Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

Health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, clinic- and hospital-based care, rehabilitation and feeding programs. In the course of this work, clinicians are frequently exposed to complex ethical issues. This paper examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data, including: tension (...) between respecting local customs and imposing values; obstacles to providing adequate care; differing understandings of health and illness; questions of identity for health workers; and issues of trust and distrust. Recommendations are made for organizational strategies that could help aid agencies support and equip their staff as they respond to ethical issues. (shrink)

Healthcare user fees present an important barrier for accessing services for the poorest (indigents) in Burkina Faso and selective removal of fees has been incorporated in national healthcare planning. However, establishing fair, effective and sustainable mechanisms for the removal of user fees presents important challenges. A participatory action-research project was conducted in Ouargaye, Burkina Faso, to test mechanisms for identifying those who are indigents, and funding and implementing user fee removal. In this paper, we explore stakeholder perceptions of ethical considerations (...) relating to participation and partnership arising in the action-research. (shrink)

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral (...) dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid organizations for preparing and supporting (...) frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral (...) dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

Patient-Centered Care and Cultural Practices: Process and Criteria for Evaluating Adaptations of Norms and Standards in Health Care Institutions Content Type Journal Article Pages 327-339 DOI 10.1007/s10730-009-9115-8 Authors Matthew R. Hunt, McMaster University Department of Clinical Epidemiology and Biostatistics Montreal Canada Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4.

Methods to facilitate co-production in mental health are important for engaging end users. As part of the Technology for Healthy Aging and Wellbeing initiative we organized two interactive co-production workshops, to bring together older adults, health and social care professionals, non-governmental organizations, and researchers. In the first workshop, we used two activities: Technology Interaction and Scavenger Hunt, to explore the potential for different stakeholders to discuss late life mental health and existing technology. In the second workshop, we used Vignettes, Scavenger (...) Hunt, and Invention Test to examine how older adults and other stakeholders might co-produce solutions to support mental wellbeing in later life using new and emerging technologies. In this paper, we share the interactive materials and activities and consider their value for co-production. Overall, the interactive methods were successful in engaging stakeholders with a broad range of technologies to support mental health and wellbeing and in co-producing ideas for how they could be leveraged and incorporated into older people’s lives and support services. We offer this example of using interactive methods to facilitate co-production to encourage greater involvement of older adults and other under-represented groups in co-producing mental health technologies and services. (shrink)

A response to Lee Basham's 'The Need for Accountable Witnesses: A Reply to Dentith'.

Conspiracy theories are typically thought to be examples of irrational beliefs, and thus unlikely to be warranted. However, recent work in Philosophy has challenged the claim that belief in conspiracy theories is irrational, showing that in a range of cases, belief in conspiracy theories is warranted. However, it is still often said that conspiracy theories are unlikely relative to non-conspiratorial explanations which account for the same phenomena. However, such arguments turn out to rest upon how we define what gets counted (...) both as a ‘conspiracy’ and a ‘conspiracy theory’, and such arguments rest upon shaky assumptions. It turns out that it is not clear that conspiracy theories are prima facie unlikely, and so the claim that such theories do not typically appear in our accounts of the best explanations for particular kinds of events needs to be reevaluated. (shrink)

Belief in conspiracy theories is typically considered irrational, and as a consequence of this, conspiracy theorists––those who dare believe some conspiracy theory––have been charged with a variety of epistemic or psychological failings. Yet recent philosophical work has challenged the view that belief in conspiracy theories should be considered as typically irrational. By performing an intra-group analysis of those people we call “conspiracy theorists”, we find that the problematic traits commonly ascribed to the general group of conspiracy theorists turn out to (...) be merely a set of stereotypical behaviours and thought patterns associated with a purported subset of that group. If we understand that the supposed prob- lem of belief in conspiracy theories is centred on the beliefs of this purported sub- set––the conspiracists––then we can reconcile the recent philosophical contribu- tions to the wider academic debate on the rationality of belief in conspiracy theories. (shrink)

The current humanitarian use of drones is focused on two applications: disaster mapping and medical supply delivery. In response to the growing interest in drone deployment in the aid sector, we sought to develop a resource to support value sensitivity in humanitarian drone activities. Following a bottom-up approach encompassing a comprehensive literature review, two empirical studies, a review of guidance documents, and consultations with experts, this work illuminates the nature and scope of ethical challenges encountered by humanitarian organizations embarking upon (...) innovation programmes. The Framework for the Ethics Assessment of Humanitarian Drones (FEAHD) identifies five values and five key questions related to ethical considerations along the decision chain of humanitarian drone activities. It fills a gap between high-level, principle-based guidance related to humanitarian innovation, and detailed operation-oriented checklists for projects involving the use of drones. In this way, the FEAHD contributes to support value sensitivity in the humanitarian use of drones. (shrink)

The current humanitarian use of drones is focused on two applications: disaster mapping and medical supply delivery. In response to the growing interest in drone deployment in the aid sector, we sought to develop a resource to support value sensitivity in humanitarian drone activities. Following a bottom-up approach encompassing a comprehensive literature review, two empirical studies, a review of guidance documents, and consultations with experts, this work illuminates the nature and scope of ethical challenges encountered by humanitarian organizations embarking upon (...) innovation programmes. The Framework for the Ethics Assessment of Humanitarian Drones (FEAHD) identifies five values and five key questions related to ethical considerations along the decision chain of humanitarian drone activities. It fills a gap between high-level, principle-based guidance related to humanitarian innovation, and detailed operation-oriented checklists for projects involving the use of drones. In this way, the FEAHD contributes to support value sensitivity in the humanitarian use of drones. (shrink)

In the literature on conspiracy theories, the least contentious part of the academic discourse would appear to be what we mean by a “conspiracy”: a secretive plot between two or more people toward some end. Yet what, exactly, is the connection between something being a conspiracy and it being secret? Is it possible to conspire without also engaging in secretive behavior? To dissect the role of secrecy in con- spiracies – and thus contribute to the larger debate on the epistemology (...) of conspir- acy theories – we dene the concepts of “conspiracy,” “conspirator,” and “secret,” and argue that while conspirators might typically be thought to commit to keeping secrets once their conspiracy is underway, the idea that conspiracies are necessarily secretive to start with is not as obvious as previously thought. (shrink)

The contributors to this volume argue that whilst there is a commonplace superstition conspiracy theories are examples of bad beliefs (and that the kind of people who believe conspiracy theories are typically irrational), many conspiracy theories are rational to believe: the members of the Dewey Commission were right to say that the Moscow Trials of the 1930s were a sham; Woodward and Bernstein were correct to think that Nixon was complicit in the conspiracy to deny any wrongdoing in the Watergate (...) Hotel break in; and if we either accept the terrorist events of 9/11 were committed by Al-Qaeda, or that the Bush Administration was responsible, then it seems we are endorsing some theory about a conspiracy to commit an act of terror on American soil. As such, there is no reason to reject conspiracy theories sui generis. This volume challenges the prima facie that conspiracy theories are irrational beliefs, arguing that we should treat conspiracy theories and the phenomena of conspiracy theories seriously. It presents fresh perspectives from the wider philosophical, sociological and psychological community on what is becoming an issue of increasing relevance in our time. (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid organizations for preparing and supporting (...) frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

New mechanisms to ensure that counter ter ror ism ac t ivit ies do not contravene international law or ethical values and principles will require careful design. Apart from the ethical and legal grounds, there are good practical rea-sons to design more effective counterter-rorism measures. Preventable harms to population health contribute to mistrust and instability and undermine the stated objectives of the intelligence services.

In this article, we focus on a particular kind of emotional impact of the pandemic, namely the phenomenology of the experience of moral injury in healthcare professionals. Drawing on Weber's reflections in his lecture Politics as a Vocation and data from the Experiences of Social Distancing during the COVID-19 Pandemic Survey, we analyse responses from healthcare professionals which show the experiences of burnout, sense of frustration and impotence, and how these affect clinicians’ emotional state. We argue that this may relate (...) to the ethical conflicts they experience when they are forced to make clinical decisions where there are no optimal outcomes, and how in turn that impacts on their own emotional state. We then further examine the notion of ‘burnout’ and the phenomenology of ‘moral injury’. Our argument is that these experiences of moral injury across a range of clinicians during the pandemic may be more prevalent and long-standing in psychiatry and mental health than in other areas of healthcare, where ethically difficult decisions and resource constraints are common outside times of crisis. Hence, in these clinical arenas, moral injury and the phenomenology of emotional changes may be independent of the pandemic. The insights gained during the pandemic may provide wider insights into the challenges of developing services and training the workforce to provide appropriate mental health care. (shrink)

Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships.

A reply to Patrick Stokes' “Between Generalism and Particularism About Conspiracy Theory".

Various authors have argued that progress in the neurocognitive and neuropsychiatric sciences might threaten the commonsense understanding of how the mind generates behavior, and, as a consequence, it might also threaten the commonsense ways of attributing moral responsibility, if not the very notion of moral responsibility. In the case of actions that result in undesirable outcomes, the commonsense conception—which is reflected in sophisticated ways in the legal conception—tells us that there are circumstances in which the agent is entirely and fully (...) responsible for the bad outcome and circumstances in which the agent is not at all responsible for the bad outcome. (shrink)

Schuklenk and van de Vathorst's paper is a very welcome addition to the literature on the assisted dying debate and will be of great interest to clinicians working in the field of mental health.1 Many psychiatrists will have had patients who have asked them to allow them to die, to desist in their efforts to prevent their suicide, and one of us has had personal experience, outside of professional life, of being asked to aid in someone's attempt to end their (...) life in the context of an episode of mood disorder. The person with depression asking professionals, friends and family members to aid them in ending their life is a very real phenomenon. In their discussion, Schuklenk and van de Vathorst's paper uses two principles that we endorse and add weight to their argument: namely, the reality of suffering in depression and the parity of mental and physical illness. Indeed, the case Schuklenk and van de Vathorst make is a strong one and our commentary will focus on the premise of the argument around choosing death and some empirical clarification about competence in depression and the nature of treatment-resistant depression (TRD) and its prognosis. The conceptual concern we wish to discuss in relation to assisted dying, endorsed by the state and legislature, is not linked to any moral or religious concern, or even on grounds related to ‘slippery slope’ or ‘abuse’ arguments. Rather the worry is how one could operationalise decisions around assisted dying as based on competence and capacity and view such decisions as rational. I think this concern is not limited to depressive illness, but to all decisions regarding choosing non-existence. Schuklenk and van de Vathorst offer the following useful criteria to regulate assisted suicide:1. (shrink)

Since the nineteenth century, hominid palaeontology has offered critical information about prehistoric humans and evidence for human evolution. Human fossils discovered at a time when there was growing agreement that humans existed during the Ice Age became especially significant but also controversial. This paper argues that the techniques used to study human fossils from the 1850s to the 1870s and the way that these specimens were interpreted owed much to the anthropological examination of Stone, Bronze, and Iron Age skeletons retrieved (...) by archaeologists from prehistoric tombs throughout Europe. What emerged was the idea that a succession of distinct human races, which were identified using techniques such as craniometry, had occupied and migrated into Europe beginning in the Ice Age and continuing into the historic period. This marks a phase in the history of human palaeontology that gradually gave way to a science of palaeoanthropology that viewed hominid fossils more from the perspective of evolutionary theory and hominid phylogeny. (shrink)

We support the goal to integrate models of culture and cognition. However, we are not convinced that the free energy principle and Thinking Through Other Minds will be useful in achieving it. There are long traditions of modeling both cultural evolution and cognition. Demonstrating that FEP or TTOM can integrate these models will require a bit more math.

This article poses a challenge to the assumption that all conceptions of the imago Dei are practical, meaning that they can coherently provide a guide for human action. The article identifies three criteria for practicality and applies them to two accounts of the imago, one in the thought of the twentieth-century theologian Helmut Thielicke, the other in the Roman Catholic tradition. It argues that Thielicke’s account of the imago, which forms the basis for what he calls ‘alien dignity’, fails to (...) meet the criteria of practicality, and thus cannot serve as an adequate guide for action. In contrast, the account of the imago and human dignity in the Roman Catholic tradition does meet the criteria. This comparison, the article concludes, ultimately helps provide a means of assessing diverse theological interpretations of the imago and their value for supporting a morally useful conception of human worth. (shrink)

Canadian health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, feeding programs, rehabilitation and hospital-based care. In the course of their work clinicians are frequently exposed to complex ethical issues. This thesis examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data including experiencing a (...) tension between respecting local customs and imposing values, knowing how to respond when basic care is impossible, addressing differing understandings of health and illness, questions of identity for health workers, and issues of trust and distrust. Recommendations are made for standards and organizational strategies that could help aid agencies better support and equip their staff as they respond to ethical issues. (shrink)

Brings together and interprets previously hard-to-find texts, new translations and passages detailing the interplay between philosophy and psychopathology.

Most philosophical defences of the state’s right to exclude immigrants derive their strength from the normative importance of self-determination. If nation-states are taken to be the political institutions of a people, then the state’s right to exclude is the people’s right to exclude – and a denial of this right constitutes an abridgement of self-determination. In this paper, I argue that this view of self-determination does not cohere with a group-agency view of nation-states. On the group-agency view that I defend, (...) a nation-state is the kind of group-agent that does not supervene on the intentionality of member/citizens. If we think that a nation-state is an intentional group-agent in its own right, then we should think that self-determination resides with the institutions of the state rather than with the citizens. If nation-states do not supervene on the intentionality of citizens, then it is unclear why citizens might have the right to control membership in the state as a feature of self-determination. (shrink)

A reply to Gérald Bronner, Véronique Campion-Vincent, Sylvain Delouvée, Sebastian Dieguez, Nicolas Gauvrit, Anthony Lantian, and Pascal Wagner-Egger's piece, '“They” Respond: Comments on Basham et al.’s “Social Science’s Conspiracy-Theory Panic: Now They Want to Cure Everyone”.

From the early modern period, Western epistemologists have often been concerned with a rigorous notion of epistemic justification, epitomized in the work of Descartes: properly held beliefs require insulation from extreme skepticism. To the degree that veridical cognitive states may be indistinguishable from non-veridical states, apparently veridical states cannot enjoy high-grade positive epistemic status. Therefore, a good believer begins from what are taken to be neutral, subjective experiences and reasons outward—hopefully identifying the kinds of appearances that properly link up to (...) the world and those that do not. Good beliefs, beliefs that are justified (warranted, etc.), are those that a believer has .. (shrink)

Previous findings indicate that negative arousal enhances bottom-up attention biases favouring perceptual salient stimuli over less salient stimuli. The current study tests whether those effects were driven by emotional arousal or by negative valence by comparing how well participants could identify visually presented letters after hearing either a negative arousing, positive arousing or neutral sound. On each trial, some letters were presented in a high contrast font and some in a low contrast font, creating a set of targets that differed (...) in perceptual salience. Sounds rated as more emotionally arousing led to more identification of highly salient letters but not of less salient letters, whereas sounds’ valence ratings did not impact salience biases. Thus, arousal, rather than valence, is a key factor enhancing visual processing of perceptually salient targets. (shrink)

The intersection of national security, foreign policy, and health has been explored in a number of arenas, but little attention has been devoted to the ethical issues surrounding the global health impact of current counterterrorism policy and practice. In this essay, we’ll review a range of harms to population health traceable to counterterrorism operations, identify concerns involving moral agency and responsibility—specifically of humanitarian health workers, military medical personnel, and national security officials and operatives—and highlight two interrelated policy issues: the need (...) for a conception of national security that incorporates a cosmopolitan concern for health, and the need for shared health governance, including governance of activities affecting health. (shrink)

Western Kansas is one of the most important agricultural regions in the world. Most agricultural production in this semi-arid region depends on the consumption of nonrenewable groundwater from the High Plains Aquifer, which will be 70 % depleted by 2070. The problem of depletion has drawn significant attention from local citizens and policymakers at the federal, state, and local levels for at least 40 years, resulting in a variety of policies and institutions to manage groundwater from the aquifer as a (...) common pool resource. Yet depletion has persisted. We explain this conundrum as an outcome of a mismatch between the scale of resource management, which has become more intensively local, and the scale of resource exchange, which has rendered the High Plains Aquifer a global common pool resource. We then explain the deeper, structural origins of the management–exchange scale mismatch. Drawing on concepts from structural human ecology theory and empirical evidence from Southwest Kansas, we show that agriculture is predicated on local metabolic rift in the hydrological cycle that is exacerbated through ecological unequal exchange with higher-income, core areas beyond the region. We conclude by highlighting two key policies that, if implemented together, may lessen the deleterious effects of these structural dynamics and thus promote a more sustainable relationship between society and environment in this region and other water-scarce regions that are net-exporters of groundwater. (shrink)

Despite the growing popularityof farmers' markets (FMs) across the UnitedStates, the experiences and perspectives offarmers who sell at markets have received verylittle research attention. This study describesthe views of 18 farmers from Upstate New Yorkon the importance of FMs as part of theirlifestyle and livelihood, the challenges theyface selling at markets, and their conceptionsof ideal FMs. Through in-depth, semi-structuredinterviews, farmers expressed economic andsocial motivations for selling at FMs; socialbenefits from interacting with customers; andthe challenges they faced as small-scalefarmers and sellers, (...) including extra-marketcompetition, uncooperative and problematicmarket vendors, rising farm input costs, andchanging consumer trends. Farmers alsodiscussed personal values associated withselling at FMs, such as pride in raising andmarketing one's own products, working togetherwith other farmer-vendors, and providingcustomers with honest information. Visions ofideal FMs were varied among farmers, but therewas general agreement that FMs should provide adiversity of products to attract customers andeducational opportunities for the public tolearn more about FMs and local produce. Theinterdependence of FM farmers was a majoremergent theme across interviews. Findingssuggested that market experiences of FMfarmers, including economic success, are notonly contingent on personal effort, but canalso be affected by the work of fellow vendors.Future research may look to further explore howFM farmers and other vendors interact ascooperative and competitive social and economicunits. At the community level, FM leadershipshould continue to focus on the experiences andperspectives of farmers and other marketvendors, in addition to identifying ways forenhancing cooperative FM enterprises. (shrink)

The contemporary methodological debate about justice has centered around a dispute about the value of so-called ideal theory. I argue that justice performs a social-guiding function, which explains how people should respond to their limited and fallible abilities to realize justice institutionally. My argument helps to re-orientate the contemporary methodological debate. The obvious disagreement between many prominent supporters and skeptics of ideal theory obscures the fact that they are united by a false assumption: the practical value of justice exclusively consists (...) of its institution-guiding function. To capture the overlooked social-guiding function, a richer normative theory of justice is required; I show how such a theory can be supplied by “ideal-transitional” principles. (shrink)

Plasticity of body representation fundamentally underpins human tool use. Recent studies have demonstrated remarkably complex plasticity of body representation in humans, showing that such plasticity (1) occurs flexibly across multiple time scales and (2) involves multiple body representations responding differently to tool use. Such findings reveal remarkable sophistication of body plasticity in humans, suggesting that Vaesen may overestimate the similarity of such mechanisms in humans and non-human primates.