ABSTRACTThe Norwegian government implemented a comprehensive welfare reform in 2012 to better manage an increasingly care-demanding patient demography while meeting budgetary constraints. This article discusses interdiscursive relationships between policy strategies and language use among rehabilitation professionals. It is based on a synthesis of textual analyses of policy documents and of transcribed interviews to produce complex insights into current rehabilitation discourse. The synthetic product is expressed in the form of two nodal discourses which subsume and articulate in particular ways the constituent (...) discourses of the policies and interviews. One nodal discourse approaches rehabilitation as a clinical practice; the other concerns rehabilitation as a management practice. These discourses serve different purposes. One is based in traditional medical science as a means for political action and relates to the body as an object of government policies and practices. The other relies on the individual... (shrink)

Unhealthy lifestyle contributes significantly to the burden of disease. Scarce medical resources that could alternatively be spent on interventions to prevent or cure sufferings for which no one is to blame, are spent on prevention or treatment of disease that could be avoided through individual lifestyle changes. This may encourage policy makers and health care professionals to opt for a criterion of individual responsibility for medical suffering when setting priorities. The following article asks whether responsibility-based reasoning should be accepted as (...) relevant for fair and legitimate healthcare rationing. The luck-egalitarian argument that inequalities in health expectancies that derive from unchosen features of people’s circumstances are unjust and should be compensated, while inequalities that reflect personal choices of lifestyle may not, is discussed. It seems that while a backward-looking interpretation of individual responsibility cannot be relevant as a criterion of priority setting, a forward-looking conception of responsibility may be approved.Within all modern societies healthcare authorities are facing difficult priority setting problems. Various criteria for rationing medical intervention have been proposed due to scarcity of resources. Until now, individual responsibility for medical suffering has been given little attention in the public or in academic debate. This is about to change. As Alexander Cappelen and Ole Norheim have pointed out in a recent article in this journal, unhealthy lifestyle contributes increasingly to the burden of disease. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge.1 In this article the following question is addressed: should responsibility-based arguments be accepted as relevant to meeting healthcare rationing fairly and legitimately? I will argue that while a backward-looking conception of individual responsibility should not be endorsed, a forward-looking notion of responsibility may be approved. (shrink)

While a number of jurisdictions internationally prohibit insuring companies to be able to use genetic information in their risk classification, a voluntary code of practice permits insurers the limited use of predictive genetic test results in the UK. Jonathan Pugh1 offers a pluralist justice-based argument in support of the UK practice. Pugh’s position is developed to avoid what he sees as flaws with the current debate on insurers’ access to genetic information, including an alleged reliance on idealised assumptions about the (...) predictive power of genetic test results, revisionary implications for the provision of insurance suggested in the debate and failings of commentators to engage adequately with a conception of justice that undergirds the status quo approach in the UK. Pugh suggests that a quasi-libertarian approach to justice is implicit within the terms of the present Code and should be phrased as a principle of equity. Further, he argues that basic egalitarian and non-comparative concerns should be captured in broad principles: equal access and need. This leaves him with three principles that should be balanced in order to guide protection insurance policy. When the argument is applied to review …. (shrink)

Many countries have imposed strict regulations on the genetic information to which insurers have access. Commentators have warned against the emerging body of legislation for different reasons. This paper demonstrates that, when confronted with the argument that genetic information should be available to insurers for health insurance underwriting purposes, one should avoid appeals to rights of genetic privacy and genetic ignorance. The principle of equality of opportunity may nevertheless warrant restrictions. A choice-based account of this principle implies that it is (...) unfair to hold people responsible for the consequences of the genetic lottery, since we have no choice in selecting our genotype or the expression of it. However appealing, this view does not take us all the way to an adequate justification of inaccessibility of genetic information. A contractarian account, suggesting that health is a condition of opportunity and that healthcare is an essential good, seems more promising. I conclude that if or when predictive medical tests (such as genetic tests) are developed with significant actuarial value, individuals have less reason to accept as fair institutions that limit access to healthcare on the grounds of risk status. Given the assumption that a division of risk pools in accordance with a rough estimate of people's level of (genetic) risk will occur, fairness and justice favour universal health insurance based on solidarity. (shrink)

Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be responsible for their children’s obesity, and if so, whether parental responsibility ought to be addressed in the physician–patient/parent encounter. We illustrate how different ideal-typical models of the physician–patient/parent interaction emphasise different understandings of patient autonomy (...) and parental responsibility and argue that these models advocate different responses to an appeal for discussing parents’ role in childhood obesity. We suggest that responsibility should be attributed to parents because of their parental roles in providing for their children’s welfare. We also argue that whether, and how, this responsibility gives rise to a requirement to act depends on the parents’ capacities. A deliberative-oriented physician–patient/parent interaction best captures the current ideals of antipaternalism, patient autonomy, and shared and evidence-informed decision-making, and might facilitate parental role development. We conclude that, while not discussing parental responsibility for childhood obesity in the clinical setting can be warranted in particular cases, this cannot be justified as a general rule. (shrink)

Susi offers a novel non-coherence theory of digital human rights to explain the change in meaning and scope of human rights rules, principles, ideas and concepts, and the interrelationships and related actors, when moving from the physical domain into the online domain. The transposition into the digital reality can alter the meaning of well-established offline human rights to a wider or narrower extent, impacting core concepts such as transparency, legal certainty and foreseeability. Susi analyses the 'loss in transposition' of some (...) core features of the rights to privacy and freedom of expression. The non-coherence theory is used to explore key human rights theoretical concepts, such as the network society approach, the capabilities approach, transversality, and self-normativity, and it is also applied to e-state and artificial intelligence, challenging the idea of the sameness of rights. This title is part of the Flip it Open programme and may also be available Open Access. Check our website Cambridge Core for details. (shrink)

Schoolgirls writing short stories have surrendered themselves to some rules of a game, which, according to Ricoeur and Gadamer, delimits a field where everything ’is played’, and thereby, ’shatters the seriousness’ of ’the self-presence of a subject’. This article proposes that this field has a serious side of its own that reveals something true about the everyday reality of being a girl. The proposed worlds in the girls’ short stories are places from which research on women’s lives should begin is (...) a central argument, along with the contention that for the researcher to be able to take the seriousness of this playful writing into account, she also has to assume the position of a playful figure. The article suggests that the empirical data of schoolgirl writing invited the researcher to think Ricoeur and feminist epistemology together. Further, a suggestion is that the roles of reading given by the texts have consequences for a ’new’ process-oriented writing pedagogy and the teacher of writing as well. (shrink)

Abstract The role accorded to the public by scientists and philosophers of science has undergone an essential historical change in the last three centuries. Public participation in (witnessing of) scientific experiments was considered an important requirement for 17th century experimenters (e.g. for Boyle or Pascal). The cognitive role played by lay persons was later substantially downgraded; witnessing went out of fashion, while science became more and more esoteric and a matter for experts only. Part of this process was that all (...) scientific disciplines became intensively compartmentalized and in consequence a rather puzzling or even paradoxical situation appeared: that the scientists themselves were and are being reduced epistemically to the status of lay persons, outside of their proper field of expertise (as was pointed out by J. Hardwig). The paper deals with some cognitive aspects of this historical process. (shrink)

One of the many important tasks of semantics is to provide an account of the substitution patterns of a language—that is, to furnish an explanation of the conditions under which semantic values of complexes are preserved when components are replaced. The importance of this issue is plain: we only have to recall the debates regarding substitutivity between proponents of direct reference theories and advocates of some version of Fregeanism, as well as the disagreements among different proponents of direct reference theories (...) as regards substitutivity in belief reports. This is why it is important to articulate an acceptable principle of substitution. A traditional statement of the principle of substitution holds that codesignative singular terms should be intersubtitutable salva veritate. In the past I have argued that such a principle is not connected properly to some pretheoretical data about the function of referring terms. In this chapter I argue that such a principle does not gain support either from other, more fundamental, laws. I end by defending the adequacy of a different principle of substitution. (shrink)

Playtime in urban cities has become an indoor activity for children due to limited access to natural outdoor environments. This product of urbanization makes the case for the introduction of biophilic design. However, playrooms are often neglected as a possibility in designing a natural space indoors. Interior designers and other specialists lack a reliable tool to identify and incorporate biophilic features into the design of these indoor environments in urban settings. The Biophilic Interior Design Matrix (BID-M) developed by McGee and (...) Marshall-Baker quantifies 52 of Kellert’s biophilic design attributes to assess their presence and absence within interior spaces. We expanded its use by testing the matrix in a new type of space, urban playrooms, and coded images of 45 children’s playrooms within Manhattan residential buildings in New York City, including assessing a larger sample and reliability rate compared to McGee and Marshall-Baker’s research. Inter-rater reliability of the overall design matrix and individual matrix items was measured with percent agreement and free-marginal multirater kappa. Reliability testing showed overall good reliability of the overall design matrix. Several matrix items had low reliability between raters. Our findings show that the BID-M needs to be modified to better assess urban interior spaces for children. (shrink)

BackgroundThe idea that individuals are responsible for their health has been the focus of debate in the theoretical literature and in its concrete application to healthcare policy in many countries. Controversies persist regarding the form, substance and fairness of allocating health responsibility to the individual, particularly in universal, need-based healthcare systems.ObjectiveTo examine how personal health responsibility has been framed and rationalised in Norwegian key policy documents on priority setting.MethodsDocuments issued or published by the Ministry of Health and Care Services between (...) 1987 and 2018 were thematically analysed. We developed a predefined conceptual framework that guided the analysis. The framework included: the subject and object of responsibility, the level of conceptual abstraction, temporality, normative justificatory arguments and objections to the application of personal health responsibility.ResultsAs an additional criterion, personal health responsibility has been interpreted as relevant if: the patient’s harmful behaviour is repeated after receiving treatment, and if the success of the treatment is conditional on the patient’s behavioural change. When discussed as a retrospective criterion, considerations of reciprocal fairness have been dominant. When discussed as a prospective criterion, the expected benefit of treatment justified its relevance.ConclusionPersonal health responsibility appears to challenge core values of equality, inclusion and solidarity in the Norwegian context and has been repeatedly rejected as a necessary criterion for priority setting. However, the responsibility criterion seems to have some relevance in particular priority setting decisions. (shrink)

It is shown that in a linearly ordered MV-algebra A , the implication is unique if and only if the identity function is the unique De Morgan automorphism on A . Modulo categorical equivalence, our uniqueness criterion recalls Ohkuma's rigidness condition for totally ordered abelian groups. We also show that, if A is an Archimedean totally ordered MV-algebra, then each non-trivial De Morgan automorphism of the underlying involutive lattice of A yields a new implication on A , which is not (...) isomorphic to the original implication. (shrink)

Graphical AbstractThe finding that viruses with RNA and DNA genomes can recombine to produce chimeric entities provides valuable insights into the origin and evolution of viruses. It also substantiates the hypothesis that certain groups of DNA viruses could have emerged from plasmids via acquisition of capsid protein-coding genes from RNA viruses.

The debate on responsibility for health takes place within political philosophy and in policy setting. It is increasingly relevant in the context of rationing scarce resources as a substantial, and growing, proportion of diseases in high-income countries is attributable to lifestyle. Until now, empirical studies of medical professionals' attitudes towards personal responsibility for health as a component of prioritisation have been lacking. This paper explores to what extent Norwegian physicians find personal responsibility for health relevant in prioritisation and what type (...) of risk behaviour they consider relevant in such decisions. The proportion who agree that it should count varies from 17.1% to 26.9%. Higher age and being male is positively correlated with acceptance. The doctors are more willing to consider substance use in priority setting decisions than choices on food and exercise. The findings reveal that a sizeable proportion have beliefs that conflict with the norms stated in the Norwegian Patient Act. It may be possible that the implementation of legal regulations can be hindered by the opposing attitudes among doctors. A further debate on the role personal responsibility should play in priority setting seems warranted. However, given the deep controversies about the concept of health responsibility and its application, it would be wise to proceed with caution.Design Nationally representative cross-sectional study. Setting Panel-data. Participants 1072 respondents, response rate 65%. (shrink)

ABSTRACT The purpose of this paper is to examine critically Julian Savulescu's claim that people should select, of the possible children they could have, the one who is expected to have the best life, or at least as good a life as the others, based on the relevant, available genetic information, including information about non‐disease genes. I argue here that in defending this moral obligation, Savulescu has neglected several important issues such as access to selection technologies, disproportionate burdens on women, (...) difficulties in determining what is best, problems with aggregate effects of individual choices, and questions about social justice. Taking these matters into account would call such a moral requirement into serious question. (shrink)

Because of the important benefits that biomedical research offers to humans, some have argued that people have a general moral obligation to participate in research. Although the defense of such a putative moral duty has raised controversy, few scholars, on either side of the debate, have attended to the social context in which research takes place and where such an obligation will be discharged. By reflecting on the social context in which a presumed duty to participate in research will obtain, (...) this article shows that decontextualized discussions of this putative moral obligation are problematic. (shrink)

This article is concerned with the devaluation of the work of public intellectuals within the academic community. The principal reason given for this devaluation is that the work of the public intellectual does not have intellectual integrity as independent thought and original scholarship. I develop three models of public intellectual work: the permanent–critic model, the popularizer model, and the public–theorist model. I then consider each model in relation to the concern with intellectual integrity and conclude that both independent thought and (...) original scholarship are possible within work that is engaged with nonacademic publics. (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)