God's disposition toward humanity in the theology of John Calvin: one will or two? : an analysis of Calvin's teaching on the knowledge of God, predestination and the atonement

In the course of this study, we find that for Calvin, God has one righteous will that is expressed as two, decidedly asymmetrical dispositions toward humanity. For Calvin, the only God that can be known, proclaimed, and trusted is God the Father, the God of creation, election and redemption who relates to his people according to his fatherly love; for reasons known only to him, God inexplicably creates some whom he does not rescue from their sinful state of rebellion against him. We first examine Calvin’s teaching on the knowledge of God and discover that God has revealed his unchanging nature to those with faith. God’s loving, righteous, wise, good, powerful, judging (of evil), and holy nature is exhibited in creation and providence, in Scripture, and most of all in Christ. We next explore Calvin’s teaching on predestination and discover that God’s one, secret, righteous will is expressed in two, decidedly asymmetrical wills toward humanity: (1) God’s disclosed electing will that directly corresponds with God’s nature and is extended to all but only effected in the elect; (2) God’s veiled reprobating will toward the reprobate that, from the human perspective, only corresponds to God’s nature in part. We continue by examining Calvin’s teaching on the reconciling work of Christ, finding that, for Calvin, creation and redemption clearly exhibit God’s disclosed disposition toward humanity while demonstrating God’s veiled disposition only in very small part. We then provide constructive analysis in three related areas: (1) Calvin’s teaching on the intra-trinitarian relations, (2) the locus of mystery in Calvin’s, Arminius’, and Barth’s accounts of predestination, and (3) the reclaimed logic of Mosaic sacrifice in relation to Calvin’s atonement teaching. In the context of a concluding summary, we consider three biblical accounts that depict God as possessing one rather than two dispositions toward humanity

Age-related references in national public health, technology appraisal and clinical guidelines and guidance: documentary analysis

$\textbf{BACKGROUND}$: older people may be less likely to receive interventions than younger people. Age bias in national guidance may influence entire public health and health care systems. We examined how English National Institute for Health & Care Excellence (NICE) guidance and guidelines consider age. $\textbf{METHODS}$: we undertook a documentary analysis of NICE public health ($\textit{n}$ = 33) and clinical ($\textit{n}$ = 114) guidelines and technology appraisals ($\textit{n}$ = 212). We systematically searched for age-related terms, and conducted thematic analysis of the paragraphs in which these occurred ('age-extracts'). Quantitative analysis explored frequency of age-extracts between and within document types. Illustrative quotes were used to elaborate and explain quantitative findings. $\textbf{RESULTS}$: 2,314 age-extracts were identified within three themes: age documented as an $\textit{a-priori}$ consideration at scope-setting (518 age-extracts, 22.4%); documentation of differential effectiveness, cost-effectiveness or other outcomes by age (937 age-extracts, 40.5%); and documentation of age-specific recommendations (859 age-extracts, 37.1%). Public health guidelines considered age most comprehensively. There were clear examples of older-age being considered in both evidence searching and in making recommendations, suggesting that this can be achieved within current processes. $\textbf{CONCLUSIONS}$: we found inconsistencies in how age is considered in NICE guidance and guidelines. More effort may be required to ensure age is consistently considered. Future NICE committees should search for and document evidence of age-related differences in receipt of interventions. Where evidence relating to effectiveness and cost-effectiveness in older populations is available, more explicit age-related recommendations should be made. Where there is a lack of evidence, it should be stated what new research is needed.This work was supported by the National Institute for Health Research's School for Public Health Research (NIHR SPHR http://sphr.nihr.ac.uk/). J.A. & M.W. are members of the Centre for Diet and Activity Research (CEDAR) a UKCRC Public Health Research Centre of Excellence

Identifying inequitable healthcare in older people:systematic review of current research practice

Background: There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair. Method: A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability. Results: Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were 'inequitable'. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles. Conclusions: Caution is needed among clinicians and other evidence-users in accepting claims of healthcare 'ageism' in some published papers. Principles for improved research practice are proposed.</p