Many servicemen and women began suffering from a variety of symptoms and illnesses soon after the 1991 Gulf War. Some veterans believe that their illnesses are related to toxic exposures during their service, though scientific research has been largely unable to demonstrate any link. Disputes over the definition, etiology, and treatment of Gulf War-related illnesses continue. The authors examine the roles of science, policy, and veteran activism in developing an understanding of GWRIs. They argue that the government’s stress-based explanation of (...) GWRIs and its insistence on a scientific link between service in the gulf and veteran illnesses forced veterans to shift from pleas for care, treatment, and compensation on moral grounds to engagement in the scientific process and debates over the interpretation of scientific findings. The authors compare the experiences of veterans to those of breast cancer activists to explain the stages of illness contestation in general. (shrink)

ABSTRACT:We examine supervisor-subordinate agreement regarding perceptions of the supervisor’s ethical leadership and its relationship to organizational deviance. We find that, on average, supervisors rate themselves more favorably on ethical leadership compared to how followers rate them. In addition, polynomial regression results reveal that unit-level organizational deviance is higher when there is agreement about lower levels of ethical leadership, and disagreement when supervisors rate themselves higher on ethical leadership than subordinates’ ratings of the supervisors. Finally, drawing on social influence theories, we (...) look at antecedents of agreement and find that supervisors’ beliefs about themselves and others are associated with self-other agreement on ethical leadership. (shrink)

The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of (...) immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people’s civil liberties. We make tentative recommendations for the ethical introduction of immunity passports. (shrink)

In this article, we outline a novel approach to understanding the role of responsibility in health promotion. Efforts to tackle chronic disease have led to an emphasis on personal responsibility and the identification of ways in which people can ‘take responsibility’ for their health by avoiding risk factors such as smoking and over-eating. We argue that the extent to which agents can be considered responsible for their health-related behaviour is limited, and as such, state health promotion which assumes certain forms (...) of moral responsibility should be avoided. This indicates that some approaches to health promotion ought not to be employed. We suggest, however, that another form of responsibility might be more appropriately identified. This is based on the claim that agents have prudential reasons to maintain their health, in order to pursue those things which make their lives go well—i.e. that maintenance of a certain level of health is rational for many agents, given their pleasures and plans. On this basis, we propose that agents have a self-regarding prudential responsibility to maintain their health. We outline the implications of a prudential responsibility approach to health promotion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 33.1 (2000) v [Access article in PDF] Editorial Announcement The editors wish to announce the departure of Pierre Kerszberg, who has joined the Departement de Philosophie, Universite de Toulouse-Le Mirail. We wish him the very best and are grateful for his editorial services. We are pleased to announce the appointment of Professor Richard A. Lee Jr., a specialist in the history of philosophy, as co-editor of (...) Philosophy and Rhetoric.Stephen H. Browne... (shrink)

Aim: To assess, against a checklist of specific areas of required information and using standard published criteria, to what extent leaflets given before cataract surgery provided patients with enough information to give adequately informed consent.Method: Twelve ophthalmology departments in the West Midlands region were asked to submit the cataract information leaflets given to their patients at the preoperative assessment for analysis. Using criteria published by the General Medical Council, British Medical Association, and Medical Defence Union the leaflets were assessed for (...) their contribution to informed consent for patients considering cataract surgery. Leaflets were scored according to the information they provided on: diagnosis, prognosis, treatment options, costs to the patient, details about the procedure, its purpose, likely benefits, how to prepare for it, what to expect during and after the operation, and the common as well as serious complications that may occur. The readability of the information was also assessed.Results: All the units’ leaflets provided information on diagnosis, the lifestyle changes required postoperatively, and cost involved to the patient. Only five units had leaflets that mentioned the risks involved in cataract surgery. The other areas of information were covered by 50–75% of the leaflets. Fifty per cent of the leaflets included a diagram. The average SMOG readability score was high.Conclusion: Although present cataract information leaflets make some contribution to the process of informed consent, most do not address important areas outlined by the General Medical Council. Many of the areas of information that are required for informed consent could easily be covered, and should be borne in mind when designing patient information leaflets. Resources are available on the internet including toolkits, guides, and means of assessment for the production of patient information leaflets. (shrink)

Health promotion efforts are commonly directed towards encouraging people to discard ‘unhealthy’ and adopt ‘healthy’ behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as ‘lifestyle behaviours.’ In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the need for people to change their behaviour, can contribute to a climate of ‘healthism’ and promote the moralisation (...) of people’s lifestyles. I begin by summarising recent trends in health promotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline and suggest is facilitated by efforts to promote health via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise about health and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people’s health-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions to promote health. (shrink)

From David Hume's famous puzzle about 'the missing shade of blue' to current research into the science of colour, the topic of colour is an incredibly fertile region of study and debate, cutting across philosophy of mind, epistemology, metaphysics and aesthetics as well as psychology. Debates about the nature of our experience of colour and the nature of colour itself are central to contemporary discussion and argument in philosophy of mind and psychology, and philosophy of perception. This outstanding Handbook contains (...) twenty-nine specially commissioned contributions by leading philosophers and examines the most important aspects of philosophy of colour. It is organised into six parts: The Importance of Colour to Philosophy The Science and Spaces of Colour Colour Phenomena Colour Ontology Colour Experience and Epistemology Language, Categories and Thought. The Routledge Handbook of Philosophy of Colour is essential reading for students and researchers in philosophy of mind and psychology, epistemology, metaphysics and aesthetics, as well as for those interested in conceptual issues in the psychology of colour. (shrink)

Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation. One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. (...) I ultimately stop short of endorsing or rejecting such a justification, though highlight some reasons for thinking it is unlikely to be practicable. (shrink)

Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies. Policies regarding who can access ART and with what support from a collective purse are highly contested, raising questions about what state responses are justified. Whilst much of this debate has focused on the status of infertility as a disease, we argue that this is something of a distraction, since disease framing does not provide the far-reaching, robust justification for state support that proponents of ART seem (...) to suppose. Instead, we propose that debates about appropriate state responses should consider the various implications for health and broader well-being that may be associated with difficulties starting a family. We argue that the harms and disruption to valued life projects of subfertility-related suffering may provide a stronger basis for justifying state support in this context. Further, we suggest that, whilst ART may alleviate some of the harm resulting from subfertility, population-level considerations can indicate a broader range of interventions aimed at tackling different sources of subfertility-related harm, consistent with broader public health aims. (shrink)

Loosely put, colour constancy for example occurs when you experience a partly shadowed wall to be uniformly coloured, or experience your favourite shirt to be the same colour both with and without sunglasses on. Controversy ensues when one seeks to interpret ‘experience’ in these contexts, for evidence of a constant colour may be indicative a constant colour in the objective world, a judgement that a constant colour would be present were things thus and so, et cetera. My primary aim is (...) to articulate a viable conception of Present Constancy, of what occurs when a constant colour is present in experience, despite the additional presence of some experienced colour variation (e.g., correlating to a change in illumination). My proposed conception involves experienced colour layering – experiencing one opaque colour through another transparent one – and in particular requires one of those experienced layers to remain constant while the other changes. The aim is not to propose this layering conception of colour constancy as the correct interpretation of all constancy cases, but rather to develop the conception enough to demonstrate how it could and plausibly should be applied to various cases, and the virtues it has over rivals. Its virtues include a seamless application to constancy cases involving variations in filters (e.g., sunglasses) and illuminants; its ability to accommodate experiences of partial colours and error-free interpretations of difficult cases; and its broad theoretical-neutrality, allowing it to be incorporated into numerous perceptual epistemologies and ontologies. If layered constancy is prevalent, as I suspect it is, then our experiential access to colours is critically nuanced: we have been plunged into a world of colour without being told that we will rarely, if ever, look to a location and experience just one of them. (shrink)

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...) could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

Currently, many women who are expecting to give birth have no option but to attempt vaginal delivery, since access to elective planned caesarean sections (PCS) in the absence of what is deemed to constitute ‘clinical need’ is variable. In this paper, we argue that PCS should be routinely offered to women who are expecting to give birth, and that the risks and benefits of PCS as compared with planned vaginal delivery should be discussed with them. Currently, discussions of elective PCS (...) arise in the context of what are called ‘Maternal Request Caesarean Sections’ (MRCS) and there is a good deal of support for the position that women who request PCS without clinical indication should be provided with them. Our argument goes further than support for acceding to requests for MRCS: we submit that healthcare practitioners caring for women with uncomplicated pregnancies have a positive duty to inform them of the option of PCS as opposed to assuming vaginal delivery as a default, and to provide (or arrange for the provision of) PCS if that is the woman's preferred manner of delivery. (shrink)

It should surprise no one familiar with the problems in rural healthcare that 87% of a randomly selected sample of Nebraskans recently called for either fundamental or complete change of the healthcare system. Rural communities in the United, States have been hard hit by the rising cost of healthcare at a time of economic and demographic decline. Unable to sustain operating costs and personnel needs, rural hospitals and medical, practices have been forced to close their doors at an, alarming rate.Furthermore, (...) rural patients are decreasingly able to afford what services are available to them. Most must purchase insurance privately because they are unlikely to be insured through employment. Therefore, they pay dearly because they are not eligible for corporate rates and because insurance companies use experience instead of community rating to assess risk. (shrink)

Before the development of the nuclear shell model estimates of the strength of the nuclear spin-orbit interaction varied widely. Wheeler was the first to conclude that the nuclear spin-orbit interaction produces splittings of several MeV. This conclusion appeared, however, to be inconsistent with some experimental results that later turned out to be faulty.

The Cambridge Quarterly has a history of presenting multidisciplinary perspectives in bioethics, welcoming a lively dialogue between clinicians, philosophers, theologians, social scientists, lawyers, and others on a range of bioethics concerns. This special issue of the journal focuses explicitly on contributions from anthropologists to the field.

This paper will consider the extent to which patients' dependence on clinical expertise when making medical decisions threatens patient autonomy. I start by discussing whether or not dependence on experts is prima facie troubling for autonomy and suggest that it is not. I then go on to consider doctors' and other healthcare professionals' status as ‘medical experts’ of the relevant sort and highlight a number of ways in which their expertise is likely to be deficient. I then consider how this (...) revised picture of medical expertise should lead us to view the potential threat to patient autonomy that results from depending on such ‘experts’. I argue that, whether or not patients are aware of the limitations of medical expertise, in practice it is difficult to do other than defer to medical advice, and this presents a threat to patient autonomy that should be addressed. I conclude by suggesting some ways in which this threat to autonomy might be mitigated. (shrink)

Editors Rachel Brown and Deva Woodly bring together Mara Marin, Shatema Threadcraft, Christopher Paul Harris, Jasmine Syedullah, and Miriam Ticktin to examine the question: what would be required for care to be an ethic and political practice that orients people to a new way of living, relating, and governing? The answer they propose is that a 21st-century approach to the politics of care must aim at unmaking racial capitalism, cisheteropatriarchy, the carceral state, and the colonial present. The politics of (...) care is an approach to political thought and action that moves beyond the liberal approach which situates care as a finite resource to be distributed among autonomous individuals, or as a necessarily feminine virtue. Instead, those elucidating the politics of care for the contemporary era draw on rich interdisciplinary traditions and social movements to theorize and practice care as an inherently interdependent survival strategy, a foundation for political organizing, and a prefigurative politics for building a world in which all people can live and thrive. (shrink)

The medial prefrontal cortex (mPFC) has been the subject of intense interest as a locus of cognitive control. Several computational models have been proposed to account for a range of effects, including error detection, conflict monitoring, error likelihood prediction, and numerous other effects observed with single-unit neurophysiology, fMRI, and lesion studies. Here, we review the state of computational models of cognitive control and offer a new theoretical synthesis of the mPFC as signaling response–outcome predictions. This new synthesis has two interacting (...) components. The first component learns to predict the various possible outcomes of a planned action, and the second component detects discrepancies between the actual and intended responses; the detected discrepancies in turn update the outcome predictions. This single construct is consistent with a wide array of performance monitoring effects in mPFC and suggests a unifying account of the cognitive role of medial PFC in performance monitoring. (shrink)

COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the (...) comparison between naturally acquired immunity and vaccine-induced immunity. While we clearly cannot settle the scientific debates on this point, we suggest that we lack clear and convincing scientific evidence that vaccine-induced immunity has a significantly higher protective effect than natural immunity. Since vaccine requirements represent a substantial infringement of individual liberty, as well as imposing other significant costs, they can only be justified if they are necessary for achieving a proportionate public health benefit. Without compelling evidence for the superiority of vaccine-induced immunity, it cannot be deemed necessary to require vaccination for those with natural immunity. Subjecting them to vaccine mandates is therefore not justified. We conclude by defending the standard of proof that this argument from necessity invokes, and address other pragmatic and practical considerations that may speak against natural immunity exemptions. There are no data in this work. (shrink)

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here (...) what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)

Colour Relationalism asserts that colours are non-intrinsic or inherently relational properties of objects, properties that depend not only on a target object but in addition on some relation that object bears to other objects. The most powerful argument for Relationalism infers the inherently relational character of colour from cases in which one’s experience of a colour contextually depends on one’s experience of other colours. Experienced colour layering—say looking at grass through a tinted window and experiencing opaque green through transparent grey—demands (...) a contextual interdependency of one’s experience of one of these colours on one’s experience of the other. However, most if not all colour ontologies, and core perceptual experiential mechanisms like acquaintance and representation, can accommodate colour layering. It follows that experienced colour layering is consistent with colours being non-relational—this contextual interdependency of colours does not entail the constitutive dependency of one colour on the other. I utilize colour layering to examine the inference from the contextual to the constitutive interdependency of colours as it is employed in a well-known argument for Relationalism. I conclude that our justification for Relationalism is far weaker than Relationalists suggest. I first introduce readers to colour layering, then to Relationalism, and following this focus on the intersection of these topics. (shrink)