Voluntary Status Research Articles

Medical care under social security in France.

Social insurance was initiated in France on a national scale in 1930 and now covers about 98.5 per cent of the population. The coverage expanded the limits of traditional sickness insurance for curative medicine and had a growing impact on overall health and social policy. French social insurance is a public service run by organizations which retain the voluntary status of the old mutual funds. The social security budget is independent of that of the government, which contributes less than 20 per cent of the overall social budget of the nation. The relationships between the medical profession, private and public hospitals, preventive care organizations, social insurance funds, and central and local governments have become very complex. The huge social security organization has acquired competence in planning and in technical organizational matters and consequently has had a great influence on medical care patterns. Social security adopted the direct payment system in its relationships with the medical profession; therefore the latter has retained its independent status. But, for public and private hospitals, the payment system is indirect. A special branch was created in 1945 to deal with capital investments in hospitals and health institutions concerned with preventive medicine. Social insurance contributed greatly to facilitating access of patients to all kinds of medical care, either public or private, curative or preventive, and helped the government by participating in the construction of a complex network of health institutions for the benefit of the whole population. This task is not yet achieved, and greater coordination and additional resources are necessary. But there is no doubt that social insurance was and still is a powerful factor in the continuing improvement of the nation's health and living conditions.

Divine Omniscience and Voluntary Action

IN Part V, Section III of his Consolatio Philosophiae, Boethius entertained (though he later rejected) the claim that if God is omniscient, no human action is voluntary. This claim seems intuitively false. Surely, given only a doctrine describing God's knowledge, nothing about the voluntary status of human actions will follow. Perhaps such a conclusion would follow from a doctrine of divine omnipotence or divine providence, but what connection could there be between the claim that God is omniscient and the claim that human actions are determined? Yet Boethius thought he saw a problem here. He thought that if one collected together just the right assumptions and principles regarding God's knowledge, one could derive the conclusion that if God exists, no human action is voluntary. Of course, Boethius did not think that all the assumptions and principles required to reach this conclusion are true (quite the contrary), but he thought it important to draw attention to them nonetheless. If a theologian is to construct a doctrine of God's knowledge which does not commit him to determinism, he must first understand that there is a way of thinking about God's knowledge which would so commit him. In this paper, I shall argue that although his claim has a sharp counterintuitive ring, Boethius was right in thinking that there is a selection from among the various doctrines and principles clustering about the notions of knowledge, omniscience, and God which, when brought together, demand the conclusion that if God exists, no human action is voluntary. Boethius, I think, did not succeed in making explicit all of the ingredients in the problem. His suspicions were sound, but his discussion was incomplete. His argument needs to be developed. This is the task I shall undertake in the pages to follow. I should like to make clear at the outset that my purpose in rearguing this thesis is not to show that determinism is true, nor to show that God does not exist, nor to show that either determinism is true or God does not exist. Following Boethius, I shall not claim that the items needed to

"Walkouts" and the open hospital: a three-month survey.

It is apparent that with the opening of psychiatric hospitals, the attitude of the patients (and, eventually, society as a whole) toward hospitalization will change. This change in attitude will result in a different usage of the hospital by the patient, and this in turn will result in a variety of motives for unauthorized absences from the hospital. As this limited survey has demonstrated, it is an oversimplification to regard absences from an open hospital as due primarily to involuntary admissions. Many of the “voluntary” patients are, in fact, “involuntary,” and enter unwillingly on voluntary status because of family pressures or for other reasons. The actual reasons for “walkouts” are often subtle and complex and frequently involve many different factors. Foremost among these would appear to be the patient's perception and use of the hospital, the reasons for his admission, and the sorts of verbal and nonverbal communications he receives from the hospital staff. The analysis of these complex factors is beyond the scope of this paper, but the key to a deeper understanding of “walkouts” undoubtedly lies in these areas.

OPIATE WITHDRAWAL TREATED WITH INDUCED HYPOGLYCEMIC REACTIONS

This paper has presented additional experiences and discussion of the author's method of insulin therapy for the alleviation of suffering from opiate withdrawal. Fifteen patients have thus far been treated without failure to produce substantial freedom from distress. All patients accepted abrupt withdrawal although they were hospitalized on a voluntary status. Sedatives of any kind were unnecessary during the period of insulin treatments. Appetite, sleep and a sense of well-being were restored within a few days. This permitted an early return to normal activities, often at a higher level of efficiency than before treatment. Because abrupt withdrawal of the opiate was feasible the period of hospitalization was materially shorter than required by any other acceptable method of treatment. The rationale of the treatment is well supported by the present knowledge about addiction and hypoglycemic therapy.