The observation that concepts used by social scientists are often problematic is not new; they have been described as Ballung concepts, cluster concepts, essentially contested, and reflexive; however, the need to work with these concepts remains. This article addresses the problem of variable choice in the social sciences by exploring and extending Woodward’s recommendations. This article demonstrates why Woodward’s criteria are difficult to apply in the social sciences and proposes an alternative, but complementary, framework for assessing variables.

Economists and philosophers disagree about the concept of choice used in economics. Some behavioural economists argue that economic models of choice will improve as they become more and more psychologically realistic. Don Ross argues that this argument fails because its hidden assumption – that the economic concept of choice is the same as the psychological counterpart – is false. Ross conjectures that the economic concept of choice concerns a population-scale pattern of behavioural changes (...) in response to incentives. We conduct a survey experiment to test two predictions that Ross’s conjecture generates. The statistical analysis of our data confirms our predictions, although with some qualifications. In interpreting our results, we distinguish two versions of commonsensible realism, strong and weak, and propose the weak one as a plausible explanation of our results. Weak commonsensible realism also produces further testable hypotheses. Some methodological implications of our study are discussed. (shrink)

Originally published in 1968. This is a critical study of the concept of 'rule' featuring in law, ethics and much philosophical analysis which the author uses to investigate the concept of 'rationality'. The author indicates in what manner the modes of reasoning involved in reliance upon rules are unique and in what fashion they provide an alternative both to the modes of logico-mathematical reasoning and to the modes of scientific reasoning. This prepares the groundwork for a methodology meeting (...) the requirements of the fields using rules such as law and ethics which could be significant for communications theory and the use of computers in normative fields. Other substantive issues related to the mainstream of legal philosophy are discussed - theories of interpretation, the notion of purpose and the requirements of principled decision-making. The book utilizes examples drawn from English and American legal decisions to suggest how the positions of legal positivism and of natural law are equally artificial and misleading. (shrink)

Our concept of choice is integral to the way we understand others and ourselves, especially when considering ourselves as free and responsible agents. Despite the importance of this concept, there has been little empirical work on it. In this paper we report four experiments that provide evidence for two concepts of choice—namely, a concept of choice that is operative in the phrase having a choice and another that is operative in the phrase making (...) a choice. The experiments indicate that the two concepts of choice can be differentiated from each other on the basis of the kind of alternatives to which each is sensitive. The results indicate that the folk concept of choice is more nuanced than has been assumed. This new, empirically informed understanding of the folk concept of choice has important implications for debates concerning free will, responsibility, and other debates spanning psychology and philosophy. -/- Specifically, 'having a choice' appears to require genuinely open alternatives, or alternative possibilities that are actually realizable, while 'making a choice' appears to only require psychological open alternatives, or the ability to consider alternatives independent of whether these alternatives are actually realizable. We argue that these findings are relevant to the free will debate because choice is central to the folk concept of free will and many philosophical analysis of free will. The kinds of alternatives required for having a choice appear to be incompatibilist in nature, while the kinds of alternatives required for making a choice appear to be compatibilist in nature. If free will requires having choices, then this is perhaps evidence against compatibilism. If free will requires making choices, then this is perhaps evidence in favor of--or at least consistent with--compatibilism. (shrink)

I develop a new reading of Frege’s argument for the indefinability of truth. I concentrate on what Frege literally says in the passage that contains the argument. This literal reading of the passage establishes that the indefinability argument is an arguably sound argument to the following conclusion: provided that the Fregean conception of judgment—which has recently been countered by Hanks—is correct and that truth is a property of truth-bearers, a vicious infinite regress is produced. Given this vicious regress, Frege chooses (...) to reject that truth is a property of truth-bearers. Frege’s choice leads to a unique version of the Fregean conception of judgment. His unique conception of judgment can cope with Hanks’s recent criticisms against the Fregean conception. (shrink)

Accountants and auditors are often faced with ethical dilemmas, which they have to process using resources available to them. Although they may be sensitive to the ethicality of the issues and have the cognitive ability to work through a judgment process, the final action they take may be dependent on a number of motivational factors, endogenous to the issue. Agency issues are a continuing area of concern providing accountants with an ability to shirk their responsibilities and hide confidential information, which (...) may affect their career prospects if disclosed. This ongoing study explores these notions within a stakeholder context and uses a post test only field experiment to gain evidence to support the existence of an agency problem and that membership to one of a number of motivational typologies directly affects the way accountants respond to ethical issues. This association causes them to adopt informational heuristics that may result in less than optimal decisions. This study identified two specific endogenous constructs, namely social consensus and venal intent that discriminate between motivational types and which possibly provide psychological underpinnings explaining membership orientation. (shrink)

Aristotle's treatment of the choice between the political and contemplative lives (in EN I 5 and X 7-8) can seem awkward. To offer one explanation of this, I argue that when he invokes self-sufficience (autarkeia) as a criterion for this choice, he appeals to two different and incompatible specifications of "lacking nothing." On one specification, suitable to a human being living as a political animal and thus seeking to realize his end as an engaged citizen of a polis, (...) a person lacks nothing by possessing a wide range of goods that directly require other people. On the other, more suitable to a god or a beast, a person lacks nothing by having no need of goods that directly require other people. The ambiguity of this criterion renders the choice between the political and contemplative lives difficult. (shrink)

Since its inception, donor conception practices have been a reproductive choice for the infertile. Past and current practices have the potential to cause significant and lifelong harm to the offspring through loss of kinship, heritage, identity, and family health history, and possibly through introducing physical problems. Legislation and regulation in Australia that specifies that the welfare of the child born as a consequence of donor conception is paramount may therefore be in conflict with the outcomes. Altering the paradigm to (...) a child-centric model, however, impinges on reproductive choice and rights of adults involved in the process. With some lobby groups pushing for increased reproductive choice while others emphasise offspring rights there is a dichotomy of interests that society and legislators need to address. Concepts pertaining to a shift toward a child-centric paradigm are discussed. (shrink)

While the addiction treatment industry holds steadfast to the idea that addiction is a disease, and the choice theorists maintam to the contrary that it is justa choice, the truth is not as simple as either. The idea of addiction is a social construct that evolved over the 20th century to encompass increasingly morephenomena, while becoming increasingly conceptually less clear. Taking a complex dynamic systems approach, rather than relying on either the obscure disease notion or the naive (...) class='Hi'>choice concept allows us to conceive of the organism, the mind, and the addiction as essentially temporal and emergent. From thisperspective, physical, mental, and social causes operate within one dynamic system, allowing for genetic, developmental, and environmental effects to be understood within a single framework. Such a framework offers much greater hope for successfully addressing the issue than does either the currently dominant disease paradigm or choice theory. (shrink)

In this paper, it is about the axiomatic basis of rational choice theory - the theory that is behind making rational choice and decisions. To make rational choices, we would require thinking rationally and understanding the reason and logic behind what makes a choice rational, and how we need to choose rationally. Decisions are made under various circumstances, i.e., under risk, and often under compulsion. In social choice theory, decisions are made by different types of decision (...) making entities, i.e., committees, groups, individuals and collective judgments by various types of organizations, etc. This paper highlights these issues and addresses the fundamental tenets of making rational choices by examining and following the previous workings of experts on this field. As such, it introduces a novel concept and the idea of Social Choice Rationality in choosing what’s rational. (shrink)

Kierkegaard’s pseudonymous work The Sickness unto Death is among his most popular and most commented works. Throughout the 20th and 21st centuries, numerous philosophers paid close attention to the theory of selfhood systematically expounded in this work. The study examines the critique of this theory formulated by Romano Guardini in a series of essays published in the 1920s. Guardini’s critique is an important contribution to the German mid-war debate on the nature of Kier- kegaard’s philosophy and continues to provoke scholarly (...) reactions even today. It is, therefore, relevant to study Guardini’s arguments in detail in order to see whether his definition of Kierkegaard’s theory as “dynamic personalism” is tenable. (shrink)

Are human beings motivated exclusively by self-interest? The orthodox theory of rational choice in economics thinks that they are. Amartya Sen disagrees, and his concept commitment is central to his vision of an alternative to mainstream rational choice theory. This book examines commitment as it has evolved in Sen's critique of orthodox rational choice theory. The in-depth focus on commitment reveals subtleties in the concept itself as well as in its relationships with other concepts which (...) Sen develops in his critique of rational choice theory, for example preference, sympathy, weakness of will, agency, personhood, social norms, rights, self-welfare goal and self-goal choice. The book provides a comprehensive understanding of commitment and offers novel interpretations of the term as a way of strengthening its plausibility. Broadly in support of Sen's conceptualization of rational choice, the book nevertheless reveals ambiguities and weaknesses in Sen's conceptual framework, and it reformulates Sen's concepts when doing so strengthens the claims he makes. The book also engages with critics of Sen and argues for the importance of commitment as a component in the theory of rational choice. (shrink)

People’s concept of free will is often assumed to be incompatible with the deterministic, scientific model of the universe. Indeed, many scholars treat the folk concept of free will as assuming a special form of nondeterministic causation, possibly the notion of uncaused causes. However, little work to date has directly probed individuals’ beliefs about what it means to have free will. The present studies sought to reconstruct this folk concept of free will by asking people to define (...) the concept (Study 1) and by confronting them with a neuroscientific claim that free will is an illusion (Study 2), which invited them to either reconcile or contrast free will with determinism. The results suggest that the core of people’s concept of free will is a choice that fulfills one’s desires and is free from internal or external constraints. No evidence was found for metaphysical assumptions about dualism or indeterminism. (shrink)

This paper addresses the changing ideology regarding reproduction, an evolving American, and potentially worldwide, value system regarding children and parenthood. Children are increasingly being seen as products, and the new technology of reproduction, including the sale of reproductive material and services and especially prenatal diagnosis and selective abortion, encourage this commodification of the fetus. While the new technology does indeed offer new choices, it also creates new structures and new limitations on choice. In the contemporary American social structure, these (...) choices are inevitably couched in terms of production and commodification, and thus do not offer individuals genuine choice or control. (shrink)

This paper analyzes the main features of rational choice theory and evaluates it with respect to the conceptions of Lakatos' research program and Laudan's research tradition. The analysis reveals that the thin rationality assumption, the axiomatic method and the reduction to the micro level are the only features shared by all rational choice models. On these grounds, it is argued that rational choice theory cannot be characterized as a research program. This is due to the fact that (...) the thin rationality assumption cannot be understood as a hard core in Lakatos' terms. It is argued that Laudan's conception of a research tradition better characterizes rational choice theory. On the basis of this conclusion, certain important criticisms of rational choice theory are answered. First, the criticisms concerning the core assumptions of rational choice theory are countered. It is argued that this critique is based on a misunderstanding of rational choice theory as a unified set of models, such as Lakatos' research program. Second, Green and Shapiro's rational choice 'pathologies' - inconsistent predictions, post hoc theory development and arbitrary domain restrictions - are evaluated. Contrary to Green and Shapiro, it is argued that post hoc theory development is a more preferable strategy for developing RCT than domain restrictions based on ex ante rules. (shrink)

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ by reference to citizen (...) autonomy and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

Representing moral choice as a function of rational choice is carried out by formalizing moral evaluation into a functional mechanism called "Moral Choice Function" whose domain is information on a state of affairs and range is a moral judgment, and upon which formal and substantive requirements are imposed. The notions such as impartiality, universalizability, proportionality, and informational invariance are employed for the issue of how to solve conflict of values faced by an individual as well as collective (...) moral agent. By utilizing the structural affinity with post-Arrovian social choice theory, it is shown that inter-attribute commensurability is indispensable for any serious moral agent who wants to solve conflict of values through pluralistic maximizing. It is also shown that once the morally relevant attributes are identified, formal requirements are powerful enough to qualify the function to behave in a certain way such that the formulas for pluralistic maximizing vary with the modes of inter-attribute commensurability. It is also shown how it is still possible to manage conflict of values rationally without value commensurability by interpreting John Rawls's theory of justice as neo-Kantian in dealing with conflicting desiderata from Kantian deontology and utilitarian consequentialism. The metaethical tenets for the project are also argued for such that it is neutral about the ontological status of morality; but it is anti-Humean with its supervenience thesis, anti-Moorean with its reducibility thesis, and anti-naturalist with its syntheticity thesis. It is also argued that behind the project there lies a fundamental metaphysical conception of an entity as a bundle of properties conjoined with epistemic foundationalism, which is evidenced not only in moral evaluation but also in other kinds of cognitive activity. (shrink)

This article seeks to contribute to the discussion on the nature of choice in virtue theory. If several different actions are available to the virtuous agent, they are also likely to vary in their degree of virtue, at least in some situations. Yet, it is widely agreed that once an action is recognised as virtuous there is no higher level of virtue. In this paper we discuss how the virtue theorist could accommodate both these seemingly conflicting ideas. We discuss (...) this issue from a modern Aristotelian perspective, as opposed to a purely exegetic one. We propose a way of resolving what seems to be a major clash between two central features of virtue ethics. Our proposal is based on the notion of parity, a concept which recently has received considerable attention in the literature on axiology. Briefly put, two alternatives are on a par (or are ‘roughly equal’) if they are comparable, although it is not the case that one is better than the other, nor that they are equally good. The advantages of applying the concept of parity to our problem are twofold. Firstly, it sheds new light on the account of choice in virtue theory. Secondly, some of the criticisms that have been mounted against the possibility of parity can be countered by considering the notion of choice from a virtue theory perspective. (shrink)

Left freely to themselves, a group of rational individuals often fail to cooperate even when the product of social cooperation is beneficial to all. Hence, the author argues, a rule of collective decision making is clearly needed that specifies how social cooperation should be organised among contributing individuals. Suzumura gives a systematic presentation of the Arrovian impossibility theorems of social choice theory, so as to describe and enumerate the various factors that are responsible for the stability of the voluntary (...) association of free and rational individuals. Among other topics covered are an axiomatic characterisation of the concept of a rational choice, the simple majority decision rule and its extensions, the social choice implications of the concept of equity as nonenvy, the constrained majoritarian collective choice rules and the conflict between the Paretian ethics and the libertarian claims of individual rights. (shrink)

Because psychotherapists are not moral teachers, they ought not to advise their clients about evaluative questions. This means that their advice must be limited to a concern with the client''s view of reality. It happens that in our times, there are prefabricated views of reality on offer from a variety of ideologies-Marxism and feminism being currently the most influential. Ideologists not only offer prefabricated realities-called consciousness- but also present a set of arguments to show that because choice is unreal, (...) consciousness is all that matters. Adopting the ideological concept of consciousness thus becomes a backdoor variant of the ultimate sin against scientific method: namely smuggling unsubstantiated, indeed undiscussed, values into therapy. (shrink)

In this paper I provide a critique of a set of assumptions relating to agency, choice and the legitimacy of actions impacting health that can be seen in some approaches to health promotion. After a brief discussion about the definition of health promotion, I outline two contrasting approaches to this area of health care practice. The first is focused on the provision of information and the second is concerned with seeking to change people’s preferences in a particular way. It (...) has been argued by a number of critics of health promotion that only the first approach is ethical, as it is for individuals to make their own lifestyle choices and adopt their own conception of the good life. I argue against this ‘information’ approach to health promotion on two grounds. First, I suggest that given the aims of health promotion, the provision of information is, as a matter of fact, of limited effectiveness in achieving these aims. Second, I argue that we have good reasons to question the appropriateness of respecting many of the preferences that individuals happen to have, given the origins and quality of such preferences. I then go on to argue, that by contrast we have good reasons to focus on changing at least some of the preferences that people have related to their lifestyle choices. This involves a commitment to both paternalism and a defence of a certain conception of the good life, but both can be defended. I use the example of potential responses to the growing problem of obesity to illustrate my argument, arguing that only policy that, at least sometimes, aims at preference change will be both effective and ethical. (shrink)

This article shows that the concept of choice is central to Isaiah Berlin’s liberalism. It argues that his valuing of choice is anchored in a particular conception of human nature, one that assumes and presupposes free will. Berlin’s works sketch a metaphysics of choice, and his reluctance to situate himself openly in the debate on free will is unconvincing. By introducing the theory of autopoiesis, this article further suggests that there is a way to take Berlin’s (...) value pluralism seriously, by considering sets of values as autopoietic conscious systems. Drawing on the works of Maturana and Varela in biology and Luhmann in sociology, autopoiesis strengthens value pluralism and acts as a critique of liberalism. By putting objectivity in parenthesis, autopoiesis finally allows for value systems to coexist side by side in a stronger sense than Berlin’s liberalism ever could. (shrink)

Recent work has shown that preschool-aged children and adults understand freedom of choice regardless of culture, but that adults across cultures differ in perceiving social obligations as constraints on action. To investigate the development of these cultural differences and universalities, we interviewed school-aged children (4–11) in Nepal and the United States regarding beliefs about people's freedom of choice and constraint to follow preferences, perform impossible acts, and break social obligations. Children across cultures and ages universally endorsed the (...) class='Hi'>choice to follow preferences but not to perform impossible acts. Age and culture effects also emerged: Young children in both cultures viewed social obligations as constraints on action, but American children did so less as they aged. These findings suggest that while basic notions of free choice are universal, recognitions of social obligations as constraints on action may be culturally learned. (shrink)

Multidimensional concepts are everywhere, and they are important. Examples include moral value, welfare, scientific confirmation, democracy, and biodiversity. How, if at all, can we aggregate the underlying dimensions of a multidimensional concept F to yield verdicts about which things are Fer than which overall? Social choice theory can be used to model and investigate this aggregation problem. Here, we focus on a particularly thorny problem made salient by this social choice-theoretic framework: the underlying dimensions of a given (...) concept might be measurable on different types of scales—e.g., some ordinal and some cardinal. An underappreciated impossibility theorem due to Anna Khmelnitskaya shows that seemingly plausible constraints on aggregation across scale types are inconsistent. This impossibility threatens to render the notion of overall Fness incoherent. We attempt to defuse this threat, arguing that the impossibility depends on an overly restrictive conception of measurement and of how measurement constrains aggregation. Adopting a more flexible—and, we think, more perspicuous—conception of measurement opens an array of possibilities for aggregation across disparate scale types. (shrink)

Many recent political philosophers have attempted to demonstrate that choice and responsibility can be incorporated into the framework of an egalitarian theory of distributive justice. This article argues, however, that the project of developing a responsibility-based conception of egalitarian justice is misconceived. The project represents an attempt to defuse conservative criticism of the welfare state and of egalitarian liberalism more generally. But by mimicking the conservative’s emphasis on choice and responsibility, advocates of responsibility-based egalitarianism unwittingly inherit the conservative’s (...) unsustainable justificatory ambitions, unattractive moralism, and questionable metaphysical commitments. More importantly, they misrepresent the nature of our concern with equality as a value. (shrink)

In this paper we present an approach between the conceptions of choice in Thomas Aquinas (1224-1274) and Jean-Paul Sartre (1905-1980). The purpose is to offer elements for a refl ection on the permanency of essentially human characteristics under quite different historical – and theoretical – conditions. The analysis follows the assumptions of Social History, from Braudel’s perspective of Long Duration. In fact, it is possible to identify analogies between Thomas’ and Sartre’s concepts of choice, which allows us, in (...) education, to make inferences about man’s responsibility for their actions. (shrink)

This book, first published in 1987, investigates what distinguishes the part of human behaviour that is action from the part that is not. The distinction was clearly drawn by Socrates, and developed by Aristotle and the medievals, but key elements of their work became obscured in modern philosophy, and were not fully recovered when, under Wittgenstein’s influence, the theory of action was revived in analytical philosophy. This study aims to recover those elements, and to analyse them in terms of a (...) defensible semantics on Fregean lines. Among its conclusions: that actions are bodily or mental events that are causally explained by their doers’ propositional attitudes, especially by their choices or fully specific intentions; that choice cannot be reduced to desire and belief, and hence that the traditional concept of will as intellectual appetite must be revived. (shrink)

The thesis studies the problem of measuring freedom of choice. It analyzes the concept of freedom of choice, discusses conditions that a measure should satisfy, and introduces a new class of measures that uniquely satisfy ten proposed conditions.

Are sexual orientations freely chosen? The idea that someone’s sexual orientation is not a choice is very influential in the mainstream LGBT political movement. But do we have good reasons to believe it is not a choice? Going against the orthodoxy, William Wilkerson has recently argued that sexual orientation is partly constituted by our interpretations of our own sexual desires, and we choose these interpretations, so sexual orientation is partly constituted by choice. In this paper I aim (...) to examine the question of whether our interpretations of our own sexual desires are constitutive of our sexual orientations. I will argue that whereas Wilkerson’s argument for the claim that sexual orientations are in part constituted by our chosen interpretations of our sexual desires is not sound, there are good reasons for endorsing a weaker claim, namely, that there are different but equally apt descriptions of the same sexual desires, depending on which concepts we have. (shrink)

This paper deals with structures ${\langle{\bf T}, I\rangle}$ in which T is a tree and I is a function assigning each moment a partition of the set of histories passing through it. The function I is called indistinguishability and generalizes the notion of undividedness. Belnap’s choices are particular indistinguishability functions. Structures ${\langle{\bf T}, I\rangle}$ provide a semantics for a language ${\mathcal{L}}$ with tense and modal operators. The first part of the paper investigates the set-theoretical properties of the set of indistinguishability (...) classes, which has a tree structure. The significant relations between this tree and T are established within a general theory of trees. The aim of second part is testing the expressive power of the language ${\mathcal{L}}$ . The natural environment for this kind of investigations is Belnap’s seeing to it that (stit). It will be proved that the hybrid extension of ${\mathcal{L}}$ (with a simultaneity operator) is suitable for expressing stit concepts in a purely temporal language. (shrink)

The concept of retroactive apparent occurrence, the main ingredient of Wheeler's delayed-choice thought experiments, is systematically incorporated into the quantum theory of measurement (in the framework of the recent review of Busch, Lahti, and Mittelstaedt). Besides, the (general) notion of individual-system measurement is introduced, and, due to it, premeasurement is defined by a truly minimal condition. Finally, retroactive apparent occurrence is made use of to derive apparent objectification in measurement. The derivation is discussed in the framework of the (...) quantum mechanical approach to the objectification problem. (shrink)

The underrepresentation of females in mathematics-related fields may be explained by gender differences in mathematics self-concept (rather than ability) favoring males. Mathematics self-concept typically declines with student age, differs with student ethnicity, and is sensitive to teacher influence in early schooling. We investigated whether change in mathematics self-concept occurred within the context of a longitudinal intervention to raise and sustain teacher expectations of student achievement. This experimental study was conducted with a large sample of New Zealand primary (...) school students and their teachers. Data were analyzed using longitudinal multilevel modeling with mathematics self-concept as the dependent variable and time (which represents students’ increasing age each year), gender, and ethnicity entered as predictors and achievement in mathematics included as a control variable. Interaction terms were also explored to investigate changes over time for different groups. All students demonstrated a small increase in mathematics self-concept over the 3-year period of the current study but mathematics self-concept was consistently greater for boys than girls. Māori, Asian, and Other students’ initial mathematics self-concept was higher than that of New Zealand European and Pacific Islanders’ (after controlling for achievement differences). However, a statistically significant decline in mathematics self-concept occurred for Māori students alone by the end of the study. The expected age-related reduction over time in student mathematics self-concept appeared to be mitigated in association with the longitudinal study. Nevertheless, the demonstration of a comparatively lower mathematics self-concept remained for girls overall and declined for Māori. Our results reinforce implications for future research into mathematics self-concept as a possible determinant of female student career choices. (shrink)

It is a commonly held position in the literature on distributive justice that choices individuals make from an equalized background may lead to inequalities of outcome. This raises the question of how to assign consequences to particular types of behaviour. Theories of justice based on the concept of moral responsibility offer considerable guidance as to how society should be structured, but they rarely address the question of what the consequences of making a particular choice should be. To fill (...) this lacuna, these theories must rely on a theory of consequences. I argue that the most plausible theories of consequences are substantive rather than procedural in nature. Such theories of consequences are inherently based on the concept of desert. By evaluating individuals' choices society may determine the appropriate consequences of choices for which they are responsible. (shrink)

Free choice of provider is heralded as a right of autonomy, but the goals of autonomy are better served in today's health care environment when there is informed choice of the care delivery system. The principle of liberty is distinguished from respect for auton omy. Free choice of provider would be demanded only by liberty, except that allocation of health care resources does not meet criteria for the application of liberty. Patients attempting to choose the best practitioner (...) do not have data to support the decision. If data were available, access to these superior practitioners would become an allocation problem. A mythology of the wise practitioner fosters the concept of provider choice as a personal judgement about clinical knowledge. The emerging trends of collaborative care, standardization of practice guidelines and diversity of delivery systems among reimbursers create a situation where a patient's autonomy to choose goals for treatment is respected through the choice of delivery sys tem. (shrink)

The concepts of social transformation, reform, and revolution are characterized. A typology of revolutions is given and revolutions of the appropriate type are compared with reforms. It is argued that reform and revolution are on a continuum and that there are social transformations that with equal propriety could be called ?a cluster of radical reforms? or ?a revolution?. What is sensibly at issue concerning the choice between reform or revolution is whether in bourgeois democracies it is more reasonable to (...) adopt the piecemeal reformist tactics of liberal reformers or whether a commitment to a revolutionary overthrow of the established order is justified. Arguments for both positions are examined and it is concluded that no general non?contextual answer can be given. (shrink)