Responsibility for Global Health

There are several reasons for the current prominence of global health issues. Among the most important is the growing awareness that some risks to health are global in scope and can only be countered by global cooperation. In addition, human rights discourse and, more generally, the articulation of a coherent cosmopolitan ethical perspective that acknowledges the importance of all persons, regardless of where they live, provide a normative basis for taking global health seriously as a moral issue. In this paper we begin the task of translating the vague commitment to doing something to improve global health into a coherent set of more determinate obligations. One chief conclusion of our inquiry is that the responsibilities of states regarding global health are both more determinate and more extensive than is usually assumed. We also argue, however, that institutional innovation will be needed to achieve a more comprehensive, fair distribution of concrete responsibilities regarding global health and to provide effective mechanisms for holding various state and nonstate actors accountable for fulfilling them.     

Toward a Pellegrino-inspired theory of value in health care

Contemporary medical practice and health policy are increasingly animated by the concept of providing high value care. Nevertheless, there can be disagreements about how value is defined and from whose perspective. Individual patients suffering from terminal cancer, for example, may have a different perception of the value of an expensive chemotherapy when compared to health policymakers, insurers, or others responsible for the financial solvency of health care organizations. Thus it seems reasonable to ask what is meant by “value” in high value care. In light of Edmund Pellegrino’s significant contributions to the philosophy of medicine, medical humanities, and bioethics, it seems equally reasonable to examine how he might answer it. This paper describes a Pellegrino-inspired theory of (health care) value that is instrumental, agent relative, and pluralistic. It then compares and contrasts this to the contemporary view and argues that only when individual patients incorporate concern for societal-level value into their conceptions of the highest good can the Pellegrino-inspired and contemporary views of value be reconciled.

     

Why So Many Questions? Measurement Issues and the Attitudinal Self-Control Scale

The Grasmick et al. (1993) scale is one of the most frequently used measures in criminology. Regardless of how commonly the scale is used, questions remain about its dimensionality and the nature of forming a composite measure from its 24 individual components. This study examines whether a composite measure is the most effective method for using the scale with a series of analyses using different approaches to combining—or not combining—these measures. Based on data from a sample of over 1,500 college students, the results indicate that a single-factor composite of the 24 items is the least effective approach in predicting crime/deviance. These results, instead, suggest using the individual components separately, multiple factors, or a composite measure made from just three of the original items lead to significant improvements over the one-factor solution.