Examining the ways and extent to which systemic factors affect health outcomes with regard to quality, affordability and access to curative healthcare, this explorative book compares the relative merits of tax-funded Beveridge systems and insurance-based Bismarck systems. The Law and Policy of Healthcare Financing charts and compares healthcare system outcomes throughout 11 countries, from the UK to Colombia. Thematic chapters investigate the economic and legal explanations for the relevant similarities, variations and trends across the globe. Concluding that systemic factors may (...) be less significant than previously believed, this comprehensive book notes that no one system consistently outperforms the others, yet incentives and funding improvements may lift performances across all curative healthcare systems. Analytical and comparative, this book will be of interest to academics working in the fields of health law and health economics. Public authorities including health ministries, policymakers and international health organisations will also find this to be an invaluable resource. (shrink)

Modem theory of law in a certain extent needs theological foundation. The dialogue of both law and theology, however, requires specific presuppositions in theological understanding. Paul Tillich's Systematic Theology in its peculiar character of combining theological »paradoxon« and openess for cultural recognition meets these demands.

Modem theory of law in a certain extent needs theological foundation. The dialogue of both law and theology, however, requires specific presuppositions in theological understanding. Paul Tillich's Systematic Theology in its peculiar character of combining theological »paradoxon« and openess for cultural recognition meets these demands.

Previously issued as author's dissertation, 1999/2000, Universiteat Berlin.

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

This paper begins with a discussion of two features of the everyday task environment. First, the everyday task environment is designed, and an important part of the design is the provision of explicit information to guide the individual in the adaptation of his activity. Second, some task environments are semi‐permanent. These two features of the task environment reveal some important characteristics in the psychology of the individual. When novelty occurs, expansion in the range of behavior of the individual is guided (...) by a process of internalization of information provided in the task environment by another. Because of the semi‐permanence of home task environments, there is pay‐off in organizing behavior in terms of the particulars of those environments. The body of this paper examines these ideas from the perspective of FLOABN. FLOABN is a computational cognitive model of an individual acquiring skill at using household and office devices. (shrink)

The rapid development of machine-learning algorithms, which underpin contemporary artificial intelligence systems, has created new opportunities for the automation of work processes and management functions. While algorithmic management has been observed primarily within the platform-mediated gig economy, its transformative reach and consequences are also spreading to more standard work settings. Exploring algorithmic management as a sociotechnical concept, which reflects both technological infrastructures and organizational choices, we discuss how algorithmic management may influence existing power and social structures within organizations. We identify (...) three key issues. First, we explore how algorithmic management shapes pre-existing power dynamics between workers and managers. Second, we discuss how algorithmic management demands new roles and competencies while also fostering oppositional attitudes toward algorithms. Third, we explain how algorithmic management impacts knowledge and information exchange within an organization, unpacking the concept of opacity on both a technical and organizational level. We conclude by situating this piece in broader discussions on the future of work, accountability, and identifying future research steps. (shrink)

Many philosophers have been persuaded that if we don’t create our own characters, we cannot be responsible for acts that flow from our characters; they also raise doubts about whether acts that do not flow from our characters can fairly be attributed to us. Both these concerns, however, reflect a simplistic and implausible conception of character and of its relation to our actions and our selves. I suggest a different relationship between character and responsibility: We can be responsible for acts (...) that are in character and also for acts that are out of character, but to be capable of being responsible at all is closely related to the capacity to have a character. I relate this capacity to the exercise of active intelligence—a capacity that is manifested in actions in or out of character, but not in the display of many psychological conditions or disorders. (shrink)

Disclosing unpublished research findings to participants during an ongoing clinical study requires careful consideration. As researchers, we are obliged to provide study participants with informati...

How should sport deal with prematurely ended seasons? This question is especially relevant to the current COVID-19 inter- ruption that threatens to leave many leagues without cham- pions. We argue that although there can be no winners, in certain situations there should be champions. Relevant to the current situation, we argue that Liverpool FC—currently with a 22+ point lead—should be crowned champions of the English Premier League. However, things are not as simple as simply handing the championship to whoever was (...) in the lead when a season is prematurely ended. Through analogy with a fictional decathlon competition—and with the understanding that sporting seasons are themselves a type of game—we identify three reasons why leading at the moment of cessation is insufficient to be crowned a victor (of an individual event) or a champion (of a season-long competition): doing so fails to respect some valuable skills, fails to allow for luck to play out in an interesting way that affects competitions, and fails to respect competitive strategies. This discussion can then inform determining what, if any, end-of-season accolades are relevant, such as championships, relegation, or promotion. No team can win in a league that has failed to be completed, but there can still be a champion. (shrink)

Previous research suggested a role of gaze in preference formation, not merely as an expression of preference, but also as a causal influence. According to the gaze cascade hypothesis, the longer subjects look at an item, the more likely they are to develop a preference for it. However, to date the connection between viewing and liking has been investigated predominately with self-paced viewing conditions in which the subjects were required to select certain items from simultaneously presented stimuli on the basis (...) of perceived visual attractiveness. Such conditions might promote a default, but non-mandatory connection between viewing and liking. To explore whether the connection is separable, we examined the evaluative processing of single naturalistic food images in a 2 x 2 design, conducted completely within subjects, in which we varied both the type of exposure (self-paced versus time-controlled) and the type of evaluation (non-exclusive versus exclusive). In the self-paced exclusive evaluation, longer viewing was associated with a higher likelihood of a positive evaluation. However, in the self-paced non-exclusive evaluation, the trend reversed such that longer viewing durations were associated with lesser ratings. Furthermore, in the time-controlled tasks, both with non-exclusive and exclusive evaluation, there was no significant relationship between the viewing duration and the evaluation. The overall pattern of results was consistent for viewing times measured in terms of exposure duration (i.e., the duration of stimulus presentation on the screen) and in terms of actual gaze duration (i.e., the amount of time the subject effectively gazed at the stimulus on the screen). The data indicated that viewing does not intrinsically lead to a higher evaluation when evaluating single food images; instead, the relationship between viewing duration and evaluation depends on the type of task. We suggest that self-determination of exposure duration may be a prerequisite for any influence from viewing time on evaluative processing, regardless of whether the influence is facilitative. Moreover, the purported facilitative link between viewing and liking appears to be limited to exclusive evaluation, when only a restricted number of items can be included in a chosen set. (shrink)

Oversight of human gene transfer research presents an important model with potential application to oversight of nanobiology research on human participants. Gene therapy oversight adds centralized federal review at the National Institutes of Health's Office of Biotechnology Activities and its Recombinant DNA Advisory Committee to standard oversight of human subjects research at the researcher's institution and at the federal level by the Office for Human Research Protections. The Food and Drug Administration's Center for Biologics Evaluation and Research oversees human gene (...) transfer research in parallel, including approval of protocols and regulation of products. This article traces the evolution of this dual oversight system; describes how the system is already addressing nanobiotechnology in gene transfer: evaluates gene therapy oversight based on public opinion, the literature, and preliminary expert elicitation; and offers lessons of the gene therapy oversight experience for oversight of nanobiotechnology. (shrink)

Answering important public health questions often requires collection of sensitive information about individuals. For example, our understanding of how HIV is transmitted and how to prevent it only came about with people's willingness to share information about their sexual and drug-using behaviors. Given the scientific need for sensitive, personal information, researchers have a corresponding ethical and legal obligation to maintain the confidentiality of data they collect and typically promise in consent forms to restrict access to it and not to publish (...) identifying data.The interests of others, however, can threaten researchers' promises of confidentiality when legal demands are made to access research data. In some cases, the subject of the litigation is tightly connected to the research questions, and litigants' interest in the data is not surprising. Researchers conducting studies on tobacco or occupational or other chemical exposures, for example, are relatively frequent targets of subpoenas. (shrink)

Developing ethical standards for clinical use of large-scale genome and exome sequencing has proven challenging, in part due to the inevitability of incidental or secondary findings. Policy of the American College of Medical Genetics and Genomics has evolved but remains problematic. In 2013, ACMG issued policy recommending mandatory analysis of 56 extra genes whenever sequencing was ordered for any indication, in order to ascertain positive findings in pathogenic and actionable genes. Widespread objection yielded a 2014 amendment allowing patients to opt-out (...) from analysis of the extra genes. In 2015, ACMG published the amended policy, providing that patients could opt out of the full set of extra genes, but not a subset. In 2016, ACMG enlarged the set and indicated planned expansion of the roster of extra genes to include pharmacogenetic findings. ACMG policy does not protect the respect for patient choice that prevails in other domains of clinical medicine, where informed consent allows patients to opt in to desired testing. By creating an expanding domain of genomic testing that will be routinely conducted unless patients reject the entire set of extra tests, ACMG creates an exceptional domain clinical practice that is not supported by ethics or science. (shrink)

In todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. We accompanied 32 migrant patients during their medical encounters at two outpatient clinics using an ethnographic approach. Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which (...) difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues. Patients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice relationship issues<. A deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals’ and patients’ perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research. (shrink)

Human interactions are often improvised rather than scripted, which suggests that efficient coordination can emerge even when collective plans are largely underspecified. One possibility is that such forms of coordination primarily rely on mutual influences between interactive partners, and on perception–action couplings such as entrainment or mimicry. Yet some forms of improvised joint actions appear difficult to explain solely by appealing to these emergent mechanisms. Here, we focus on collective free improvisation, a form of highly unplanned creative practice where both (...) agents' subjective reports and the complexity of their interactions suggest that shared intentions may sometimes emerge to support coordination during the course of the improvisation, even in the absence of verbal communication. In four experiments, we show that shared intentions spontaneously emerge during collective musical improvisations, and that they foster coordination on multiple levels, over and beyond the mere influence of shared information. We also show that musicians deploy communicative strategies to manifest and propagate their intentions within the group, and that this predicts better coordination. Overall, our results suggest that improvised and scripted joint actions are more continuous with one another than it first seems, and that they differ merely in the extent to which they rely on emergent or planned coordination mechanisms. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

Researchers now commonly collect biospecimens for genomic analysis together with information from mobile devices and electronic health records. This rich combination of data creates new opportunities for understanding and addressing important health issues, but also intensifies challenges to privacy and confidentiality. Here, we elucidate the “web” of legal protections for precision medicine research by integrating findings from qualitative interviews with structured legal research and applying them to realistic research scenarios involving various privacy threats.

With the originality and energy that have marked his earlier works, Eric Wolf now explores the historical relationship of ideas, power, and culture. Responding to anthropology's long reliance on a concept of culture that takes little account of power, Wolf argues that power is crucial in shaping the circumstances of cultural production. Responding to social-science notions of ideology that incorporate power but disregard the ways ideas respond to cultural promptings, he demonstrates how power and ideas connect through the (...) medium of culture. Wolf advances his argument by examining three very different societies, each remarkable for its flamboyant ideological expressions: the Kwakiutl Indians of the Northwest Pacific Coast, the Aztecs of pre-Hispanic Mexico, and National Socialist Germany. Tracing the history of each case, he shows how these societies faced tensions posed by ecological, social, political, or psychological crises, prompting ideological responses that drew on distinctive, historically rooted cultural understandings. In each case study, Wolf analyzes how the regnant ideology intertwines with power around the pivotal relationships that govern social labor. Anyone interested in the history of anthropology or in how the social sciences make comparisons will want to join Wolf in _Envisioning Power_. (shrink)

Despite the fact that the requirement to obtain informed consent for medical procedures is deeply enshrined in both U.S. moral and legal doctrine, empirical studies and anecdotal accounts show that women's rights to informed consent and refusal of treatment are routinely undermined and ignored during childbirth. For example, citing the most recent Listening to Mothers survey, Marianne Nieuwenhuijze and Lisa Kane Low state that "a significant number of women said they felt pressure from a caregiver to agree to having an (...) intervention that they did not want during birth". Specifically, Nieuwenhuijze and Low cite that "19% of women who did not have epidural analgesia felt... (shrink)

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

This chapter contains sections titled: Problems for a Theory of Intergenerational Justice Libertarianism and Intergenerational Justice A Liberal Theory of Intergenerational Justice Intergenerational Justice and Saving Just Saving behind the Veil of Ignorance Sustainability: Alternative Conceptions Intergenerational Justice and Sustainability Conclusion.

This paper draws on ideas about policy innovation and adaptation to assess the extent to which ‘payments for ecosystem services’ (PES) can be seen as a challenge to traditionally more bureaucratic, state-centered ways of paying for the provisioning of environmental goods from agricultural landscapes through agri environmental policy (AEP). Focussing on recent experience in the United States and the UK, the paper documents the extent to which PES is now an established term of reference in AEP research and debate in (...) both countries and postulates that this may usher in a new discourse of environmental provisioning in agriculture. The PES landscape is, however, currently highly fragmented and largely experimental, with ‘PES-like’ approaches being piloted in the field through partnerships between state agencies and localized private and charitable interests. State-supported AEP programs remain substantially intact, and rather than any displacement of state action, there appears to be a more gradual insertion of PES approaches and metrics into standard AEP operating procedures. This institutional stickiness is partly due to the continuing difficulty of agreeing the metrics necessary for measuring outcomes but may also be due to the politically well defended nature of traditional AEP entitlements and associated policy networks. We conclude by suggesting a need for further research to better understand these specifically political constraints and sources of resistance to PES and the ambiguous consequences for institutions, policy networks, rural communities and environment. (shrink)

This paper argues that we ought to conceive of the Dark Energy problem—the question of how to account for observational data, naturally interpreted as accelerated expansion of the universe—as a crisis of underdetermined pursuit-worthiness. Not only are the various approaches to the Dark Energy problem evidentially underdetermined; at present, no compelling reasons single out any of them as more likely to be true than the other. More vexingly for working scientists, none of the approaches stands out as uncontroversially preferable over (...) its rivals in terms of its rationally warranted promise, i.e. the reasons to further work on, explore, and develop it. We demonstrate this claim by applying a Peircean economic model of pursuit-worthiness in terms of a cognitive cost/benefit estimate—with the instantiation of theory virtues as key indicators of cognitive gains—to the four main Dark Energy proposals (the cosmological constant approach, modified gravity, quintessence, and inhomogeneous cosmologies). According to our analysis, these approaches do not admit of an unambiguous, or uncontroversial, ranking with respect to which ansatz deserves distinguished attention and research efforts. The overall methodological counsel that our analysis underwrites recommends a pragmatic double research strategy forward: to encourage and foster theory pluralism and the search for tests—with the goal of enhancing the testability of the \(\Lambda \) CDM model and “testing it to destruction". (shrink)

Participant-driven research is a burgeoning domain of research innovation, often facilitated by mobile technologies. Return of results and data are common hallmarks, grounded in transparency and data democracy. PDR has much to teach traditional research about these practices and successful engagement. Recommendations calling for new state laws governing research with mHealth modalities common in PDR and federal creation of review mechanisms, threaten to stifle valuable participant-driven innovation, including in return of results.