Moral atrophy in the welfare state

The welfare state is often accused of being counterproductive: as the scope of public responsibility expands, private morality (especially altruism and benevolence) atrophies. This essay surveys psychological findings for evidence, which turns out to be broadly consistent with either of two models of moral development, each bearing distinct policy implications. The model of morally keeping in practice that is implicit in the term moral atrophy suggests the need for frequent opportunities to exercise moral skills, which would seem inconsistent with the welfare state. Alternatively, the model of moral character-building favoured by both philosophers and ordinary discourse would require only occasional reminders of one's moral principles. On this model, benevolence could usefully supplement the welfare state.     

The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.     

Jurisprudential Dilemmas of European Law

Making a first sketch of philosophical issues arising fromEuropean Community law I want to present a series ofmore or less obvious, and more or less interrelated dilemmas,or even double binds.(i) Deepening the community becomes incompatible withwidening membership. (ii) National states seem bothnecessary for and obstructive in articulating transnationalproblems. (iii) The more democracy is needed as a warrantfor the public exercise of political power in Europe, themore the very concept of democracy on a European scaleevades understanding. (iv) European unity presupposes aunifying rule of law, while member states have radicallydifferent conceptions of this principle. (v) Even the verycore of European integration, the common market, is subjectto two conflicting and, indeed, incompatible doctrines ofcompetition. In explaining the nature of each dilemma I willtry to take my cue from the Maastricht Treaty wherever thisseems suitable. Then I will elaborate on the jurisprudentialproblems involved in it. Finally, each section will be closedby an attempt to state the nature of these problems inphilosophical terms.