Hastings Center Report, Volume 52, Issue 2, Page 10-14, March‐April 2022.

Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases ’s 2015 Health Survey, this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes towards health responsibilities and individual (...) lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies. The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial. (shrink)

Artificial intelligence surveillance can be used to diagnose individual cases, track the spread of Covid‐19, and help provide care. The use of AI for surveillance purposes (such as detecting new Covid‐19 cases and gathering data from healthy and ill individuals) in a pandemic raises multiple concerns ranging from privacy to discrimination to access to care. Luckily, there exist several frameworks that can help guide stakeholders, especially physicians but also AI developers and public health officials, as they navigate these treacherous shoals. (...) While these frameworks were not explicitly designed for AI surveillance during a pandemic, they can be adapted to help address concerns regarding privacy, human rights, and due process and equality. In a time where the rapid implementation of all tools available is critical to ending a pandemic, physicians, public health officials, and technology companies should understand the criteria for the ethical implementation of AI surveillance. (shrink)

[1] Elul. Yamim Noraʼim. Sukot -- [2] Pesaḥ. Shevuʻot. Galut u-geʼulot. Ḥanukah. Purim.

There is a puzzle in the very notion of passive motivation ("passion" or "inclination"). To be motivated is not simply to be moved from the outside. Motivation is in some sense self-movement. But how can an agent be passive with respect to her own motivation? How is passive motivation possible? In this paper I defend the ancient view that inclination stems from a motivational source independent of reason, a motivational source that is both agential and nonrational.

Background This manuscript explores the pervasive issue of moral distress among nurses and its impact on their well-being and professional satisfaction. Focusing on diverse factors contributing to moral distress, the review spans various experience levels and patient care settings. Method Utilizing integrative reviews and sourcing from PubMed, CINAHL, SCOPUS, PsycINFO, and ProQuest, the study synthesizes findings from studies worldwide. The conceptual framework by Whittemore & Knafl is employed to comprehensively analyze nurses’ experiences. Results Key factors were identified as contributing to (...) moral distress, including concerns about care quality, team dynamics, and insufficient support. Interventions range from light-touch approaches like mentorship programs to resource-intensive strategies such as staff wellness initiatives. The impact of the COVID-19 pandemic on nurses’ moral distress is also explored. Conclusion Moral distress in nurses leads to burnout and, in some cases, prompts professionals to leave the field. The study emphasizes the need for organizational-level initiatives, support networks, and interventions to address moral distress. Identified gaps in the literature underscore opportunities for future research to better prepare clinicians and advance understanding across experience levels and settings. (shrink)

If you trained someone to emit a particular sound at the sight of something red, another at the sight of something yellow, and so on for other colors, still he would not yet be describing objects by their colors. Though he might be a help to us in giving a description. A description is a representation of a distribution in a space (in that of time, for instance).

Ethical considerations The study was conducted according to the principles of Declaration of Helsinki, and was approved by the Norwegian Social Science Data Services. Objective To describe patients’ experiences of staying in multiple- and single-bed rooms. Patients and methods This qualitative study employed a descriptive and exploratory approach, and systematic text condensation was used to analyze the material. Data were collected in a hospital trust in Norway. A total of 39 in-depth interviews were performed with patients discharged from the medical, (...) surgical, and maternity departments. Results Patients had ambiguous views on whether multiple-bed rooms or single-bed rooms were to be preferred. Main results include how patients cherished “the importance of others” but at the same time valued “the importance of privacy.” Being hospitalized in multiple-bed rooms was for many patients a very positive experience in terms of social interaction. Patients in single-bed rooms reported being more dependent on nurses to maintain social contact and obtain safety. Conclusion This research provides new knowledge on how the need for privacy can be in contradiction with the need for socializing with other patients. When hospitalized, the physical structure of a hospital impacts with whom patients interact and to what extent they depend on the nursing staff to have their social needs met. (shrink)

Volume 24, Issue 8, August 2024, Page 96-98.

In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car’s damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent (...) exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes. (shrink)

BackgroundPatients not attending their appointments without giving notice burden healthcare services. To reduce non-attendance rates, patient non-attendance fees have been introduced in various settings. Although some argue in narrow economic terms that behavioural change as a result of financial incentives is a voluntary transaction, charging patients for non-attendance remains controversial. This paper aims to investigate the controversies of implementing patient non-attendance fees.ObjectiveThe aim was to map out the arguments in the Norwegian public debate concerning the introduction and use of patient (...) non-attendance fees at public outpatient clinics.MethodsPublic consultation documents (2009–2021) were thematically analysed (n=84). We used a preconceived conceptual framework based on the works of Grant to guide the analysis.ResultsA broad range of arguments for and against patient non-attendance fees were identified, here referring to the acceptability of the fees’ purpose, the voluntariness of the responses, the effects on the individual character and institutional norms and the perceived fairness and comparative effectiveness of patient non-attendance fees. Whereas the aim of motivating patients to keep their appointments to avoid poor utilisation of resources and increased waiting times was widely supported, principled and practical arguments against patient non-attendance fees were raised.ConclusionA narrow economic understanding of incentives cannot capture the breadth of arguments for and against patient non-attendance fees. Policy makers may draw on this insight when implementing similar incentive schemes. The study may also contribute to the general debate on ethics and incentives. (shrink)

Feeling like doing something is not the same as deciding to do it. When you feel like doing something, you are still free to decide to do it or not. You are having an inclination to do it, but you are not thereby determined to do it. I call this the moment of drama. This book is about what you are faced with, in this moment. How should you relate to the inclinations you “have,” given that you are free to (...) “act on” them or not? To answer this question, we need an account of what sort of thing we are relating to, in this moment. But here we find a genuine philosophical problem. Our inclinations are forms of motivation, with respect to which we are distinctively passive. To be motivated is to be self-moved. But how can we be passive in relation to our own self-movement? Is our relation to our inclinations like that of rider to horse? Or is it like our relation to our own, spontaneous judgments or perceptions? I lay out three constraints on any theory of inclination, and I argue that familiar theories fail to meet them, because they make being inclined to φ‎ too similar or dissimilar to φ‎-ing. I then put forward the “inner animal” view, which holds that when you are merely inclined to act, the instinctive part of yourself is already active, while the rest of you is not. In this moment, your will is “at a crossroads.” You can humanize your inclination, or dehumanize yourself. (shrink)

Family accommodation refers to the attempt of family members to prevent their child’s distress related to psychopathology. Family accommodation can limit meaningful participation in personal and social routines and activities. Accommodation has been studied extensively in the context of childhood anxiety and has been linked to greater impairment, and poor intervention outcomes. Like anxiety, sensory over-responsivity symptoms are associated with heightened distress and thus, may also be accommodated by family members. The current study describes the validation of a new pediatric (...) family accommodation scale for SOR. Parents of 301 children ages 3–13 years completed an online survey, of which 48 had medical or developmental conditions. The survey included the Child Sensory Profile 2 and the newly developed family accommodation scale for sensory over-responsivity. Three Sensory Profile 2 scores were analyzed: SOR, sensory under-responsivity and sensory seeking. The FASENS consists of 18 items; 12 describing the frequency of accommodation behaviors and 6 describing the impact of the accommodation on the wellbeing of the family and the child. Results indicated that the FASENS has high internal consistency as well as a significant 3-factor confirmatory model fit: accommodations, family impact, and child impact. FASENS scores significantly correlated with SOR symptoms. However, they also correlated with under-responsivity and seeking. Parents of children with health conditions reported significantly higher FASENS scores, which corresponded with their child’s significantly higher sensory scores. Family accommodations for SOR occur to some extent in the general population, but their prevalence and impact are significantly greater when the child has a health condition, in addition to SOR. Additional research is needed to explore whether these accommodations are adaptive and whether families and children would benefit from learning to reduce them, as with anxiety. (shrink)

Discharges against medical advice (AMA) make up a significant number of hospital discharges in the United States, and often involve vulnerable patients who struggle to obtain adequate medical care. Unfortunately, much of the AMA discharge process focuses on absolving the medical center of liability for what happens to these patients once they leave the acute setting. Comparatively little attention is paid to the ethical obligations of the medical team once an informed decision to leave the acute care setting AMA has (...) been made. Via a case narrative, we offer an ethical framework that we believe can help guide an ethically defensible AMA discharge process. By emphasizing our duty to provide the best care possible under the circumstances, we contend, our ethical obligations to promote the patient's best interests can still be met despite their decision to leave the acute setting against medical advice. (shrink)

A task of any moral theory is to account for both the rigidity and the flexibility of moral rules. Utilitarianism faces the problem of building rigidity into a framework that tends towards objectionable flexibility. Kantianism faces the problem of building flexibility into a framework that tends towards objectionable rigidity. I offer an argument on this front on behalf of Kantians. I show how Kantians can maintain that actions are right and wrong "in themselves," while still maintaining that such actions can (...) be corrupted under certain "nonideal" circumstances. (shrink)

Sanchez and Sanchez have selected, edited, translated, and introduced some of the most influential texts in Mexican philosophy, which constitute a unique and robust tradition that will challenge and complicate traditional conceptions of philosophy. The texts collected here are organized chronologically and represent a period of Mexican thought and culture that emerged from the Mexican Revolution of 1910 and which culminated in la filosofia de lo mexicano (the philosophy of Mexicanness). Though the selections reflect on a variety of philosophical questions, (...) collectively they represent a growing tendency to take seriously the question of Mexican national identity as a philosophical question--especially given the complexities of Mexico's indigenous and European ancestries, a history of colonialism, and a growing dependency on foreign money and culture. More than an attempt to describe the national character, however, the texts gathered here represent an optimistic period in Mexican philosophy that aimed to affirm Mexican culture and philosophy as a valuable, if not urgent, contribution to universal culture. (shrink)

The central question in this book is why it seems reasonable for the words of our language to divide up the world in ordinary ways rather than other imaginable ways. Hirsch calls this the division problem. His book aims to bring this problem into sharp focus, to distinguish it from various related problems, and to consider the best prospects for solving it. In exploring various possible responses to the division problem, Hirsch examines series of "division principles" which purport to express (...) rational constraints on how our words ought to classify and individuate. The ensuing discussion deals with a wide range of metaphysical and epistemological topics, including projectibility and similarity, alternative analyses of natural properties and things, the inscrutability of reference, and the relevance of such pragmatic notions as salience and economy. The final chapters of the book develop what Hirsch contends is the most promising response to the division problem: a theory in which constraints on classification and individuation are seen to derive from the necessary structure of "fine-grained" propositions and the necessary dependence of some concepts on others. (shrink)

In this paper I defend Kant’s Incorporation Thesis, which holds that we must “incorporate” our incentives into our maxims if we are to act on them. I see this as a thesis about what is necessary for a human being to make the transition from ‘having a desire’ to ‘acting on it’. As such, I consider the widely held view that ‘having a desire’ involves being focused on the world, and not on ourselves or on the desire. I try to (...) show how this view is connected with a denial of any deep distinction between reason and inclination. I then argue for an alternative view of what ‘having a desire’ involves, one according to which it involves being focused both on the world and on ourselves. I show how this view fits naturally with the Kantian distinction between reason and inclination, accounts for independent intuitions about ‘having a desire’, and supports the Incorporation Thesis. I then make some further suggestions about how we might conceive of the object of incorporation. (shrink)

BackgroundAlthough patient advocates have developed templates for standard consent forms, evaluating patient preferences for first in human (FIH) and window of opportunity (Window) trial consent forms is critical due to their unique risks. FIH trials are the initial use of a novel compound in study participants. In contrast, Window trials give an investigational agent over a fixed duration to treatment naïve patients in the time between diagnosis and standard of care (SOC) surgery. Our goal was to determine the patient-preferred presentation (...) of important information in consent forms for these trials.MethodsThe study consisted of two phases: (1) analyses of oncology FIH and Window consents; (2) interviews of trial participants. FIH consent forms were analyzed for the location(s) of information stating that the study drug has not been tested in humans (FIH information); Window consents were analyzed for the location(s) of information stating the trial may delay SOC surgery (delay information). Participants were asked about their preferred placement of the information in their own trial’s consent form. The location of information in the consent forms was compared to the participants’ suggestions for placement. Results34 [17 FIH; 17 Window] of 42(81%) cancer patients approached participated. 25 consents [20 FIH; 5 Window] were analyzed. 19/20 FIH consent forms included FIH information, and 4/5 Window consent forms included delay information. 19/20(95%) FIH consent forms contained FIH information in the risks section 12/17(71%) patients preferred the same. Fourteen (82%) patients wanted FIH information in the purpose, but only 5(25%) consents mentioned it there. 9/17(53%) Window patients preferred delay information to be located early in the consent, before the “Risks” section. 3/5(60%) consents did this.ConclusionsDesigning consents that reflect patient preferences more accurately is essential for ethical informed consent; however, a one-size fits all approach will not accurately capture patient preferences. We found that preferences differed for FIH and Window trial consents, though for both, patients preferred key risk information early in the consent. Next steps include determining if FIH and Window consent templates improve understanding. (shrink)

Transhumanism is a sociopolitical and intellectual movement focused on the use of technology to transform humans and the human experience. Transhumanism promises that, through the use of physical and cognitive enhancements, humans will be able to achieve the “good life.” However, understandings of “enhancement” and “the good life” vary across time, place, and culture. Additionally, the biological modification/elimination of a specific characteristic may lead to not only loss the loss of that feature, but of a specific personal identity as well. (...) The potential consequences of transhumanist enhancement suggest both that they may constitute a newer form of eugenics and that they may lead to the production of new societal inequalities. (shrink)

In this paper I try to undermine complacency with a predominant conception of desire, for the sake of refocusing attention on a philosophical problem. The predominant conception holds that to have a desire is to occupy an evaluative outlook, a perspective from which the agent 'sees' the world in practically salient terms. I argue that it is not clear what this theory is a theory of, because the concept of desire at its center is deeply ambiguous. Understood as a theory (...) of desire in what I call the "placeholder" sense, the evaluative outlook theory is at bottom a theory of action explanation. So construed, its claim is relatively uncontroversial, and falls far short of being a full theory of action explanation. Understood as a theory of desire in what I call the "substantive" sense, it does not even go so far as to acknowledge the central problem such a theory has to answer. That problem is how we can be passive (in a particular sense) with respect to our own motivation. (shrink)

Representation and computation are the best tools we have for explaining intelligent behavior. In our program, we explore the space of representations present in the mind by constraining them to explain data at multiple levels of analysis, from behavioral patterns to neural activity. We argue that this integrated program assuages Brette's worries about the study of the neural code.

The utilitarian conception, which I call “action as production,” holds that action is a way of making use of the world, conceived as a causal mechanism. According to the rational intuitionist conception, which I call “action as assertion,” action is a way of acknowledging the value in the world, conceived as a realm of status. On the Kantian constructivist conception, which I call “action as participation,” action is a way of making the world, qua causal mechanism, come to count as (...) a realm of status. My rather limited aim in this paper is to identify three substantively different answers the question of how action relates an agent to the world, regarded as a context of action. (shrink)

In the work of both Matti Eklund and John Hawthorne there is an influential semantic argument for a maximally expansive ontology that is thought to undermine even modest forms of quantifier variance. The crucial premise of the argument holds that it is impossible for an ontologically "smaller" language to give a Tarskian semantics for an ontologically "bigger" language. After explaining the Eklund-Hawthorne argument (in section I), we show this crucial premise to be mistaken (in section II) by developing a Tarskian (...) semantics for a mereological universalist language within a mereological nihilist language (a case which we, and Eklund and Hawthorne, take as representative). After developing this semantics we step back (in section III) to discuss the philosophical motivations behind the Eklund- Hawthorne argument’s demand for a semantics. We ultimately conclude that quantifier variantists can meet any demand for a semantics that might reasonably be imposed upon them. (shrink)

Eli Alshanetsky considers how we make our thoughts clear to ourselves in the process of putting them into words and examines the paradox of those difficult cases where we do not already know what we are struggling to articulate.

Towards Justice and Virtue is Onora O’Neill’s most developed account thus far of her distinctive approach to moral and political philosophy. Readers who are already familiar with O’Neill’s articles and her two previous books will appreciate the way it brings together in one sustained and rigorous argument the various themes which have occupied her attention over the years. Those who are new to O’Neill’s work will find in it a lucid, accessible, and provocative challenge to contemporary ethical theories.

Adapting critical methods from such wide-ranging fields as anthropology, linguistics, philosophy, biology, and other sciences, Schapiro appraises fundamental semantic terms such as "organic style," "pictorial style", "field and vehicle," and "form and content"; he elucidates eclipsed intent in a well-known text by Freud on Leonardo da Vinci, in another by Heidegger on Vincent van Gogh.