Browsing by Subject "reform"
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Item Open Access The Mutualities of Conscience: Satire, Community, and Individual Agency in Late Medieval and Early Modern England(2014) Revere, William FThis study examines the representation of "conscience" in English literature, theology, and political theory from the late fourteenth century to the late seventeenth. In doing so it links up some prominent conceptual history of the term, from Aquinas to Hobbes, with its imaginative life in English narrative. In particular, beginning with William Langland's Piers Plowman and moving through texts in the "Piers Plowman tradition" and on to John Bunyan's allegories and polemics, I explore what I call the "satiric" dimensions of conscience in an allegorical tradition that spans a long and varied period of reform in England, medieval and early modern. As I argue, conscience in this tradition is linked up with the jolts of irony as with the solidarities of mutual recognition. Indeed, the ironies of conscience depend precisely on settled dispositions, shared practices, common moral sources and intellectual traditions, and relationships across time. As such, far from simply being a form of individualist self-assurance, conscience presupposes and advocates a social body, a vision of communal life. Accordingly, this study tracks continuities and transformations in the imagined communities in which the judgment that is conscience is articulated, and so too in the capacities of prominent medieval literary forms to go on speaking for others in the face of dramatic cultural upheaval.
After an introductory essay that examines the relationship between conscience, irony, and literary form, I set out in chapter one with a study of Langland's Piers Plowman (ca. 1388 in its final version), an ambitious, highly dialectical poem that gives a figure called Conscience a central role in its account of church and society in late medieval England. While Langland draws deeply on scholastic accounts of conscientia--an act of practical reason, as Aquinas says, that is binding as your best judgment and yet vexing in its capacity for error and need for formation in the virtues--he dramatizes error in terms of imagined practice, pressing the limits of theory. A long, recursive meditation on how one's socially embodied life constitutes distinctive forms of both blindness and vision, Langland's poem searches out the forms of recognition and mutuality that he takes a truth-seeking irony of conscience to require in his contemporary moment. My reading sets the figure of Conscience in Piers Plowman alongside the figure of Holy Church to explore some of these themes, and so also to address why the beginning of Langland's poem matters for its ending. In chapter two I turn to an anonymous early fifteenth-century poem of political complaint called Mum and the Sothsegger (ca. 1409) that was written in response to new legislation introducing capital punishment for heresy in England. In Mum I show how an early "Piers Plowman tradition" gets taken up into a rhetoric of royal counsel and so subtly, but decisively, revises aspects of Langland's political and ecclesial vision. In a final chapter moving across several of John Bunyan's works from the 1670s and 1680s, I show how Bunyan conceptualizes coercion in terms of the state and the market, and so defends a "liberty" of conscience that resists both Hobbesian assimilations of moral judgment to the legal structures of territorial sovereignty and an emergent market nominalism, in which exchange value trumps all moral reflection. In part two of Bunyan's The Pilgrim's Progress, Bunyan draws surprisingly on medieval sources to display the forms of mutuality that he thinks are required to resist "consent" to such unjust forms of coercion.
Item Open Access Wielding the Wand without Facing the Music: Allowing Utilization Review Physicians to Trump Doctors' Orders, but Protecting them from the Legal Risk Ordinarily Attached to the Medical Degree(2010) Record, Katherine LThis Note identifies a discrepancy in the law governing the decisionmaking that directs patient care. Seeking treatment that a third party will pay for, a patient needs not only a physician-prescribed course of treatment but also an insurer's verification that the cost is medically necessary or otherwise covered by the patient's plan. Both of these decisions directly impact the ultimate care delivered to the patient, but are governed by two very different liability regimes. A patient who suffers an adverse outcome may sue his physician in tort, while a patient who suffers from a lack of coverage may generally sue his insurer only under contract. In other words, when a patient suffers from inadequate care, his potential remedies vary considerably depending on whether the physician or the insurer is the defendant. This discrepancy in liability is the consequence of the federal law governing the administration of employer-sponsored health plans, and its extensive preemption of related state law. Many commentators have called for legal reform to address the distortion of managed care liability that results, arguing that managed care liability must be consistent or that wronged beneficiaries must have access to meaningful remedies. This Note argues that the federal law governing managed care organizations is problematic for a different reason and that the first step toward reform may be more elementary than previously suggested. Specifically, it suggests that the law governing insurers' coverage decisions is inconsistent with the law governing treatment recommendations. Patients suffer the same harm from error in both contexts-but because they can recover substantially more from treating physicians, doctors are named as defendants even when the insurers make errors. Further, this Note argues that simply aligning these two standards might offer a gateway to reform.