Individual Responsibility and Solidarity in European Health Care: Further Down the Road to Two-Tier System of Health Care

University of Texas Southwestern Medical Center in Ethics in Science & Medicine Department of Psychiatry 5323 Harry Hines Boulevard, Dallas, TX 75390-9070, USA.
Journal of Medicine and Philosophy (Impact Factor: 0.79). 07/2008; 33(3):191-7. DOI: 10.1093/jmp/jhn012
Source: PubMed
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    • "This debate can be explained by two factors: First, bioethics reacts to political reforms in which public welfare and health care systems are cut back so that the tasks and burdens of the individual citizen are redefined. There arose an “increase of individual responsibility … (as) an explicit purpose of the introduction of market forces in European health care systems” (Meulen and Ruud 2008: 192). According to the political philosopher Iris Young (2011), “a key term helping to propel welfare reform in the United States in the 1990s, as well as in some other reforming states” was “personal responsibility” (10). "
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    ABSTRACT: Purpose Although the term “responsibility” plays a central role in bioethics and public health, its meaning and implications are often unclear. This paper defends the importance of a more systematic conception of responsibility to improve moral philosophical as well as descriptive analysis. Methods We start with a formal analysis of the relational conception of responsibility and its meta-ethical presuppositions. In a brief historical overview, we compare global-collective, professional, personal, and social responsibility. The value of our analytical matrix is illustrated by sorting out the plurality of responsibility models in three cases (organ transplantation, advance directives, and genetic testing). Results Responsibility is a relational term involving at least seven relata. The analysis of the relata allows distinguishing between individual versus collective agency, retrospective versus prospective direction, and liability versus power relations. Various bioethical ambiguities result from insufficient, implicit, or inappropriate ascriptions of responsibility. Conclusions A systematic conception of responsibility is an important tool for bioethical reflection. It allows an in-depth understanding and critique of moral claims on a meta-ethical level without presuming one particular normative approach. Considering the concept of responsibility can also help to complement the current bioethical focus on individual autonomy by including the perspectives of other actors, such as family members or social groups.
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    ABSTRACT: The roles of measurement activities in manufacturing enterprises of the assume fragmentary forms of operation such as inspection by measurement after completion, control of accuracy of measuring instruments used for inspection, development of measuring methods or instruments intended for new evaluation, etc., are discussed. The Total Measurement Action Program (TMAP), which was built up for the purpose of systematizing the measurement control and the measuring techniques in manufacturing enterprises so as to pursue and realize the total effects of measurement activities, is implemented in groups of our company and is promoted in the following 5 steps: 1. Instrument control and precision control. 2. Correct method and correct operation. 3. Matching and standardization to measurement purposes. 4. Measurement and instrumentation improvement. 5. Measurement and instrumentation development. This paper is intended to report the promotion method and the results of these activities
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