines celebrated the event by establishing interdisciplinary websites where readers can access essays on aspects of genome mapping and directly link to databases to search for more information on the topics (IV. Genome Gateway 2001; The Human Genome 2001). Since 1994, the National Information Resource on Ethics and Human Genetics (NIREHG), a special project of the National Reference Center for Bioethics Literature (NRC), has been providing such an integrated information service on ethics and genetics. Designed to enable a wide range of users to go from annotated bibliographies (Scope Notes) and brief essays (called "enotes") to database searching, NIREHG fosters an interdisciplinary approach to research on ethics and genetics. Links are provided between and among Scope Notes and enotes to information maintained on the NIREHG site as well as to sources found throughout the Internet. In providing the following annotations added to NIREHG materials since 1997, the Kennedy Institute of Ethics Journal (in its online presence through Project Muse) becomes an additional forum for NIREHG links. "It is a rare and wonderful moment when success teaches us humility, and this, I argue, is precisely the moment at which we find ourselves at the end of the twentieth century" (IV. Keller 2000, p. 7). It is with both joy and humility that we celebrate the mapping of the human genome. [End Page 103] I. Genetic Testing Andrews, Lori B. Future Perfect: Confronting Decisions About Genetics. New York: Columbia University Press, 2001. 264 p.Noting the wide impact of genetic testing, Andrews discusses patient self concept, reproduction decisions, confidentiality, discriminations in health insurance and employment, the need for competent counseling, and the legal, ethical, and social regulations she deems important to help solve dilemmas arising from the tests and their ensuing ramifications. She describes three models, pointing out both advantages and problems: a medical model with physician gatekeepers, a public health model that could provide education as well some testing for those unable to afford tests, and a fundamental rights model that could give greater weight to individuals decisions about the use of health care services. The book has 85 pages of footnotes.American Society of Human Genetics. Social Issues Subcommittee on Familial Disclosure. Professional Disclosure of Familial Genetic Information. American Journal of Human Genetics 62 (2): 474-83, February 1998.The ASHG statement outlines points to consider: the general rule of confidentiality, exceptional circumstances that permit disclosure, and the ethical duty to inform patients about familial implications. Background discussion includes: ethical frameworks for disclosure of otherwise confidential information, the duty to warn under law, and international trends and positions.Boetzkes, Elisabeth. Genetic Knowledge and Third-Party Interests. Cambridge Quarterly of Healthcare Ethics 8 (4): 386-92, Summer 1999.Protection from the interests of insurers or prospective employers are discussed from the point of view of the ethical basis of the professional obligation to confidentiality as well as the right to privacy of those tested. However, the author supports family members, saying that "first-party resistance to disclosure may be overcome by weighty third-party claims."Chadwick, Ruth; Shickle, Darren; ten Have, Henk; and Wiesing, Urban, eds. The Ethics of Genetic Screening. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1999. 255 p.Twenty-one chapters and 23 authors provide views of genetic testing/screening in different European countries and offer brief discussions of sociological perspectives, moral and philosophical issues, privacy, reconciling liberty and the common good, and questions raised in genetic testing of children.Clayton, Ellen Wright. Genetic Testing in Children. Journal of Medicine and Philosophy 22 (3): 233-51, June 1997.Clayton argues that there is room for... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Venn. A Life in Logic by Lukas M. VerburgtClaudia CristalliLukas M. VerburgtJohn Venn. A Life in Logic Chicago and London: The University of Chicago Press, 2022. 411 pp., incl. indexThis is the first intellectual biography of John Venn (1834–1923), British logician, “philosopher and antiquarian” (DNB). Until now, Venn had not been studied as a philosophical figure in its own right. He is mostly remembered today for the (...) “Venn Diagrams,” a graphical device illustrating logical relations such as inclusion, exclusion, conjunction, disjunction, and for having systematically articulated a frequentist theory of probability. Together with an in-depth account of Venn’s logical developments, of his studies in probability theory, and of its applications to history and to anthropometry, Lukas M. Verburgt brings to life Venn’s spiritual struggles within—and eventually out of— his family’s religion, evangelicalism. Verburgt’s reconstruction is substantiated by many extracts from Venn’s correspondence and private notes, which add substantially to the value of this biography. (Of note is Verburgt’s 2022 editon of Venn’s unpublished writings and slected correspondence, which can be considered a companion to this biography).While showing the connections of epistemology, religion and academic politics in Victorian Cambridge, Verburgt contributes an important chapter in the history of logic and of empiricist philosophy.The book opens with a chapter on Venn’s childhood and early youth (1834–53), largely drawn from manuscript material of the Venn family—the “Parentalia”—and from Venn’s Annals of a Clerical Family, where he included “autobiographical recollections” (p. 2). The chapter introduces the reader to the values of a prominent evangelical family and to their peculiar way of understanding Christianity as a faith to be embedded in habit and to be taught by example. The following two [End Page 385] chapters follow Venn’s development, first as a student at Caius college, Cambridge (1853–57) and then as a country curate; the chapters elaborate on the institutional history of the college and on parish life from the perspective of evangelical orthodoxy. Chapter 4 is still chronologically situated within Venn’s early clerical service but is arranged thematically around his first publication (1862), “Science of History,” which contains some elements of the fundamental ideas elaborated in the Logic of Chance (1866): namely, that probability theory could only make predictions about long-run frequencies of events, and never about individual cases (p. 77). The core of Venn’s argument in 1862 revolved around possible atheistic implications of a science of history. If at some point it would be possible to predict future events, would there still be free will? Or a God? In his reply, Venn maintained that any prediction concerning individual agents could be defeated by assuming that the agent gets to know the prediction and changes her actions accordingly (pp. 74–76).After the publication of the “Science of History” essay, Venn left the parish for Cambridge, where he worked first as a Catechist (1862– 1867) and then as a moral sciences lecturer. Verburgt devotes chapter 5 to that and to the Cambridge milieu, where Venn sides for university reforms and engages with the Grote Club, all while drifting away from evangelical orthodoxy. After laying out Venn’s theory of probability (Chapter 6), Verburgt returns to an integrated analysis of Venn’s scientific and religious thought in chapter 7. This chapter may be particularly relevant for pragmatist readers, since here Verburgt highlights the commonalities between Venn’s “religious logic” and the notion of belief that will be expressed in more detail by pragmatism. Verburgt focuses on Venn’s logic in three subsequent chapters (Chapters 8, 9 and 11). Considered together, they provide a comprehensive history of Venn’s logical development, which Verburgt proudly announces as the first of this kind (p. xx). The last chapter on Venn’s logic (Chapter 11) also includes Verburgt’s argument for “includ[ing] Venn in the local history of early analytic philosophy at Cambridge” (p. 262). Chapters 10 and 12 recount Venn’s last years with particular emphasis on his interests in natural and historical sciences; they provide relevant material for scholars interested in the history and philosophy of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Re-dating Ausonius’ War PoetryJ. F. DrinkwaterThe extant works of ausonius contain a small but intriguing number of references to military activity on the Rhine in which he himself appears to have been closely involved. In perhaps the best known of these (Mosella 420–24), he declares that the Moselle has seen the “united triumphs of father and son”—that is, of the ruling western Augusti, Valentinian I and Gratian—which they have (...) won by defeating enemies beyond the River Neckar and the former Roman city of Lupodunum (normally written Lopodunum, the modern Ladenburg), and the source of the Danube: Nicrum super et Lupodunum / et fontem Latiis ignotum annalibus Histri (425/4). However, Ausonius also devotes two of his epigrams to the same topic. In one (Epig. 3/28 [Green/Peiper]), he depicts the Danube, at its source, hailing the Augusti, again “father and son,” and anticipating with pleasure its announcing to their colleague in the East, Valentinian’s brother, Valens, the destruction of the “Suebians” and the fact that the Rhine is no longer the frontier of Gaul. In the other (Epig. 4/31), Ausonius’ Danube rejoices that, though its head was once concealed in lands remote, it now flows for its entire length under Valentinian’s sway. In the preface to his Griphus (line 14 Green) and in the introduction to his Cento Nuptialis (line 48 Green) Ausonius makes passing allusion to the time when he was on “active service” (expeditione; quia sub imperatore meo tum merui). We may conclude this short catalogue with others of his better-known works, the “Bissula poems,” in which he sings the praises of his “Suebian girl,” his “pet,” taken as a spoil of war beyond the Rhine, at the source of the Danube (17.1.3-4/9.1.3-4).All such references are generally assumed to derive from a single action, the campaign of 368 in which, according to Ammianus Marcellinus, both Valentinian and Gratian (and, presumably, the latter’s entourage, including Ausonius) campaigned over the Rhine against the Alamanni. 1 The terminus post quem of the composition of all the works [End Page 443] concerned is, therefore, 368. As far as completion and publication are concerned, most attention has been given to his Mosella, where two internal references have been interpreted as indicating a date late in 370 or in 371: as Green has recently put it, “in or close to 371.” 2But neither of these dates is as solidly founded as they may seem. The precise details of the 368 fighting are unclear. It may have remained north of the Main, and may therefore have not taken Roman forces south to the Neckar; and even if it had, it may still not have taken them as far as Ladenburg and beyond, to the source of the Danube at Donaueschingen. 3 However, we can be fairly sure that Valentinian reached Ladenburg in 369; 4 and this has led some to treat the two campaigns as one, with Ausonius probably accompanying Gratian in the earlier stage, and certainly being with him during the later. Thus he would have reached, or have been able to claim that he had reached, the Danube source, have been given Bissula, and have been inspired to write Mosella not in 368, but in 369. 5 In addition, the internal references in Mosella are very opaque. As Seeck observed, and some have accepted, the unnamed high official who “ruled Rome... bearing a title all but the highest, though he was peer of the highest” (trans. Evelyn White) of lines 409–11 should not necessarily be taken to be Sextus Petronius Probus, consul posterior to Gratian in 371. 6 If Ausonius’ language allows of any precise identification of an individual or an office, it is equally, if not more, likely that the reference is to the holder of a Roman metropolitan position, specifically that of vicarius urbis or praefectus annonae, both of which were subordinate to the praefectus Urbi, who had close links with Trier or its region. Seeck in fact suggested that Ausonius was here referring to the Gallo-German Bappo, who reached the premier position of City Prefect in 372; but... (shrink)

BackgroundThe Public Health Service Increased Risk designation identified organ donors at increased risk of transmitting hepatitis B, hepatitis C, and human immunodeficiency virus. Despite clear data demonstrating a low absolute risk of disease transmission from these donors, patients are hesitant to consent to receiving organs from these donors. We hypothesize that patients who consent to receiving offers from these donors have decreased time to transplant and decreased waitlist mortality.MethodsWe performed a single-center retrospective review of all-comers waitlisted for liver (...) transplant from 2013 to 2019. The three competing risk events (transplant, death, and removal from transplant list) were analyzed. 1603 patients were included, of which 1244 (77.6%) consented to offers from increased risk donors.ResultsCompared to those who did not consent, those who did had 2.3 times the rate of transplant (SHR 2.29, 95% CI 1.88–2.79, p < 0.0001), with a median time to transplant of 11 months versus 14 months (p < 0.0001), as well as a 44% decrease in the rate of death on the waitlist (SHR 0.56, 95% CI 0.42–0.74, p < 0.0001). All findings remained significant after controlling for the recipient age, race, gender, blood type, and MELD. Of those who did not consent, 63/359 (17.5%) received a transplant, all of which were from standard criteria donors, and of those who did consent, 615/1244 (49.4%) received a transplant, of which 183/615 (29.8%) were from increased risk donors.ConclusionsThe findings of decreased rates of transplantation and increased risk of death on the waiting list by patients who were unwilling to accept risks of viral transmission of 1/300–1/1000 in the worst case scenarios suggests that this consent process may be harmful especially when involving “trigger” words such as HIV. The rigor of the consent process for the use of these organs was recently changed but a broader discussion about informed consent in similar situations is important. (shrink)

! The Stabilization and Association Agreement between BiH and the European Union is available for readers at the BiH Parliament web page. The content of SAA is available at the front web page of BiH Parliament, under the link entitled "highlighted", BiH Parliament Office for Public Relations stated. ! Thanked to donation of Norway in the amount of about 20.000 KM and UNDP aid with 3.000 KM, National Library in Srebrenica reconstructed its premises for students and reading. They bought (...) furniture and equipment for the reading room which now provides with new services - web page and internet, since six new computers were bought. The library now has more than 35.000 books. Reading room is equipped entirely and it will be open daily. !BiH Defense Ministry announced the second public notice for recruitment of soldiers in professorial military service of BiH Army Forces, valid to August, 4, BiH Defense Ministry stated. The announcement read that in total there are 541 vacancies in the military service for admission to professional service of BiH Army forces, where 202 vacancies are envisaged for Bosniaks, 204 for Croats and 135 for Serbs. Having in mind the fact that the candidates' documents were retained on which basis the candidates were called to testing on the public announcement, on March 27, these potential candidates can apply only by application form. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response 4: The Summer of Our DiscontentCaroline EdwardsI write this response on the eve of another wave of industrial action in the UK in November 2022—the Universities and Colleges Union (UCU) “UCU Rising” campaign, the latest in a series of regular disputes over pay and working conditions, the gender and ethnicities pay gap, and casualisation that has been ongoing since 2018. In 2022’s “summer of discontent,” we’ve seen our (...) rail, maritime and transport workers, airport staff, bus drivers, telecommunications workers, postal workers, nurses, refuse workers, and higher and further education staff engage in ongoing industrial disputes with intractable bosses. Even criminal barristers continue with an indefinite, uninterrupted strike after years of government cuts and chronic underinvestment. Everywhere you look, there is a palpable sense of a country on its knees. It’s nearly 100 years since the last General Strike of 1926 and in the UK it’s looking increasingly likely that we will have another General Strike on our hands soon. In “Two Cheers for Blueprints, or, Negative Reasons for Positive Utopianism” Antonis Balasopoulos contextualizes this within the longer economic durée of the shift from Fordist production to so-called flexible accumulation after 1972, writing in this issue that “the turn of capital to the faster and higher [End Page 554] profits involved in financialization rather than infrastructural and industrial investment, form much of the objective, structural ground for what can only be described as the rapid rise of a dystopian structure of feeling in western societies since the early 1970s.” Antonis’s brilliant summary reminds us of the monumental scale of the challenges facing utopian thought and praxis in our current moment. Make no mistake—the “crisis ordinariness” of everyday life under late capitalism that Lauren Berlant identified in Cruel Optimism (2011) has intensified in the years following the Global Financial Crisis (2007–8), the wave of Occupy protests in 2011, and, more recently, the COVID-19 pandemic (2020–). “For some time now,” as Antonis writes, the utopian goals of “happiness, fulfilment, [and] emancipation... have been out of the question altogether.”It’s hard not to agree with this assessment, given the current chaos of life in the UK. Adam Stock’s roundtable contribution “Funding Utopia: Utopian Studies and the Discourse of Academic Excellence” focuses on the academy’s complicity with the neoliberal financialization of what were previously protected as public goods (education, our health service, transport infrastructure, and so on) over the past three decades. As Adam notes, the rhetoric of “excellence” that has come to dominate all areas of university life—teaching, research, public engagement, and the quantifiable “impact” of university research beyond the academy—is really just another way of using competition to mask the market logic of scarcity. Swingeing cuts to publicly funded research have led to a scarcity of resources in scholarly knowledge production, which is legitimated through the discourse of “excellence” and “prestige.” Only a handful of elite research leaders are granted awards and the value of all research becomes judged by its proximity to this distribution (concentration) of wealth within a small number of institutions. Defending education as a public good has long given way to the desperate, existential struggle for survival at UK universities. Numerous institutions are on the brink of bankruptcy, which was the goal all along for the ideologically driven Office for Students (OfS). Market exit, as they euphemistically term it, proves market efficiency.At my own institution, Birkbeck, University of London, the challenge to utopian thinking is all too violently clear. Birkbeck has a special place in the UK higher education system—a university founded nearly 200 years ago in the Crown and Anchor Tavern on the Strand (it was called the London Mechanics’ Institution back then) to offer education to working-class Londoners that [End Page 555] fitted around their busy working lives. As my colleague Joanna Bourke writes in Birkbeck: 200 Years of Radical Learning for Working People (2022), life expectancy in the poorest parts of London was just twenty-nine years; cholera, typhoid, and typhus were major killers; and illiteracy was widespread. At Birkbeck, we are the only university to teach evening classes and offer the requisite support... (shrink)

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

On 22nd September 2020 the UK Government announced new lockdown restrictions to supress the COVID-19 virus, with some areas of England having more restrictive lockdown guidance. Students in a number of cities have been confined to their halls of residences after outbreaks of COVID-19 and in Manchester security guards were preventing students leaving the buildings. The scientific community are, unsurprisingly, divided over the question of how far lockdowns should extend.1 Monday 21st September 2020 saw the publication of two open letter (...) to the UK government and Chief Medical Officers. One group, Sunetra Gupta et al,2 argued for a selective lockdown targeting the most vulnerable. The other, headed by Trisha Greenhalgh, arguing that attempts to suppress the virus should operate across the whole community.3 As we enter what appears to be a second wave of COVID-19 infections and accompanying lockdown measures, ethical debates over the appropriateness and extent of such measures are critical. Julian Savulescu and James Cameron4 in their article on lockdown of the elderly and why this is not ageist, put forward the case that, ‘an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly.’ Their central claim is that selective isolation of the elderly is to be preferred to imposing lockdown on all members of society. The aim of lockdown, restricting movement and key activities, is designed to reduce the number of deaths from COVID-19 and also to prevent the healthcare system from becoming overwhelmed. As the elderly are at significantly more risk of having severe cases of COVID-19 and therefore more likely to place demands on healthcare services, they are clearly prime candidates for lockdown measures, measures that will not only benefit them but the whole of society. This is not ageist as …. (shrink)

Industry 4.0 The present work enables us to take the first steps in the world of the 4th Industrial Revolution, a world where robots, artificial intelligence and digital manufacturing technologies will change forever the way we design, produce and buy products and services. The first characteristics of this revolution is globalization: for the first time in history, an industrial transformation is taking place simultaneously on a global scale. The second key-factor is the word ecosystem: unlike the first three industrial revolutions (...) (steam engine, electricity and computers) over the past few years, no technologies nor machines were invented anew, but we understood how to keep together different technological platforms by using the same language (bit). If the revolution in place will complete the transformations announced, in twenty years we will look at today’s society the same way we nowadays look at the 19th Century society. (shrink)

BackgroundTranscranial magnetic stimulation (TMS) is an FDA approved treatment for major depression, migraine, obsessive compulsive disorder, and smoking addiction. TMS has gained popular media support, but media coverage and commercial reporting of TMS services may be contributing to the landscape of ethical issues.MethodsWe explore the differences between the academic and print media literature portrayals of TMS to evaluate their ethical impact for the public. We performed a comprehensive literature review using PubMed and NexisUni databases to evaluate the literature available (...) on TMS from 2014 to 2019. Our sample consisted of 1632 academic articles and 468 print media articles for a total of 2100 articles. We then coded each article for seven specific top-level codes: (1) type of source, (2) year of publication, (3) purpose of TMS application, (4) age of subjects, (5) population, (6) overall tone, and (7) specification of TMS parameters. We also made some additional notes of the TMS parameters where specified and the breakdown of mental health applications.ResultsOur results indicated several discrepancies between the academic and the print media reporting about TMS technology, particularly with regards to tone and specificity. Namely, the academic sample was largely neutral and specific about the parameters under which TMS was being applied, while the print media sample was heavily optimistic and presented the application of TMS with far less specificity. There was some convergence between the two samples, such as the focus of both on therapy as the predominant TMS application.ConclusionsWe call upon the academic community to increase scrutiny of TMS services in order to ensure that people’s knowledge of health technologies is not unduly influenced by sensational claims and a general lack of adequate information. (shrink)

: Recently, various suggestions have been made to respond to the increasingly great shortage of organs by paying for them. Because of the undesirable side effects of such approaches (commodification, injustice, and costs), a communitarian approach should be tried first. A communitarian approach to the problem of organ shortage entails changing the moral culture so that members of society will recognize that donating one's organs, once they are no longer of use to the donor, is the moral (right) thing to (...) do. This approach requires much greater and deeper efforts than sharing information and making public service announcements. It entails a moral dialogue, in which the public is engaged, leading to a change in what people expect from one another. Among the devices that could help to change the moral culture are a public statement, endorsed by community members and leaders, that expresses the community sense that donation "is what a good person does" and a community-specific web page that lists those who have made the commitment. A change in law so that a person's wishes in the matter are recognized as final and binding is also desired. This position paper deals only with cadaver organs and not living donors. (shrink)

The genre of public service advertisements that appear with two- and four-year cyclical regularity is familiar. Cameras pan across scenes of marines hoisting the flag on Iwo Jima, a bald eagle soaring in splendid flight, rows of grave markers at Arlington. The somber-voiced announcer remonstrates: “ They did their part; now you do yours.” Once again it is the season to fulfill one's civic duty, to vote.

This study examines the public's and physicians' willingness to support deception of insurance companies in order to obtain necessary healthcare services and how this support varies based on perceptions of physicians' time pressures. Based on surveys of 700 prospective jurors and 1617 physicians, the public was more than twice as likely as physicians to sanction deception (26% versus 11%) and half as likely to believe that physicians have adequate time to appeal coverage decisions (22% versus 59%). The odds (...) of public support for deception compared to that of physicians rose from 2.48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources. (shrink)

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Qur’an courses have been opened for 4-6 years old by Presidency of Religious Affairs, showed academic success and ensure children realize the values of Islamic religion meaning to human life, recognize sound and form of Qur’an, develop healthy religion and morality. Applied courses prepared by academicians, pre-school teachers and experts. Graduates educated from Faculty of Theology, İlitam, Associate of Theology degree and Imam-Hatip High School, public education, distance education centres of universities, and instructor work in these courses who receive (...) certificates from programs which is organized by Presidency. Because there aren’t undergraduate or graduate levels educational institutions for training people who give religious education in early childhood in Turkey. The aim of study reveal competencies 4-6 years old of instructors works in courses based on experiences of teachers with students and their parents. In the study, it is used qualitative methodology, interview and document analysis. 18 instructors were interviewed and content analysis was used for data obtained. Similar data was combined and interpreted within framework of certain concepts and themes. It was determined that instructors have considered themselves insufficient in pedagogical formation. According to the findings, trainings are theoretically and long intervals in-service. During training process, the necessity of parent education and positive developments in families demonstrated which determined that parents had requests for their children to be prepared for school. In addition, it was determined that students showed academic success who graduated from course and started primary school. However, the achievement was determined individual efforts of instructors, and there wasn’t content preparing children for school course of 4-6 years. (shrink)

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Related to the research of working conditions, the link between organizational factors and health was traditionally analyzed using linear models. However, the literature analysis suggests inconsistencies in linear models predicting workers’ health levels. To clarify this issue, this exploratory research compares the linear and non-linear relationships between job demands-resources, and the psychological and physical symptoms of employees working in the main five service subsectors: commerce, horeca, public administration, education, and healthcare. With a final sample of 4,047 participants, our (...) study data were extracted from the II Andalusian Working Conditions Survey. Following the theoretical framework of JD-R Model and considering the Vitamin Model theoretical approach for non-linear relationships, our results showed that there were significant differences among the five subsectors analyzed regarding the linear and non-linear relationships between job demands-resources and psychological and physical symptoms of employees. Furthermore, task complexity generated non-linear relationships in higher proportion than time pressure and contact with users. Likewise, non-linear relationships found showed a U-shape. Moreover, the findings of non-linear relationships suggested that medium levels of task complexity should not be exceeded to avoid further negative impact on psychological and physical symptoms for service sector employees, preserving their health. Finally, some general practical implications of work environment interventions are suggested. (shrink)

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

We investigate the causal effects of religious service attendance on prosocial behaviours using longitudinal data from a nationally representative sample of 33,198 New Zealanders collected between 2018 and 2021. Our study innovates in three ways: (1) we use longitudinal rather than cross-sectional data; (2) we incorporate measures of help received alongside self-reported giving; and (3) our statistical models are designed to address causal questions, rather than simply to describe change over time. We model causal contrasts for three hypothetical interventions (...) – increasing, decreasing, or maintaining religious service attendance – and assess their effects on eight distinct prosocial domains. Study 1 focuses on self-reported charitable donations and volunteering. Studies 2 and 3 examine receiving help – both personal and financial – from family, friends, and the wider community. Across all analyses, we find that the causal effects of religious service attendance are notably smaller than cross-sectional correlations suggest. However, even modest increases in regular attendance would result in charitable donations equivalent to approximately 4% of the New Zealand Government’s annual spending – a considerable public benefit. By applying robust methods for causal inference to national-scale panel data, our study provides insights that can inform public policy about the social functions of religious participation and advances a methodological framework for investigating the social consequences of cultural practices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 373-378 [Access article in PDF] The Forgotten Self:Training Mental Health and Social Care Workers to Work With Service Users Kim Woodbridge Keywords self, workers perspective, them and us, win-win situation The three main papers and the case studies presented in this issue of Philosophy, Psychiatry, & Psychology all focus on the service user perspective in relation to the self as illustrated (...) by different aspects of philosophy. This is also in the context of the service user looking for help during a time when they are experiencing levels of distress and difficulty.Important as this is, evident by the substantial clinical and philosophical literature in this area, what has been overlooked is the perspective of the mental health and social care worker responsible for the care of individuals whose sense of self is disturbed. The significance of this omission has been brought home to me through my experiences in running training workshops for workers working with service users with a diagnosis of personality disorder. (From here on, in this paper, the terms worker and trainee are used interchangeably to refer to the mental health and social care worker).During these workshops challenges to the worker's sense of self have been revealed emotionally ("this doesn't feel like me"), ideologically ("I am not a bad person"), and/or practically ("I don't usually behave like this") when discussing their work with service users. This paper draws from the workshop experiences to explore and consider the workers perspective in relation to the self in more detail.There follows a descriptive account of three workshop sessions which include the trainees responses. With each activity the responses are considered within the context of the self, particularly from the worker's perspective. In the conclusion the argument is made, as evidenced by these illustrations, for the importance of including the workers' perspective when attempting to understand the self. The Trainees and Service Users Workers from various professional and nonprofessional backgrounds attend the workshops. They include psychiatrists, nurses, social workers, support workers, and occupational therapists who work in both in-patient and community settings. They usually have several years of clinical experience working with people with a [End Page 373] diagnosis of personality disorder, but rarely have they had any formal education or training in the area. Discussing their experiences of working with this service user group generates strong and highly emotionally charged personal responses during training.It is their experiences of the relationships with service users whose sense of self is absent, inconsistent, or unstable, that make a substantial contribution to the content of the workshops.Often service users are struggling with fragmented, distorted, or threatening perceptions of the world, themselves, and others. The worker, while embedded within their own sense of self, is engaged in a relationship with the service user. The issues that arise as a part of this relationship can be challenging and distressing for the workers. There are two main areas:The impact the service user's chaotic, fragmented, and unstable sense of self has on the worker's own sense of self.The response of the workers when their sense of self is challenged, and the impact that response has on the service user. These can be seen in more detail in the examples taken from the training sessions presented later in this paper. The Training Sessions The training sessions are either run alone or form part of a 1- or 2-day workshop. As mentioned, the groups are composed of a variety of professionally and nonprofessionally qualified staff. The experiences they share mainly relate to people with a diagnosis of Borderline Personality Disorder, although other subcategories are mentioned occasionally. Information regarding these and other related sessions can be found in two recent publications: Making positive connections (Duff, Meredith, & Woodbridge,2003) and "Whose good practice?" (Woodbridge & Fulford, 2003). The First Activity: Revealing Internal Models Given the lack of available evidence, even the best-informed trainees are likely to have to fill in the knowledge gaps with their own interpretations of... (shrink)

My concern in this essay is a family of liberal theories that I shall call “public reason liberalism,” which arose out of the social contract theories of Hobbes, Locke and Rousseau. These social contract accounts stressed that the justification of the state depended on showing that everyone would, in some way, consent to it. However, by relying on consent, social contract theory seemed to suppose a voluntarist conception of political obligation and authority: I am only bound by political authority (...) if I choose to be bound.1 Only in Kant, I think, does it become clear that consent is not fundamental to a social contract view: Kant insists that we have a duty to agree to act according to the idea of the “original contract.”2 Rawls’s revival of the social contract tradition in A Theory of Justice also made no important appeal to consent, though the apparatus of an “original agreement” of sorts persisted. The aim of the original position, Rawls announced, is to settle “the question of justification…by working out a problem of deliberation.”3 As the question of public justification takes center stage (we might say as contractualist liberalism becomes justificatory liberalism), it becomes clear that posing the problem of justification in terms of a deliberative or a bargaining problem is simply a heuristic: the real issue is “the problem of justification”4 — what principles can be justified to all reasonable persons. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XX, Number 1, April 1994, pp. 143-149 David Hume and Public Debt: Crying Wolf? JOHN CHRISTIAN LAURSEN and GREG COOLIDGE David Hume's views on public credit have not only received prominent attention in the literature on his political thought, but have even been the subject of attention in The Wall Street Journal.1 Most of the attention has centered on Hume's essay "Of Public (...) Credit" of 1752, and treats it only as an expression of ideas, without relating it to the historical facts. This note lays out Hume's views on this matter throughout his lifetime, and juxtaposes them with figures for the actual public debt, carrying the story down to the twentieth century. Public debt as we know it only goes back about 300 years. The British government in the 1690s was the first modern government to establish enough genuine credit that private citizens would loan it money without having to be compelled.2 At the turn of the century, in the year 1700, the British public debt amounted to 14.2 million pounds sterling.3 As early as 1741, Hume was already worrying about the public debt in the essay "Of Liberty and Despotism" (later changed to "Of Civil Liberty"). In the last paragraph of that essay, he wrote of the "degeneracy" brought about by public debt, suggested that debt-service "taxes may, in time, become altogether intolerable, and all the property of the state be brought into the hands of" the government. If it is not curbed, we may come to "curse our very liberty," he wrote.4 That year, the national debt totaled 48.8 million pounds (45.2 million in 1701 pounds5). John Christian Laursen and Greg Coolidge are at the Department of Political Science, University of California, Riverside, Riverside, CA 92521 USA. Laursen e-mail: [email protected]. 144 John Christian Laursen and Greg Coolidge Hume's essay of 1752, "Of Public Credit, " was devoted entirely to criticism of the public debt (Essays, 349-365). His thoughts on public credit at this time can be summed up in this ominous warning: It must, indeed, be one of these two events; either the nation must destroy public credit, or public credit will destroy the nation. (Essays, 360-361) Hume acknowledged that the use of public credit could benefit the economy in some ways: more men with large stocks and incomes, may naturally be supposed to continue in trade, where there are public debts; and this, it must be owned, is of some advantage to commerce, by diminishing its profits, promoting circulation, and encouraging industry. (Essays, 354) But the many disadvantages would outweigh such advantages (Essays, 354355 ): 1) "It is certain, that national debts cause a mighty confluence of people and riches to the capital," making the head too large for the body. 2) Public stocks "banish gold and silver from the most considerable commerce of the state." 3) The taxes levied to pay the interest oppress the poorer people. 4) "As foreigners possess a great share of our national funds, they render the public, in a manner, tributary to them, and may in time occasion the transport of our people and our industry." 5) Public credit encourages an idle and useless rentier class. All of this pales, however, in comparison to the political consequences. From the point of view of the body politic, public credit was a threat to the security of the state. It would die a natural or a violent death. In wartime, or some national emergency, the funds necessary for the functioning of the economy would be diverted to other purposes. The economy, now dependent on credit, would crumble. The whole fabric, already tottering, falls to the ground, and buries thousands in its ruins. And this, I think, may be called the natural death of public credit. (Essays, 363) Hume Studies David Hume and Public Debt: Crying Wolf? 145 Another scenario would occur if the government became too indebted to intervene in maintaining the balance of power in Europe. Our children, weary of the struggle, and fettered with encumbrances, may sit down secure, and see their neighbors oppressed and conquered ; till, at last, they themselves... (shrink)

The concentration of high-frequency controls in a limited period of time constitutes an important feature of many law-enforcement policies around the world. In this paper, we offer a comprehensive investigation on the relative efficiency and effectiveness of various crackdown policies using a lab-in-the-field experiment with real passengers of a public transport service. We introduce a novel game, the daily public transportation game, where subjects have to decide, over many periods, whether to buy or not a ticket knowing (...) that there might be a control. Our results show that concentrated crackdowns are less effective and efficient than random controls; prolonged crackdowns reduce fare-dodging during the period of intense monitoring but induce a burst of fraud as soon as they are withdrawn; pre-announced controls induce more fraud in the periods without control. Overall, we also observe that real fare-dodgers fraud more in the experiment than non-fare-dodgers. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based on the (...) variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Earlier this year, the U.S. Department of Health and Human Services announced its intent to strengthen enforcement of legal protections for health care providers' conscience rights. It proposed regulations that would give the DHHS Office of Civil Rights greater authority to ensure that recipients of federal funding comply with federal conscience laws. This recent development creates an opportunity for scholars and policy‐makers to revisit the perennial debate about whether and how law should protect health care providers' rights of conscience. Arguments (...) about who should be protected, what actions should be protected, and whether there should be any limitations on the exercise of conscience rights have brought us no closer to a resolution. However, there is one remaining avenue for analysis that has, surprisingly, received very little attention—the question of how providers are protected, and from what consequences. Existing U.S. conscience laws immunize health care providers from a wide range of adverse consequences—including civil liability, criminal prosecution, administrative penalties, adverse action by employers, and discrimination by private actors, among others. However, academic and public policy debates rarely acknowledge the breadth of these protections. It is essential to disentangle this network of possible protections. (shrink)

This Paper identifies seven positive elements of an _ethics system_, or framework, for public officials - namely, (1) the culture and values prevailing in a country; (2) codes and laws and their enforcement; (3) new institutions to uphold ethics in public life; (4) audit, public accountability and openness; (5) guiding principles and motivation to encourage good conduct; (6) external and internal education and training for public life; and (7) the views of the public in regard (...) to their call for greater trust, honesty, and integrity in public life. The Paper next discusses in detail each of these seven elements of an _ethics system_ in the context of British Central Government. However, these seven elements are deemed appropriate for the Public Service of any country seeking to strengthen its standards of conduct and uphold its ethical responsibilities. Finally, this Paper concludes with a reference to business companies and the relevance to them of an _ethics system_. For example, there is a defence in the new UK Bribery Act of 2010 (to be implemented on 1st July 2011 and applicable also to foreign corporations doing business in the UK) that, if a business company has procedures in place to prevent corruption (that is, an _ethics system_), it will be treated more leniently. (shrink)

The red tape and delays around research ethics and governance approvals frequently frustrate researchers yet, as the lesser of two evils, are largely accepted as unavoidable. Here we quantify aspects of the research ethics and governance approvals for one interview- and questionnaire-based study conducted in England which used the National Health Service procedures and the electronic Integrated Research Application System. We demonstrate the enormous impact of existing approvals processes on costs of studies, including opportunity costs to focus on the (...) substantive research, and suggest directions for radical system change. We have recorded 491 exchanges with 89 individuals involved in research ethics and governance approvals, generating 193 pages of email text excluding attachments. These are conservative estimates. The exchanges were conducted outside IRAS, expected to be the platform where all necessary documents are provided and questions addressed. Importantly, the figures exclude the actual work of preparing the ethics documentation. We propose six areas of work to enable system change: 1. Support the development of a broad range of customised research ethics and governance templates to complement generic, typically clinical trials orientated, ones; 2. Develop more sophisticated and flexible frameworks for study classification; 3. Link with associated processes for assessment, feedback, monitoring and reporting, such as ones involving funders and patient and public involvement groups; 4. Invest in a new generation IT infrastructure; 5. Enhance system capacity through increasing online reviewer participation and training; and 6. Encourage researchers to quantify the approvals processes for their studies. Ethics and governance approvals are burdensome for historical reasons and not because of the nature of the task. There are many opportunities to improve their efficiency and analytic depth in an age of innovation, increased connectivity and distributed working. If we continue to work under current systems, we are perpetuating, paradoxically, an unethical system of research approvals by virtue of its wastefulness and impoverished ethical debate. (shrink)

“The play's the thing,” according to Hamlet . Stephen Hilgartner agrees, and he has taken the notion of performance—public drama—and used it as an extended metaphor and analytical tool to explore ways in which scientific advice is generated, how advisory bodies seek to present themselves, and how they achieve credibility.Hilgartner focuses on three reports from the 1980s of the National Academy of Sciences that deal with diet and health. These were not typical reports, for they generated huge controversies that (...) swirled around them. The reports' potential influence on doctors and patients, on the food and agriculture industries, and even on parents who admonish their children to drink their milk and eat their vegetables was also huge.Like most NAS products, the three reports were written by committees. The authors of the first one managed to fend off critics. The second was, to use Hilgartner's theatrical term, virtually “upstaged” by its critics. And the third was never published at all. The draft of this report, a 1985 study that dealt with recommended dietary allowances for foods, proved so disputatious that the effort was canceled by the president of the academy. All three cases are interesting and well presented, but the cancelled RDA report naturally has the most dramatic interest and is the most instructive.Credibility is the central issue in scientific advice. Even a body as august as the National Academy of Sciences cannot assume that its advice will be accepted at face value by policymakers, the public, or the scientific community itself. Hilgartner examines the techniques the academy used to enhance the credibility of its reports. These techniques included the literary structure of the publications as well as the maintenance of a sharp distinction between the “front stage” and “back stage” components of the advisory group's “performance.” Backstage, in the committee's deliberations, there may be sharp disagreements, but out front, the report is presented to the world as the product of consensus. Sometimes, however, these stage management techniques fail and internal dissension emerges into public view. Hilgartner's account of the saga of the RDA report illustrates how leaks and “unauthorized performances” effectively killed the report.Hilgartner carries the theatrical metaphor well beyond what one might expect in a scholarly book on science policy. In Chapter 4 he takes the academy's announcement canceling the 1985 RDA report and recasts it in explicitly dramatic form—a ten‐page script for a play entitled “A Letter from the Chairman: A Play in Three Acts,” complete with stage directions and a Greek chorus. Surprisingly, it works. While it may never be performed on Broadway, “A Letter from the Chairman” effectively makes Hilgartner's point. The episode illustrates how the academy, faced with a breakdown of its regular procedures, managed to portray the report's cancellation as “completely normal, … a logical consequence of the situation, not an aberration” .From my own standpoint as a political scientist, I might have liked a bit more emphasis on the interests the various committee members represented. Hilgartner acknowledges the roles vested interests play in the controversies that surrounded the three reports, but in maintaining his focus on information management by the academy, he fails to devote much attention to them. Similarly , he does not deal at all with a key category of scientific advice—that rendered privately by scientific advisors to policymakers.These are minor criticisms, however. On the whole this is an interesting and well‐written book that contributes a unique and valuable perspective to the literature on scientific advice given to the public. (shrink)

BackgroundSolitary death (kodokushi) has recently become recognized as a social issue in Japan. The social isolation of older people leads to death without dignity. With the outbreak of COVID-19, efforts to eliminate solitary death need to be adjusted in line with changes in lifestyle and accompanying changes in social structure. Health monitoring services that utilize wearable devices may contribute to this end. Our goals are to outline how wearable devices might be used to (1) detect emergency situations involving solitary older (...) people and swiftly connect them with medical treatment, to (2) reduce the frequency of deaths that remain undiscovered and (3) to reduce social isolation by promoting social interaction. MethodsTheoretical and philosophical approaches were adopted to examine ethical issues surrounding the application of wearable devices and cloud-based information processing systems to prevent solitary death in the world with/after COVID-19.Main body(1) Technology cannot replace social connections; without social support necessary to foster understanding of the benefits of health management through wearable devices among older adults, such devices may remain unused, or not used properly. (2) Maturity of the technology; systems face the difficult task of detecting and responding to a wide range of health conditions and life-threatening events in time to avert avoidable morbidity and mortality. (3) Autonomy and personhood; promoting the voluntary use of wearable devices that are a part of larger efforts to connect isolated individuals to a community or social services might be effective. Legal force should be avoided if possible. There is some concern that landlords may require an older person to sign a contract agreeing to wear a device. The autonomy of solitary older people should be respected. (4) Governance: policies must be developed to limit access to data from wearables and the purposes for which data can be used.ConclusionIf thoughtfully deployed under proper policy constraints, wearable devices offer a way to connect solitary older people to health services and could reduce cases of solitary death while respecting the personhood of the user. (shrink)

The Build-Operate-Transfer (BOT) model is a financing model used especially in the financing of infrastructure projects in developing countries. It is one of the most common methods used by the countries to provide non-budgetary financing. The fact that becoming popular in the world as of the 20th Century, this model started to be implemented in the Islamic countries created the need for examining the model in terms of Islamic law. No substantive studies have been conducted on this matter in Turkey. (...) In the Arab world, the first significant development in this regard was the 23rd Term meeting of Al Baraka Group organized in Mecca in November 2002. Next, the Islamic Fiqh Community, which operates under the Organization of Islamic Cooperation, organized a meeting about the BOT model in 2009. At this meeting, ten experts from different countries presented papers on the BOT model, and a final declaration was announced at the end of the meeting. After this meeting, some independent studies were carried out on the BOT model. However, it was observed that these efforts did not reach a sufficient level, and generally remained within the framework of the papers presented at the meeting. The BOT model is a model that takes place in the form of the transfer of the facility to the relevant public institution or organization free of charge at the end of the period after the depreciation and profit of the invested capital are realized. All expenses are covered by the private enterprise. The public service or activity is operated for a certain period of time by the private enterprise. It was observed that the studies on the BOT model in Turkey mainly dated back to the last quarter of the Twentieth Century. In this context, the Law No. 3996 about the BOT model was enacted on 08 June 1994 in Turkey. Today, the BOT model is actively used in many areas, and the delivery of the service begins after the projects are completed. The BOT model has three main successive stages. In the first stage, the project is completed with the financing of OGS. In the second stage, the operating right of this project would be awarded to the investor in accordance with the contract. In the third stage, the ownership of the facility would be transferred to the relevant public institution. The BOT model was discussed in terms of Islamic law, firstly in general and then in terms of the interests and convictions. The BOT model contains many interests in terms of both the state and the society. In addition, it has certain disadvantages. There are many reasons and aims in selecting the BOT model. The most important of these reasons is the continuation of the projects and the required work without imposing a burden on the public budget. Islamic law has a structure that prioritizes public interest. In this context, the state must observe the public interest in its operations. In the BOT model, the existence of public interest is particularly notable with the projects implemented in the fields of hospitals, roads, bridges, airports and etc. Islamic jurists have different opinions regarding the contracts administered in the BOT model. Some of them consider this model as a new contract that does not exist in the tradition, while others compare it to a traditional contract. The analogies of the traditional contract have been compared to leasing, payment, foundation, fief, corporate (with partnership) and exception contracts. Others, on the other hand, considered the BOT model as an atramentous contract combining several different contracts. It seems difficult to argue that the BOT model is completely similar to any of the classical fiqh contracts. However, as a result of the BOT model, it is considered an agreement with a company to conclude a contract; therefore there is a more prominent similarity to an exception contract. Nonetheless, it is not possible to say that the BOT model fully complies with the traditional exception contract. As a matter of fact, while there is no time determination in the exception contract, the time is determined in the BOT model. In the exception contract, while the material must be completely covered by the private sector, in the BOT model, issues such as the right to land and building construction are covered by the employer. In addition, the classical exception contract does not contain many contracts as in the BOT model; and it is an agreement in which the fee is presented and terminated after the order is placed. Nonetheless, the BOT contract includes three basic contracts (construction-operation-transfer) as well as many contracts related to these contracts. Finally, considering that the BOT model was a contract, the issues in the context of the basic elements that should be included in a contract were discussed in this study. In addition, situations such as ignorance, gharar and interest in terms of affecting the validity of the contract were discussed and dealt with in terms of the BOT contract. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 209 Trysh Travis Toward a Feminist History of the Drug-Using Woman— and Her Recovery In 1995, public health scholars Laura Schmidt and Constance Weisner published “The Emergence of Problem-Drinking Women as a Special Population in Need of Treatment.”1 The article, aimed at specialists in the growing field of behavioral sciences, explored the history of medpsych attitudes toward (...) women drinkers. That history had been characterized, until the 1970s, by ignorance and neglect, but it began to shift in the wake of Second Wave feminism and what Schmidt and Weisner called “the women’s alcoholism movement.”2 To be fair, attitudes toward male drinkers had also long been inchoate. But beginning in the 1940s, advocacy by a handful of scientific and legal professionals, as well as the mutual aid group Alcoholics Anonymous (founded in 1935) and the National Council on Alcoholism (founded in 1944), created a new vision, which went on to be underwritten by federal funding and private insurance.3 “Alcoholism is a disease 1. Laura Schmidt and Constance Weisner, “The Emergence of Problem-Drinking Women as a Special Population in Need of Treatment,” in Recent Developments in Alcoholism, Vol. 12: Women and Alcoholism, ed. Marc Galanter (New York: Plenum Press, 1995), 309–334. 2. Ibid., 310. 3. The organization was originally called the National Committee for Education on Alcoholism; it became the National Council on Alcoholism in 1950 and changed to the current National Council on Alcoholism and Drug Dependence in 1990. 210 Trysh Travis Books Discussed in This Essay Lady Lushes: Gender, Alcoholism, and Medicine in Modern America. By Michelle L. McClellan. New Brunswick, NJ: Rutgers University Press, 2017. The Recovery Revolution: The Battle over Addiction Treatment in the United States. By Claire D. Clark. New York: Columbia University Press, 2017. Addicted to Rehab: Race, Gender, and Drugs in the Era of Mass Incarceration. By Allison McKim. New Brunswick, NJ: Rutgers University Press, 2017. Through a Trauma Lens: Transforming Health and Behavioral Health Systems. By Vivian Barnett Brown. New York: Routledge, 2017. and the alcoholic a sick person,” argued National Council on Alcoholism founder Marty Mann in a host of magazine articles beginning in the late 1940s. From that assertion followed the beliefs that “the alcoholic can be helped and is worth helping” and that “alcoholism is a public health problem and therefore a public responsibility” (29).4 Behind Mann’s carefully gender-neutral language lay an image of the alcoholic as a white man from the respectable middle classes. The mid-century legitimation of that man’s problems, Schmidt and Weisner argue, paved the way for “problem-drinking women” to finally come into focus half a century later. Schmidt and Weisner’s article centers on the ways the Great Society funding streams that first steered funds to community-based alcohol and drug treatment changed during the 1980s. But along the way, they briefly explore organized feminism’s views of alcohol- and drug-using women. They note that Second Wave feminists had dealt aggressively with behavioral health issues such as domestic violence, child sexual 4. Marty Mann, “Can We Conquer Alcoholism?” Health (1947): 12–13, 29–30. Trysh Travis 211 abuse, and rape—all of which correlated closely with substance use and abuse. But they see no feminist activism around alcohol or drugs. Instead, “representatives from organizations in the broader feminist and women ’s health movements” were “conspicuously absent” from the women’s alcoholism movement, which consisted chiefly of activists motivated by alcohol issues, not gender.5 Interest in—and action on—women’s alcohol and other drug use consequently became the province chiefly of clinicians and policy makers, not movement women. Although many of those professionals saw substance-using women’s needs as important and worthy of services, few viewed them through the lenses of gender and power. The blind spot that Schmidt and Weisner observe among feminist activists is interesting not only for what it tells us about a conceptual boundary of Second Wave feminism (both liberal and radical) but also for the way it points to a gap in the feminist scholarship that is ostensibly a central legacy of the earlier movement. Like... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:138 In 2010 the city of Colorado Springs was strapped for cash. Government officials announced that they would either have to raise revenue through increased taxation or cut public services—­ in some cases rather severely—­ including, perhaps, police and fire protection, and even more basic bits of municipal infrastructure. The city shut down one-­ third of residential streetlights and closed public restrooms. Citi­ zens were outraged, but (...) a majority of voters had recently defeated a proposed tax increase. It’s tempting to suppose that the city was trying to teach its citizens a lesson: if you want public services, you have to be willing to pay for them. Colorado Springs is, and has been for some time now, a died-­in-­the-­wool small-­government, anti-­tax-­increase, fiscally conservative town. As Colorado Springs resident Bo Sharifi put it, “As soon as I hear government [say] ‘Oh, we need more money’... I guess I kind of automatically assume there’s probably some other things you could probably cut before firemen, policemen, city lights and that sort of thing.”1 On the surface, that seems reasonable. So... what comes to mind? How about food stamps? What about WIC? Of course these are federal services, not funded by Coloradans alone. There’s government, and then there’s government. Well, how about... well... what? Doesn’t the government spend money on all sorts of things we could very easily do without? Perhaps. Isn’t it part of our job to know or to decide which things these are? If we don’t trust government, even more obviously we don’t trust it with our money, though we pretty clearly have no idea how public funds are actually allocated or spent. When asked whether he remembered the proposed tax increase that the city had voted against, Sharifi replied, “maybe.” Bo and his wife were charged $125 to have Connected: How Trains, Genes, Pineapples, Piano Keys, and a Few Disasters Transformed Americans at the Dawn of the Twentieth Century By Steven Cassedy Stanford: Stanford University Press, 2014 JOHN MARIANA Book Reviews 139 their streetlight turned back on. Bo’s wife Sara viewed this as extortion. “By shoveling out a hundred dollars to turn on a streetlight that we kind of felt was supposed to be on anyway, that it was giving them what they wanted,” she said. They who? One resident wrote the city of Colorado Springs a check for $300 to turn the lights on for his entire neighborhood. City Councilwoman Jan Martin pointed out to him that the total cost to the individual Colorado Springs taxpayer to keep the streetlights on—­and to fund the maintenance of public parks and medians, as well as community centers and pre-­recession-­level police and fire services—­by approving the tax increase would have been: $200. He replied that he would never vote for a tax increase. In other words, as the reporter who covered the story (Robert Smith) observed, he would rather pay more to keep the streetlights on in his own neighborhood than to pay for all city services combined. Smith remarked that “Colorado Springs was stepping away from one of the things that we take for granted in most American cities: that we’re all in it together—­ at least when it comes to basic services.”2 As near as I can tell, this is the moral of Steven Cassedy’s exceptionally timely Connected: that we’re all in it together. For much of the book Cassedy merely traces the history of the emergence in the consciousness of ordinary Americans of the concept of the social network, but he is not so much talking about the notion of a network society as such, as I understand him. Or, at any rate, the network society as such is not really his main concern. He is talking about the idea of social, political, national, and ultimately global and universal human interconnectedness that was a distinct product of the complex networked structures (both concrete and abstract) that came to constitute modern American life in the twentieth century (and of course life pretty much everywhere ), and about our understanding of ourselves as so networked.3 On this... (shrink)

1. In the circumstances of the overgrowth signs the scientific-technical revolution the following events in essential way are influencing the activities of public administration : 1° the establishing, under thepressure of the technical progress and specialization, of the big economic units ; 2° the acceleration of the processus of urbanization ; 3° the increasing threat of the biological environment and the appearance of newpossibilities for its protection; and 4° the leveling of differences between the living standards of the population (...) in town and in countryside. In that situation the socialist state has first of all to develop its organizationalfunctions.2. The organizational functions of the socialist state are implemenied above all by the supreme and local representative organs of the state authority and by the subordinated to them organs of the state administration. In the result of this organizational activity the scope of civic rights is extending. The state apparatus therefore is responsible for calling into being and for activities of the public institutions and facilities being used by the citizens at their choice. The regulating role of the state has hence respect more to these public institutions and facilities, and it is addressed more seldom directly to the citizens. That takes place especially in the sphere of the administration of national economy, the organization of technical public services as well as the services rendering administration.3. The social and economic assumptions of the socialist system are putting into effect by the organizational activities of the state apparatus. One of the fundamental features of this system is to gain the conscioussupport of the overwhelming majority of the society for actions of the socialist state and to consolidate this support. Such support is possible to reach only by the development of the democratic principles of thestate activities. The democratic institutions are established by the law, and the law is one of instruments of the realization of the political tasks of the socialist society being organized into the state. The state apparatus' function is to embody in action the tasks established by the law. And this therefore makes the role of the state apparatus very important as welt as provides to the necessity of permanent improvement of this apparatus.4. The social and economic plans create the substantial basis for the state administration activities. In the both national and local plans, voted by representative organs of the state authority, there are determined theeconomic and social tasks as welt as the aims concerning in advancement of the living standards of the population. In the state enterprises plans are voted by the organs of the workers' self-government. The principles of socialist democracy and democratic centralism are reflected in the procedure of planning.5. The processus of the administration in the contemporary state becomes more and more complicated. This processus demands an improvement of th social nature, but not of the technocratic one. And that improvement, realized in conformity with the social necessities, is safeguarded by the fact that the state machinery in the socialist country is inspired and vivified by the political leadership of the working class' party. (shrink)

This essay reviews the place and role of Public Service Media (PSM) in promoting social justice in the changing digital media landscape through the ethos of diversity. Media diversity – the value and practice of including varied viewpoints, social groups, voices, and channels or outlets in media – has long been a declared pillar of PSM organizations worldwide. However, current changes in the digital media landscape and the growing extension of PSM organizations to digital platforms require re-reading the (...) premise of promoting media diversity as a tool for social justice. This essay identifies a paradox. On one hand, online media appear to accommodate a greater range of diverse voices and players, particularly in the PSM ecosystem. At the same time, these very same online spaces jeopardize diversity, as the increasing practices of personalization, algorithmic curation, and platformization often reduce diversity of representations, voices, and exposure to content, thereby hindering opportunities for social justice and equality. This essay shines a spotlight on this nexus of conflicting mechanisms. The essay begins with in-depth definitions of the two somewhat convoluted terms diversity and social justice. This section includes a review of global perspectives on PSM organizations, and the long-standing value of diversity promoted through them for decades. We then review the impact and changes identified in PSM platforms worldwide in light of the digital turn in the media field. This is followed by an in-depth discussion of the inherent tension between mechanisms that promote and hinder diversity online. Throughout this discussion, we raise questions about the practical dimensions of using online media to promote social justice through diversity. It provides a useful starting point for considering the intersection of Public Service Media, online platforms, diversity, and social justice. Thus, the essay will serve academic scholars studying social justice on a conceptual level as well as practitioners and stakeholders in the media industry at large, and PSM in particular, seeking to practically promote social justice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:American Journal of Philology 122.1 (2001) 87-106 [Access article in PDF] Homo Fandi Dulcissimus: The Role of Favorinus in the Attic Nights of Aulus Gellius Stephen M. Beall ONE OF THE INDIRECT BENEFITS of reading the Attic Nights of Aulus Gellius is that he offers us a glimpse of the "smart set" of Antonine Rome. Many chapters are cast as anecdotes featuring Gellius' mentors and acquaintances, among whom he (...) counted such illustrious figures as Herodes Atticus, Marcus Fronto, and the grammarian known as Domitius "the Insane." But the "star" of the work is clearly Favorinus of Arles, a flamboyant orator who described his life in three paradoxes: he was a native of Gaul who spoke Greek, a eunuch who was accused of adultery, 1 and a citizen who quarreled with an emperor and lived (Philostratus, VS 489). To Gellius, he was "Favorinus noster," and the twenty-seven anecdotes involving him indicate that the two were on fairly intimate terms. 2We are left to wonder, however, how someone as eccentric as Favorinus should have become the special friend and mentor of a "fairly conservative, practically minded Roman" such as Gellius. 3 Perhaps, following Polemo, we can attribute the attraction to Favorinus' skill in the black arts. 4 It is more likely, however, that he possessed qualities that could be adapted to Gellius' intellectual program but which have not been fully elucidated by scholarship. 5 These can best be expounded, I believe, as three additional paradoxes: Favorinus was a polymath who passed for a philosopher, a philhellene who studied Roman culture, and [End Page 87] a Greek "Asianist" with ties to Latin archaism. All three paradoxes, as we shall see, relate to thematic issues in the Attic Nights and may help us to account for the paradoxical nature of the work as a whole. 1. Favorinus: The Miscellaneous Philosopher Favorinus' professional status was open to question even in antiquity. Philostratus describes him as a "philosopher" who "was called a sophist" by dint of his charm as a speaker (VS 489). The Suda puts the case less charitably, saying that "he was full of philosophy, but more devoted to rhetoric" (Phi 4). Lucian's Demonax found him too effeminate in style and appearance to wear the mantle (Demonax 12-13). When Favorinus claimed a philosopher's exemption from public service, the emperor Hadrian was prepared to rule against him (Philostratus, VS 490). Favorinus averted this disaster by accepting the priesthood in question, claiming that he had been advised to do so in a dream.The question of Favorinus' calling is further complicated by the mixed character of his published work, little of which survives. 6 He wrote treatises on philosophical skepticism, including the celebrated Pyrrhonian Tropes (Phil. VS 491; cf. Gellius, 11.5.5). 7 He did not, however, restrict himself to writing of a technical kind. He also produced two miscellanies, the Memorabilia and Omnigena Historia, which seem to have combined philosophical anecdotes with other sorts of trivia, including etymologies and wonder tales. 8 His oratorical remains likewise indicate a versatile and playful intellect. Two speeches preserved in the corpus of Dio Chrysostom (37, 64), and a third on a recently discovered papyrus, are notable for their witty use of stock themes and exempla. He declaimed on "absurd" themes, such as the virtues of Thersites and the advantages of the quartan fever (Gellius, NA 17.12). Indeed, he was so adept at sophistic role-playing that Gellius could not tell when he was speaking in earnest (14.1.2). Philostratus reports that he drew crowds with a highly musical style of speaking, at times almost like singing, which won applause even from people who could not understand Greek (VS 491).In the anecdotes of the Attic Nights, we find a similarly ambiguous [End Page 88] characterization. Although Gellius regularly honors his mentor with the epithet philosophus, 9 he praises him chiefly for the "sweetness of his diction," which, he says, held him captive for entire days (16.3.1; cf. 14.1.32). Elsewhere he lauds him... (shrink)

In the post-broadcast era, public service media (PSM) organizations have to innovate, stay up-to-date with new ways of consuming content, and experiment with the manifold opportunities that interactivity offers for audience engagement. At the same time, they are still obligated to achieve their public service remit and guarantee that services comply with values such as universality, diversity, creativity, and innovation. This article analyzes the innovation policies and strategies of PSM to understand if these are shifting from (...) a technology-centric to a user-centric approach. It evaluates what areas of innovation are prioritized by both policy-makers and public broadcasters and whether these areas correspond with the innovation goals entrusted to PSM organizations by scholars. To this end, we adopted a multi-case study approach. The focus is on three public broadcasters of varying size and situated in different political, cultural, and economic backgrounds: RTVE (Spain), RTÉ (Ireland), and VRT (Belgium). Based on a qualitative document analysis, we conclude that innovation remains largely technology-centric. Strategies are oriented to the implementation of new technologies, the digital distribution of the content, and the collaboration with external partners. However, these public broadcasters have not yet promoted concrete actions to encourage the participation of their audiences. (shrink)

Morality constructs the relationship between the self and others, providing a sense of appropriateness that facilitates and coordinates social behaviors. We start from Moral Foundation Theory (MFT), and argue that multiple moral domains can shape the meaning of public service and engender Public Service Motivation (PSM). From the lens of cognitive science, we develop a causal map for PSM by understanding the social cognition process underlying PSM, focusing on five innate moralities as the potential antecedents of (...) PSM: Care, Fairness, Authority, Loyalty, and Sanctity. Extending moral domains beyond compassion and justice can provide a disaggregated view of PSM, which may help to identify institutional and cultural variation in the meaning of PSM. We discuss the theoretical implications of synthesizing MFT and PSM literatures, and provide directions for future research that could improve our understanding of PSM. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)