Remember Pearl Harbor /

A poem.Mode of access: Internet

Discrepancy between Health Care Rationing at the Bedside and Policy Level

Background. Whether doctors at the bedside level should be engaged in health care rationing is a controversial topic that has spurred much debate. From an empirical point of view, a key issue is whether there exists a behavioral difference between rationing at the bedside and policy level. Psychological theory suggests that we should indeed expect such a difference, but existing empirical evidence is inconclusive. Objective. To explore whether rationing decisions taken at the bedside level are different from rationing decisions taken at the policy level. Method. Behavioral experiment where participants (n = 573) made rationing decisions in hypothetical scenarios. Participants (medical and nonmedical students) were randomly assigned to either a bedside or a policy condition. Each scenario involved 1 decision, concerning either a life-saving medical treatment or a quality-of-life improving treatment. All scenarios were identical across the bedside and policy condition except for the level of decision making. Results. We found a discrepancy between health care rationing at policy and bedside level for scenarios involving life-saving decisions, where subjects rationed treatments to a greater extent at the policy level compared to bedside level (35.6% v. 29.3%, P = 0.001). Medical students were more likely to ration care compared to nonmedical students. Follow-up questions showed that bedside rationing was more emotionally burdensome than rationing at the policy level, indicating that psychological factors likely play a key role in explaining the observed behavioral differences. We found no difference in rationing between bedside and policy level for quality-of-life improving treatments (54.6% v. 55.7%, P = 0.507). Conclusions. Our results indicate a robust bedside effect in the life-saving domain of health care rationing decisions, thereby adding new insights to the understanding of the malleability of preferences related to resource allocation

Normativity is the key to the difference between the human and the natural sciences

In this paper I take the human sciences to comprise psychology, social, economic, and political sciences, archaeology, history, ethnology, linguistics, philologies, literary and cultural studies, and similar fields having emerged besides and in between. So, the human sciences study the individual and collective ways and products of the human mind. After the term “Geisteswissenschaften” has narrowed its meaning, the term “Humanwissenschaften”, “human sciences”, seems more appropriate. By contrast, the natural sciences are to comprise all the other fields of empirical study, physics, astronomy, chemistry, biology, geology, engineering, etc. In this paper I would like to give an update of, and a fresh attempt at, the longstanding heated issue whether or not there is a principled difference between the human and the natural sciences

Angelic organization : hierarchy and the tyranny of heaven

This paper suggests that one of the first influential legitimations of hierarchy comes from the writings of Pseudo-Dionysius, about 1500 years ago. Despite the fact that he was ordering angels, he suggests both ontological and political reasons for accepting that organization must equal hierarchy. This is an assumption that is rarely contested even today, and the idea of hierarchy is central to theories of organization, and justifications of managerialism. However, angels have been mutable creatures, and I employ some of their various incarnations in order to open up this 5th century common sense. I conclude by suggesting that angelic obedience should be treated with suspicion, and that other sorts of angels, particularly the fallen ones, might lead us away from the tyranny of hierarchy