This paper provides a critical review of economic outcome metrics used in healthcare value assessment, emphasizing the evolving landscape of resource allocation, patient-centered approaches, and standardization efforts. With healthcare costs rising globally, the efficient allocation of limited resources is essential. Metrics like Quality-Adjusted Life Years (QALYs), Disability-Adjusted Life Years (DALYs), Incremental Cost-Effectiveness Ratios (ICERs), and Cost-Benefit Analysis (CBA) are central to guiding funding decisions, influencing insurance coverage, and shaping treatment prioritization. Emerging trends, such as the integration of artificial intelligence (AI) (...) and big data, are enhancing the precision of these assessments, while patient-centered metrics underscore the importance of patient satisfaction and quality of life. Additionally, there is a growing push for the standardization of these metrics to create consistent frameworks across diverse health systems. This paper explores case studies, practical applications, and future directions to provide insights into how healthcare systems can adopt more effective, globally aligned economic assessments. (shrink)

En este estudio, en el que hemos tomado como centro de referencia el catálogo (ai-Fihrist) del erudito musulmán del siglo X de nuestra era Muhammad Ibn Ishak an-Nadí'm, nos proponemos trazar, en primer lugar, las líneas del desarrollo del pensamiento matemático y del pensamiento astronómico en el mundo del Islam desde el siglo VIII hasta el siglo XVII; y, en segundo lugar, y al hilo de nuestra traducción al texto de Ibn an-Nadí'm, indicar en lo posible y de acuerdo a (...) las investigaciones más recientes, los aportes individuales de los matemáticos y astrónomos que vivieron entre Jos siglos VIII y IX de la era cristiana. Con ello pretendemos ofrecer un capítulo casi olvidado de algunos aspectos del cultivo de la ciencia en un determinado período de su historia dentro de un determinado ámbito cultural a partir de sus propias fuentes. Asimismo, pretendemos dar un balance del estado actual de las investigaciones en este campo con el fin de llamar la atención sobre el profundo cambio de perspectivas que se está realizando en la historia de la ciencia2 y que, en Jo tocante al legado musulmán, encuentra su punto de giro en la obra del gran erudito turco, profesor de la Universidad de Frankfurt, Fuad Sezgin•. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

LET ME BEGIN this inquiry with the simple but fundamental fact that the flow of time, or passage, as it is also known, is given in experience, that it is as indubitable an aspect of our perception of the world as the sights and sounds that come in upon us, even though it is not the peculiar property of a special sense. Consider, by way of illustration, that I am now sitting at the desk in my study. This particular event (...) was not present at any earlier time, nor will it be present shortly as I become involved in other activities. The present, as I experience it, is regularly associated with later and later events. It does not hop about capriciously from here to a later time, to a previous time, and then to a much later time, or trace out some other such indiscriminate pattern; instead I find it always in association with the next moment, and as I look backward and inward, so to speak, I find that the prior moment was present and that this next-later moment is present. Quite often this condition is expressed by means of imagery. We are asked to envision either a moving present racing along a fixed track of moments or events from earlier to later, or alternatively a fixed present through which stream a series of moments or events, first the earlier and then the later ones. One is in truth hard-pressed to find references to passage which do not employ quasi-poetical tropes and metaphors, and while these do help in some sense to say what we mean, great caution is required when handling them because of their ready tendency to draw us away from the actual phenomenon requiring explanation. (shrink)

The traditional mode of explanation in physics via deduction from partial differential equations is contrasted here with explanation via simulations. I argue that the different technologies employed constitute different languages, which support different sorts of narratives. The narratives that accompany simulations and articulate their meaning are typically historical or natural historical in kind. They explain complex phenomena by growing them rather than by referring them to general laws. Examples of such growth simulations and growth narratives come from the evolution of (...) wave functions in quantum chaos, snowflake formation, and Etruscan genetics. The examples suggest a few concluding remarks on historical explanation. (shrink)

Presentism is a controversial and much discussed position in the metaphysics of time. The position is often glossed as simply the view that everything that exists is present. This gloss, however, does not in itself characterize a single view. In this paper, I first propound the variety of presentist views, characterizing the primary dimensions along which the views differ. I then present the version of presentism I deem optimal. The variety among presentist views is so great that the version that (...) I prefer and shall defend—transient presentism—is not even characterized by the standard gloss given above. I next discuss all of the objections to presentism of which I am aware, considering the relevance of each to transient presentism. I conclude that transient presentism provides the most satisfying responses to the traditional objections and, furthermore, captures very well the motivation for adopting a presentist position in the first place. The grounds for these two conclusions constitute my defense of transient presentism. (shrink)

According to the ‘fact-plus-value’ model of pathology propounded by K. W. M. Fulford, ‘disease’ is a value term that ought to reflect a ‘balance of values’ stemming from patients and doctors and other ‘stakeholders’ in medical nosology. In the present article I take issue with his linguistic-analytical arguments for why pathological status must be relative to such a kind of medico-ethical normativity. Fulford is right to point out that Boorse and other naturalists are compelled to utilize evaluative terminology when they (...) characterize the nature of diseases and biological dysfunctions. But the relevant ‘biofunctional judgements’ are no less factual and empirical for that. While it is indeed evaluative to say that biological dysfunctions involve failures to execute naturally selected functions, such judgments are not bound to entail anything about what is good or bad for us, and what should be treated or not. In the last part of the paper I ruminate briefly on the relationship between ‘biological evaluationism’, on my construal, and descriptions of ‘causal biology’. As I note in my conclusion, a strict bioevaluative concept of disease can be valid for every species on earth, and thus be of particular usefulness in general biological contexts. (shrink)

The use of genetic testing and neuroscientific evidence in legal trials raises several issues. Often their interpretation is controversial: the same evidence can be used to sustain both the prosecution’s and defense’s argument. A recent Italian case confirms such concerns and stresses other relevant related questions.

This paper inquires into the nature of intertheoretic relations between psychology and neuroscience. This relationship has been characterized by some as one in which psychological explanations eventually will fall away as otiose, overthrown completely by neurobiological ones. Against this view it will be argued that it squares poorly with scientific practices and empirical developments in the cognitive neurosciences. We analyse a case from research on visual perception, which suggests a much more subtle and complex interplay between psychology and neuroscience than (...) a complete take-over of the former by the latter. In the case of vision, cross-theory influences between psychology and neuroscience go back and forth, resulting in refinement in both disciplines. We interpret this case study as showing that: (1) Mutual co-evolution of psychological and neurobiological theories, exemplifying persisting top-down influences from psychology, is a more empirically adequate way to describe psychoneural theory relations than a view on co-evolution, favoured by reductionists, which regards the cross-theory contributions from psychology as merely heuristically useful with no enduring influence on neurobiological theorizing; (2) In research on vision, discovering (or hypothesizing) the neural basis of functions vindicates psychological approaches, it does not eliminate them; (3) Current work on vision shows that many perceptual phenomena must be understood in terms of dynamical interactions between an observer and his/her environment. Therefore, we argue that internalist characterizations of the visual system must be supplemented with externalist accounts that address these reciprocal observer-environment interactions involved in vision. Such processes seem quite different from (internal) cellular and molecular ones, and as such seem to lie outside the scope of neuroscientific inquiry. We conclude that psychoneural reduction or elimination is implausible as a meta-theoretical prediction of theory choice in empirical work. Instead, this case study of vision shows that both psychology and neuroscience contribute to, and complement one another in the study of visual perception. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:M. C. Henberg GEORGE ELIOT'S MORAL REALISM No moment in the history of ethics could be more propitious than the present for a comprehensive restudy of George Eliot's moral realism. Analysis of the "logic" of moral language has proved barren, prescriptivism is in full flight, and schematic divisions of moral theories into descriptive versus normative, deontological versus teleological, or substantive versus meta-ethical have promised much but delivered little. Such (...) distinctions dominate maps to the modern moral terrain, but awanderer in the land ofchoice itselfstill finds himselfwithout signposts. A particularly unhealthy bias in contemporary ethics has been the belief that moral principles ought to withstand all counterexamples, however plausible or implausible, whether concocted from a sense of men's actual capacities or from a fondness for outrageous possibilities, many of them lifted from the pages of science fiction. If moral rules do not govern in hard cases, it is thought, they do not govern at all. Few philosophers have bothered to distinguish between the hard cases common to men's actual choices and the hard cases confronted by one man in a million or by the imagined inhabitants of some future world. (Witness, for example, the present preoccupation with "lifeboat ethics" and ask yourself how many actual moral choices are so starkly dramatic.) Any logically possible circumstance is too often assumed to qualify as a fruitful area for moral investigation; and any conceivable counterexample, achieved by whatever stretch of the imagination, is assumed to be fair ammunition in the debate over principles. Closely related to this first bad tendency in modern philosophical ethics is another, equally bad. Too often the examples used are of little moral significance, obviously conceived to make a point rather than to direct attention to commonplace but nonetheless important circumstances where informed choice is essential. Philosophy journals have treated us to discussions about whether failing to wear tennis whites is or is not "rude" and about whether a first sinner's crossing of a patch of lawn does or does not have a "threshold-related effect" 20 M. C. Henberg21 which must be considered in assessing later consequences (a bare path ultimately worn in the grass). Such examples rightly earn a contemptuous snort from anyone who expects philosophy to increase our understanding in matters of serious consequence. Whatever her other accomplishments as a moralist and philosophical thinker, George Eliot never commits either of the preceding crimes. Her moral realism constitutes first and foremost an ethics aimed at the bulk of her fellow men. She yields to the theoretic impulse solely in criticizing other theories. When it comes to providing answers, she depicts fictional characters whose struggles, failings, and passions are ultimately akin to what we ourselves are likely to experience. Her ethical precepts are not aimed at proving themselves in every conceivable situation. They are instead precepts which are sometimes susceptible to ruin, just as are the changeable creatures who profess them. To know the natural boundaries of a moral rule, Eliot tells us, is as difficult and important as knowing the rule itself. Moral realism requires a combination of clear-eyed perception and imaginative sympathy—faculties ill-served by lectures on abstract principles. Eliot reminds us that our best moral judgments must be "checked and enlightened by a perpetual reference to the special circumstances that mark the individual lot" (The Mill on the Floss, Book VII, chap. 3). This emphasis in particular—found both in her early essays and early fiction—makes Eliot's moral realism a welcome anodyne to the worst tendencies of modern ethics. The discussion which follows will be confined to early works, including Scenes of Clerical Life, Adam Bede, and The Mill on the Floss. The ruminations of her authorial voice in these novels may conveniently be juxtaposed with her essays, for the works are near to one another both temporally and thematically. Later novels such as Middlemarch and Daniel Deronda—however interesting from an ethical perspective— do not lend themselves to this mode of analysis. To what extent Eliot's views are modified in these later novels constitutes a separate topic whose omission here does not reflect upon its intrinsic interest or importance. Since George Eliot offers no... (shrink)

Hermeneutic non-assertivism is a thesis that mathematical fictionalists might want to endorse in responding to a recent objection due to John Burgess. Brad Armour-Garb has argued that hermeneutic non-assertivism is false. A response is given here to Armour-Garb's argument.

The failure to maintain a canonical Christian understanding of the family as a microcosm of the church oriented toward deification instead of a microcosm of society aimed at social ends has opened Christians up to an uncritical adoption of non-Christian approaches in medical decision making. This article begins by identifying the Christian family crisis not as a liberal versus conservative debate centered on the form and function of the family, but more fundamentally as an ecclesial versus sociological understanding of the (...) Christian family. The article presents a historical sketch of the circumstances that have led to this contemporary crisis in the Western Christian family, followed by an analysis that provides a canonical account of the Christian family as exemplified in the thought of Gregory the Theologian. This article concludes by looking at the specific issue of labor and delivery in the United States, and the implications for a canonical Christian understanding of labor and delivery in light of contemporary medical practices. (shrink)

Kierkegaard's "Works of Love" provocatively presses for a reconsideration of impartiality, partiality, and equality. Past readings of this text have typically (1) criticized its focus on the abstract category of "human being," ignoring its attention to distinctiveness and difference; (2) defended it from the charge of abstraction by accenting its treatment of distinctiveness and difference, playing down its assumptions about the "essentially" human; (3) acknowledged its emphases on both essence and difference, arguing that they are incompatible and irreconcilable; or (4) (...) acknowledged both emphases, assuming they are compatible without exploring or accounting for the apparent incompatibility. As a means of resolving this seeming inconsistency, I will focus on Kierkegaard's recommendation of moral blindness and its implications for moral vision, and I will argue that "Works of Love" contains resources for an understanding of impartiality that allows moral attention to concrete difference. (shrink)

I argue that, If one adopts a minimal naturalism (of a kind rejected by moore, Hare, "et al".), One would adopt a methodology which yields conclusions identical to that yielded by intuitionistic methodology (of a kind employed by ross, Prichard, "et al".). I dilate upon the advantages which thus accrue to each theory, And I defend my minimal naturalism against a variety of objections.

Health care professionals who travel from their home countries to participate in humanitarian assistance or development work experience distinctive ethical challenges in providing care and services to populations affected by war, disaster or deprivation. Limited information is available about organizational practices related to preparation and support for health professionals working with non-governmental organizations. In this article, we present one component of the results of a qualitative study conducted with 20 Canadian health care professionals who participated in international aid work. The (...) findings reported here relate to expatriate clinicians’ experiences and perceptions of ethics preparation, training and support. The strategies examined include pre-departure training and preparation, in-field supports and retrospective debriefing of ethical issues. Participants experienced a range of training and supports as beneficial for addressing ethical challenges in humanitarian assistance and development work. Participants also expressed ambivalence or scepticism about the benefits offered by specific modalities. This analysis can contribute to informing discussions of how organizations and individual practitioners can best develop, implement and utilize ethics training and support for international aid work. (shrink)

IN the preceding section, the immediate contact effected by sense-intuition between a percipient and existents was seen to enfold an epistemological value enabling us to regard this perception as the point of departure, the terminus a quo, of all our knowledge. Here we ask ourselves whether there is a sense in which we may say that this initial intuition is not only the point of departure, but is also the point of resolution for all our knowledge. May we not, to (...) pursue an analogy, consider experience as a terminus ad quem as well as a terminus a quo? The present chapter seeks the solution to this problem principally under the guidance of Aquinas and his interpreters, both classical and modern. However, before taking up the specific question we have just proposed, two more general considerations impose themselves as logically prior. (shrink)

R kirk ("analysis", volume 33, 1973, pages 195-201) proposes an argument against quine's deduction of indeterminacy of translation from underdetermination of physical theory. the present paper is a reply to kirk, aimed primarily at showing that his argument is "ignoratio elenchi".