Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A (...) Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives. (shrink)

Healthcare institutions have been making increasing efforts to standardize consultation methodology and to accredit both bioethics training programs and the consultants accordingly. The focus has traditionally been on the ethics consultation as the relevant unit of ethics intervention. Outcome measures are studied in relation to consultations, and the hidden assumption is that consultations are the preferred or best way to address day-to-day ethical dilemmas. Reflecting on the data from an internal quality improvement survey and the literature, we argue that having (...) general ethics education as a key function of ethics services may be more important in meeting the contemporaneous needs of acute care settings. An expanded and varied ethics education, with attention to the time constraints of healthcare workers’ schedules, was a key recommendation brought forward by survey respondents. Promoting ethical reflection and creating a culture of ethics may serve to prevent ethical dilemmas or mitigate their effects. (shrink)

This article examines preventive constraints on suspected terrorists that can lead to restrictions on liberty similar to imprisonment and disrespect the target’s autonomy. In particular, it focuses on two examples: travel bans and asset freezes. It seeks to develop guidelines for setting appropriate limits on their future use. Preventive constraints do not generate legal protections as constraints in response to conduct do. In addition, these constraints are often seen as a permissible alternative to imprisonment. Still, preventive de facto detentions, or (...) what I term “exprisonments”, imperil the free and autonomous life of the targeted person. With the recognition that such constraints can infringe on one’s ability to lead a free and autonomous life, this article argues that some of these constraints require similar protections as their counterparts that put persons under lock and key. (shrink)

Some causal situations appear similar but causally different. Preemptive prevention offers such an example. However, it is difficult to capture the causal difference. In fact, it resists analysis. I discuss Collins’ s account of causal difference, and argue that it is not adequate. I also argue that the causal difference is not analyzable in terms of either dependence or production. I then examine some non-reductive account of causal difference, and claim that the sense of causal difference has yet to (...) be specified. Preemptive prevention shows that the concept of causation, whether it is reducible to something else or not, still requires some further scrutiny. (shrink)

Preventive War, Pro-Americanicanism and Anti-Americanism. Protests against the war in Iraq or against American support for Israel have led to the accusation that there now exists an Anti-Americanism of the left that is virtually indistinguishable from an Anti-Americanism of the right. D. Losurdo points out that the United States was actually endowed with a certain fascination for Marx, Engels, Lenin, Boukharin or Gramsci, and that the indignation which they voiced concerning the regime of white supremacy was not unmitigated. In contrast, (...) an American Herrenvolk democracy met with widespread admiration in the leading circles of the Hitlerian regime, while American racial theorists such as Ford and Stoddard received a warm welcome in Berlin. The current celebration in the US of the imperial presidency on the part of fundamentalist Christians, along with the contempt recently shown toward America’s « allies », stems from an exclusivist nationalism which harks back to this tradition. (shrink)

In this article we address torture in military and police organizations as a public health and human rights challenge that needs to be addressed through multiple levels of intervention. While most mental health approaches focus on treating the harmful effects of such violence on individuals and communities, the goal of the project described here was to develop a primary prevention strategy at the institutional level to prevent torture from occurring in the first place. Such an approach requires understanding and (...) altering the conditions that cause and sustain “atrocity producing situations”. Given the persistence of torture across the world and its profound health consequences, this is an increasingly important issue in global health and human rights. (shrink)

A European Union counter-terrorism strategy was devised in 2005.1 Of its four strands—prevent, pursue, protect, and respond—only two have a direct connection with policing. Perhaps surprisingly, th...

It is well known that prisoners’ human rights are often violated. In this chapter we examine whether guidelines can be effective in preventing such violations and in helping physicians resolve the significant conflicts of interest that they often face in trying to protect prisoners’ rights. We begin by explaining the role of clinical and ethical guidelines outside prisons, in the context of healthcare for non-incarcerated prisoners, and then the specific role of such guidelines within prisons, where the main concerns are (...) ensuring respect for the principle of equivalence of care, and for a prisoner patient’s autonomy in health care decisions. After reviewing and analysing various national and international guidelines, we review the literature and assess whether the good practices set out in these guidelines actually translate into changes in professional behaviour and consequent benefits for prisoners. It emerges that physicians both outside and within prisons tend to be insufficiently familiar with the relevant guidelines, and that they too infrequently use the guidance to make decisions, preferring instead to use personal codes of conduct. Guidelines designed specifically for the prison context are important to ensure equivalence of care and should be better known by health care personnel and other professional groups working in prison. Further guidelines should be developed that describe challenging situations and provide concrete guidance as to how to deal with them. (shrink)

When the state aims to prevent responsible and dangerous actors from harming its citizens, it must choose between criminal law and other preventive techniques. The state, however, appears to be caught in a Catch-22: using the criminal law raises concerns about whether early inchoate conduct is properly the target of punishment, whereas using the civil law raises concerns that the state is circumventing the procedural protections available to criminal defendants. Andrew Ashworth has levied the most serious charge against civil preventive (...) regimes, arguing that they evade the presumption of innocence. After sketching out a substantive justification for a civil, preventive regime, I ask what Ashworth’s challenge consists in. It seems that there is broad disagreement over the meaning and requirements of the presumption of innocence. I thus survey the myriad possibilities and extract two claims that have potential bearing on preventive regimes. One claim is that of substantive priority—the criminal law comes first when assessing blame. This is the claim at the root of objections to pretrial detention based on consideration of the crime charged. The second strand of argument is one of procedural symmetry. This is the concern that with respect to citizen/state relations, certain procedures are required, including, for example, proof beyond a reasonable doubt as to the offense or defense. Having extracted these claims, I then assess their applicability with respect to the preventive regime defended. I first conclude that the criminal law must share blame and censure with other fora, and thus, the criminal law only has substantive priority when criminal proceedings have been instituted. I then survey whether procedural symmetry is required, specifically assessing whether the preventive regime I defend requires proof beyond a reasonable doubt. My tentative conclusion is that proof beyond a reasonable doubt is warranted. (shrink)

There are entitlements, opportunities, and rights presently reserved to married couples by the basic structure of society, its major social institutions. Some claim that this is as it should be. But given the abiding effects of the basic structure on the prospects of individuals living within it, restrictions on liberty built into the basic structure require justification. One might think that we could justify reserving the benefits of marriage to married couples by appealing to harm prevention. In this paper, (...) I argue that the prospects of doing so successfully are dim. (shrink)

Over the past decade the use of closed circuit television (CCTV) as a means of crime prevention has reached unprecedented levels. Though critics of this development do not speak with one voice and have pointed to a number of different problems in the use of CCTV, one argument has played a dominant role in the debate, namely, that CCTV constitutes an unacceptable violation of people’s right to privacy. The purpose of this paper is to examine this argument critically. It (...) is suggested that the argument is hard to sustain. (shrink)

Sickle cell anemia is a disease characterized by abnormal hemoglobin structure. There is a mutation in the beta-globin gene that changes the sixth amino acid from glutamic acid to valine causing the mutated hemoglobin to polymerize reversibly when deoxygenated to form a gelatinous network of fibrous polymers that stiffen and distort the red blood cell membrane. This leads to episodes of microvascular vasoocclusion and premature RBC destruction leading to hemolytic anemia. For reasons that are unclear, some children develop a large (...) artery vasculopathy involving the intracranial arteries supplying the brain.The risk of stroke for a child with SCD is many times greater than that of a healthy child without SCD or heart disease. There is a technique that allows the identification of the children with SCD who have high risk even within this relatively high-risk group. And there is a highly effective preventive treatment. (shrink)

The first in a series of 4 articles, this article provides an overview of the concepts and methods developed by a team of researchers concerned with preventing harm and promoting ethical discourse in the helping professions. In this article we introduce conceptual, research, analytical, and action frameworks employed to promote the centrality of ethical discourse in mental health practice. We employ recursive processes whereby knowledge gained from case studies refines our emerging conceptual model of applied ethics. Our participatory conceptual framework (...) differs markedly from the restrictive model typically used in applied ethics. Our research relies on lived experiences of ethics, while our analytical framework draws attention to the multiple levels and contexts in which ethical dilemmas take place. Finally, our action framework is designed to collaborate with research participants and practitioners in making use of our data and interpretations. We demonstrate how the various frameworks inform each other in an integrative fashion. The article sets the stage for 2 case studies presented in subsequent articles. (shrink)

Internet-based health research is increasing, and often offers financial incentives but fraudulent behavior by participants can result. Specifically, eligible or ineligible individuals may enter the study multiple times and receive undeserved financial compensation. We review past experiences and approaches to this problem and propose several new strategies. Researchers can detect and prevent Internet research fraud in four broad ways: through the questionnaire/instrument ; through participants' non-questionnaire data and seeking external validation through computer information,, and 4) through study design. These approaches (...) each have pros and cons, and raise ethical, legal, and logistical questions, given that ethical tensions can emerge between preserving the integrity of research vs. protecting the privacy and confidentiality of study respondents. While past discussions concerning the ethics of online research have tended to focus on the participants' ability to trust the researchers, needs now arise to examine researchers' abilities to trust the participants. This analysis has several critical implications for future practice, policy, and research. (shrink)

Evidence-based recommendations for lifestyles to promote healthy cognitive aging root in reductionistic studies of mostly physical measurable factors with large effect sizes. In contrast, most people consider factors like autonomy, purpose, social participation and engagement, etc. as central to a high quality of life in old age. Evidence for a direct causal impact of these factors on healthy cognitive aging is still limited, albeit not absent. Ultimately, however, individual lifestyle is a complex composite of variables relating to both body and (...) mind as well as to receiving input and generating output. The physical interventions are tied to the more subjective and mind-related aspects of lifestyle and wellbeing in the idea of the “embodied mind,” which states that the mind is shaped by and requires the body. The causality is reciprocal and the process is dynamic, critically requiring movement: the “embodied mind” is a “embodied mind in motion.” Hiking, playing musical instruments, dancing and yoga are examples of body–mind activities that assign depth, purpose, meaning, social embedding, etc. to long-term beneficial physical “activities” and increase quality of life not only as delayed gratification. The present motivational power of embodied activities allows benefiting from the side-effects of late-life resilience. The concept offers an access point for unraveling the mechanistic complexity of lifestyle-based prevention, including their neurobiological foundations. (shrink)

The precautionary principle brings a special challenge to the practice of evidence-based public health decision-making, suggesting changes in the interpretative methods of public health used to identify causes of disease. In this paper, precautionary changes to these methods are examined: including discounting contrary evidence, reducing the number of causal criteria, weakening the rules of evidence assigned to the criteria, and altering thresholds for statistical significance. All such changes reflect the precautionary goal of earlier primary preventive intervention, i.e. acting on insufficient (...) evidence, the least amount, or minimum level, of evidence for causation. Evaluating the impact of these changes will be difficult without a careful study of how well the current methods of causal inference work, their theoretical foundations, and the ethical implications of their applications. That research program will be most productive if it is jointly developed by public health professionals trained in the ethics and philosophy and by bioethicists and philosophers trained in the theories, methods, and practice of public health. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether (...) moral claims justify the provision of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

In this article, an intervention aimed at improving quality of care to prevent seclusion in psychiatry by focusing on the first five minutes at admission is analyzed from a care ethics perspective. Two cases are presented from an evaluation study in a psychiatric hospital. In both cases, the nurses follow the intervention protocol, but the outcome is different. In the first case, the patient ends up in the seclusion room. In the second case, this does not happen. Analyzing the cases (...) from a care ethics perspective, we conclude that applying the intervention in the right way implies more than following the steps laid down in the protocol. It requires a new way of thinking and acting, resulting in new relationships between nurses and patients. Care ethics theory can help clarify what good care is actually about and keep in mind what is needed to apply the intervention. Thus, care ethics theory can be highly practical and helpful in changing and improving healthcare practice. (shrink)

According to the traditional view, preventive uses of force between states and preventive killings of individuals, to be legal, have one basic requirement in common, namely, the requirement of the immediacy of the threat posed. The U.S. National Security Strategy of September 2002, the so-called Bush doctrine, and the so-called Israeli policy of "targeted killing" challenge precisely this core requirement for the preventive use of force against states and against individuals. The author argues that abandonment of the traditional standard is (...) unwarranted, even when taking into account the new kinds of threats that have arisen in recent times. Such abandonment, he argues, would risk transforming indispensable foundations of the international law on the use of force and on human rights. (shrink)

IN THE UNITED STATES, 25 PERCENT OF PEOPLE LIVING WITH HIV/AIDS HAVE spent time in the correctional system. HIV is known to spread among incarcerated individuals through high-risk behaviors including unprotected sex, injection drug use, tattooing, and body piercing. When released from prison, persons living with HIV can spread the disease in the wider community. This essay explores the complex problem of HIV infection among US prisoners from a common good approach rooted in Catholic social teachings by examining available data (...) on US prison populations, describing recent trends in the prosecution of drug-related crimes, and proposing concrete policy recommendations for HIV prevention interventions in US prisons. (shrink)

Medical interventions that cure or prevent medical conditions are central to medicine; and thus, understanding them is central to our understanding of medicine. My purpose in this paper is to explore the conceptual foundations of medicine by providing a singular analysis of the concept of a ‘preventive or curative medical intervention’. Borrowing a general account of prevention from Phil Dowe, I provide an analysis of prevention, cure, risk reduction, and a preventive or curative intervention, before turning to preventive (...) and curative medical interventions. The resulting counterfactual-mechanistic account holds that preventive and curative medical interventions reduce the probability of a medical condition in an actual population compared to their counterfactual omission, commonly by disrupting an etiological or constitutive mechanism for the condition. (shrink)

Through a theoretical examination of the preventive turn in criminal law and justice which has gained momentum in Anglo-American criminal justice systems since the late-twentieth century, The Preventive Turn in Criminal Law demonstrates how recent transformations in criminal law and justiceare intrinsically related to and embedded in the way liberal society and liberal law have been imagined, developed, and conditioned by its social, political, and historical context. Henrique Carvalho identifies a tension between the idea of punishment as an expression of (...) individual justice, andprevention as a manifestation of the need for security and the promotion of welfare. Tracing this tension back to an intrinsic ambivalence within the modern conception of individual liberty, which is both repressed and preserved by liberal conceptions of responsibility and punishment, Carvalhoproves that as long as this ambivalence remains unexamined, liberal law has the potential to both promote and undermine individual justice.Engaging with the dominant contemporary literature on criminal law, prevention, risk, security, and criminalisation, this volume deploys a theoretical perspective developed through a critical analysis of both classical and contemporary works of social and political theory. The book reveals that thepervasiveness of prevention in 21st century criminal justice systems represents not only the consequence of new and unprecedented features of contemporary politics and society, but also the manifestation of essential aspects of the liberal legal and political tradition. (shrink)

This book arises from a three-year study of Preventive Justice directed by Professor Andrew Ashworth and Professor Lucia Zedner at the University of Oxford. The study seeks to develop an account of the principles and values that should guide and limit the state's use of preventive techniques that involve coercion against the individual. States today are increasingly using criminal law or criminal law-like tools to try to prevent or reduce the risk of anticipated future harm. Such measures include criminalizing conduct (...) at an early stage in order to allow authorities to intervene; incapacitating suspected future wrongdoers; and imposing extended sentences or indefinate on past wrongdoers on the basis of their predicted future conduct - all in the name of public protection and security. The chief justification for the state's use of coercion is protecting the public from harm. Although the rationales and justifications of state punishment have been explored extensively, the scope, limits and principles of preventive justice have attracted little doctrinal or conceptual analysis. This book re-assesses the foundations for the range of coercive measures that states now take in the name of prevention and public protection, focussing particularly on coercive measures involving deprivation of liberty. It examines whether these measures are justified, whether they distort the proper boundaries between criminal and civil law, or whether they signal a larger change in the architecture of security. In so doing, it sets out to establish a framework for what we call 'Preventive Justice'. (shrink)

How can we register the participation of a range of elements, extending beyond the human subject, in the production of HIV events? In the context of proposals around biomedical prevention, there is a growing awareness of the need to find ways of responding to complexity, as everywhere new combinations of treatment, behavior, drugs, norms, meanings and devices are coming into encounter with one another, or are set to come into encounter with one another, with a range of unpredictable effects. (...) In this paper I consider the operation of various framing devices that attribute responsibility and causation with regard to HIV events. I propose that we need to sharpen our analytic focus on what these devices do, their performativity—that is, their full range of worldly implications and effects. My primary examples are the criminal law and the randomized control trial. I argue that these institutions operate as framing devices: They attribute responsibility for HIV events and externalize other elements and effects in the process. Drawing on recent work in science and technology studies as well as queer theory, I set out an analytic frame that marks out a new role for HIV social research. Attentiveness to the performative effects of these devices is crucial, I suggest, if we want better to address the global HIV epidemic. (shrink)

Prior research has consistently established the pragmatic nature of literature regarding occupational injuries and accidental happenings faced by nursing professionals. However, current realities require a subjective approach to identify preventative measures that could influence occupational health and safety in healthcare sectors. A qualitative design followed a descriptive approach to assess unbiased opinions towards occupational obstructions that lead to accidental happenings. This study used the social capital framework in particular as a support resource to eliminate its detrimental effects on nurse's capacity (...) to serve their patients. The findings extended the fundamental understanding of social capital from social ties to workplace and personal ties as potential mechanisms of support. Healthcare organizations need to redefine their control policies to provide the ultimate support to their care agents. A social capital model offers nursing practitioners and nursing managers an approach for building evidence‐based policies with implications for nurse's safety, education and training. (shrink)

The current literature review is part of a project-based study exploring the perceptions of university students, scholars, and policymakers in Bulgaria on the issue of academic plagiarism. The paper focuses on plagiarism prevention. The review explores the issue of plagiarism in light of the psychological motivations behind the conscious act of the misconduct, outlining possible directions for minimizing the misconduct in academia in the areas of psychology, law and education separately and in combination. The current literature review considers the (...) misconduct of plagiarism as a universal phenomenon closely linked to the heuristics of human nature. The paper delves into the heuristics of human nature motivating the misconduct from personal, cultural, legal, and educational psychology perspectives, drawing general (universal) and specific (for the Bulgarian context) implications regarding culture and educational and legal policy. Creating, regulating and preserving an empathic, trauma-healing and value-oriented organisational environment in academia emerges as a positive point of convergence and synergy where psychology meets education, culture and the law. (shrink)

I defend a form of preventive detention through the creation of an offence of ‘being a persistent violent dangerous offender’. This differs from alternative proposals and actual habitual offender laws that impose extra periods of incarceration on offenders after they have completed the sentence for their most recent crime or as a result of a certain number of prior convictions. I, instead, would make ‘being a persistent violent dangerous offender’ an offence itself. Persons to be preventively detained would be tried (...) and convicted of this offence. My approach would then have one significant advantage: provided the elements of being a PVDO could be rendered sufficiently determinate, punishing persons under such an offence would comport with central rule of law values, most importantly legality and fair notice, as well as principles of proportionality in sentencing. (shrink)

More so than in the past, the US is now embracing the logic of preventive force: using military force to counter potential threats around the globe before they have fully materialized. While popular with individuals who seek to avoid too many “boots on the ground,” preventive force is controversial because of its potential for unnecessary collateral damage. Who decides what threats are ‘imminent’? Is there an international legal basis to kill or harm individuals who have a connection to that threat? (...) Do the benefits of preventive force justify the costs? And, perhaps most importantly, is the US setting a dangerous international precedent? In Preventive Force, editors Kerstin Fisk and Jennifer Ramos bring together legal scholars, political scientists, international relations scholars, and prominent defense specialists to examine these questions, whether in the context of full-scale preventive war or preventive drone strikes. In particular, the volume highlights preventive drones strikes, as they mark a complete transformation of how the US understands international norms regarding the use of force, and could potentially lead to a ‘slippery slope’ for the US and other nations in terms of engaging in preventive warfare as a matter of course. A comprehensive resource that speaks to the contours of preventive force as a security strategy as well as to the practical, legal, and ethical considerations of its implementation, Preventive Force is a useful guide for political scientists, international relations scholars, and policymakers who seek a thorough and current overview of this essential topic. (shrink)

In some jurisdictions, the institutions of criminal justice may subject individuals who have committed crimes to preventive detention. By this, I mean detention of criminal offenders (i) who have already been punished to (or beyond) the point that no further punishment can be justified on general deterrent, retributive, restitutory, communicative or other backwardlooking grounds, (ii) for preventive purposes—that is, for the purposes of preventing the detained individual from engaging in further criminal or otherwise socially costly conduct. Preventive detention, thus understood, (...) shares many features with the quarantine measures sometimes employed in the context of infectious disease control. Both interventions involve imposing (usually severe) constraints on freedom of movement and association. Both interventions are standardly undeserved: in quarantine, the detained individual deserves no detention (or so I will, for the moment, assume), and in preventive detention, the individual has already endured any detention that can be justified by reference to desert. Both interventions are, in contrast to civil commitment under mental health legislation, normally imposed on more-or-less fully autonomous individuals. And both interventions are intended to reduce the risk that the constrained individual poses to the public. Yet despite these similarities, preventive detention and quarantine have received rather different moral report cards. (shrink)

Driven by concern about the suffering of animals in nature, Christopher Belshaw (2016) argued that if we were exclusively concerned with these animals’ good, we should reduce the number of free-living animals. We should prevent free-living animals from coming into existence and, if this is not possible, we should painlessly end their lives as soon as we can. This holds, according to Belshaw, even if the future lives of these animals would contain much more enjoyment than suffering. Belshaw’s argument rests (...) on two premises. First, he assumes that death does not harm an animal in a way that matters. Second, he takes it that most free-living animals lead a life of uncompensated suffering because the enjoyments in an animal’s life, even if more predominant, cannot outweigh the animal’s suffering. Therefore, since uncompensated suffering exists in about every animal’s life and matters morally and killing the animal does not harm the animal in a way that matters, killing the animal is an appropriate intervention with the aim of preventing its suffering. This article criticizes both assumptions of Belshaw’s argument and shows that his conclusion is insufficiently supported. (shrink)

The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element of assistance (...) cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die. (shrink)

This article is about the recent and profound changes in the conceptualization of dementia, especially the turn towards prevention. The main argument is that more attention needs to be paid to “situated prevention” — the framing of internationally circulating data on the “new dementia” in different contexts. After introducing some of the more problematic issues related to the “new dementia,” a first comparison of major preventive clinical trials in Europe and in North America will be provided. The major (...) insight stemming from situating the global message of preventing dementia is recognition of the responsibility researchers and policy makers bear with respect to the implicit and potential moral narratives in emerging scientific landscapes. (shrink)

This interdisciplinary course, which included students from medicine, public health, law, and public policy, explored the concept of “prevention” and the role of law and public policy preventing disease and injury and improving population health. In addition to interdisciplinary course content, students worked in interdisciplinary teams on public health law and policy projects at community organizations and agencies.

Research and intervention involving primary prevention have grown dramatically in the past 10 years. However, little attention has been paid to ethical issues in primary prevention. This article proposes a framework for increasing awareness of such issues. The framework centers on explicating the contexts where prevention activities occur and the roles adopted by interventionists engaging in these activities. Several assumptions underlying primary prevention are stated, and ways of clarifying ethical issues are proposed.

This paper explores the rationale for violence and coercion aimed at preventing abortion conceived as the killing of an innocent person. Some important arguments for personhood at conception are examined, and in the light of the examination the paper considers whether they warrant concluding that a free and democratic society should pass laws recognizing personhood at conception. The wider concern is what principles such a society should use as a basis for legal coercion and what principles conscientious individuals should use (...) insofar as they judge that self-defense or, especially, protection of the innocent, requires violence. (shrink)

In the late 1960s, the Federal Bureau of Investigation (FBI), a United States of America (US) intelligence agency, developed what is famously known as Counter Intelligence Program (COINTELPRO). Its mission was to surveil, misinform, misdirect and subvert or destroy black ‘subversive’ militant groups. The main intention of COINTELPRO was to ‘prevent the rise of a messiah’ who could ‘unify, and electrify, the militant black nationalist movement’. This insight is important as it reveals how those outside of black life (FBI) would (...) invoke biblical language to define the possibility of revolution. This article through Black liberation theology seeks to present the idea of messianism as both an experience of Africans and oppressed peoples in the Global North and Global South. The idea of messianism is part of biblical reception in Africa and the African experience of colonialism. In South Africa, messianism would be observed from the perspective of African Christianity, while another form of messianism would be seen from Nat The Prophet Turner as well as the radical identity of Christ in Black liberation theology. The article will not take lightly the idea of surveillance of black militant groups in the same way as the priestly class surveillance Christ ministry. At the same time, the article would reflect on why lunacy is associated with those that seek to subvert oppression. This article seeks to discuss the role of messianism and militancy in Black or African Christianity and highlighting biblical reception and African affectivity. Contribution: This article explores the imaginative ways the Bible or its themes have been used by both the oppressor and the oppressed, often the latter using the Bible for its prerogative, namely, revolution and liberation. (shrink)

In 2004, the first ever multi‐sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre‐exposure prophylaxis—‘PrEP’). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and protocol. (...) While some of the disputes, especially those pertaining to community engagement mechanisms, were ultimately resolved in international fora and implemented in later PrEP trials, concerns over science rationales and assumptions were never addressed. We argue that scientific rationales should be treated as ethical concerns and suggest that such concerns should be deliberated at host sites before the trial protocol is finalized. (shrink)

What solutions can we find in the research literature for preventing sexual violence, and what psychological theories have guided these efforts? We gather all primary prevention efforts to reduce sexual violence from 1985 to 2018 and provide a bird’s-eye view of the literature. We first review predominant theoretical approaches to sexual-violence perpetration prevention by highlighting three interventions that exemplify the zeitgeist of primary prevention efforts at various points during this time period. We find a throughline in primary (...) prevention interventions: They aim to change attitudes, beliefs, and knowledge (i.e., ideas) to reduce sexual-violence perpetration and victimization. Our meta-analysis of these studies tests the efficacy of this approach directly and finds that although many interventions are successful at changing ideas, behavior change does not follow. There is little to no relationship between changing attitudes, beliefs, and knowledge and reducing victimization or perpetration. We also observe trends over time, including a shift from targeting a reduction in perpetration to targeting an increase in bystander intervention. We conclude by highlighting promising new strategies for measuring victimization and perpetration and calling for interventions that are informed by theories of behavior change and that center sexually violent behavior as the key outcome of interest. (shrink)

In this paper we discuss Ned Hall's critique of David Lewis's counterfactual theory of causation, in particular for its alleged inability to account for cases of double prevention. To do so, we focus on Pablo Melogno's response to Hall, where he claims that Hall's proposed tension between the concept of dependence and the locality thesis in cases of double prevention is the effect of the omission of essential details to complete the causal chain in the examples used by (...) Hall. Here we propose to take a further step in the defense of the counterfactual theory begun by Melogno, by reviewing the examples proposed by Hall, the modifications complexified by Melogno and the corollaries that follow from them, and proposing some relevant conceptual extensions to the ideas of the three authors. (shrink)

Does A cause B simply if A prevents what would have prevented B? Such a case is known as double prevention: where we have the prevention of a prevention. One theory of causation is that A causes B when B counterfactually depends on A and, as there is such a dependence, proponents of the view must rule that double prevention is causation.<br><br>However, if double prevention is causation, it means that causation can be an extrinsic matter, (...) that the cause and effect need not be connected by a continuous chain of events, that there can be causation by absence, and that there can be causation at a distance. All of these implications jar with strong intuitions we have about the nature of causation. There is, on the other hand, a theory of causation based on an ontology of real dispositions, where causation involves the passing around of powers. This theory in contrast entails that double prevention is not causation and, on this issue, it can claim a victory over the counterfactual dependence account. (shrink)

Preventive use of force may be defined as the initiation of military action in anticipation of harmful actions that are neither presently occurring nor imminent. This essay explores the permissibility of preventive war from a cosmopolitan normative perspective, one that recognizes the basic human rights of all persons, not just citizens of a particular country or countries. It argues that preventive war can only be justified if it is undertaken within an appropriate rule-governed, institutional framework that is designed to help (...) protect vulnerable countries against unjustified interventions while also avoiding unacceptable risks of the costs of inaction. The key to ensuring the fairness of rules governing the preventive use of force is accountability.This essay proposes a scheme that would make those promoting and those rejecting the preventive use of force more accountable. The proposal contains the following crucial features:States proposing preventive war are required to enter into a contract with a diverse body of states as a condition for authorization of their actions;Prior to taking preventive action, states must make an evidence-based case to the UN Security Council, and agree in advance to submit themselves to an evaluation by an impartial body after the preventive action occurred;Both proponents of action and those opposing it will be held accountable ex post for the accuracy of their prior statements and the proportionality of their actions;Sanctions will be imposed against intervening states or states that opposed preventive action, respectively, depending on the findings of the ex post evaluation.If preventive action were blocked in the Security Council, states seeking to engage in preventive action could then present their case in a different body–a coalition of democratic states–with its own ex post and ex ante accountability procedures. (shrink)

This article seeks to show that death prevents one’s life from being meaningful on balance. Proponents of what has come to be known as the ‘imperfection thesis’ about life’s meaning claim that it is sufficient for one’s life to be meaningful that one relates to only a non-maximal conceivable value. In many, if not all, contexts, holding the imperfection thesis appears to be the sole reason for supposing that death need not prevent one’s life from being meaningful. Counter to this, (...) it is argued that there is good reason to believe that the imperfection thesis is false, that arguments in favour of the imperfection thesis fail, and that attempts to show that the imperfection thesis can counter the arguments against it in a principled way are unsuccessful. Given this, it can be concluded that the imperfection thesis is false, and so there is no reason for supposing that death need not prevent one’s life from being meaningful. (shrink)

The adoption and reporting of CSR policies have important ethical and managerial implications that need scrutiny. This study answers the call of CSR scholars for further studies in controversial sectors by focusing on the voluntary reporting practices of companies that market products or services that generate addiction among consumers. It contributes to the debate on organizational legitimacy and corporate reporting by empirically analyzing whether and how corporations in the tobacco, alcohol and gambling industries disclose their CSR actions and what reactions (...) such disclosures generate in stakeholders. Drawing on legitimacy theory and organizational façades, we apply a consequent mixed-methods design (initiation approach) built on (i) a content analysis of reports prepared by a large set of companies listed on the European, British, US, Canadian, Australian and New Zealand stock exchanges and (ii) an experiment on how different actions taken by the companies (preventive vs. remedial) elicit different perceptions of company hypocrisy and action effectiveness. While previous analyses have focused on “sin” or “harm” industries, this is one of the first to assess how companies account for “addiction”, which is more difficult for them to report and legitimate due to long-term negative consequences. This study contributes to the literature on the instrumental use of CSR reporting by empirically investigating how addiction companies shape their organizational façades and manage organizational legitimacy through disclosure. Moreover, the experimental evidence advances the knowledge of how cognitive mechanisms influence stakeholders in terms of legitimacy assessment and the perceived hypocrisy/effectiveness of CSR disclosure. (shrink)

From the perspectives of Jewish tradition, particularly that of the Halakhah (Jewish law), this paper considers the policy problem of the balance in health care allocations between preventive and curative or crisis medicine. Since the value of human lives has a high degree of supremacy, and the duties to rescue imperiled life and to treat the sick are recognized, it might be argued that a basically curative policy should be favored. On the other hand, the duty of personal health maintenance (...) and safety would appear to argue in favor of a preventive policy. In balancing these considerations, it is suggested that the halakhic tradition can accommodate a preventive policy of health care because the duty to rescue is lessened or negatived by risk to the as-it-were rescuers. It is further suggested that Halakhah permits a non-divertable allocation of tax-generated funds to preventive health care. Keywords: Preventive medicine, curative medicine, value of human lives, duty to rescue, risk taking, Jewish law ( Halakhah ), charity tax CiteULike Connotea Del.icio.us What's this? (shrink)

As the ball flew towards us I leapt to my left to catch it. But it was you, reacting more rapidly than I, who caught the ball just in front of the point at which my hand was poised. Fortunate for us that you took the catch. The ball was headed on a course which, unimpeded, would have taken it through the glass window of a nearby building. Your catch prevented the window from being broken.