As an incapacitated patient is unable to make decisions regarding their care, physicians turn to next-of-kin when appointing a surrogate decision-maker in the absence of an advanced directive. With the increasing complexity of modern families, physicians are facing new ethical dilemmas when choosing the individual to make end-of-life decisions for their patients. Legal definitions and hierarchies are no longer adhering to the purpose of a surrogate-decision maker, which is to maintain a patient’s autonomy. Moral criteria for surrogates, which emphasize the (...) importance of making decisions that align with the patient’s desires and wishes and negate biological relationships over emotional connections, are becoming much more important. This paper explores a case study in which physicians must appoint a surrogate decision-maker for an incapacitated patient, forced to choose between a biological relationship and a strong emotional connection. (shrink)

Health care reform that includes universal coverage could lower a major barrier to care for people of color and ethnic minorities—the inability to pay for care. But universal coverage alone, even with comparable fee-for-service payment or appropriately risk-adjusted capitated reimbursement, will not eradicate the racial and ethnic inequities in health care delivery. Restrictive admissions practices, geographic inaccessibility, culture, racial stereotypes, and the failure to employ minority health care professionals will still create barriers to minority health care. In addition to universal (...) financing, health care reform should include new civil rights legislation to address and reduce these noneconomic barriers to minority health care. (shrink)

A popular critique of the kalām cosmological argument is that one argument for its second premise illicitly assumes a finite starting point for the series of past temporal events, thereby begging the question against opponents. Rejecting this assumption, opponents say, eliminates any objections to the possibility that the past is infinitely old and undermines the IFA’s ability to support premise 2. I contend that the plausibility of this objection depends on ambiguities in extant formulations of the IFA and that we (...) may resolve these ambiguities in a way that does not presuppose a finite staring point. I also argue that this disambiguation allows us to construct an argument demonstrating that the concept of an infinite past entails a contradiction. (shrink)

The distinguished historian and author of The Medici Conspiracy examines atheism as a modern intellectual achievement that has motivated individuals to pursue invention and self-reliance, citing the accomplishments of secular philosophers, scientists and artists who have worked in the absence of religious belief.

Introduction Most of the papers gathered here were contributions to a series of joint meetings of the Department of Social Administration and Social Work ...

Discourse topic is an intractable and inherently subjective notion making analysis problematic. This paper overcomes some of the problems by treating topic as a fuzzy concept and views discourse topics as sets of topic keywords. The study examines the identification of topic boundaries and topic keywords by informants and by four methods of analyzing topics — topical structure analysis, given-new progression, lexical analysis, and topic-based analysis. Comparing the findings from these four methods against those from the informants, it was found (...) that given-new progression is the most valid method for identifying topic boundaries, and topic-based analysis is the most valid for identifying topic keywords. There are also notable differences in the types of keywords identified and the bases for identifying keywords between the methods and the informants. (shrink)

The paper gives an account of Rāmakaṇṭha’s (950–1000) contribution to the Buddhist–Brāhmaṇical debate about the existence or non-existence of a self, by demonstrating how he carves out middle ground between the two protagonists in that debate. First three points of divergence between the Brāhmaṇical (specifically Naiyāyika) and the Buddhist conceptions of subjectivity are identified. These take the form of Buddhist denials of, or re-explanations of (1) the self as the unitary essence of the individual, (2) the self as the substance (...) to which mental properties belong, (3) the self as the agent of both physical actions and cognitions. The difference of Rāmakaṇṭha’s position from both Nyāya and Buddhism is then elaborated. He posits a self, but not one that is an eternally unchanging substance, nor one that is anything other than consciousness. Hence his difference from Nyāya. He falls with Buddhism in holding that consciousness does not require anything other than itself to inhere in, but departs from Buddhism in holding that consciousness is not momentary but enduring. The guiding metaphor here is light, but light considered as a dynamic, qualitatively unchanging repetition of the action of illumination. (shrink)

This column describes the history, mission, and work of Saint Louis University School of Law’s service-learning course Health Law, Policy and Advocacy: Grassroots Advocacy. Grassroots Advocacy allows law students to work with advocacy organizations on state and federal health policy initiatives, engaging in legislative and administrative advocacy and public education. The course uses community collaboration, community-led advocacy, and collaborative learning to train the next generation of health policy advocates for Missouri and the nation.

This article challenges dominant explanations in the comparative political economy literature on the origins and purposes of social protection. Far from being a tool of working-class mobilization, social protection in southern Spain was strategically employed by a left party to politically demobilize its supposedly “natural” constituencies. This peculiar outcome is the result of a setting that is common in welfare states outside of northern Europe: the context of a divided left, in which parties and unions are seeking to mobilize different (...) constituencies and in which left parties are themselves divided between moderate and far-left groups. The result in Spain was that social policy became a weapon in parties' efforts to undermine their political competition. This suggests the need to rethink the received wisdom about what the welfare state does to build working-class power in the context of a divided left. (shrink)

A significant proportion of the U.S. population exhibits low health literacy. Evidence suggests that low health literacy is correlated with higher medical costs and poorer health outcomes. Even more concerning, evidence suggests that low health literacy threatens patients’ and families’ autonomy and exacerbates injustices in patients who are already vulnerable to difficulties navigating the health care system. There is also, however, increasing evidence that health literacy interventions—including initiatives such as plain language practices and teach-back—improve comprehension and usefulness of health care (...) information. I show how health literacy best practices can enhance the work of clinical ethicists in their primary roles of policy, consultation, and education. In the final section, I suggest ways health literacy initiatives may be enhanced with insights from clinical ethicists. (shrink)