While in America most people think of “welfare” as means-tested programs such as Aid to Families with Dependent Children, in reality in the United States and other affluent democracies the heart of the welfare state is social insurance programs, such as health insurance, old-age or retirement pensions, and unemployment insurance. They are insurance programs in the sense that they protect against common risks of a loss of income if and/or when certain events come to pass ; they are “social” because (...) unlike market insurance they are not run on a sound actuarial basis, the premiums are not voluntarily incurred but compulsory, and there is very limited choice or flexibility concerning the type of policy one can purchase. Why have social insurance rather than market insurance? In this essay, I take up this question with regard to old-age or retirement pensions, which at present absorb around 9 percent of the gross domestic product and 25 percent of government spending of the affluent industrial countries comprising the Organization for Economic Cooperation and Development. My aim is to show that old-age or retirement social insurance is worse in virtually every relevant normative respect than its alternative, some form of market or private pensions. By relevant normative respect, I mean those values or principles which are used by contemporary political philosophers in their discussions and justifications of welfare-state policies, and which are applicable to assessments of different systems of old-age or retirement pensions. (shrink)

There are two principal philosophical conceptions of socialism, corresponding to two interpretations of the notion of a rational society. The first conception corresponds to an instrumental view of social rationality. Captured by the image of socialism as “one big workshop,” the instrumental view holds that social ownership of the means of production is rational because it promotes the optimal development of the productive forces. Social ownership is optimal because it eliminates the costs of coordination imposed by the conduct of economic (...) activities in formally independent enterprises, and, more generally, overcomes fetters on development that result from the control of resources by individuals whose particular interests imperfectly correspond to a general interest in productive advance. (shrink)

This paper stands at the confluence of two streams in contemporary political thought. One stream is composed of those critics of liberal political philosophy who are often described collectively as ‘communitarians’. What unites these critics is a belief that contemporary liberalism rests on an impoverished and inadequate view of the human subject. Liberal political thought – as manifested, for instance, in the writings of John Rawls, Robert Nozick, and Ronald Dworkin – claims centrally to do justice to individuality: to specify (...) the conditions under which distinct individuals, each with his own view about how life should be lived, can pursue these visions to the best of their ability. But, the critics claim, liberalism is blind to the social origins of individuality itself. A person comes by his identity through participating in social practices and through his affiliation to collectivities like family and nation. An adequate political philosophy must attend to the conditions under which people can develop the capacity for autonomy that liberals value. This, however, means abandoning familiar preoccupations of liberal thought – especially the centrality it gives to individual rights – and looking instead at how social relationships of the desired kind can be created and preserved. It means, in short, looking at communities – their nature and preconditions. (shrink)

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of (...) the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge. (shrink)

Article 25 of the Universal Declaration of Human Rights reads as follows: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” I shall refer to the right postulated here as “the right to an adequate standard of living” or “The Right.”.

The question I wish to take up in this paper is whether competitive markets, as mechanisms that initiate the distribution of scarce goods, allocate those goods in accordance with what participants in those markets deserve. I want to argue that in general people do not in fact deserve what they get from market interactions, when “what they get” is determined by the competitive forces coming to bear on the market. This more general claim is meant to apply to all participants (...) in the market. However, my strategy here is to focus on the particular case of the role of entrepreneurs, as I will define them, and whether they deserve the profits they reap in a competitive capitalist market. In particular, I will argue that the claim that entrepreneurs deserve their profits, when spelled out precisely, is indeed not plausible. Generalizing from this claim, I want to suggest how moral desert is inappropriate as a justification of market shares whenever competition determines the magnitude of those shares. I should stress, though, the particularity of my central claim: it is that “ entrepreneurs do not deserve their profits.” This is not to say that, for other reasons, people should not receive the rewards doled out by a market. My claim is only that desert has nothing directly to do with it. I am deviating significantly here from the usual strategy for denying the relevance of desert claims to principles of distributive justice. (shrink)

Mainstream economics evaluates capitalism primarily from the perspective of efficiency. Social philosophy typically applies other or additional normative criteria, such as equality, democracy, and community. This essay examines the implications of these contrasting sets of criteria in the evaluation of capitalism. Its first two sections consider the criteria themselves, assuming that a trade-off exists between them. The last three sections question whether such a trade-off necessarily occurs, and explore the claim that improvements in nonefficiency dimensions of capitalist society may enhance, (...) rather than conflict with, efficiency. (shrink)

John Donne's song was hardly written in the tradition of political philosophy, but it has a good deal to say about the theme of luck, both good and bad, which I want to address. There is no doubt but that bad luck has bad consequences for the persons who suffer from it. If there were a costless way in which the consequences of bad luck could be spread across everyone in society at large, without increasing the risk of its occurrence, (...) then most of us would pronounce ourselves better off for the change. In this sense it can be said, for example, that there is a utilitarian grounding for a moral obligation to care and provide for those persons who suffer the fortunes of bad luck. For the sake of argument I do not wish to contest this particular starting point, although there are many who would. Instead, I want to ask the question of whether this moral obligation should be converted into a legal obligation, backed by public force. The dominant answer to that question today is yes. Even those who think that markets should determine decisions on production find that the state has a proper role to reduce the adverse consequences of bad luck. My cast of mind is more skeptical. In life, or, in this instance, politics, “come bad chance, and we do join to it our strength.” In general the effort to use coercion to counter the adverse effects of luck tends only to make matters worse. (shrink)

The city of Cincinnati, we know, can be an engaging place, but federal judge Arthur Spiegel also found, in the mid-'90s, that it could be quite a vexing place. The city council of Cincinnati had passed what was called the Human Rights Ordinance of 1992, which barred virtually all species of discriminationAppalachian origin.sexual orientation.minority status” in the law. The framers of the amendment objected to the tendency to treat gays and lesbians on the same plane as groups that have suffered (...) discrimination based on race, religion, or gender. The proposal, known as Issue 3, drew wide support and passed in a referendum in 1993. It was, of course, challenged in the courts, which is why it found its way into the hands of Judge Spiegel. (shrink)

Natural selection generated a natural sense of justice. This natural sense of justice created a set of natural rights; rights humans accorded to each other in virtue of being members of the same tribe. Sharing the responsibility for natural rights between all members of the same tribe allowed humans to take advantage of all opportunities for cooperation. Human rights are the present day political emanation of natural rights. Theoretically, human rights are accorded by all humans to all humans in virtue (...) of being humans; however, the idea that the corresponding responsibility is now shared among all humans is not broadly accepted. The natural sense of justice creates an ambiguity: on the one hand humans consider the nation they belong to as the social system that should guarantee their human rights (and likewise they do not consider themselves as having responsibility for the human rights of inhabitants of other nations); on the other hand, as cooperation between nations intensifies, expectations of global mutual responsibility increase as well. As the West does not feel responsible for the human rights of humans in the rest of the world, not even for their most basic survival needs, the West is perceived as unworthy of cooperation. If human rights are understood as conditions for the well-functioning communities, lifting the responsibility for the human rights of all humans to the global level can be understood as a condition to take full advantage of all opportunities globalization presents, or as a condition to adequately address all challenges globalization presents. However, this would have to happen without disregarding the particular feelings of mutual responsibility nations embody; we need a sliding scale of responsibility. The first step would be an acknowledgement that all humans are responsible for meeting the very basis survival needs of all humans, which could be achieved through a Framework Convention on Global Health and a Global Health Fund. (shrink)

Conducting empirical research on gender in medical ethics is a challenge from a theoretical as well as a practical point of view. It still has to be clarified how gender aspects can be integrated without sustaining gender stereotypes. The developmental psychologist Carol Gilligan was among the first to question ethics from a gendered point of view. The notion of care introduced by her challenged conventional developmental psychology as well as moral philosophy. Gilligan was criticised, however, because her concept of ‘two (...) different voices’ may reinforce gender stereotypes. Moreover, although Gilligan stressed relatedness, this is not reflected in her own empirical approach, which still focuses on individual moral reflection. Concepts from social psychology can help overcome both problems. Social categories like gender shape moral identity and moral decisions. If morality is understood as being lived through actions of persons in social relationships, gender becomes a helpful category of moral analysis. Our findings will provide a conceptual basis for the question how empirical research in medical ethics can successfully embrace a gendered perspective. (shrink)

I distinguish between two forms of consequentialism: reductionist and anti-reductionist. Reductionist consequentialism holds that the deontic properties of rightness and wrongness are identical with the axiological properties of optimality and suboptimality, respectively. Anti-reductionist consequentialism denies this identification, hence accepting what I call the autonomy of the deontic. In this article I ignore reductionist consequentialism. Instead I argue that anti-reductionist consequentialism is deeply problematic or even incoherent. Simply put, the main point is that the criterion of rightness of any ethical theory (...) that respects the autonomy of the deontic must entail that an object that meets that criterion is an action, and anti-reductionist consequentialism does not meet that requirement (while certain competing theories arguably do). (shrink)

The notion of self-interest has not received from philosophers of this century the attention it deserves. In this paper, I shall first elucidate the views on self-interest of a philosopher who nourished in the last century. It could be argued that Henry Sidgwick's views on this topic are the most considered in the history of philosophy. I shall then point to a number of misconceptions in his position, and suggest a more satisfactory account. I shall attempt also to solve a (...) problem for this new account with the aid of a Sidgwickian distinction. (shrink)

This paper is a comparative analysis of egalitarianism and utilitarianism from a naturalistic perspective that offers some insight into the manner in which we come to make interpersonal comparisons of welfare.

What I call hegemonism holds that a satisfactory moral theory must in a fairly direct way guide action. This, the hegemonist believes, provides a constraint on moral theorizing. We should not accept moral theories which cannot in the proper sense guide us. There are two alternatives to hegemonism. One is motivational indirection, which is the idea that while agents remain motivated by a moral theory, they may be only indirectly motivated. The other is non-hegemonism, which holds that a correct moral (...) theory need not in any direct or indirect sense guide or motivate actions. In the main part of the paper I discuss widely endorsed objections to motivational indirection and nonhegemonism, and I argue that these objections all fail. Hence, motivational indirection and non-hegemonism remain viable conceptions of moral theory. (shrink)

My question, which is central to the business of moral philosophy, is implicitly addressed by many philosophers, yet explicitly addressed by only a few. In this paper I address the question head-on, and propose a qualified affirmative answer.

The Interpersonal Addition Theorem, due to John Broome, states that, given certain seemingly innocuous assumptions, the overall utility of an uncertain prospect can be represented as the sum of its individual utilities. Given ‘Bernoulli's hypothesis’ according to which individual utility coincides with individual welfare, this result appears to be incompatible with the Priority View. On that view, due to Derek Parfit, the benefits to the worse off should count for more, in the overall evaluation, than the comparable benefits to the (...) better off. Pace Broome, the paper argues that prioritarians should meet this challenge not by denying Bernoulli's hypothesis, but by rejecting one of the basic assumptions behind the addition theorem: that a prospect is better overall if it is better for everyone. This conclusion follows if one interprets the priority weights that are imposed by prioritarians as relevant only to moral, but not to prudential, evaluations of prospects. (shrink)

Sidgwick maintains, plausibly, that the concept of a person's good is a normative one and takes for granted that it is normative for the agent's own choice and action. I argue that the normativity of a person's good must be understood in relation to concern for someone for that person's own sake. A person's good, I suggest, is what one should want for that person in so far as one cares about him, or what one should want for him for (...) his sake. I examine Sidgwick's defence of the axioms of rational prudence and argue that it is powerless to convince anyone who lacks self-concern or thinks he has no reason to care for himself. To the extent that Sidgwick is persuasive, I argue, it is because he insinuates an assumption of self-concern. Similarly, Sidgwick's defence of the axiom of rational benevolence tacitly assumes, not just impersonality, but equal concern. (shrink)

Modern utilitarianism has largely abandoned the view that human well-being consists solely in pleasurable sensations. Too much was wanting in that view for it to withstand the critique of a more refined philosophical psychology than was available to Bentham and Mill. The objections are by now familiar and need no detailed rehearsal. The older view failed to characterize adequately the structure of human satisfactions, forgetting that we can care about things that will happen after we are dead, that we generally (...) prefer to be told a distasteful truth to a comforting lie, and that we wish to be actors in our own lives and not merely passive recipients of pleasures from external sources. The extent to which a life is a flourishing one cannot be determined by summing the pleasures and pains, and calculating the balance. Nor, indeed, can it be determined by summing anything else. A life that is happy or eudaimon in the Aristotelian sense is an organic unity in which the significance of its parts rests on their contribution to the meaning of the whole. Nur im Zusammenhange eines Lebens hat ein Erlebnis Bedeutung. Utilitarianism needs to find a way of incorporating an organic view of human satisfaction. (shrink)

According to what one might call ‘indirect” forms of utilitarian thinking, the proper end of all human action is the greatest happiness of the greatest number of individuals, but due to the fallibility of moral agents this end cannot, and must not, be directly pursued. Instead, according to at least one version of the indirect theory, moral agents have a duty to act in conformity with a set of general rules which, in their turn, have been designed to promote the (...) greatest happiness of humankind. But acts which conform to such general rules can under exceptional circumstances occasion more suffering than happiness. This is clearly problematical to indirect utilitarians. If they follow the rules regardless of the evil consequences, it can be argued that they have abandoned the basic principles of utilitarianism. If, on the other hand, they refuse to follow the rules which normally promote the general good, their view can be seen to collapse into the direct form of the creed. (shrink)

Brian Barry's Justice as Impartiality is a highly enjoyable and rewarding book. It throws new light on some familiar theories of justice, and shows how the idea that principles of justice are those principles which no one could reasonably reject can yield prescriptions for constitutional design. But I shall argue that Barry's defence of his theory is less robust than he thinks, and more generally that there is reason to suppose that principles of justice are as contestable as conceptions of (...) the good. (shrink)

In Justice as Impartiality Brian Barry seeks to present ‘a universally valid case in favour of liberal egalitarian principles’. It is an ambitious enterprise undertaken with originality, vigour, and wit; and containing a wealth of interesting argumentation. If, ultimately, Barry fails in the task he sets himself, as I shall argue he does, the attempt is none the less highly instructive; not only because of the many local successes in his arguments with proponents of alternative theories and his often illuminating (...) discussions of particular issues, but also because of the lessons to be learnt from his failure. For if even Barry's formidable defence of a contractualist, neutralist liberalism does not succeed then there may be good reason to think that none will. While this larger claim will not be fully justified here, and the case against justice as impartiality does not depend upon it, one of my deeper motivating concerns is to try to show that the most important failures in Barry's argument are inextricably bound up with the nature of his undertaking. We are concerned, I believe, not just with some inevitable imperfections of execution but with a flawed project. (shrink)

Moral egalitarianism will depend on one of two basic ideas. The first is the idea of equality itself. We might believe that it is a good thing if different people have equal shares of resources, or if their lives score equally well in terms of whatever makes lives valuable, at least if there is no reason based on some other moral value for one person to do better than the other. Equality is a relationship between the lives of different people. (...) This version of egalitarianism claims that the existence of the relationship makes an outcome better. It attributes value to relations between lives rather than to the content of lives. (shrink)

The egalitarian values of equality and priority are standardly given maximal scope in that they are applied to the overall condition of peoples' lives and to temporally complete lifetimes. They are also standardly restricted to interpersonal choices. This paper argues that egalitarian values can also reasonably be applied to particular dimensions of lives, to people at particular times, and to choices made about one person's life. It contends that these special applications of egalitarianism are easier to defend in the case (...) of priority than in the case of equality. (shrink)

Bentham, a founder of political science based on the calculation of interest, has been misread as a crass materialist. I argue, instead, that Bentham's interest is a specific product of the imagination, and the pleasures and pains of which it is composed are also products of the imagination. On my reading, interests and imaginations are always governed and the role of Bentham's political science is to help govern them more effectively and efficiently. Political science is a mode of what he (...) calls. Various interest-based modes of analysis have been attacked by constructivist critics, but I argue that the arch-theorist of interest himself relies on constructivist modes of analysis. What lessons can we learn from this? We should pay less attention to methodological and foundational conflicts, and pay more attention to the practices of government that social science may or may not indirectly legislate. (shrink)

The note claims that Rosen's arguments about distribution and aggregation do not support his central claim, either in their own terms or as a reading of Bentham; and suggests a different account of the relation of the objective to the subjective in Bentham.

An argument has been made for identifying Mill as an individualistic thinker. Certainly, A System of Logic develops views, such as methodological individualism and a conception of the ‘art of life’, which portray persons as having unique essences that, when supported by autonomous choices with respect to life experiments, reveal their individuality. These views are at least loosely applied in later works. Principles of Political Economy treats economic aspects of social life frequently in terms consistent with those of classical economists (...) for whom the self-interested actions of individuals achieve economic growth. On Liberty, the flagship volume in this view, and, less centrally, The Subjection of Women provide impressive testimony for an individualistic way of life in terms of its contributions to social progress. Considerations on Representative Government examines means for institutionalizing an individualistic way of life. And Utilitarianism provides a basis for justifying an individualistic view of this social programme: more satisfaction of individual desires. But such an account, Mill's own assessment notwithstanding, would be unsatisfactory. (shrink)

In the near future, our life will normally be surrounded with fairly complicated artifacts, enabled by the autonomous robot and brain–machine interface technologies. In this paper, we argue that what we call the responsibility flaw problem and the inappropriate use problem need to be overcome in order for us to benefit from complicated artifacts. In order to solve these problems, we propose an approach to endowing artifacts with an ability of socially communicating with other agents based on the artifact-as-a-half-mirror metaphor. (...) The idea is to have future artifacts behave according to the hybrid intention composed of the owner’s intention and the social rules. We outline the approach and discuss its feasibility together with preliminary work. (shrink)

It is often assumed that conventional ethics will contribute positively to economics and business, but here, this judgment will be examined. The conventional ethics of our time is dominated by altruistic philosophy, which has deep roots in religion. Such an idealistic ‘altruistic ethics’ especially emphasizes helping the least advantaged. This principle is contrasted with a more profane ‘reciprocal ethics.’ This term is used for the principle of mutual advantage central to a number of significant philosophers. This latter principle is compatible (...) with the practical norms constituting the morals of the market, while the former implies major adjustment of behavior and policies. Many ethicists consider their field to be ‘applied ethics,’ bringing the concrete rules and practices of the economic sector closer to honored first principles of philosophy. Is it reasonable to expect an influence by the ideas of altruistic ethics to improve the morals and policies of the economy? The process of the Heavily Indebted Poor Countries (HIPC) Initiative of the United Nations illustrates a probably crucial connection with altruistic ethics. Is this project, supported by religiously inspired groups, a sound way to treat a serious global problem? The disadvantages of this project are discussed and alternatives with better potential are presented. The article suggests that altruistic ethics is a dubious foundation for constructive morality and that its dominance in contemporary philosophy constitutes a major obstacle to a more open-minded analysis and sound policies. (shrink)

One of the traditional requirements of jus in bello is that military action should be proportionate in the loss and injury caused to troops to the military objectives it secures. However, the ?overwhelming force? applied in two Gulf Wars has been criticised as disproportionate. This article suggests a criterion for judging whether force is proportionate by considering what those who enter the profession of arms might be expected to tolerate or to undertake. A tacit agreement between troops on each side (...) is postulated, breaches of which count as unfair conduct, including cases of the disproportionate use of force. (shrink)

What, exactly, is the relationship between ethics and law in the contemporary discourse on military ethics? Gregory Reichberg (PhD, Emory University, 1990) is Senior Researcher at the International...

Though the papers in this volume for the most part address the question, “What is Christian about Christian Bioethics”, this paper addresses instead a closely related question, “How would a Christian approach to bioethics differ from the kind of secular academic bioethics that has emerged as such an important field in the contemporary university?” While it is generally assumed that a secular bioethics rooted in moral philosophy will be more culturally authoritative than an approach to bioethics grounded in the contingent (...) particularities of a religious tradition, I will give reasons for rejecting this assumption. By examining the history of the recent revival of academic bioethics as well as the state of the contemporary moral philosophy on which it is based I will suggest that secular bioethics suffers from many of the same liabilities as a carefully articulated Christian bioethics. At the end of the paper I will turn briefly to examine the question of how, in light of this discussion, a Christian bioethics might best be pursued. (shrink)

This essay critically explores resources and reasons for the study of culture in religious ethics, paying special attention to rhetorics and genres that provide an ethics of ordinary life. I begin by exploring a work in cultural anthropology that poses important questions for comparative and cultural inquiry in an age alert to "otherness," asymmetries of power, the end of value-neutrality in the humanities, and the formation of identity. I deepen my argument by making a foundational case for the importance of (...) culture as a topic of normative analysis through a discussion of the emotions as cultural artifacts. To illustrate how cultural analysis can inform religious ethics, I turn to works by Wayne Meeks, Margaret Trawick, and Charles Taylor. I conclude by sketching some implications of a "cultural turn" for future work in religious ethics. (shrink)

Abstract Susan Moller Okin has criticized Michael Sandel's view that the family is an example of an institution that is sometimes ?above? or ?beyond? justice, and for which justice is not, under the best conditions, a virtue. She argues that he both misses the point of justice as a virtue of social institutions and that he idealizes the family, and after undertaking this ?ground-clearing?, goes on to argue that families should be just. This paper offers a qualified defense of Sandel. (...) I argue, first, that Sandel has not missed the point of justice as a virtue of social institutions. But I go on to argue, more centrally, that if we distinguish between what I call ?internal? and ?social? justice of the family, and look carefully at the conclusions of Okin's own arguments, we see that she has really argued for the social justice of the family, and that this can be maintained alongside Sandel's vision of the family as an institution within which considerations of justice are neither central, nor necessarily appropriate. I try to carve out space both for Sandel's vision of the family, and for Okin's substantive feminist conclusions about family-based gender injustice. (shrink)

The moral/conventional task has been widely used to study the emergence of moral understanding in children and to explore the deficits in moral understanding in clinical populations. Previous studies have indicated that moral transgressions, particularly those in which a victim is harmed, evoke a signature pattern of responses in the moral/conventional task: they are judged to be serious, generalizable and not authority dependent. Moreover, this signature pattern is held to be pan‐cultural and to emerge early in development. However, almost all (...) the evidence for these claims comes from studies using harmful transgressions of the sort that primary school children might commit in the schoolyard. In a study conducted on the Internet, we used a much wider range of harm transgressions, and found that they do not evoke the signature pattern of responses found in studies using only schoolyard transgressions. Paralleling other recent work, our study provides preliminary grounds for skepticism regarding many conclusions drawn from earlier research using the moral/conventional task. (shrink)

Issues of social justice have traditionally been given short shrift by American healthcare professionals, feeling that justice at the bedside is inapplicable and possibly even misplaced. However, perhaps motivated by the realization that escalating costs and maldistribution of healthcare represent an intolerable situation, an ever-growing amount of medical literature and healthcare ethics literature is turning to considerations of justice.

A referral was made to our Cardiac Transplant Program for a patient who was in the New Jersey Prison System. The Medical Director of the New Jersey Department of Corrections called regarding a 39-year-old inmate who was being treated in a New Jersey hospital that has a unit for prisoners from a nearby cor- rectional facility. The referring physician described the patient to our Medical Director of heart transplantation as a “murderer” who had been incarcerated since 1987 and sentenced to (...) prison for 30 years without eligibility for parole before completion of his 30-year sentence. The patient was being treated in the CCU of the facility and according to preliminary studies, was suffering from a possible dilated cardiomyopathy. There was evidence of a prior cerebrovascular accident (etiology unknown) with a dense hemiplegia of the left side. The patient was alert but unable to care for himself. There were a number of specific tests necessary to evaluate the patient's candidacy for heart transplantation before actually placing him-on a waiting list. However, the transplant director was uncertain about having the patient brought to our facility for further testing and called some members of the Transplant Selection Committee team to discuss the case. (shrink)

The past two decades have been a time of heightened interest in the moral aspects of the practice of medicine. This interest has been reflected in medical education by the establishment of medical humanities programs in both preclinical and clinical education in many medical schools. It has also been reflected in the literature with a dramatic increase in journal articles on medical ethics as well as the development of medical ethics in textbooks. A number of journals have developed that are (...) specifically devoted to medical ethics, including The Journal of Medical Ethics, The Journal of Medicine and Philosophy, The Journal of Medical Humanities, Theoretical Medicine, Cambridge Quarterly of Healthcare Ethics, just to name a few. The literature includes both theoretical foundations and conceptual analyses of particular issues as well as practical advice and general suggestions for how to implement programs in medical humanities. (shrink)

Populations around the world are aging at a very fast rate, so much so that care for the elderly will soon rupture even the most carefully planned, enlightened care provisions societies can offer. The demographics in advanced countries demonstrate this dilemma, even without projections based on antiaging medications that may be possible in the near future, and a healthier lifestyle that has preoccupied the yuppies for about 10 years.

In September 1994, theNew York Timescarried a front page article declaring healthcare reform dead in Congress. The obituary on healthcare followed a Congressional decision not to pursue the issue further in 1994. Although Congress and the President will likely revisit healthcare reform during 1995, the choices may be between various incremental steps, rather than substantive changes to bring about universal coverage.