Tom Beauchamp

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion.

Hume notoriously maintains that contiguity, succession, and constant conjunction are individually necessary and jointly sufficient conditions of causation. While his arguments for the necessity of constant conjunction have been thoroughly dissected, his arguments for contiguity and succession have generally been either ignored or misstated. I hope both to correct this unfortunate state of affairs and to show some fatal defects in Hume's account.The pertinent passages in Hume's writings acknowledge three conceivable ways in which the temporal relation between causes and effects might be construed: as separated by some interval; as perfectly contiguous, so that the effect succeeds the cause in the very next moment; as perfectly contemporaneous, existing at the same moment. Hume defends the correctness of and denies the tenability of both and.