Authenticity is often defined as the extent to which people feel that they know and express their true selves. Research in the psychological sciences suggests that people view true selves as more morally good than bad and that this “virtuous” true self may be a central component of authenticity. In fact, there may be reasons to suspect that authenticity serves as a cue that one’s behaviors are virtuous, and feelings of authenticity may help sustain virtuous actions. However, in previous research, (...) operationalizations of virtue may not clearly capture virtue as virtue theorists might recognize it. The possibility that feelings of authenticity keep people oriented toward virtuous activities is compatible with theorizing, but the precise ways that it might do so has not received direct conceptual or empirical scrutiny. We propose an interdisciplinary hypothesis of how feelings of authenticity could function to serve as a feedback mechanism for virtuous behavior. Feelings of authenticity could play a role in sustaining motivation to engage in virtuous activity insofar as the experience of subjective authenticity encourages one to approach that activity or environment in the future. Furthermore, virtuous behavior incorporates a few key elements that are predictive of experiencing subjective authenticity. We review emerging research that offers initial support for the idea that authenticity may guide sustained and virtuous civic action and develop a theoretical framework that positions authenticity as integral to sustained virtuous behavior. (shrink)

In this paper, we provide an overview of our ongoing project in the Genetics and Human Agency Initiative sponsored by the John Templeton Foundation. Our project focuses on the ways that lay beliefs about the heritability of virtue influence reasoning about the nature of virtue, parenting behaviors, and the development of virtue in children. First, we provide philosophical perspectives on the nature of virtue and suggest that viewing virtue as a malleable skill may have important advantages. Next, we review theory (...) and research that highlights the ways that lay heritability beliefs potentially undermine conceptualizations of virtue as a malleable skill. Finally, we discuss how lay heritability beliefs might ultimately affect parent–child interactions and child virtue development. The paper thus provides a brief description our project’s theoretical foundation and a general look at the empirical questions it will tackle. (shrink)

Essays omhandlende den etiske dimension i det militære liv.

Objective. We investigated associations between adults’ beliefs about the heritability of virtue and endorsements of the efficacy of specific parenting styles. Design. In Studies 1 (N = 405) and 2 (N = 400), beliefs about both the genetic etiology of virtuous characteristics and parenting were assessed in samples of parents and non-parents. In Study 3 (N = 775), participants were induced to view virtue as determined by genes or as determined by social factors. Heritability beliefs and authoritarian parenting endorsements were (...) subsequently measured. Results. Study 1 and Study 2 converged to reveal that tendencies to view characteristics as determined by genes were positively associated with endorsement of authoritarian parenting styles. This association occurred independent of individual differences in essentialism and rightwing authoritarianism. Study 3 revealed that exposure to genetic accounts of virtue increased beliefs that virtue is caused by genes, which in turn was positively associated with endorsements of authoritarian parenting responses to child problem behavior. Exposure to genetic accounts of virtue increased endorsement of authoritarian parenting among parents, but was unrelated to authoritarian parenting among non-parents. Conclusions. These studies suggest that genetic accounts of virtuous characteristics reliably relate to more positive beliefs about harsh and controlling parenting practices, illuminating an unrecognized cognitive factor associated with authoritarian parenting endorsement. (shrink)

On 8 October 2020, the British Medical Association published the results of its survey of BMA members on physician-assisted dying. With 28 986 respondents, this was one of the largest surveys of medical opinion on this topic ever carried out. This represents 19.35% of those who received an invitation to participate and the respondents were broadly representative of the BMA’s overall membership. The BMA was clear throughout this process that the results of the survey would not determine its policy. Its (...) current policy of opposition to all forms of physician-assisted dying would remain unless and until the Representative Body, which makes BMA policy, decided otherwise. The survey results would, however, inform a future debate on policy, currently scheduled to take place in June 2021. When asked what the BMA’s position should be on whether there should be a change in the law to allow doctors to prescribe drugs for an eligible patient to self-administer to end their own life, 40% said the BMA should be supportive, 33% opposed, 21% thought the BMA should be neutral and 6% were undecided. In relation to their own personal views, 50% were supportive, 39% opposed and 11% undecided. When asked whether they would be willing to participate in some way in the process, if it were to be legalised, 36% said yes, 45% said no and 19% were undecided. The same three questions were asked about a change in the law to allow doctors to administer drugs to end the life of an eligible patient. In response, 40% thought the BMA should oppose such a change, 30% thought the BMA should be supportive and 23% thought the BMA should be neutral; 7% of members responding were undecided on this question. In …. (shrink)

During the first UK wave of the pandemic, there were two areas of immediate ethical concern for the medical profession. The first was the possibility that life-saving resources could be overwhelmed. Early reports from hospitals in the Italian city of Bergamo suggested that ventilatory support might need rationing and emergency ‘battlefield’ triage was a real possibility.1 In the UK, several professional bodies, including the British Medical Association and the Royal College of Physicians rapidly developed guidance for doctors should triage become (...) a reality.2 The second issue was the acute shortage of personal protective equipment. Where doctors were unable to protect their patients – and themselves – from the risk of COVID-19, ethical challenges emerged. Ordinarily, doctors and patients do not present risks of significant harm to each other. To shift to a position where every patient – and every health professional – could potentially be a threat presented serious clinical and ethical challenges. To treat with inadequate PPE, so options for mitigating harms are radically reduced, deepens the challenges. Among the questions the BMA wrestled with was the extent of doctors’ duties to treat infected or potentially infected patients in the absence of effective PPE. The BMA was clear that despite obligations to treat, medicine is not a self-sacrificing profession: there were limits to the risk doctors could be required to expose themselves to.3 These issues no longer seem so pressing. In the UK at least, there is adequate PPE and with the second steep wave behind us, and significant numbers vaccinated, it is less likely that triage will be required in the UK. But as those concerns have receded so other ethical questions have arisen. Among them is a cluster of issues associated with what might be called COVID-19’s indirect harms. Understandably, in response to …. (shrink)

This chapter presents the advantages of the use of functional regions of interest along with its specific concerns, and provides a reference to Karl J. Friston related to the subject. Functionally defined ROI help to test hypotheses about the cognitive functions of particular regions of the brain. fROI are useful for specifying brain locations and investigating separable components of the mind. The chapter provides an overview of the common and uncommon misconceptions about fROI related to assumptions of homogeneity, factorial designs (...) versus independent localizers, a summary measure, and the naming of fROI. (shrink)

Drawing on social comparison theory, we investigate employees’ ethical and performance comparisons relative to a similar coworker and subsequent emotional and behavioral responses. We test our theoretically driven hypotheses across two studies. Study 1, a cross-sectional field study, reveals that employees who perceive they are more ethical than their coworkers experience negative emotions toward the comparison coworkers and those feelings are even stronger when the employees perceive they are lower performers than their coworkers. Results also reveal that negative emotions mediate (...) the indirect relationship between being more ethical than a coworker, but also being a lower performer than that coworker onto social undermining and ostracism. Study 2, a 2 × 2 between-subjects experimental design, provides further support for our moderated mediation model. Results reveal that participants experience negative emotions when they receive information that they are more ethical than a comparison participant. Negative emotions are amplified if the participant is told they were a lower performer than the comparison participant. Those participants indicate their desire to mistreat and ignore the comparison participant if given the opportunity. Thus, we find support for our hypotheses using a multi-method design. (shrink)

Drawing on theoretical work on humans’ adaptive capacity, we propose that supervisors’ perception of top management’s high bottom-line mentality (BLM) has a dysfunctional effect on their ethical leadership practices. Specifically, we suggest that these perceptions hinder supervisors’ empathy, which eventuates in less ethical leadership practices. We also investigate, in a first-stage moderated mediation model, how supervisors high in trait mindfulness are resistant to the ill effects of perceptions of top management’s high BLM. Supervisors high (versus low) in this trait are (...) less likely to respond to perceptions of top management’s high BLM with reduced empathy that then hinders ethical leadership. Results from a multi-wave, multi-source sample of working adults from the Chinese high technology industry provide general support for our theoretical model. Theoretical and practical implications are discussed. (shrink)

Drawing on theoretical work on humans’ adaptive capacity, we propose that supervisors’ perception of top management’s high bottom-line mentality (BLM) has a dysfunctional effect on their ethical leadership practices. Specifically, we suggest that these perceptions hinder supervisors’ empathy, which eventuates in less ethical leadership practices. We also investigate, in a first-stage moderated mediation model, how supervisors high in trait mindfulness are resistant to the ill effects of perceptions of top management’s high BLM. Supervisors high (versus low) in this trait are (...) less likely to respond to perceptions of top management’s high BLM with reduced empathy that then hinders ethical leadership. Results from a multi-wave, multi-source sample of working adults from the Chinese high technology industry provide general support for our theoretical model. Theoretical and practical implications are discussed. (shrink)

As a result of the world-wide COVID-19 epidemic, an internal tension in the goals of medicine has come to the forefront of public debate. Medical professionals are continuously faced with a tug of...

An Amnesty International briefing, published in July 2020, highlights the grave risks health workers are facing globally, particularly in the face of the COVID-19 pandemic.1 The report uses data from 63 countries across the world from January to June 2020 and is rich with examples. While recognising that information about the pandemic is constantly evolving, and each country is in a separate phase of the outbreak, Amnesty International draws attention to several troubling trends. By virtue of the role undertaken by (...) health workers, they face a greater exposure to COVID-19, which has contributed to many of the concerns they now deal with. The briefing notes the evidence of the higher death rate from health workers compared with the general population in countries ranging from Denmark to Argentina, while also pointing out the significantly higher death rate in BAME health workers raised by the BMA in the UK.2 PPE shortages had been reported in nearly all of the 63 countries analysed. Many health workers globally stated that they had to buy their own PPE and others described cases of ‘improvisation’, when suitable PPE was not available, such as using bin bags or raincoats. Furthermore, health workers in several countries had experienced increases in workload with formal measures to extend health workers’ contracted hours passed in some countries as well as further changes to their terms and conditions of service. There were also reports of increased mental stress, particularly from those working in ICUs; the increased work and stress is not being matched with suitable compensation or remuneration. Despite many countries passing special benefits for health workers, it was commonly stated that these benefits had not been received yet or that they did not apply to all health workers, with cleaners and other lower-paid yet vital roles excluded. Deeply concerning …. (shrink)

At the time of writing the COVID-19 pandemic was entering its ninth month, with nearly 800 000 recorded fatalities and 22 million infections in 188 countries and territories.1 In previous ethics briefings2 we raised concerns about the possibility that demand for life-sustaining treatment would overwhelm supply, with a consequent requirement for health professionals to make challenging triage decisions. Fortunately, to date, these have largely not been realised, although there is a possibility that countries in which containment measures have been less-successful, (...) such as South Africa, may still be required to triage.3 Despite the successful ‘flattening of the curve’ in many countries, there is a wide consensus that we remain firmly within the pandemic. Enormous practical challenges remain. It is unclear whether the pandemic will ultimately take the form of two or more successive waves, or whether the patchwork of global responses will lead to a sustained slow ‘burn’ with sporadic flare-ups.4 Areas of uncertainty include whether infection confers some immunity, how long any such immunity might last, whether effective vaccines can be developed and if seasonal temperature fluctuations alter the spread of the virus. The pandemic will also be fundamentally shaped by the decisions that governments make and the extent to which their diktats are complied with by citizens. With the – possibly temporary – retreat of urgent clinical ethics issues, such as triage, opportunities have arisen to reflect on some of the ethical questions that underlie and structure the demanding policy decisions that governments are wrestling with. One of the early questions was how to balance the complex constellation of costs and benefits associated with lockdown. Countries that …. (shrink)

In December, the National Data Guardian 1 for health and care in England, Dame Fiona Caldicott, published the outcomes of a public consultation about the Caldicott Principles and the role of Caldicott Guardians.1 The Caldicott Principles are good practice guidelines which have been used by health and social care organisations in the UK since 1997 to ensure that people’s data are kept safe and used in an ethical way.2 The role of the Caldicott Guardian is well-established in the UK. Caldicott (...) Guardians are senior people which support the upholding of the Caldicott Principles within organisations. In response to views expressed during the consultation the NDG has added an eighth Caldicott Principle to the existing seven and will use her statutory powers to issue guidance about the appointment of Caldicott Guardians for health and adult social care organisations. The new eighth Caldicott Principle is: ‘Inform patients and service users about how their confidential information is used’. It provides that: > A range of steps should be taken to ensure no surprises for patients and service users, so they can have clear expectations about how and why their confidential information is used, and what choices they have about this. These steps will vary depending on the use: as a minimum, this should include providing accessible, relevant and appropriate information - in some cases, greater engagement will be required. The NDG explains that the introduction of the new principle was prompted by consideration of the role that the legal concept of ‘reasonable expectations’ should play in shaping the circumstances under which health and care data may be legitimately shared. The NDG does not envisage that this principle will establish reasonable expectations as a legal basis in its own right …. (shrink)

The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.

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)

In this Introduction to a special section on ‘Visualizing Surfaces, Surfacing Vision’, the authors argue that to conceive vision in the contemporary world it is necessary to examine its embedding within, expression via and organization on the surface. First, they review recent social and cultural theories to demonstrate how and why an attention to surfaces is salient today. Second, they consider how vision may be understood in terms of surfaces, discussing the emergence of the term ‘surface’, and its transhistorical relationship (...) with vision. Third, they introduce the contributions to the special section, which cover written articles and artworks. They make connections between them, including their exploration of reflexivity and recursion, observation, objectivity and agency, ontology and epistemology, relationality, process, and two- and three-dimensionality. Fourth, the authors consider some implications of an understanding of visualizing surfaces/surfacing vision. (shrink)

The name of the first author was incorrect in the initial online publication. The original article has been corrected.

ABSTRACT A robust literature indicates that when people feel that they are expressing and aware of their true selves, they show enhanced psychological health and well-being. This feeling, commonly referred to as authenticity, is therefore a consequential experience. In this paper, we review a program of research focused on the relevance of authenticity for civic engagement. We describe how a virtuous orientation to civic engagement might make civic actions feel more authentic and how the experience of authenticity might help sustain (...) civic behavior. We then discuss the role that education might play in fostering a deeper connection between civic engagement and the subjective experience of authenticity. (shrink)

Attentional bias towards threat can be demonstrated by enhanced processing of threat-related targets and/or greater interference when threat-related distractors are present. These effects are argued to reflect processing within the orienting and executive control networks of the brain respectively. This study investigated behavioural and electrophysiological correlates of early selective attention and top-down attentional control among females with high or low spider fear. Participants completed a novel flanker go/nogo task in which a central schematic flower or spider stimulus was flanked by (...) either congruent or incongruent distractors. Participants responded to green stimuli and withheld response to yellow stimuli. High fear participants demonstrated significantly shorter reaction times and greater P1 amplitude to spider targets, suggesting specific hypervigilance towards threat-relevant stimuli. In contrast to predictions, there was little evidence for behavioural interference effects or differences in N2 amplitude when distractor stimuli were threat-relevant. (shrink)

This chapter focuses on the archetypal image of the necromancer: the black‐robed creator and master of the undead. The necromancer is often depicted as a mere cackling villain, using her power over death to forward her evil agenda. In this way, necromancy has been philosophically maligned. Although necromancers were traditionally considered to be evil in Dungeons Dragons (DD), the game came to accommodate the idea that necromancers, in theory, could be neutral, or even good‐aligned, with their powers used for the (...) greater good. The distaste for necromancy and its mindless minions is instead a relic of “pre‐theoretical intuition” a common‐sense belief that may not hold up to philosophical scrutiny. Films and TV series depict the walking dead as ravenous, brain‐eating monstrosities. Next to such depictions, the relatively harmless nature of Dungeons Dragons’ mindless undead is easy to overlook. (shrink)

Emerging adult newlywed couples often experience many demands on their time, and three common problems may surface as couples try to balance these demands—problems related to finances, sleep, and sex. We used two waves of dyadic data from 1,001 emerging adult newlywed couples to identify four dyadic latent profiles from husbands’ and wives’ financial management behaviors, sexual satisfaction, and sleep quality: Flounderers, Financially Challenged Lovers, Drowsy Budgeters, and Flourishers. We then examined how husbands’ and wives’ marital satisfaction, in relation to (...) profile membership, varied at a later wave. We found that Financially Challenged Lovers and Flourishers had significantly higher marital satisfaction than Drowsy Budgeters and Flounderers. Whereas, Financially Challenged Lovers and Flourishers did not differ in terms of marital satisfaction, Drowsy Budgeters seemed to have slightly higher marital satisfaction than Flounderers for wives only. However, we did not find evidence that these connections meaningfully differed by sex. Implications for the efforts of clinicians and educators are discussed. (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)

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)

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)

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)

The idea that science is or should be value-free, and that values are or should be formed independently of science, has been under fire by philosophers of science for decades. Science and Moral Imagination directly challenges the idea that science and values cannot and should not influence each other. Matthew J. Brown argues that science and values mutually influence and implicate one another, that the influence of values on science is pervasive and must be responsibly managed, and that (...) science can and should have an influence on our values. This interplay, he explains, must be guided by accounts of scientific inquiry and value judgment that are sensitive to the complexities of their interactions. Brown presents scientific inquiry and value judgment as types of problem-solving practices and provides a new framework for thinking about how we might ethically evaluate episodes and decisions in science, while offering guidance for scientific practitioners and institutions about how they can incorporate value judgments into their work. His framework, dubbed "the ideal of moral imagination," emphasizes the role of imagination in value judgment and the positive role that value judgment plays in science. (shrink)

Proponents of the value ladenness of science rely primarily on arguments from underdetermination or inductive risk, which share the premise that we should only consider values where the evidence runs out or leaves uncertainty; they adopt a criterion of lexical priority of evidence over values. The motivation behind lexical priority is to avoid reaching conclusions on the basis of wishful thinking rather than good evidence. This is a real concern, however, that giving lexical priority to evidential considerations over values is (...) a mistake and unnecessary for avoiding the wishful thinking. Values have a deeper role to play in science. (shrink)

This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about (...) the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position, including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing. (shrink)

Anthropogenic climate change is arguably one of the biggest problems that confront us today. There is ample evidence that climate change is likely to affect adversely many aspects of life for all people around the world, and that existing solutions such as geoengineering might be too risky and ordinary behavioural and market solutions might not be sufficient to mitigate climate change. In this paper, we consider a new kind of solution to climate change, what we call human engineering, which involves (...) biomedical modifications of humans so that they can mitigate and/or adapt to climate change. We argue that human engineering is potentially less risky than geoengineering and that it could help behavioural and market solutions succeed in mitigating climate change. We also consider some possible ethical concerns regarding human engineering such as its safety, the implications of human engineering for our children and society, and we argue that these concerns can be addressed. Our upshot is that human engineering deserves further consideration in the debate about climate change. (shrink)

There are challenges to the dominant research paradigm in breast cancer science. In the United States, science and social activism create paradigmatic shifts. Using interviews, ethnographic observations, and an extensive review of the literature, we create a three-dimensional model to situate changes in scientific controversy concerning environmental causes of breast cancer. We identify three paradigm challenges posed by activists and some scientists: to move debates about causation upstream to address causes; to shift emphasis from individual to modifiable societal-level factors beyond (...) an individual’s control; and to allow direct lay involvement in research, which may raise new questions and change how questions are approached, the methods used, and the standards of proof. We use our model to examine controversies about doing scientific research, interpreting scientific results, and acting on science. Ultimately, we aim to understand what impedes construction of new methodologies and knowledge about environmental factors in human disease. (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)

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)

Neural engineering technologies such as implanted deep brain stimulators and brain-computer interfaces represent exciting and potentially transformative tools for improving human health and well-being. Yet their current use and future prospects raise a variety of ethical and philosophical concerns. Devices that alter brain function invite us to think deeply about a range of ethical concerns—identity, normality, authority, responsibility, privacy, and justice. If a device is stimulating my brain while I decide upon an action, am I still the author of the (...) action? Does a device make the interiority of my experience accessible to others? Will the device change the way I think of myself and others think of me? Such fundamental questions arise even when a device is designed for only a relatively circumscribed purpose, such as restoring functioning via a smart prosthetic. We are part of a National Science Foundation-funded Engineering Research Center tasked with investigating philosophical and social implications of neural engineering research and technologies. Neural devices already in clinical use, such as deep brain stimulators for Parkinson's disease or essential tremor, have spurred healthy debate about such implications. Devices currently under development—such as the BrainGate System of implanted brain sensors coupled to robotics in persons with paralysis, exoskeletons for augmented movement, transcranial do-it-yourself stimulators, closed-loop brain stimulating systems, or even brain-to-brain interfacing—promise to extend and deepen these debates. At our center, brain-computer interfaces are the principal focus of work. Even acknowledging that the clinical translation of neural devices and seamless integration by end users may still largely reside in the future, the potential these devices hold calls for careful early analysis. The launching of the Brain Research through Advancing Innovative Neurotechnologies Initiative in April 2013 provides further impetus for this work. (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)

Ethical medical care of pregnant women in Australia should include the real provision of information regarding the risks and benefits of vaginal birth. Routinely obtaining consent for the different ways in which childbirth is commonly intervened on and the assistance involved (such as midwife-led care or a planned caesarean section) and providing sufficient information for women to evaluate the harms and benefits of the care on offer, would not only enable the empowerment of women but would align with the current (...) standard of care as established by Rogers v Whittaker. (shrink)

Background Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. Objective To describe UK mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Design Thematic content analysis. Subjects National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between January (...) 2005 and February 2010. Setting UK mass media. Results The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; oppo- sition came from rival politicians, taxpayersÕ representatives, certain charities and from some journalists themselves. Conclusions Those promoting incentive schemes for people who might be regarded as ÔundeservingÕ should plan a media strategy that anticipates their public reception. (shrink)

Prozac's introduction in the late 1980s, caused a furor and focused debate on the acceptability of a drug that could do more than merely cure illness, pharmacological mood enhancement – that is, the use of drugs to improve mood beyond a level that is merely normal or healthy. As the possibilities and demand for mood enhancement increase, existing legislation will prove inadequate, designed as it is to regulate pharmaceuticals mainly for therapeutic use. This chapter explains why mood enhancement might be (...) desirable, explores some key ethical issues associated with it, and suggests how policy makers can respond to ensure that people use mood enhancement safely and responsibly. Whether it is appropriate to enhance one's mood might also depend on the manner in which the mood is experienced. While unpleasant states like depression may be appropriate and valuable in some cases, they can be disruptive and disabling if they continue indefinitely. (shrink)

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)