Ideological notions in public health care rationing : Case studies from Oregon, New Zealand and Finland

The purpose of this dissertation is to analyze and explicate the ideological content, which is often implicit, in the health care rationing discussion. The phrase "ideological content" refers to viewpoints and assumptions expressed in the rationing discussion that may be widespread and accepted, but without clear evidential support. The study method is philosophical text analysis. The study begins by exploring the literature from the 1970s that affects the present-day rationing discussion. Since ideological contents may have different emphases in realm of health care, three representative cases were studied. The first was a case study of the first and best-known rationing experiment in the American state of Oregon, namely, an experimental rationing plan within the public health program Medicaid, which is designed to provide care for the poor and underprivileged. The second was a study of the only national-level public priority setting that has been conducted in New Zealand. The third examined the Finnish Care Guarantee plan introduced in March 2005. The findings show that several problematic and scientifically mostly unproven concepts have remained largely uncontested in the debate about public health care rationing. Some of these notions already originated decades ago in studies that relied on outdated data or research paradigms. The problematic ideological contents have also been taken up from one publication into another, thereby affecting the rationing debate. The study suggests that before any new public health care rationing experiments are undertaken, these ideological factors should be properly examined, especially in order to avoid repetitious research and perhaps erroneous rationing decisions.

One Word, One Body, One Voice : Studies in Apophatic Theology and Christocentric Anthropology in Gregory of Nyssa

The thesis consists of five international congress papers and a summary with an introduction. The overarching aim of the studies and the summary is to examine the inner coherency of the theological and anthropological thinking of Gregory of Nyssa (331-395). To the issue is applied an "apophatic approach" with a "Christological focus". It is suggested that the coherency is to be found from the Christological concept of unity between "true God" and "true man" in the one person of Jesus Christ. Gregory is among the first to make a full recognition of two natures of Christ, and to use this recognition systematically in his writings. The aim of the studies is pursued by the method of "identification", a combination of the modern critical "problematic method" and Gregory's own aphairetic method of "following" (akolouthia). The preoccupation with issues relating to the so-called Hellenization of Christianity in the patristic era was strong in the twentieth-century Gregory scholarship. The most discussed questions have been the Greek influence in his thought and his philosophical sources. In the five articles of the thesis it is examined how Gregory's thinking stands in its own right. The manifestly apophatic character of his theological thinking is made a part of the method of examining his thought according to the principles of his own method of following. The basic issue concerning the relation of theology and anthropology is discussed in the contexts of his central Trinitarian, anhtropological, Christological and eschatological sources. In the summary the Christocentric integration of Gregory's thinking is discussed also in relation to the issue of the alledged Hellenization. The main conclusion of the thesis concerns the concept of theology in Gregory. It is not indebted to the classical concept of theology as metaphysics or human speculation of God. Instead, it is founded to the traditional Judeo-Christian idea of God who speaks with his people face to face. In Gregory, theologia connotes the oikonomia of God's self-revelation. It may be regarded as the state of constant expression of love between the Creator and his created image. In theology, the human person becomes an image of the Word by which the Father expresses his love to "man" whom he loves as his own Son. Eventually the whole humankind, as one, gives the divine Word a physical - audible and sensible - Body. Humankind then becomes what theology is. The whole humanity expresses divine love by manifesting Christ in words and deeds, singing in one voice to the glory of the Father, the Son and the Holy Spirit.