Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts

It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients’ rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks. The opinions expressed are the authors’ own. They do not reflect any position or policy of the National Institutes of Health, US Public Health Service, or Department of Health and Human Services. This research was supported by the Intramural Research Program of the NIH Clinical Center.     

Avoiding The Unavoidable? Judith Shklar’s Unwilling Search For An Overlapping Consensus

No less an authority than John Rawls identified Judith Shklar as a ‘political’ liberal. However, though their respective conceptions of political liberalism are similar in a number of important respects, Shklar emphasizes that her vision differs notably from that of Rawls. In particular, she explicitly eschews Rawls’s focus on establishing and sustaining an overlapping consensus, arguing that his belief in the possibility of securing such a consensus is naïve and, indeed, dangerous insofar as it embodies an obvious disregard for the painful lessons of history and thereby not only allows but invites the occurrence of new cruelties and horrors. Obviously, such an approach would seem to diverge dramatically from that promoted by Rawls and many other political liberals. The purpose of this essay is to analyze Shklar’s arguments and determine the validity of her claims regarding the differences between her conception and that of Rawls and, in so doing, assess the extent to which Shklar’s ‘liberalism of fear’ can be said to represent a meaningfully distinctive model of political liberalism.     

心理健康素质测评系统·中国成年人健康信念量表的编制

编制适合中国社会文化特点的成年人健康信念量表。根据健康信念对心理健康影响的大量研究结果,确定健康信念量表包括合理性和可控性两个维度的理论构想;通过访谈相关医务工作者以及在心理学专家中征集项目的方式形成初始问卷,并通过预测筛选,确定量表的最终项目。对天津市387名大学生、事业单位职员、公务员和农民工进行正式施测,检验量表的各项心理测量学指标。结果：健康信念量表包括两个维度,分别是可控性和合理性,量表具有良好的重测信度、内部一致信度、结构效度、内容效度以及校标关联效度。结论：健康信念量表具备令人满意的心理测量     

'You’re Being Unreasonable’: Prior and Passing Theories of Critical Discussion

A key and continuing concern within the pragma-dialectical theory of argumentation is how to account for effective persuasion disciplined by dialectical rationality. Currently, van Eemeren and Houtlosser offer one response to this concern in the form of strategic manoeuvring. This paper offers a prior/passing theory of communicative interaction as a supplement to the strategic manoeuvring approach. Our use of a prior/passing model investigates how a difference of opinion can be resolved while both dialectic obligations of reasonableness and rhetorical ambitions of argumentative success are simultaneously accommodated. The paper explores the model with particular reference to the pragma-dialectical rules of critical discussion, strategic manoeuvring and fallacious reasoning.     

Certainty,reasonableness and argumentation in law

This paper defends a position that parts ways with the positivist view of legal certainty and reasonableness. I start out with a reconstruction of this view and move on to argue that an adequate analysis of certainty and reasonableness calls for an alternative approach, one based on the acknowledgement that argumentation is key to determining the contents, structure, and boundaries of a legal system. Here I claim that by endorsing a dialectical notion of rationality this alternative account espouses an ambitious approach to reasoning in law and conceives of the theory of legal argumentation as the vantage point from which to analyze legal systems and tackle the main problems connected with their existence. Next, I look at what this alternative approach does for the way we should go about treating certainty and reasonableness, considered singularly as well as in their reciprocal relationship. I conclude on this basis that when argumentation receives its due emphasis in law we have to redefine certainty and reasonableness and recast their connection as non-conflictive.     

Rhetoric,reasonableness and ethics: An essay on Perelman

The article deals with an interpretation of the work of Ch. Perelman. The author tries to determine the meaning of reasonableness in a hermeneutical and anthropological perspective. He then places the work of Perelman in the light of the theory of symbolic interactionism of G.H. Mead.     

Reasonable Partiality in Professional Relationships

First, two aspects of the partiality issue are identified: (1) Is it right/reasonable for professionals to favour their clients’ interests over either those of other individuals or those of society in general? (2) Are special non-universalisable obligations attached to certain professional roles? Second, some comments are made on the notions of partiality and reasonableness. On partiality, the assumption that only two positions are possible – a detached universalism or a partialist egoism – is challenged and it is suggested that partiality, e.g. to family members, lies between these two positions, being neither a form of egoism, nor of impersonal detachment. On reasonableness, it is pointed out that ‘reasonable’ is an ambiguous concept, eliding the notions of the ‘morally right’ and the ‘rational.’ Third, a series of practical examples are taken from counselling, medicine, law, education and religious practice and some common principles are abstracted from the cases and discussed. These include truth-telling, confidentiality, conflicts of interest between clients and particular others and between clients and society. It is concluded that while partiality can be justified as a useful tool in standard cases, particular circumstances can affect the final verdict.     

Self-Defeating Beliefs and Misleading Reasons

We have no reason to believe that reasons do not exist. Contra Bart Streumer’s recent proposal, this has nothing to do with our incapacity to believe this error theory. Rather, it is because if we know that if a proposition is true, we have no reason to believe it, then we have no reason to believe this proposition. From a different angle: if we know that we have at best misleading reasons to believe a proposition, then we have no reason to believe it. This has two consequences. Firstly, coming close to believing the error theory is idle or pointless. Secondly, philosophers who argue that believing sweeping theories like determinism or physicalism is self-defeating because they are either false or believed for no reason pursue a worthwhile argumentative strategy.     

Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty,Utility, Fairness,and Accountability for Reasonableness

Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning policy choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations.     

Genetic Ignorance and Reasonable Paternalism

The question concerning an individual's rightto remain in ignorance regarding her owngenetic makeup is central to debates aboutgenetic information. Whatever is decided onthis matter has a weighty bearing on all of therelated third-party issues, such as whetherfamily members or employers should be toldabout an individual's genetic makeup. Thosearguing that no right to genetic ignoranceexists tend to argue from a viewpoint I havecalled in this paper reasonablepaternalism. It is an appealing position whichrests on widely shared intuitions on reasonablechoices, but which, in the end, smugglespaternalism back to medical practice.