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)

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)

The essays in this book offer an in-depth exploration of value theory. Portions examine the theoretical foundations of values and valuation exploring the rational groundwork for judgments. Other aspects, appealing to value distinctions of inherent, intrinsic, and instrumental, bring to light matters of aesthetic, social political, ethical, and ontological issues.

This book challenges common historical misperceptions of both the history of the sciences in early modern France and the history of the French Enlightenment. Tracing the complex historical relationship between them, this reinterpretation critiques the view that the sciences were always politically neutral and that the philosophes were proto-republican. By reexamining the moral, political, and social ideas of those who defended the ascendency of the sciences, this book demonstrates the evolution of political views, in particular with the marquis de Condorcet, (...) from a commitment to absolute monarchy to revolutionary republicanism. (shrink)

This article is an attempt to clarify a confusion in the brain death literature between logical sufficiency/necessity and natural sufficiency/necessity. We focus on arguments that draw conclusions regarding empirical matters of fact from conceptual or ontological definitions. Specifically, we critically analyze arguments by Tom Tomlinson and Michael B. Green and Daniel Wikler. which, respectively, confuse logical and natural sufficiency and logical and natural necessity. Our own conclusion is that it is especially important in discussing the brain death issue to observe (...) the distinction between logical and natural sufficiency/necessity in a strict fashion. (shrink)