Joseph DeMarco

Patient noncompliance with physician prescriptions, especially in nonsymptomatic chronic diseases, is frequently characterized in the literature as harmful and economically costly (Miller 1997).1 Nancy Houston Miller views patient noncompliance as harmful because noncompliance can result in continued or new health problems leading to hospital admissions. Further, she places the annual monetary cost of noncompliance at $100 billion.Patient noncompliance with prescribed treatment is considered the least understood form of health behavior (Coons 2001). Despite the plethora of attention in journal articles, the issue of noncompliance remains unresolved even in terms of understanding the main correlates to ..

Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity—finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the ‘unreasonable’ attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making.

In this study, which is volume 113 of the International Archives of the History of Ideas, Peperzak attempts to link Hegel's declared "external and subjective" Preface to the relevant "scientifically analyzed" aspects of his philosophy. In this Peperzak insists, with Hegel, that politics and philosophy must be viewed in unity. The tension between the critical function of philosophy, the rationality of the then-current order, and the political demands of the censor dominates the commentary. Hegel is upbraided for his excessive endorsement of the then current state, yet this is tempered by the analysis of Hegel's overall position relying on the subject's rationality as the way to understand the, at least partial, rationality of the current order.

Utilitarians take an uncritical attitude toward the sort of individual claims they seek to aggregate. In this way they cannot account for an individual's valid claim against a policy which actually maximizes aggregate satisfaction. We thus claim that utilitarianism properly functions only after conflicting claims have been adjudicated; consequently, Utilitarianism properly maximizes the satisfaction of claims judged to be valid. In such a program, Utilitarianism ceases to be considered a part of ethics, But is seen as maintaining a principle of feasibility and efficiency. Finally, We briefly suggest the methods we believe to be most effective in the resolution of ethical conflict.

In order for a moral theory to support application it must be able to provide determinate answers to actual moral problems or, at the least, to significantly narrow acceptable options. It must also support the development of a genuine consensus, one that is disinterested, reasonable, and unbiased. I argue that theories concentrating on principles, or on rules, or on particular cases fail to meet these standards. A full coherence theory, taking into account principles, rules, practices, and judgments holds the greatest promise for successful application. I present a detailed outline of a full coherence theory that is principled, pluralistic, and comprehensive. This coherence theory includes three basic principles (expressed both negatively and positively), but binds these, in terms of their explication and application, to rules and practices. This theory respects current practices but also directs us to change practices and institutions and even the interpretation of basic moral principles. The theory includes ways to determine which aspect of moral experience should take precedence in given circumstances, ways to determine who has particular obligations, and how — by means of a mutuality principle — value may be enhanced under conditions of value conflict.

Recently both whole brain death (WBD) and higher brain death (HBD) have come under attack. These attacks, we argue, are successful, leaving supporters of both views without a firm foundation. This state of affairs has been described as “the death of brain death.” Returning to a cardiopulmonary definition presents problems we also find unacceptable. Instead, we attempt to revive brain death by offering a novel and more coherent standard of death based on the permanent cessation of mental processing. This approach works, we claim, by being functionalist instead of being based in biology, consciousness, or personhood. We begin by explaining why an objective biological determination of death fails. We continue by similarly rejecting current arguments offered in support of HBD, which rely on consciousness and/or personhood. In the final section, we explain and defend our functionalist view of death. Our definition centers on mental processing, both conscious and preconscious or unconscious. This view provides the philosophical basis of a functional definition that most accurately reflects the original spirit of brain death when first proposed in the Harvard criteria of 1968

Neil Levy offers the most prominent moral principles that are specifically and exclusively designed to apply to neuroethics. His two closely related principles, labeled as versions of the ethical parity principle, are intended to resolve moral concerns about neurological modification and enhancement [1]. Though EPP is appealing and potentially illuminating, we reject the first version and substantially modify the second. Since his first principle, called EPP, is dependent on the contention that the mind literally extends into external props such as paper notebooks and electronic devices, we begin with an examination of the extended mind hypothesis and its use in Levy’s EPP. We argue against reliance on EMH as support for EPP. We turn to his second principle, EPP, which is not dependent on EMH but is tied to the acceptable claim that the mind is embedded in, because dependent on, external props. As a result of our critique of EPP, we develop a modified version of EPP, which we argue is more acceptable than Levy’s principle. Finally, we evaluate the applicability of our version of EPP.

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics.

_Bioethics: Legal and Clinical Case Studies_ is a case-based introduction to ethical issues in health care. Through seventy-eight compelling scenarios, the authors demonstrate the practical importance of ethics, showing how the concerns at issue bear on the lives of patients, health-care providers, and others. Many central topics are covered, including informed consent, medical futility, reproductive ethics, privacy, cultural competence, and clinical trials. Each chapter includes a selection of important legal cases as well as clinical case studies for critical analysis. The case studies are often presented as moral dilemmas and are conducive to rich discussion. A companion website offers a curated collection of relevant legal precedents along with additional case studies and other resources.