Joseph DeMarco

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.