Access to Assistive Technology,Systems Thinking,and Market Shaping: A Response to Durocher et al.

Fairness of access to assistive technology is important for its allocation on an equitable basis and for broader social justice and rights issues. Although the use of Daniels’s notion of “justice as fair opportunity” is helpful to the context of assistive technology, other aspects of Daniels’s broader conceptualisation of “just health” are not appropriate in this context. It is argued that fairness of access to assistive technology is crucial for the equitable attainment of the sustainable development goals; however, such access will be achieved only by the sector developing a much stronger systems thinking and market shaping perspective.     

Care,Oppression, and Marriage

This article draws attention to a form of injustice in intimate relationships of care that is largely ignored in discussions about the legal rights and obligations of intimate partners. This form of injustice is connected to a feature of caregiving I call “flexibility,” in virtue of which caregiving requires “skills of flexibility.” I argue that the demands placed by these skills on caregivers create constraints that amount to “vulnerability to oppression.” To lift these constraints, caregivers are entitled to open‐ended responses to their work, responses that would enable them to pursue their own projects while providing care. Instead of protecting individual choice of intimate relationships, marriage law should protect these entitlements.     

Clarifying the task

Those who would enquire into therelationship between “health conceptions” and “health care consequences” are faced with a formidable task. In order to make this challenge manageable it is necessary to define the scope of the task as precisely as possible. Are we, for instance, faced with a purely theoretical challenge; a task for applied philosophy, or must we employ multi-disciplinary methods? This paper argues that while philosophy has a central clarifying role, inquiry into the relationship between “health conceptions” and “health care organisation” can be done properly only through the combined efforts of several disciplines. Unless we are to be concerned only with abstract models it is essential to take account of the reality of health care situations. Given this it is suggested that the study of “health conceptions” is only a part of a greater task (unless all conceptions are to count as “health conceptions”). What is needed is understanding of the possible and actual purposes of health care, and detailed study of their practical implications.     

全球基本健康研究

在过去的10年间,世界各国的卫生研究意识都在增强,每个国家都很重视基本的国家研究在医疗卫生及医疗卫生系统中的作用。基因组计划将改变我们理解健康和疾病的方式,导致人们对“预防性治疗”的需要,但其带来的负面影响不可忽视。     

Making the Case for Primary Care and Mandated Suicide Prevention Education

During its 2012 legislative session, Washington State passed ESHB 2366, otherwise known as the Matt Adler Suicide Assessment, Treatment, and Management Act of 2012. ESHB 2366 is a significant legislative achievement as it is the first law in the country to require certain health professionals to obtain continuing education in the assessment, treatment, and management of suicide risk as a requirement to obtain and maintain licensure. However, ESHB 2366 does not apply to primary care providers, an important next step for legislation that has as its goal “to help lower the suicide rate in Washington.” This commentary addresses objections raised against the law and potential responses as Washington considers strengthening its own law to include primary care providers and as other states consider similar legislation.     

Bonhoeffer and Universal Health Care as a Human Right

Bonhoeffer gave a theocentric basis for human rights, as God is the ground of ethics. In our earthly world, the “ultimate” must be prepared by what is “penultimate.” That includes humanity’s natural life and bodily wholeness, leading to human duties crafted by human reason. Nowadays, biblical texts should not be used as partisan weapons attacking government provision of health care, since all Scripture (even the Law) is seen as a Christ-centered focus on human redemption. Thus, Bonhoeffer implies a right to universal health care, but leaves entirely open which practical structures may best provide it.     

Just health care (I): Is beneficence enough?

Few in our society believe that access to health care should be determined primarily by ability to pay. We believe instead that society has an obligation to assure access to adequate health care for all. This is the view explicitly endorsed in the President's Commission Report Securing Access to Health Care. But there is an important moral ambiguity here, for this obligation may be construed as being either beneficence-based or justice-based. A beneficience-based construal would yield a much weaker obligation with respect to the distribution of health care. In the first section of this paper I argue that the President's Commission is committed only to this weaker construal of this obligation. In the second section I argue that such a beneficence-based obligation is really rooted in a libertarian conception of justice, similar to that recently articulated by Engelhardt, and that this conception is seriously flawed when it comes to effecting a just distribution of health care.     

Rodin on Self-Defense and the “Myth” of National Self-Defense: A Refutation

David Rodin denies that defensive wars against unjust aggression can be justified if the unjust aggression limits itself, for example, to the annexation of territory, the robbery of resources or the restriction of political freedom, but would endanger the lives, bodily integrity or freedom from slavery of the citizens only if the unjustly attacked state (or someone else) actually resisted the aggression. I will argue that Rodin’s position is not correct. First, Rodin’s comments on the necessity condition and its relation to an alleged “duty to retreat” misinterpret the law, and a correct interpretation of the law is not only compatible with, but implies a permission to resist the “bloodless invader,” and this is also the correct view from the perspective of morality. Second, Rodin’s remarks on the proportionality of self-defense against conditional threats focus on physical or material harm but implausibly ignore the severity of the violations of autonomy and of the socio-legal or moral order that such conditional threats involve. Third, I will address Rodin’s claim that (“often”) defensive wars against “political aggression” are disproportionate because they risk the lives of those defended in an attempt to secure lesser interests. I will argue that this take on proportionality misses the point in an important respect, namely by confusing wide and narrow proportionality, and makes unwarranted assumptions about the alleged irrationality or impermissibility of incurring or imposing lethal risks to safeguard less vital interests. Next, I will also show that while Rodin talks of a “myth of national self-defense” and of the necessity of moving beyond traditional just war theory and international law, it is actually his interpretation of just war theory and international law that weaves myths. Finally, I will argue that Rodin’s views on national self-defense on the one hand, and “war as law enforcement” on the other, are incoherent.     

Who is my neighbor? A communitarian analysis of access to health care for immigrants

Immigrants lacking health insurance access the health care system through the emergency departments of non-profit hospitals. Because these persons lack health insurance, continued care can pose challenges to those institutions. I analyze the values of our health care institutions, utilizing a Walzerian approach that describes its appropriate sphere of justice. This particular sphere is dominated by a caring response to need. I suggest that the logic of this sphere would be best preserved by providing increased access to health insurance to this population. This access would marry the rights of these members of our community to access care to our responsibility to contribute to financing of the system. I close with some considerations on what it means to be a member of the community.     

Les autorisations d’équipements lourds d’imagerie médicale : un désordre organisé

Medical imaging is essential for all medical specialties and it is natural that the government wants to create a real healthcare provision policy in this area. Medical imaging and particularly the “heavy” equipment are subject to a regulatory and legal framework. This framework results in respect of administrative authorization mechanism. These authorizations are a major tool for development of medical imaging on French territory. This mechanism is an important instrument of economic regulation in controlling health costs. However, the access to this kind of equipment raises various issues in governance and administration but also in matter of economic regulation, distribution of healthcare supply in medical imaging in health territories and respect of public health issues. The authorization mechanism raises questionings, not only at national and regional level in terms of unequal access, but also at European and international level. Indeed, France is among the last countries in the ranking of CT (computed tomography) and MRI (magnetic resonance imaging) equipment rates in comparison with many OECD (Organization for Economic Cooperation and Development) countries. Now, these authorizations will integrate much more the concepts of accessibility and quality of patient care. The legal and regulatory framework of these authorizations will have to evolve and to adapt to new technologies and practices, which today should be a source of significant cost savings.     

Should a criminal receive a heart transplant? Medical Justice vs. Societal Justice

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled to at least a “decent minimum” level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of “rudimentary decent minimum” granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants.     

Moral Rights and the Limits of the Ought‐Implies‐Can Principle: Why Impeccable Precautions are No Excuse

This essay argues against the commonly held view that “ought” implies “can” in the domain of morality. More specifically, I contest the notion that nobody should ever be held morally responsible for failing to avoid the infliction of any harm that he or she has not been able to avoid through all reasonably feasible precautions in the carrying out of some worthwhile activity. The article explicates the concept of a moral right in order to show why violations of moral rights can occur even when no one has acted wrongfully in any fashion. In so doing, it will effectively be maintaining that strict liability (i.e., liability irrespective of the presence or absence of culpability) exists in morality as well as in law. When we take account of the distinction between exoneration and extenuation, we can see that scrupulously thorough precautions are never sufficient to constitute an excuse in morality. Having made that point with some extended examples, the article goes on to consider a number of possible objections – objections that lead into discussions of some basic distinctions within moral philosophy and some central principles within deontic logic.     

The Embodied Subjective Perspective

Perspective is a distinctive feature of external perception. There is a question of how to account for perceptual constancy in spite of changing perspectives. Alva Noe proposes the notion of ＂perspectival property＂ [P-property] and appeals to the perspectival aspect of perceptual content. His proposal conflicts with perceptual experiences and hence incurs many criticisms. Drawing on Husserl＇s phenomenology and Gibsonian psychology, I propose the notion of ＂perspectival awareness＂ [P-awareness]. I will argue that P-awareness is embodied pre-thematic self-awareness instead of the experience of a special kind of objective property. With the notion of P-awareness in mind, I then elaborate on the embodied subjective feature of perspective.     

Can Norman Daniels Help You Get a Wheelchair? A Commentary on Durocher et al.

Durocher and colleagues (2019) argue that Norman Daniels’s notion of just health could provide a useful framework for decreasing inequities in access to assistive technology. I argue that it would provide limited help for two reasons. First, Daniels’s reliance on normal species functioning as the goal of health care and his assumptions regarding the impact of normal species functioning on reasonable life projects create substantial difficulties for application to assistive technology. Second, although Daniels’s requirements for distributive justice provide a critical starting point for any discussion of health equity, these requirements appear already met within current assistive technology funding schemes.     

The patient-physician relationship and the allocation of scarce resources: a law and economics approach

Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient-physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient-physician trust, which the legal rules were designed to enhance.     

The physician and social renewal: Julius B. Richmond as role model

We live in an age of “high tech” medicine which affects both health care recipients and physicians who are taught its many wonders and uses. It is easy in this atmosphere of specialization for clinicians, professors and medical students to become isolated and to ignore social issues which affect health care in its broadest sense. Individuals who are committed to the “common good” are the ones historically who have been effective change agents. It would be tragic simply to stand back and allow the cynical and greedy to dominate any profession which deals with the poor, the uninsured and the homeless. It is imperative for physicians to take a broad view of today's problems in health care delivery systems, for they can have an enormous impact on the kind of world our children will inherit. It is essential for physicians to become involved in social concerns, and in improving health care delivery, at all levels in their practice. Given their power and prestige, it is crucial for physicians and aspiring physicians to have positive role models. Dr. Julius B. Richmond provides an admirable example of a physician who cares about his profession, his patients and his nation. Through his research, his public service and his teaching, Dr. Richmond has demonstrated the difference a single individual can make in improving the quality of life for all Americans.     

Workplace Violence and Worker Injury in Elderly Care Settings

Abstract

Many incidents of injury, assault, and abuse occur in health care settings. To better examine the situational context of the workplace, this paper examines whether workers providing care to elderly persons experience injuries that are consistent with the “for-profit” and “interpersonal conflict” explanations of elder abuse or neglect. Using data from the Bureau of Labor Statistics, results indicate that nursing home workers and home health care workers have higher rates of workplace injuries resulting from assaults and overexertion than do other workers. The data suggest that there are unique structural and situational factors present in the nursing home, which create a work setting vulnerable to conflict, violence, and elder abuse.