Some philosophers and physicians have argued that alcoholic patients, who are responsible for their liver failure by virtue of alcoholism, ought to be given lower priority for a transplant when donated livers are being allocated to patients in need of a liver transplant. The primary argument for this proposal, known as the Responsibility Argument, is based on the more general idea that patients who require scarce medical resources should be given lower priority for those resources when they are responsible for (...) needing them and when they are competing with patients who need the same resources through no fault of their own. Since alcoholic patients are responsible for needing a new liver and are in direct competition with other patients who need a new liver through no fault of their own, it follows that alcoholic patients ought to be given lower priority for a transplant. In this article, I argue against the Responsibility Argument by suggesting that in order for it to avoid the force of plausible counter examples, it must be revised to say that patients who are responsible for needing a scarce medical resource due to engaging in behavior that is not socially valuable ought to be given lower priority. I'll then argue that allocating organs according to social value is inconsistent or in tension with liberal neutrality on the good life. Thus, if one is committed to liberal neutrality, one ought to reject the Responsibility Argument. (shrink)

This article aims to foreground alcohol abuse by cancer patients and explore how alcohol abuse functions as a biographic master motive and at the same time is a shadow side in the oncological field and research. The research is based on a single case study which draws on empirical material from interviews, field notes and staff policy, with analysis using Bourdieu’s concepts of trajectory of life and habitus. The findings show that the cancer patient’s alcohol abuse is (...) an important part of the trajectory of his private life and spare time. In social life with family and friends alcohol is given and normal and acts as a socialisator. Alcohol abuse provides both stability and instability in the cancer patient’s life. When cancer results in work breaks and retirement, and spare time often is used as drinking time, then all daily life becomes drinking time for the cancer patient. Alcohol is often a hidden abuse at the working place and in the oncological field. In meetings with healthcare professionals, the patient chooses not to speak about his alcohol abuse to avoid further medicalisation. The challenge for the healthcare professionals is to see and accept alcohol abusers with cancer and their social lives without always trying to change their ‘unhealthy’ lifestyles. (shrink)

I develop an externalist perspective and analysis of the relatedness of loneliness and (harmful) alcohol use and the concept of loneliness. I depart from twenty qualitative interviews with people undergoing inpatient treatment for alcohol dependence. Both, loneliness and its relatedness to alocohol dependence turn out to be complex relational and interactional phenomena whose occurrence and dynamics depend on the social and situational conditions under which they arise. Despite huge variations in interviewees’ experiences of loneliness, they share a common (...) phenomenological and analytical structure. Loneliness arises when instances of social interaction fail to arrive at mutual understanding within a certain social context. Loneliness is neither reducible to individual experiences nor to distinctive characteristics of a person. Rather, it presents an evaluative and interactional phenomenon, a person’s awareness of his/her failure to establish mutual understanding with others in social interaction. The relatedness of alcohol dependence and loneliness is neither conceptual nor causal nor explainable by facts about the individuals concerned, but depends on the kind of loneliness involved and the function habitual ways of drinking alcohol have in a person’s everyday life and social environment. (shrink)

A man who has sex with a woman who has passed out after consuming vast amounts of alcohol is undeniably guilty of rape. Equally, a man who has sex with a woman who is slightly tipsy after consuming a small amount of alcohol, but who later regrets their lovemaking, is innocent of this crime. This paper is devoted to examining sexual encounters, in which the woman's judgment is significantly impaired by alcohol, that fall in between these two (...) extremes. She slurs her words, is unsteady on her feet, and the next day remembers little about the night before. Does such "impaired sex" constitute rape? An approach that stresses women's responsibility for their own actions would deny that any sexual offense has occurred, since the woman who later regrets their night together has failed to make clear her wishes about sex. In contrast, Lois Pineau's "communicative sexuality" model puts the burden on men to ensure that their partners really do consent to sex. This second model gives us good reason to believe that men are morally obligated to refrain from impaired sex, since they lack evidence that their partners' acquiescence to sex is autonomous. However, we would do better to deal with impaired sex by means of moral disapproval and educational measures rather than by legal sanctions. (shrink)

Various kinds of alcohol and drug testing, such as preemployment, routine, and for-cause testing, are commonly performed by employers. While healthcare organizations usually require preemployment drug testing, they vary on whether personnel will be subjected to further testing. Recently, a call has gone out for postincident testing among physicians who are involved in serious, preventable events, especially ones leading to a patient's death. This article will offer a number of counterarguments to that proposal and discuss an alternate approach: that (...) health institutions can better improve patient safety and employees’ well-being by implementing an organizational policy of “speaking up” when system operators notice work behaviors or environmental factors that threaten harm or peril. The article will conclude with a description of various strategies that facilitate speaking up, and why the practice constitutes a superior alternative to mandatory alcohol and drug testing in the wake of serious, harm-causing m.. (shrink)

Khalafzai, Rida Usman Harms of alcohol consumption are not limited to the consumer. For women, it poses a significant threat to their unborn child. This article discusses one type of alcohol-related harm to the fetus: the fetal alcohol spectrum disorders (FASD).

One approach to hypnosis suggests that for hypnotic experience to occur frontal lobe activity must be attenuated. For example, cold control theory posits that a lack of awareness of intentions is responsible for the experience of involuntariness and/or the subjective reality of hypnotic suggestions. The mid-dorso-lateral prefrontal cortex and the ACC are candidate regions for such awareness. Alcohol impairs frontal lobe executive function. This study examined whether alcohol affects hypnotisability. We administered 0.8 mg/kg of alcohol or a (...) placebo to 32 medium susceptible participants. They were subsequently hypnotised and given hypnotic suggestions. All participants believed they had received some alcohol. Participants in the alcohol condition were more susceptible to hypnotic suggestions than participants in the placebo condition. Impaired frontal lobe activity facilitates hypnotic responding, which supports theories postulating that attenuation of executive function facilitates hypnotic response, and contradicts theories postulating that hypnotic response involves enhanced inhibitory, attentional or other executive function. (shrink)

In the setting of transplant medicine, decision making needs to take into account the multiple clinical and psychosocial case variables, rather than turn to arbitrary rules that cannot be scientifically supportedThe yearly demand for liver transplants far exceeds the supply of available organs .1 Additionally, alcoholic cirrhosis has been a controversial indication for transplant as these recipients can be viewed as having caused their own illness—an illness that is preventable by abstaining from alcohol . While not categorically denying liver (...) transplantation to those with alcoholic cirrhosis, many hospitals have incorporated a six month alcohol abstinence criterion 2 in an effort to select optimal candidates. The six month rule has two purposes; namely, allowing the liver a chance to recover in the absence of alcohol , and also observation of the patient to verify that he/she remains alcohol free, with the hope of reducing the risk of relapse. Everhart et al,3 determined that 85% of US liver transplant programmes and 43% of third party payers require a defined period of abstinence—for example, three or six months—as part of the waiting list process.Liver transplantation does not cure alcoholism, as evidenced by the fact that roughly 20% of these patients use alcohol following transplant, with one third exhibiting “repetitive or heavy drinking”.4 Arguments abound as to the scientific merit of a six month abstinence criterion in reducing the risk of alcohol relapse following transplant. Some propose that a minimum of six months abstinence itself predicts a lower relapse rate,5 while others argue that six months is not predictive or that other factors—for example, illicit drug use—in combination with a minimum number of months abstinent is predictive.6,7 Even the United …. (shrink)

The anecdotal and historical literature describing intoxication in elephants from fermented fruit or alcoholic beverages is reviewed. Seven African elephants readily self-administered 7% unflavored alcohol solutions; the results included separation from herd groupings and changes in the frequency and/or duration of several behaviors as scored according to a quantitative observational system. Alcohol decreased feeding, drinking, bathing, and exploration for most animals. Inappropriate behaviors such as lethargy and ataxia increased for all elephants. Results are discussed in terms of stress-induced (...) drinking and intoxication. (shrink)

Public policy on alcohol in the UK relies on health promotion campaigns that encourage individuals who misuse alcohol to make healthier choices about their drinking. Individuals with alcohol-dependence syndrome have an impaired capacity to choose health. As a result, individuals with the worst alcohol misuse problems lie largely outside the reach of choice-based policy. However, such policy has been widely criticized and efforts to reform it are underway. This paper argues that the British Medical Association's recent (...) attempt to improve policy on alcohol in the UK by introducing strategies which have been shown to control drinking within populations still gives insufficient attention to alcohol dependence. This is because it fails accurately and consistently to characterize alcohol dependence and gives insufficient attention to the social challenges it presents. (shrink)

Alcoholism is endemic in Nigeria’s traditional religion and society. This abuse is especially common at New Yam festivals, Ekpe, Ekpo and Nmanwu masquerades festivals, burial rituals, birth, marriage and naming ceremonies. Some claim that this is driven by specific beliefs and activities in African culture, such as beliefs in ancestors, libation, hospitality and entertaining guests and strangers and the desire to maintain the cultural traditions of the ancestors. Alcohol abuse has generated major health and social issues for abusers, their (...) families and society, plunging families, towns and tribes into crises and conflicts that bring economic and political retrogression. This research studied how the African traditional religion encourages alcohol misuse and how to decrease it for national development. This study was on Nigeria’s South-South region. The study uses qualitative and ethnographic research methodologies, including key informants, in-depth and focus group interviews and the reward deficiency syndrome as a theoretical framework. Although African Traditional Religion (ATR) supports alcohol usage, greed, a lack of self-control, peer pressure, indiscipline and lack of moral upbringing led to alcohol misuse, which harms the person, family, community and country as a whole. Education and enlightenment are a remedy to free alcoholics and utilise them for national integration and development.Contribution: Some say Africans drink a lot because their religious heritage promotes drinking, leading to abuse. However, peer pressure, selfishness, a lack of self-control, bad parenting and not religion push persons with reward deficiency syndrome into alcoholism, according to this research. (shrink)

Brussen, Kerri Anne On 29 November 2012, one of the Standing Committees of the Commonwealth House of Representatives released a report on the prevention, diagnosis and management of Fetal Alcohol Spectrum Disorders in Australia. This article explores the findings and recommendations of this report. The Commonwealth parliamentary committee noted that FASD is a serious health issue in Australia. It therefore called for a National Plan of Action, education for health professionals, and public awareness campaigns to encourage women not to (...) drink when pregnant or when planning a pregnancy. Other recommendations included better management of FASD within education, disability services, and the criminal justice system. (shrink)

A basic criticism of Perry Hendrick's "Even if the fetus is not a person, abortion is immoral: The Impairment Argument," is offered, namely that the reasons why intentionally causing fetal alcohol syndrome is wrong simply do not apply to fetuses and so the "Impairment Argument" against abortion fails.

Several years ago, Cohen, Dearnaley, and Hansel [1] demonstrated that under the influence of alcohol drivers became more risk prone, although their risk perception remained unchanged. Research shows that ambiguity aversion is to some extent positively correlated with risk aversion, though not very highly [2]. The question addressed by the present research is whether alcohol reduces ambiguity aversion. Our research was conducted in a natural setting (a restaurant bar), where customers with differing levels of alcohol intoxication were (...) offered a choice between a risky and an ambiguous lottery. We found that alcohol reduced ambiguity aversion and that the effect occurred in men but not women. We interpret these findings in terms of the risk-as-value hypothesis, according to which, people in Western culture tend to value risk, and suggest that alcohol consumption triggers adherence to socially and culturally valued patterns of conduct different for men and women. (shrink)

This paper examines the competing construals of the phrase recovering alcoholic, which, as a Membership Categorization Device, serves to fulfill a commitment to an identity category and at the same time evokes other category-bound activities, often with unintended consequences. Former problem drinkers are routinely referred to by themselves and others as recovering alcoholics, yet they are not ‘recovering’ in the canonical sense of the word, and they participate in a behavior – not drinking – which is a negation of the (...) behavior that originally qualified them as alcoholics. This use of the relatively new identity marker recovering alcoholic may discourage a problem drinker from attempting sobriety, as it implies an unbounded, never-ending period of recovery, unlike recovery from other diseases. (shrink)

This book discusses and provides insight on the legal and ethical dilemmas of managing those with Fetal Alcohol Spectrum Disorder (FASD). This book provides a clear perspective for those clinicians and legal professionals who are working with those with this disorder, and correspondingly increases their understanding when arranging effective supports for this population. Historically, the primary focus on FASD has been on children. However, this is a lifelong disorder, and the implications of this disorder become even more prominent and (...) complex in adulthood. Those with this condition can struggle with impulsiveness, and a host of cognitive difficulties. This correspondingly impacts their independence and employability, and produces an elevated risk for homelessness and other residential issues, involvement in substance use, being exploited, development of behavioural issues, and subsequent legal difficulties. Their cognitive difficulties result in challenges for legal systems around the world to understand their issues, and to design appropriate remedial strategies, recommendations for treatments and supports, and even for understanding the failure of many of these individuals to be able to change their behaviours effectively. This produces various legal and ethical dilemmas, which are discussed in detail in this volume by 28 authors from Europe, New Zealand, and North America. These include discussions regarding the rights of the unborn child, the alcohol industry's duty to warn, whether small amounts of alcohol during pregnancy can be condoned, and even the current use of involuntary hospitalization for addicted mothers. Other chapters discuss the need for training on FASD for front line officers, use of lies during interrogation of those with FASD, medical and legal interventions for offenders with FASD, access to diagnostic services and follow-up supports, and whether FASD can be considered a mitigating factor for sentencing. Furthermore, caregivers also provide their stories regarding the daily dilemmas that are faced in raising those with FASD. (shrink)

Alcohol use disorder is a burden to society creating social and health problems. Detection of AUD and its effects on the brain are difficult to assess. This problem is enhanced by the comorbid use of other substances such as nicotine that has been present in previous studies. Recent machine learning algorithms have raised the attention of researchers as a useful tool in studying and detecting AUD. This work uses AUD and controls samples free of any other substance use to (...) assess the performance of a set of commonly used machine learning classifiers detecting AUD from resting state functional network connectivity derived from independent component analysis. The cohort used included 51 alcohol dependent subjects and 51 control subjects. Despite alcohol, none of the 102 subjects reported use of nicotine, cannabis or any other dependence or habit formation substance. Classification features consisted of whole brain rsFNC estimates undergoing a feature selection process using a random forest approach. Features were then fed to 10 different machine learning classifiers to be evaluated based on their classification performance. A neural network classifier showed the highest performance with an area under the curve of 0.79. Other good performers with similar AUC scores were logistic regression, nearest neighbor, and support vector machine classifiers. The worst results were obtained with Gaussian process and quadratic discriminant analysis. The feature selection outcome pointed to functional connections between visual, sensorimotor, executive control, reward, and salience networks as the most relevant for classification. We conclude that AUD can be identified using machine learning classifiers in the absence of nicotine comorbidity. (shrink)

That alcohol provides a benefit to creative processes has long been assumed by popular culture, but to date has not been tested. The current experiment tested the effects of moderate alcohol intoxication on a common creative problem solving task, the Remote Associates Test . Individuals were brought to a blood alcohol content of approximately .075, and, after reaching peak intoxication, completed a battery of RAT items. Intoxicated individuals solved more RAT items, in less time, and were more (...) likely to perceive their solutions as the result of a sudden insight. Results are interpreted from an attentional control perspective. (shrink)

Drink driving causes great suffering and material destruction. The alcohol interlock promises to eradicate this problem by technological design. Traditional counter-measures to drink driving such as policing and punishment and information campaigns have proven insufficient. Extensive policing is expensive and intrusive. Severe punishment is disproportionate to the risks created in most single cases. If the interlock becomes inexpensive and convenient enough, and if there are no convincing moral objections to the device, it may prove the only feasible as well (...) as the only justifiable solution to the problem of drink driving. A policy of universal alcohol interlocks, in all cars, has been proposed by several political parties in Sweden and is supported by the National Road Administration and the 2006 Alcohol Interlock Commission. This article assesses two possible moral objections to a policy of universal interlocks: (i) that it displaces the responsibility of individual drivers and (ii) that it constitutes a paternalistic interference with drivers. The first objection is found unconvincing, while the second has only limited bite and may be neutralized if paternalism is accepted for the sake of greater net liberty. Given the expected technological development, the proposed policy seems a commendable health promotion measure for the near future. (shrink)

In the aftermath of the horrors of the First World War and during the years of American Prohibition, Paris became a cheap and popular tourist destination as well as the home to a new generation of aspiring writers from artists including Pablo Picasso, F. Scott Fitzgerald, Gertrude Stein, James Joyce, and Ernest Hemingway. Novels written during that period and memoirs remembering it have described the exciting, boozy community there but none have been read as widely as Hemingway’s The Sun Also (...) Rises and A Moveable Feast. This paper aims to discuss the ways in which alcohol and sports play a part in the community of American expatriates in 1920s Paris and how this can be seen in particular in Hemingway’s works. It will also discuss how the prevalence of alcohol and sports in this period affected Hemingway and his work for the rest of his life. (shrink)

This paper offers a new perspective on historical understandings of the relationship between alcohol, climate and the body, by studying the way that British explorers of tropical Africa drank alcohol and wrote about drink between c.1850 and c.1910. We demonstrate that alcohol was simultaneously classified as a medicinal, a preventative and a pleasurable drink, shaped by competing medical theories, but that distinctions between these different roles were highly blurred. We also show how many explorers thought certain drinks (...) helped to protect white bodies from the effects of tropical diseases. While popular amongst travellers, these views came under growing scrutiny in the latter part of the nineteenth century, reflecting both changing scientific views about the relationship between alcohol, climate and the body and the development of a much larger European presence in tropical Africa. However, even those who opposed tropical drinking often supported the use of other stimulants and viewed the tropics as uniquely dangerous. As such, the paper challenges the idea that the late nineteenth century marked a paradigm shift in scientific attitudes towards tropical environments, as much previous scholarship has suggested. At the same time, our examinations of explorers’ descriptions of drinking by African people demonstrates how ideas about racial difference played an important role within medical understandings of alcohol. Overall, this paper examines the heterogeny of attitudes to alcohol to be found within tropical medicine and documents the continuities in approach shown between the nineteenth and twentieth centuries. (shrink)

En el artículo analizo los imaginarios etílicos elaborados en Oda al vino de Pablo Neruda y Borrachos dionisíacos de Pablo de Rokha. A modo de hipótesis, propongo que ambos textos constituyen una defensa o apología del alcohol y sus efectos embriagadores, donde la valoración del consumo etílico se vincula con la idea de masculinidad a la que adscriben las voces poéticas. Desde esta perspectiva, postulo también que ambos textos configuran una poética de la embriaguez, que se inscribe en la (...) tradición de poetas que desde la Antigüedad hasta la Modernidad han cantado las bondades del alcohol y sus efectos. In this article, I analyze the alcoholic imaginaries elaborated in Oda al vino by Pablo Neruda and Borrachos dionisíacos by Pablo de Rokha. As a hypothesis, I propose that both texts are a defense or apology of alcohol and drunkenness, where the worth of alcohol consumption is closely connected with the idea of masculinity postulated by poetic voices. In this sense, I also propose that both texts configure a poetic of drunkenness, which belongs to the tradition of poets who have sung the virtues of alcohol and its effects from Antiquity to Modernity. (shrink)

Alcohol use has been recognized as a challenge in eldercare and social care, and some anticipate that problems related to alcohol use will increase in the future as the current adult generation has high alcohol consumption rates. Accordingly, it is suggested that care workers are at risk of becoming passive bystanders to the destructive lifestyles of vulnerable older adults and even facilitating these lifestyles. In the present paper, we suggest that alcohol exacerbates and underscores inherent difficulties (...) in eldercare, such as finding an appropriate balance between the personal freedom of the older adult and the responsibility of the care worker to provide care. The specific focus in the paper regard the communication and interaction involving values between people in eldercare in cases of problematic alcohol‐related situations to uncover the difficulties. We found it noteworthy that the objectives and perspectives of older adults, care workers, managers and relatives have implications regarding their interactions and communications because their varying experiences involve values that are not necessarily aligned. Sometimes, care workers have no choice but to act against what, in the public sphere and to the other care workers, is ruled out by virtue of their professional ethics. It is suggested that care workers describe and judge situations where alcohol is present paradoxically by virtue of their professional ethics, yet regulate their care to preserve the dignity of older adults, even when they find the situation to be an apparent dilemma. (shrink)

When does behavior trigger a lesser claim to medical resources? When does chronic drinking, for example, mean that one has a lesser claim to a liver transplant? Only when one's behavior becomes a callous indifference to others' needs—when one knows the consequences of heavy drinking and knows that by drinking one may end up depriving someone else of a liver.

Sociological studies into alcohol use seem to find it difficult to deal with the substance itself. Alcohol tends to be reduced to a symbol of a social process and in this way the sociological research loses sight of effects beyond the social. This article suggests a new theoretical approach to the study of alcohol and teenagers' (romantic) relationships, inspired by actor-network theory (ANT). The central feature of ANT is to search for relationships, or rather networks, between all (...) things relevant to the phenomenon. All material and semantic structures, things, persons, discourses, etc. that influence a given situation are described as actants and are entered into the analysis. The aim of this article is to propose a way of including materiality in sociological analyses of alcohol and to explore ways of using focus group interview material in ANT-inspired analysis. By analysing a girl's development from being a non-drinker at the age of 14, to a heavy drinker at 16, the article investigates how the actants brought out by young people in the focus groups themselves constitute different forms of agency. The analysis is based on a qualitative study consisting of 37 focus groups conducted with teenagers in Denmark over a three-year period. (shrink)

There is evidence to the effect that exposing children to alcohol consumption in the media increases the chances that they will consume alcohol as minors or as adults, and since alcohol consumption is associated with numerous public health issues, calls for stricter regulation can be heard from many quarters. This article argues that with the available research we cannot conclude that exposure to portrayals of alcohol consumption plays a genuine causal role in bringing about the things (...) with which it is associated, that the strength of the correlation is too weak to justify regulation and that the sorts of things with which it is associated only rarely count as genuine harms from a liberal point of view. This article also argues that even if genuine harms were caused, no justification for regulation would directly follow because alcohol in the media could still be protected by freedom of speech and expression. Yet, the article argues that regulation is defensible if it can be shown that the harmful consequences arise in ways that bypass autonomy, or if it can be shown that the harmful consequences are unacceptable from the point of view of so-called ‘proleptic’ autonomy. (shrink)

This article examines the relation of risks and public policy through the lens of alcohol and crime. Alcohol thus lives a double-life as a fountain of celebration while also a wellspring of potentially serious harms. The issue of how risks might be managed much better is approached through considering three different arenas within the criminal law concluding that it is a crude mechanism for grappling with complex issues of criminal responsibility for any higher risks associated with becoming under (...) the influence. The article defends the use of nudges as an under explored area for public policy decision-making and proposes new policies based on them. (shrink)