Baruch Brody

(1943 - 2018)

This paper argues, contrary to what has sometimes been claimed, that public commissions need to be more philosophical than they have been in analyzing crucial bioethical issues. It argues (a) that the failure of the President's Commission to develop and use even simple distinctions between life and personhood led to flaws in both its discussion of death and its discussion of persistent vegetative patients, and (b) that its treatment of access to health care fails to develop a coherent approach precisely because it is based on no serious philosophical reflections about justice in health care. Keywords: justice in health care, life, persistent vegetative patients, personhood, President's Commission on Bioethics CiteULike Connotea Del.icio.us What's this?

BACKGROUND: Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN: We examined 54 reports of surgical trials chosen randomly from a database of 110 influential trials conducted in 2008. Seven that reported having adequate statistical power were excluded from further analysis, as were the 32 that reported significant differences between the treatment arms. We examined the remaining 15 to see whether the authors interpreted their negative findings appropriately. Appropriate interpretations discussed the lack of power and/or called for larger studies. RESULTS: Three of the 7 trials that did not report an a priori power calculation offered inappropriate interpretations, as did 3 of the 8 trials that reported an a priori power < 0.90. However, we examined only a modest number of trial reports from 1 year. CONCLUSIONS: Negative findings in underpowered trials were often interpreted as showing the equivalence of the treatment arms with no discussion of the issue of being underpowered. This may lead clinicians to accept new treatments that have not been validated.

I will, in this paper, set out the philosophical foundations and the basic structure of a new theory of justice. I will argue that both these foundations and the theory which is based upon them are intuitively attractive and theoretically sound. Finally, I will argue that both are supported by the fact that they lead to attractive implications such as the following: One can justify at least some governmental redistributive programs which presuppose that those receiving the wealth have a right to it, without being committed to any form of egalitarianism. The justification for these redistributive programs respects property entitlements; it argues, in effect, that property entitlements and rights to some redistribution of wealth presuppose each other, rather than being in conflict with each other. The amount of redistribution to which each indigent person is entitled is directly proportional to the wealth of the society in question and inversely proportional to the number of indigents in the society in question. There are at this stage in the history of Western thought few entirely new ideas in philosophy. Too much has been written about the important issues to allow for entirely new approaches. My theory is no exception to these generalizations, for it draws upon the tradition of John Locke, of the agrarian reforms such as Paine, Spence, and Ogilvie, and of libertarian writers such as Robert Nozick. Nevertheless, I will argue, the resulting theory is a significant advance over the ideas of these earlier writers.

A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special obligations and a traditional ethic for contemporary healthcare, we need a deeper examination of what the traditional ethic of special obligations really means. Here we offer a conception of ‘doubly distributed’ special obligations. Physicians and similarly minded healing professionals abiding by a traditional ethic have always spread their devotion and attention across multiple patients and have shared responsibilities with physician and non-physician colleagues in much the same way devoted parents have frequently distributed their special obligations across multiple children and across multiple parents. By taking up the extended analogy of parent we argue that doubly distributing special obligations need not contradict the possibility of special obligations in restructured collective forms of healthcare delivery and financing.