The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship. We now are in a “post-managed care era,” where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the (...) DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes. (shrink)

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to (...) be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay. (shrink)

Contemporary religious studies contains many studies of Orthodox theology of the twentieth century, but there are almost no studies of the most prominent modern trend in Orthodox theology, neo-patristics. In particular, in the works of L. Voronkova, G. Gabinsky, M. Gordienko, Y. Kalinin, P. Kurochkin, I. Mozgovy, V. Molokov, M. Novikov, N. Petelinskaya, V. Chertikhin, A. Chertkov, a thorough analysis of tendencies was carried out Modernism of Orthodox theology of the Russian Church. Of these, only M. Novikov briefly criticizes the (...) views of V. Lossky, a representative of Neopatristics, but the researcher does not realize the originality of this trend in Orthodox theology. Especially the tendencies of the development of Orthodox theology of spiritual academic schools of the XIX-beg. XX century. M. Ivanov, M. Glubokovsky, I. Kondratieva, G. Pankov, O. Pechurina, O. Sarapin, L. Fokina were thoroughly researched, but these studies were usually conducted outside the context of all Orthodox theology of the XX century. (shrink)

The Stepford Wives, a novel by Ira Levin, provides the theme for this allegory. The men of Stepford belong to the Men’s Association. Their wives are “perfect”, in that they do nothing other than clean, cook, preen, and provide satisfaction without argument for their husbands. They are, furthermore, content with their lot, and believe that their previous interests and freedoms were self indulgent. Levin never informs his readers how the men came to obtain total mastery over their “Stepford wives”, although (...) there is the suggestion that the real wives have been replaced by robotic lookalikes. (shrink)

_The Ethics of Homelessness_ is a compilation of essays analysing the philosophical, legal and social implications of the seemingly intractable condition that people endure without a home, where their fundamental human rights, autonomy and privacy are compromised. Authors use literature and arguments to demonstrate the failings of public policy.

Plutarch, in his work,_ Peri __Deisidaimon_ia_ __,_ presents a striking portrayal of superstition in the First Century. The Philosopher who also served for decades as a priest of Apollo portrays the pernicious effects of some supposed religious practices as worse than the outcome of atheism. His position constitutes a forceful explanation to ostensibly controversial socio-religious behaviours. This article discusses some of the priest’s concerns as well as his rebuff of religious attitudes that are borne out of what he describes as (...) misrepresentation of the gods or superstition. Plutarch’s essay is seen as illustrating a reason for a socio-religious situation in Africa, a continent that shares a similar religious background with the world of the writer. Specifically, with the example of the hard fight against street begging in some parts of Nigeria, the article shows how social reform programmes could fail when effects of traditional African beliefs and cultural practices remain potent. __. (shrink)

In this article I draw on two scenarios from my personal life—the diagnosis of my newborn grandnephew with CHARGE syndrome and the diagnosis of my father with depression—to reflect on whether and when diagnosis may be harmful to patients. Despite the great differences between the two scenarios, I argue that in both cases the tendency of diagnosis to generalize, categorize, and stigmatize can lead to insidious and counterproductive effects. The perspective of disability studies can help physicians to anticipate, minimize or (...) avoid these negative ramifications. I also reflect on the matter of who "owns" a particular diagnosis, whose purposes it serves, and how. (shrink)