Some ethicists assert that there is a consensus that maximising medical outcomes takes precedence as a principle of resource allocation in emergency triage of absolutely scarce resources. But the nature of the current severe acute respiratory syndrome-related coronavirus 2 pandemic and the history of debate about balancing equity and efficiency in resource allocation do not support this assertion. I distinguish a number of concerns with justice and balancing considerations that should play a role in critical care triage policy, focusing on (...) discrimination and on fundamental egalitarian and social justice concerns. (shrink)

The seriousness of the risk that healthcare workers faced during SARS, and their response of service in the face of this risk, brings to light unrealistic assumptions about duty and risk that informed the debate on duty to care in the early years of HIV/AIDS. Duty to care is not based upon particular virtues of the health professions, but arises from social reflection on what response to an epidemic would be consistent with our values and our needs, recognizing our shared (...) vulnerability to disease and death. Such reflection underwrites a strong duty of care, but one not to be borne solely by the altruism and heroism of individual healthcare workers. (shrink)

The professionalism movement has animated medical education and practice; an extensive literature expresses and categorizes many interpretations of the concept (Hafferty 2006a; Hafferty and Levinson 2008). The inception of the current wave of the movement was in the American Board of Internal Medicine's Project Professionalism. In the face of threats from the growth of managed care and public concerns about conflict of interest, the ABIM's "Physician Charter" called for the profession to publically commit to values of patient welfare, social justice, (...) and respect for patient autonomy (Brennan et al. 2002). The concept of professionalism, or the physician as occupying the role of professional, has taken hold in .. (shrink)

While much of the debate around the practice of normothermic regional perfusion (NRP) is focused on the potential violation of the dead donor rule (DDR), another concern is whether allowing this pr...

The multi-disciplinary unit Social Responsibility in Action was developed for students with an interest in ethics who were completing undergraduate degrees in Arts, Commerce, Design or Science at an Australian research-intensive university. The academic objectives of this unit were to increase student awareness, knowledge, understanding and critical thinking skills related to various ethical issues. Lecturers from five disciplines collaborated in the design and delivery of SRA, which comprised lectures, tutorials and a research-based project. Anonymous surveys were administered at the start (...) and end of the semester to obtain feedback on student expectations and learning experience, respectively. Data across three student cohorts showed that at the start of semester, 80% of student comments indicated a desire to expand their interest of ethical matters, 59% a desire to gain understanding and knowledge and 59% to gain critical thinking or communication skills. SRA was extremely well received by students, with 98% of respondents indicating that this multi-disciplinary ethics unit had met their expectations. Students also found that the variety of teaching styles, unit content and multi-disciplinary approach stimulated learning. (shrink)

I discuss some reservations about the exegetical power of the claim that the Tractatus is “anti-metaphysical.” The “resolute” reading has the virtue of fidelity to important and neglected features of the work, both its anti-metaphysical moves and its account of the nature of the activity of philosophy and its status. However, its proponents underestimate the barriers to maintaining a consistent fidelity to these features of the text. The image of a ladder suggests a mere instrumental means to arrive at a (...) place that can itself be characterized independently of our means of arrival; where we arrive via the process of the TLP is the conclusion of an argument, and so cannot be characterized independently of the argument that got us there. In his commitments about the process of logical analysis “within language,” he strives as much as in his statements about the world to return us to our ordinary ways of talking and making sense of what we say to one another. Given the internal relationship Wittgenstein is at pains to emphasize between language, thought, and reality, he could hardly have philosophical commitments about one of these terms (have a residual metaphysics of language) and isolate this from how he thinks about the others. In a discussion of “Senator, you’re no Jack Kennedy” and “Chairman Mao is rare,” I argue that, pace Conant and Diamond’s claims to the contrary, logical categories are being invoked to explain why one cannot mean what one thinks one means in this phrase, and that Wittgenstein is both more anti-metaphysical in his treatment of these logical categories (in contrast with Frege) than the resolute readers consider him to be, and less successful in his treatment of how logical categories rule our judgments of sense and nonsense than they imply he is. Finally, I question the sharp boundary between logic and psychology and the “claustrophobic” feel that is created by a narrow construal of what one can make sense of in another’s words and person that underwrites their account of nonsense via a conflict between the meaning words can contain and our confused desires. Throughout, I discuss relevant passages of the Investigations that resolute readers treat as a re-expression of the themes of the Tractatus, to contrast the “anti-metaphysical” treatment these themes express in the Tractatus with the less dogmatic treatment they receive in the Investigations. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC is a (...) solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

The Greek polis has been arousing interest as a subject for study for a long time, but recent approaches have shown that it is a subject on which there are still important questions to be asked and worthwhile issues to be explored. This book contains a selection of essays which embody the results of the latest research. Beyond the historical development of the Greek polis , the contributors ask questions about the civic institutions of ancient Greece as a whole and (...) their relationships to each other. Questions of power or the significance of a written code of law are discussed as well as the nature of Greek overseas settlements. Development of the Greek Polis presents up-to-date research and asks up-to-date questions on various aspects of an important topic. (shrink)

Abstract Tibor Scitovsky's The Joyless Economy distinguished the pleasure of moving from discomfort to comfort and the pleasure of replacing boredom with stimulation. I have argued that there are also pleasures distinctive to participating in public life. A third form of pleasure berlongs to both the private and the public domain: the common meal leads to individual satiation and, as a result of commensality, has important social and public effects. A good example is the banquet in ancient Greece, closely connected (...) to the lottery?the basic mechanism of Athenian democracy. But the common meal can also lead to the degradation of human relations and political life. (shrink)

This book discusses affective practices in performance through the study of four contemporary performers – Keith Hennessy, Ilya Noé, Caro Novella, and duskin drum – to suggest a tentative rhetoric of performativity generating political affect and permeating attempts at social justice that are often alterior to discourse. The first part of the book makes a case for the political work done alongside discourse by performers practising with materials that are not-known, in ways that are directly relevant to people carrying out (...) their daily lives. In the second part of the book, four case study chapters circle around figures of irresolvable paradox – hendiadys, enthymeme, anecdote, allegory – that gesture to what is not-known, to study strategies for processes of becoming, knowing and valuing. These figures also shape some elements of these performances that make up a suggested rhetorical stance for performativity. (shrink)

The feminist in academe, says Paula Bennett, is like Procne married to Tereus, "inextricably wedded to the sources of her harm." An ethical justification of academic feminism can be found, not in cooperation and affiliation, but in the strategies currently necessary to ensure curricular and cultural diversity. Historically contextualized and strategically politicized, this ethic is founded on the claim that universities are places where we may all learn to know what is other than ourselves.

In "Public Health and Precarity," Michael Doan and Ami Harbin have done important work extending Sherwin's concept of relational autonomy to encompass relational agency—including agents such as communities and states. This opens up new ways of thinking about responsibility for public health in long-standing debates about the role of the state in public health.The case studies Doan and Harbin analyze are also important for thinking of the account of relational solidarity that Sherwin developed together with Baylis and Kenny, one element (...) of relational public health. The discussion may even open the space for a reformulation of relational solidarity. I will use the... (shrink)

In writing about `whiteness' we are trying to enact a `way of talking' that draws in part on Aboriginal ideas about how to conduct a conversation or tell a story. We also use Homi Bhabha's ideas of `third space' (an `interruptive, interrogative, and enunciative' space) and hybridity as a related way to think through the problems of essentializing binaries and rigid identities. In Aboriginal cultures in Australia and Canada, rather than adopting the `neutral' or `objective' stance common in the academy, (...) it is customary to introduce oneself to one's audience, providing a context to assist in interpretation and exchange. Without such an introduction, real stories cannot be told and productive conversations cannot happen. We thus begin our conversation with each other and with you by examining our personal relationship to the idea of whiteness in order to reveal some of its complexity in Canada and Australia. `Whiteness' as an abstraction has proved useful in moving the invisible norm to visibility, but we show how an awareness of `whiteness' in the two locations can be recuperated to re-privilege the already privileged. Aboriginal speakers and writers have theorized `whiteness', in many cases from outside the academy, in the process `hybridizing' traditional genres. For many of them, Aboriginality, like whiteness, is a construct that often stands in the way of thinking clearly about where to go next in the fight against racism. (shrink)

Are the small and indolent cancers found in abundance in cancer screening normal variations, risk factors, or disease? Naturalists in philosophy of medicine turn to pathophysiological findings to decide such questions objectively. To understand the role of pathophysiological findings in disease definition, we must understand how they mislead in diagnostic reasoning. Participants on all sides of the definition of disease debate attempt to secure objectivity via reductionism. These reductivist routes to objectivity are inconsistent with the Bayesian nature of clinical reasoning; (...) when they appeal to the sciences, they are inconsistent with what philosophy of biology tells us about its natural kinds. Proposals that we narrow the scope of our claims in the disease definition debates are useful, but paradigms can still distort our reasoning in particular cases, even when we are self-conscious about their status. (shrink)

Systems of universal health coverage may aspire to provide care based on need and not ability to pay; the complexities of this aspiration call for normative analysis. This special issue arises in the wake of a judicial inquiry into preferential access in the Canadian province of Alberta, the Vertes Commission. I describe this inquiry and set out a taxonomy of forms of differential and preferential access. Papers in this special issue focus on the conceptual specification of health system boundaries and (...) on the normative questions raised by complex models of funding and delivery of care, where patients, providers, and services cross system boundaries. (shrink)

Temkin asks how we should distribute resources between the social determinants of health and health care; Sreenivasan argues that if our goal is fair opportunity, funding universal health coverage is the wrong policy. He argues that social equality in health has not improved under UHC and concludes that fair opportunity would be better served by using the resources to address the SDOH instead. His criticism applies more broadly than he claims: it applies to any argument for UHC based on health (...) equity. However, neither his strong causal conclusion nor his stark policy proposal is justified. I review methodological challenges for establishing the relative causal contributions of health care and social policy, concluding that we may never have a robust causal account to support a consequentialist choice. Fortunately, we may not need to answer the allocation question as a dichotomy. Given what Sen calls the multidimensional nature of health equity and the role of UHC in cost containment, UHC may not be a threat to health equity. I also argue against Sreenivasan's claim that the data he discusses should not trouble sufficientists and prioritarians. The worst-off are not simply lagging in improvement; rather, their health status is stagnating or worsening. (shrink)

Verweij and Dawson claim that population health has a distributive dimension; Coggon argues that this presupposes a normative commitment to equity in the very definition of population health, which should, rather, be neutral. I describe possible sources of the distributive view, several of which do not presuppose egalitarian commitments. Two relate to the nature of health as a property of individuals ; two relate to the epistemology and pragmatics of public and population health. A fifth source of the distributive view (...) is a critical stance on the concept of population health; I contrast this with Coggon’s account of the public as a shared political imaginary. None of these views is ‘neutral’: they exhibit several different kinds of normativity and quasi-normativity, but this is not problematic. I argue that the critical stance appropriately distinguishes and relates social justice and public health. (shrink)

In their article, “Rare Disease, Advocacy and Justice: Intersecting Disparities in Research and Clinical Care,” Halley et al. (2023) use three case examples to describe challenges patients with rar...

This book offers an interdisciplinary approach to concepts of the self associated with the development of humanism in England, and to strategies for both inclusion and exclusion in structuring the early modern nation state. It addresses writings about rhetoric and behavior from 1495–1660, beginning with Erasmus’ work on sermo or the conversational rhetoric between friends, which considers the reader as an ‘absent audience’, and following the transference of this stance to a politics whose broadening democratic constituency needed a legitimate structure (...) for governance-at-a-distance. Unusually, the book brings together the impact on behavior of these new concepts about rhetoric, with the growth of the publishing industry, and the emergence of capitalism and of modern medicine. It explores the effects on the formation of the ‘subject’ and political legitimation of the early liberal nation state. It also lays new ground for scholarship concerned with what is left out of both selfhood and politics by that state, studying examples of a parallel development of the ‘self’ defined by friendship not only from educated male writers, but also from women writers and writers concerned with socially ‘middling’ and laboring people and the poor. (shrink)

Ethics is enabling of agency, but also normative and conventional. At the moment a gendered ethics, or the gendering of ethics, is a helpful approach because it is concerned with issues to do with people often peripheral to and excluded from power. At the moment it can work to keep ethics responsive, but how do we halt the drift into the normative, both as prescriptive and as ideological? A feminist ethics maintains the responsive and undermines prescriptive categories, and is committed (...) to involving disempowered voices in the conversation. The article is particularly concerned with the articulation of the situated, and raises questions about attending to, learning how to listen to and learning how to speak, so that many people from different places can get involved in ethics. Otherwise ethics isn’t ethical. (shrink)

In Canada, laws and policies consistently reject the commodification of human organs and tissues, and Canadian practice is consistent with international standards in this regard. Until the Assisted Human Reproduction Act of 2004, gamete donation in Canada was an exception: Canadians could pay and be paid open market rates for gametes for use in in vitro fertilization. As sections of the AHR Act forbidding payment for gametes and permitting only reimbursement of receipted expenses gradually came into effect in 2005, Canada (...) did away with this anomaly. Medical practice and legal prohibitions in assisted human reproduction are now consistent with other areas of medicine where tissues and organs are taken from one person to benefit others: Altruistic donation, rather than selling and buying, will be the norm. (shrink)

In a survey spanning over half a century of his own work, Hirschman, among the most influential thinkers of the twentieth century on political economy, celebrates the ability to undermine one’s own claims and theories. Whereas skepticism toward other people’s work is not noteworthy, Hirschman argues, self-critque is crucial in relation “to one’s own generalizations or constructs.” But self-criticism and interpretive changes do “not in the end cancel out or refute the earlier findings”; rather, they help to define (...) domains of the social world where originally postulated relations do not hold. Exercises in “self-subversion,” while often experienced at first as traumatic, are eventually, as Hirschman’s own career attests, “rewarding and enriching.”. (shrink)

In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models in which physicians provide insured services while requiring or requesting that patients pay for services or for the non-insured services of the physicians themselves or their associates. This choice for such (...) practice models is different from the decision to design an insurance plan to include or exclude user fees, co-payments and deductibles. I analyze the issues raised with regards to familiar health care values of equity and efficiency, while highlighting additional concerns about fair terms of access, provider integrity, and fair competition. I then analyze the common Canadian regulatory response to block fee models, considering their extension to wellness clinics, with regards to fiduciary standards governing the physician–patient relationship and the role of informed consent. I close by highlighting briefly issues that are of common concern across different fundamental normative frameworks for health policy. (shrink)

Lisa A. Eckenwiler, Long-term care, globalization, and justice, Baltimore: The Johns Hopkins University Press, 2012, reviewed by Lynette Reid.