Mark Waymack

Health Maintenance Organization (HMO) administrators have been accused of engaging in selective marketing. That is, through such strategies as tailoring the benefits package of the program or advertising in styles or in media that do not appeal to certain undesirable audiences, the administrator can minimize the percentage of persons in the HMO who are heavy users of health care services.By means of analyzing what insurance is (philosophically) and what it means for something to be a free market commodity, the author argues that, as long as American society chooses to regard health insurance as a commodity or service of the free market, the use of such strategies is within the moral rights of health administrators.

A debate has simmered concerning the nature of clinical reasoning, especially diagnostic reasoning: Is it a “science” or an “art”? The trend since the seventeenth century has been to regard medical reasoning as scientific reasoning, and the most advanced clinical reasoning is the most scientific. However, in recent years, several scholars have argued that clinical reasoning is clearly not “science” reasoning, but is in fact a species of narratival or hermeneutical reasoning. The study reviews this dispute, and argues that in a theoretical sense, the dispute rests upon a naïve—but very popular—caricature of what constitutes “science reasoning.” But, if the dispute rests upon just such a caricature, why is it so persistent? The study concludes by suggesting that we, as patients and as physicians, have deep psychological tendencies that incline us to adopt the very naïve “science” concept/model of diagnostic reasoning, even if (or when) we understand its inaptness.

With the reintroduction of Hume’s philosophical works in the form of the Green and Gross editions, and the concomitant decline of the British Hegelians about a century ago, respect for Hume’s philosophical talent rose enormously. Our respect and admiration for Hume’s genius, whether we entirely agree with his work or not, has been a sustained, perhaps ever growing, philosophical attitude throughout the time since. However, we have been much slower to recapture and appreciate the philosophical discourse that helped to shape Hume’s thought. One can, I think, argue that doing justice, in a historical sense as well as a moral sense, requires sufficient attention to Hume’s immediate predecessors. And perhaps the most important figure in that sense is Francis Hutcheson, for even the most cursory study of Hutcheson’s works reveals and sheds much light on where Hume found many ideas on the moral sense and moral psychology, as well as ideas concerning the very nature of moral philosophy as a discipline of inquiry.

This thesis studies the development of empiricist Scottish moral philosophy from its origins in the work of Gershom Carmichael through the works of Francis Hutcheson, David Hume, and Adam Smith. Impressed by the successes of the new sciences, particularly Newtonian science, these philosophers each sought to bring this modern scientific method to bear upon the pursuit of moral theory. By tracing the development of moral philosophy through these four authors, we find important changes in how they understand the questions, methodology, aim, and even the very nature of moral philosophy. ;Carmichael introduced this tradition to Scotland by rejecting then current moral philosophies. In their stead, he introduced a conception of moral philosophy as empirically derived natural law. ;Seeking to mirror not only Newton's method but also, by analogy, Newton's results, Hutcheson argued that the moral world was structured by a divinely designed balance between the powerful but opposing forces of benevolence and self-interest. ;Next, Hume felt that religious belief was not only philosophically unjustifiable, but also practically harmful. He sought, therefore, to change moral theory by rendering it entirely secular. Furthermore, he aimed to change moral practices by rejecting the religious-grounded, personally and socially harmful 'monkish' virtues, and rehabilitating pride as a virtue rather than a vice. ;Finally, Smith was distrustful of such grand schemes. Arguing that philosophy is not so much the discoverer of truth as the fabricator of truth, Smith sought to woo men away from outmoded moral schemes, and to lead them to trust in their natural moral sentiments. This, Smith believed, was the most effective and beneficial way of leading men, as social beings, into the modern, commercial society. The only real areas in which moral philosophy can constructively offer concrete contributions are jurisprudence and political economy. ;In conclusion, we should understand that moral philosophy changes its complexion from time to time and place to place. Accepting this can be a step towards questioning our own preconceptions of what moral philosophy is or should be

Ethics, Aging and Society...is the first major work in ten years to critically address issues and methodologies in aging and ethics...This well-organized volume begins theoretically and offers new ways of thinking about ethics that can handle the complexities and realities of aging in particular social contexts."--Choice This new research-based book, by experts in the field of ethics, is excellent and much-needed...I challenge you to consider reading this book and seeing all the ways in which you might be forced to rethink things that most of us take as given for ethics and aging. I know you will not be disappointed and I guarantee you will end up thinking long and hard about personal and professional decisions you may have made as well as your assumptions about aging in America."--CFLE Network Newsletter This is a book that should be required reading for all involved in the ethical provision of services to the aging on any level, as well as for policy makers and administrators in positions of influence over the lives of older patients."--PsycCRITIQUES...the authors' application of feminist ethics to frail elders rings true to both my clinical experience working with frail elders, and my research experience trying to understand their quality of life concerns...there were true gems of ideas [in this book] that illuminated the limitations of the dominant paradigm of autonomy in bioethics. [The authors] make a compelling critique of end-of-life care."--GeriPal: A Geriatrics and Palliative Care Blog This book presents second generation issues in ethics, aging, and society by presenting critical outcomes that arise when ethics is applied to the practical concerns that occur in day-to-day elder care. The first volume in over 10 years to address ethics and gerontology, it is unparalleled in its comprehensiveness and integration of well-developed philosophical arguments with empirical research, humanistic scholarship, and insights gained from practical experience. This book challenges the tried and true approaches to ethical issues in aging and opens avenues for creative problem-solving. The authors' diverse backgrounds bring the advantages of both interdisciplinary scholarship and practical experience to this comprehensive textbook. It is an essential resource for those interested in, and working with, older people, from upper-level undergraduate students and graduate-division students, to gerontology practitioners in training. Key Features: Presents the first major work in over 10 years to integrate the disciplines of ethics and aging Includes case studies derived from day-to-day practice Addresses individual/clinical ethics in health and long-term care and ethical issues raised by public policy, cultural norms and social attitudes Examines such critical issues as Alzheimer's disease, long-term care, ageism, public policy, anti-aging medicine, elder abuse, and natural disasters Explores new directions in ethical and social philosophy as they pertain to gerontology and care.