The state of Parhae (in Chinese reading- Bohai) existed in what is now Russian Maritime region, North Korea and Northeastern China from the late 7th to the early 10th centuries AD. Parhae played a major role at relations between Silla, Japan and Chinese empire Tang. Of course, Parhae was subjected to important cultural influence from other countries and in some cases followed their ritual and diplomatic tradition. Many specialists from Japan, Russia, China and both Korean states have done research of (...) different aspects of Parhae history and culture. However, many scholars have not paid attention to influence of ritual system at international relation of Parhae. In opinion of author, Parhae and Silla had antagonistic relation during 200 years because they could not agree about their respective vis-à-vis status each other. For example, Silla did not want to recognize Parhae as a sovereign state, which by recognized and independence state from China, but Silla was vassal of empire Tang. This article critically analyzes relation between Parhae and Silla for of the origin of conflict of between countries using Russian and Korean materials (materials by South and North Korean works). (shrink)

Despite advances in treatments over the last decades, a uniformly reliable and free of side effects therapy of human cancers remains to be achieved. During chromosome replication, a premature halt of two converging DNA replication forks would cause incomplete replication and a cytotoxic chromosome nondisjunction during mitosis. In contrast to normal cells, most cancer cells bear numerous DNA deletions. A homozygous deletion permanently marks a cell and its descendants. Here, we propose an approach to cancer therapy in which a pair (...) of sequence‐specific roadblocks is placed solely at two cancer‐confined deletion sites that are located ahead of two converging replication forks. We describe this method, termed “replication blocks specific for deletions” (RBSD), and another deletions‐based approach as well. RBSD can be expanded by placing pairs of replication roadblocks on several different chromosomes. The resulting simultaneous nondisjunctions of these chromosomes in cancer cells would further increase the cancer‐specific toxicity of RBSD. (shrink)

Family income is associated with gray matter morphometry in children, but little is known about the relationship between family income and white matter structure. In this paper, using Tract-Based Spatial Statistics (TBSS), a whole brain, voxel-wise approach, we examined the relationship between family income (assessed by income-to-needs ratio) and white matter organization in middle childhood (N = 27, M = 8.66 years). Results from a nonparametric, voxel-wise, multiple regression (threshold-free cluster enhancement, p < 0.05, FWE corrected) indicated that lower family (...) income was associated with lower white matter organization (assessed by fractional anisotropy) for several clusters in white matter tracts involved in cognitive and emotional functions including fronto-limbic circuitry (uncinate fasciculus and cingulum bundle), association fibers (inferior longitudinal fasciculus, superior longitudinal fasciculus), and corticospinal tracts. Further, we examined the possibility that cumulative risk exposure might function as one of the potential pathways by which family income influences neural outcomes. Using multiple regressions, we found lower fractional anisotropy in portions of these tracts, including those found in the left cingulum bundle and left superior longitudinal fasciculus, was significantly related to greater exposure to cumulative risk (β = -0.47, p < 0.05 and β = -0.45, p < 0.05). (shrink)

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of (...) capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

A common and driving assumption in agricultural research is that the introduction of research trials, new practices and innovative technologies will result in technology adoption, and will subsequently generate benefits for farmers and other stakeholders. In Lao PDR, the potential benefits of introduced technologies have not been fully realised by beneficiaries. We report on an analysis of a survey of 735 smallholder farmers in Southern Lao PDR who were questioned about factors that influenced their decisions to adopt new technologies. In (...) this study, we have constructed measures or states of adoption which identify key elements of an adoption decision-making nexus. Analysis was conducted to statistically group explanatory factors of adoption. The key explanatory factors represented attributes of the farmer, the factors considered when undertaking production decisions and elements of the agricultural value chain that present as opportunities or constraints. We describe the combination of farmer’s personal attributes, perceptions of the value chain, and the introduction of new technologies by external actors as an “agricultural research value chain”, where agricultural research activities intervene to derive greater benefits for local farmers. A generalised linear model, via Poisson regression analysis on the identified explanatory factors, was applied to explore how they influence adoption measures and we found several significant relationships. (shrink)

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...) the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public. Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected ‘fair innings’ and ‘life projects’ principles as justifications for age-based allocation. They were also wary of the ‘maximise life-years’ principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This ‘triad’ of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage. (shrink)

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient (...) and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)

Identity construction — the process of creating and building a new future self — is an integral part of a person’s professional career development. However, at present we have little understanding of the psychological mechanisms that underpin this process. Likewise, we have little understanding of the barriers that obstruct it, and which thus may contribute to inequality in career outcomes. Using a social identity lens, and particularly the Social Identity Model of Identity Change (SIMIC), we explore the process of academic (...) identity construction among doctoral students. Through thematic analysis of semi-structured interviews with 22 PhD candidates, we observe that the identity construction process relies on a person’s perception of a navigable pathway between their current self and their future self. Importantly, participants who were able to access multiple identity resources were more likely to perceive a navigable pathway to a future professional self (e.g., as an academic), unless they perceived these identities to be incompatible with those held by leading members of the profession (e.g., their supervisors). This research suggests that the identities that people are able to access as they progress in their careers may play an important role in their ongoing professional identity construction and career success. (shrink)

The COVID-19 pandemic has witnessed an increase and amplification of anti-Asian racism and violence across the globe. Stop AAPI Hate1 in the United States and the COVID-19 Racism Incident Report2 i...

Alexithymia, psychological distress, and posttraumatic stress disorder (PTSD) are highly related constructs. The ongoing debate about the nature and relationship between these constructs is perpetuated by an overreliance on cross-sectional research. We examined the longitudinal interactive relationship between alexithymia, psychological distress, and PTSD. We hypothesised that there is an interactive relationship between the three constructs. Military personnel (N = 1871) completed the Toronto Alexithymia Scale, the Kessler 10 and a PTSD Checklist (PCL-C) at pre-deployment, post-deployment, and at 3–4 years following (...) the post-deployment assessment. We initially tested whether psychological distress is either a moderator or mediator in the relationship between alexithymia and PTSD across the time points. General psychological distress was a partial mediator of total PTSD severity and hyperarousal symptomology at all three time points. Psychological distress fully mediated re-experiencing and avoidance symptomology at all three time points. Our results suggest that those with alexithymia are at longitudinal risk of developing more severe PTSD symptomology and experiencing hyperarousal irrespective of temporal proximity to traumatic exposure. Further, vulnerability to the emergence of re-experiencing and avoidance symptomology for those with alexithymia is increased when one experiences greater distress. Our results show that alexithymia is a persistent risk factor for PTSD symptomology. (shrink)

A growing body of literature critical of ethics review boards has drawn attention to the processes used to determine the ethical merit of research. Citing criticism on the bureaucratic nature of ethics review processes, this literature provides a useful provocation for (re)considering how the ethics review might be enacted. Much of this criticism focuses on how ethics review boards _deliberate,_ with particular attention given to the lack of transparency and opportunities for researcher recourse that characterise ethics review processes. Centered specifically (...) on the conduct of ethics review boards convened within university settings, this paper draws on these inherent criticisms to consider the ways that ethics review boards might enact more communicative and deliberative practices. Outlining a set of principles against which ethics review boards might establish strategies for engaging with researchers and research communities, this paper draws attention to how _Deliberative communication_, _Engagement with researchers_ and the _Distribution of responsibility_ for the ethics review might be enacted in the day-to-day practice of the university human ethics review board. This paper develops these themes via a conceptual lens derived from Habermas’ (The theory of communicative action. Volume 1: Reason and the rationalization of society, 1984 ) articulation of ‘communicative action’ and Fraser’s (Social Text, 25(26), 56–80, 1990 ) consideration of ‘strong publics’ to cast consideration of the role that human ethics review boards might play in supporting university research cultures. _Deliberative communication_, _Engagement with researchers_ and the _Distribution of responsibility_ provide useful conceptual prompts for considering how ethics review boards might undertake their work. (shrink)

Kim’s model of ‘functional reduction’ of properties is shown to fail in a class of cases from physics involving properties at different spatial levels. The diagnosis of this failure leads to a non-reductive account of the relation of micro and macro properties.

Non-reductive physicalists have made a number of attempts to provide the relation of supervenience between levels of properties with enough bite to analyze interesting cases without at the same time losing the relation's acceptability for the physicalist. I criticize some of these proposals and suggest an alternative supplementation of the supervenience relation by imposing a requirement of robustness which is motivated by the notion of structural stability familiar from dynamical systems theory. Robust supervenience, I argue, captures what the non-reductive physicalist (...) wants from supervenience; most importantly, it provides a natural background for reconstructing the notion of (diachronic) property emergence in a way acceptable to physicalists. (shrink)

Is there a problem of causal exclusion between micro- and macro-level physical properties? I argue (following Kim) that the sorts of properties that in fact are in competition are macro properties, viz., the property of a (macro-) system of 'having such-and-such macro properties' (call this a 'macro-structural property') and the property of the same system of 'being constituted by such-and-such a micro- structure' (call this a 'micro-structural property'). I show that there are cases where, for lack of reducibility, there is (...) a prima facie intra-level causal competition between the two kinds of properties. The problem can be resolved without giving up on the causal efficacy of the macro-structural properties if we understand instances of macro-structural properties to be parts of micro-structural property instances. The parthood relation between both kinds of property instances can be mapped onto the way physical theory deals with the relation of their descriptions in the framework of perturbation theory. The application of this framework to the problem of emergent properties is discussed. (shrink)

Although Jürgen Habermas and Richard Rorty both reject the traditional picture of cultural change in which intellectuals are supposed to have the ‘last word’ on cultural issues and envisage cultural changes as the result of ‘dialogue’ or ‘conversation’ between them and the lay public, they nevertheless end up espousing different pictures of cultural change because of their totally different conception of the role and function of language, truth and rationality in such dialogue. In the first two sections of this article, (...) I will recount Habermas’s critique of Rorty’s neo-pragmatism and the latter’s responses to it so that they can reveal the core issues of the debate. In the third section, I will argue that, as a ‘sociologized version’ of Rorty’s philosophy, Jeffrey Alexander’s theory of social performance provides us with a sociological framework that makes possible a wide range of empirical studies of cultural change. (shrink)

Serious doubts about nonreductive materialism — the orthodoxy of the past two decades in philosophy of mind — have been long overdue. Jaegwon Kim has done perhaps the most to articulate the metaphysical problems that the new breed of materialists must confront in reconciling their physicalism with their commitment to the autonomy of the mental. Although the difficulties confronting supervenience, multiple-realizability, and mental causation have been recurring themes in his work, only mental causation — in particular, the specter of epiphenomenalism (...) — has really captured the interest of philosophers in general in recent years.This growing attention has spawned a large body of literature, which it is not our aim here to explore or assess. Rather, we want to call attention to what we believe is a new and quite different argumentative strategy against epiphenomenalism voiced in some recent articles by Tyler Burge and Stephen Yablo. Each has challenged two central assumptions of the existing mental causation debate. (shrink)

Reflections on Crime and Culpability seeks to elaborate, extend, and occasionally qualify the insights reached by Larry Alexander and Kim Ferzan in their influential prior collaboration, Crime and Culpability. They deftly explore any number of new issue that all criminal theorists should be encouraged to address. In my essay, I discuss and challenge their positions on omissions as well as on moral ignorance. Their treatment of the latter issue is a clear improvement over that in their earlier book. But (...) their views on omissions suggest to me that they should have had reservations about some of the most fundamental claims of their overarching theory. (shrink)

In the United States, patients have a clear right to determine what is done to them by doctors. Starting in the early 20th century, multiple court cases paved the way for our current understanding...

Unfortunately, there is broad confusion regarding the justification for healthcare professionals unilaterally limiting or withdrawing life-prolonging interventions. Many mistakenly believe that suc...

Volume 20, Issue 6, June 2020, Page 30-32.

The American Journal of Bioethics, Volume 11, Issue 11, Page 22-23, November 2011.

(2010). Ethical Rules for Human Subjects Research: A Case Where the “Is” Must Inform the “Ought”. The American Journal of Bioethics: Vol. 10, No. 6, pp. 14-15.

There has long been tension between bioethicists whose work focuses on classical philosophical inquiry and those who perform empirical studies on bioethical issues. While many have argued that empirical research merely illuminates current practices and cannot inform normative ethics, others assert that research-based work has significant implications for refining our ethical norms. In this essay, I present a novel construct for classifying empirical research in bioethics into four hierarchical categories: Lay of the Land, Ideal Versus Reality, Improving Care, and Changing (...) Ethical Norms. Through explaining these four categories and providing examples of publications in each stratum, I define how empirical research informs normative ethics. I conclude by demonstrating how philosophical inquiry and empirical research can work cooperatively to further normative ethics. (shrink)

To figure out whether the main empirical question “Is our brain hardwired to believe in and produce God, or is our brain hardwired to perceive and experience God?” is answered, this paper presents systematic critical review of the positions, arguments and controversies of each side of the neuroscientific-theological debate and puts forward an integral view where the human is seen as a psycho-somatic entity consisting of the multiple levels and dimensions of human existence (physical, biological, psychological, and spiritual reality), allowing (...) consciousness/mind/spirit and brain/body/matter to be seen as different sides of the same phenomenon, neither reducible to each other. The emergence of a form of causation distinctive from physics where mental/conscious agency (a) is neither identical with nor reducible to brain processes and (b) does exert “downward” causal influence on brain plasticity and the various levels of brain functioning is discussed. This manuscript also discusses the role of cognitive processes in religious experience and outlines what can neuroscience offer for study of religious experience and what is the significance of this study for neuroscience, clinicians, theology and philosophy. A methodological shift from “explanation” to “description” of religious experience is suggested. This paper contributes to the ongoing discussion between theologians, cognitive psychologists and neuroscientists. (shrink)

Shocking. There seems no other response to the Fox findings. The bioethics community has been working for decades to improve the quality of, and access to, competent healthcare ethics consultation....

Volume 20, Issue 3, March 2020, Page 19-21.

Leech et al.'s analysis adds to an emerging consensus of the role of priming in analogy-making. However, their model cannot scale up to adult-level performance because not all relations can be cast as functions. One-size-fits-all accounts cannot capture the richness of analogy. Proportional analogies and transitive inferences can be made by nonstructural mechanisms. Therefore, these tasks do not generalize to tasks that require structure mapping.

A new interpretation of quantum mechanics, the interpretation which became popular in XXI, has been taken under consideration. This is the quantum baysinism (QBism) which may be taken as an extrapolation of the baysian philosophy of probability over the interpretation of quantum mechanics. The baysian philosophy of quantum mechanics has been compared with the Copenhagen interpretation of quantum mechanics, the interpretation which can been treated as standard as it is represented in the main textbooks. In contrast to the Copenhagen interpretation (...) which proceeds from the triplets – nature, apparatus and observer (agent), QBism emphasizes the conscious of the observer: the quantum state is the observer’s state, and by means of the quantum conceptual technique the observer constructs his/her own image of quantum processes. By means of measurement the observer updates his/her quantum state, the measuring apparatus being an extension of the observer’s sensuality. From the point of the QBism’s view the phenomenon of decoherence which is widely discussed in the contemporary literature is not essential for the theory of measurement in quantum mechanics. The decoherence explains why the macroscopic phenomena don’t expose the interference behavior which is characteristic for quantum superposition. From the historicо-philosophical point of view Qbism can be traced back to American instrumentalism and operationalism. (shrink)

In the Soviet scientific literature of 1920‒30 the concept of probability was holly debated. The frequency concept which was proposed by R. von Mises became popular among Soviet physicists belonging to the L.I. Mandelstam community. Landau and Lifshitz were also close to this concept in their famous course of theoretical physics. A.Khinchin, a mathematician who cooperated with Kolmogorov, opposed to the frequency conception. In this paper we try to demonstrate that the frequency position was connected with the anthropomorphous approach to (...) physics, whereas Khinchin’s positions implied the criticism of anthropomorphism and put forward the ideal of objective knowledge. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 15-17, August 2012.

The value of resting electroencephalogram (EEG) in revealing neural constitutes of consciousness (NCC) was examined. We quantified the dynamic repertoire, duration and oscillatory type of EEG microstates in eyes-closed rest in relation to the degree of expression of clinical self-consciousness. For NCC a model was suggested that contrasted normal, severely disturbed state of consciousness and state without consciousness. Patients with disorders of consciousness were used. Results suggested that the repertoire, duration and oscillatory type of EEG microstates in resting condition quantitatively (...) related to the level of consciousness expression in brain-damaged patients and healthy-conscious subjects. Specifically, results demonstrated that (a) decreased number of EEG microstate types was associated with altered states of consciousness, (b) unawareness was associated with the lack of diversity in EEG alpha-rhythmic microstates, and (c) the probability for the occurrence and duration of delta-, theta- and slow-alpha-rhythmic microstates were associated with unawareness, whereas the probability for the occurrence and duration of fast-alpha-rhythmic microstates were associated with consciousness. In conclusion, resting EEG has a potential value in revealing NCC. This work may have implications for clinical care and medical–legal decisions in patients with disorders of consciousness. (shrink)

BackgroundThe emphasis on ethics and professionalism in medical education continues to increase. Indeed, in the United States the ACGME will require residency programs to include professionalism training in all curricula by 2007. Most courses focus on cases generated by the course instructors rather than on cases generated by the trainees. To date, however, there has been no assessment of the utility of these two case discussion formats. In order to determine the utility of instructor-generated cases (IGCs) versus resident-generated cases (RGCs) (...) in ethics and professionalism training, the author developed an innovative course that included both case formats. The IGCs were landmark cases and cases from the experience of the course instructors, while the RGCs were selected by the residents themselves. Residents were then surveyed to assess the strengths and weaknesses of each format.ResultsOf twenty-two second and third year residents, fourteen completed surveys (response rate 64%). Residents were nearly evenly split in preferring RGCs (38%), IGCs (31%), or not preferring one to the other (31%). 29% stated that they learn more from the RGCs, 21% stated that they learn more from the IGCs, and 50% stated that they did not find a difference in their learning based on format. In general, residents surveyed prefer a mix of formats. Residents tended to find the RGCs more relevant and interesting, and felt the IGCs were necessary to ensure adequate breadth of cases and concepts.ConclusionBased on our relatively small sample at a single institution, we believe that educators should consider incorporating both instructor-generated and resident-generated cases in their ethics and professionalism curricula, and should evaluate the utility of such a model at their own institution. Further work is needed to illuminate other potential improvements in ethics and professionalism education. (shrink)

Adequate assessment of (un)consciousness is not only of theoretical interest but also has a practical and ethical importance, especially when it comes to disorders of consciousness (DOC). Accurately determining the presence or absence of consciousness in patients with DOC allows informed decisions to be made about long-term care support, referral for rehabilitation, pain management and withdrawal of life support. We believe that a theoretical account of what conscious experience is and how it emerges within the brain will advance the search (...) for appropriate neuromarkers of the presence or absence of consciousness in non-communicative brain-damaged patients. (shrink)

The advent of functional imaging has reinforced the attempts to define dreaming as a sleep state-dependent phenomenon. PET scans revealed major differences between nonREM sleep and REM sleep. However, because dreaming occurs throughout sleep, the common features of the two sleep states, rather than the differences, could help define the prerequisite for the occurrence of dreams. [Hobson et al.; Nielsen; Solms; Revonsuo; Vertes & Eastman].

Some RNases possess preferential cytotoxicity against malignant cells. The best known of these RNases, onconase, was isolated from frog oocytes and is in clinical trials as anticancer therapy. Here we propose an alternative platform for anticancer therapy based on T1 RNases of microbial origin, in particular binase from Bacillus intermedius and RNase Sa from Streptomyces aureofaciens. We discuss their advantages and the most promising directions of research for their potential clinical applications. BioEssays 30:781–790, 2008. © 2008 Wiley Periodicals, Inc.

The present study investigated whether individual differences between psychologists in thinking styles are associated with accuracy in diagnostic classification. We asked novice and experienced clinicians to classify two clinical cases of clients with two co-occurring psychological disorders. No significant difference in diagnostic accuracy was found between the two groups, but when combining the data from novices and experienced psychologists accuracy was found to be negatively associated with certain decision making strategies and with a higher self-assessed ability and preference for a (...) rational thinking style. Our results underscore the idea that it might be fruitful to look for explanations of differences in the accuracy of diagnostic judgments in individual differences between psychologists (such as in thinking styles or decision making strategies used), rather than in experience level. (shrink)

In “Publicity and Measurement,” Marie Collins Swabey writes that “if democracy is not to be abandoned, some attempt must be made to devise ways in which what is of genuine public concern may be made to concern the public." Her article grapples with the problem of democratic governance in an age of policy complexity and voter ignorance, a problem that remains arguably the core problem of democracy today, with policy issues having become, if anything, substantially more complex. Unfortunately, despite the (...) prominence and extent of her work on this topic—including four articles in Ethics and a widely reviewed book— her contributions to political philosophy have been entirely lost. In this piece, I aim to highlight the continuing importance of the problem with which Swabey is grappling, and the distinctiveness, prescience, and continuing interest of her response to that problem. (shrink)

Although the individual mandate was upheld and the Commerce Clause may have been cabined, the decision to strike down a significant element of the “Medicaid expansion” may prove to be the most significant aspect of the Supreme Court’s decision in NFIB v. Sebelius. Under the Affordable Care Act (ACA), States were required to extend Medicaid coverage to all individuals under the age of 65 with incomes below 133 percent of the poverty line, a new “essential health benefits” package was required (...) for all new Medicaid recipients, and the increased costs due to the expansion would be entirely covered by the Federal government through 2016, with the Federal payment gradually decreasing to a minimum of 90 percent of the total cost from the expanded coverage. The element found to be unconstitutional was §1396c of the ACA, which permitted the withdrawal of all Federal Medicaid funds from those States that did not comply with the ACA’s requirements for Medicaid expansion. The effect on access to health care may be significant: roughly half of those expected to gain coverage under the ACA were going to gain it through the Medicaid expansion; it is unclear how many States will choose to opt into that expansion in the absence of §1396c.1 Additionally, the argument offered by the Court to strike down that provision might be used to attack other federal programs—concerning transportation, social services, environmental protection, and others—that have a similar structure. This paper will demonstrate that the argument rests on a theoretical mistake concerning the relationships between coercion, compulsion, and political accountability and that, further, this mistake is not one legally forced upon the Court. (shrink)