Nursing research has commonly taken a problem‐based approach to research design seeking to ground research endeavour within the phenomena with which nursing is occupied. The aim of this paper is to explore an alternative of using philosophical imperative as a research driver, considering both the appropriateness and implications of this approach for nursing. Jamesian pragmatism, with its emphasis on plural, fluid ontology and evolving knowledge, aligns with nursing and is one philosophical imperative which has much to the profession. The paper (...) offers an exemplar of research into family members' experience of the diminishing drinking of a dying relative, which was undertaken within, and from, a pragmatic imperative. Research driven by philosophical imperative has consequences. The philosophical imperative will likely to be pervasive across the research, influencing research topic, conceptualisation, design, delivery and utilisation, bringing both advantages and constraints. (shrink)

AimsAlcohol consumption could lead to a series of health problems and social issues. In the current study, we investigated the resting-state functional brain networks of healthy volunteers before and after drinking through graph-theory analysis, aiming to ascertain the effects of acute alcohol intake on topology and information processing mode of the functional brain networks.Materials and methodsThirty-three healthy volunteers were enrolled in this experiment. Each volunteer accepted alcohol breathalyzer tests followed by resting-state magnetic resonance imaging at three time points: before (...) drinking, 0.5 h after drinking, and 1 h after drinking. The data obtained were grouped based on scanning time into control group, 0.5-h group and 1-h group, and post-drinking data were regrouped according to breath alcohol concentration (BrAC) into relative low BrAC group (A group; 0.5-h data, n = 17; 1-h data, n = 16) and relative high BrAC group (B group; 0.5-h data, n = 16; 1-h data, n = 17). The graph-theory approach was adopted to construct whole-brain functional networks and identify the differences of network topological properties among all the groups.ResultsThe network topology of most groups was altered after drinking, with the B group presenting the most alterations. For global network measures, B group exhibited increased global efficiency, Synchronization, and decreased local efficiency, clustering coefficient, normalized clustering coefficient, characteristic path length, normalized characteristic path length, as compared to control group. Regarding nodal network measures, nodal clustering coefficient and nodal local efficiency of some nodes were lower in B group than control group. These changes suggested that the network integration ability and synchrony improved, while the segregation ability diminished.ConclusionThis study revealed the effects of acute alcohol intake on the topology and information processing mode of resting-state functional brain networks, providing new perceptions and insights into the effects of alcohol on the brain. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 46, no. 2. © 2020 by Feminist Studies, Inc. 431 Cynthia Belmont and Angela Stroud Bugging Out: Apocalyptic Masculinity and Disaster Consumerism in Offgrid Magazine Popular conceptions of survivalism in the United States typically feature the eccentric, backwoods, working-class figures found in television shows such as Doomsday Preppers and Prepper Hillbillies. Offgrid magazine, which first hit the stands in the summer of 2013, however, sells a compellingly (...) bourgeois personal connection to disaster in the vein of men’s self-improvement literature, wherein successful masculinity requires courage, preparedness for calamity, and the resources to shop. Each issue of Offgrid focuses on a “real-life” survivalist or a singular catastrophic event that is dramatically represented on the cover by a self-sufficient man decked out in gear that will allow him to survive a crash landing, escape a city devastated by an earthquake, navigate the hazards of a hacker-created blackout, or evade the destruction of an erupting volcano.1 Filled with articles offering tips on how to prepare, self-defense strategies, profiles of survivalists, disaster scenarios, gear reviews, and advertisements, Offgrid mainstreams prepper culture by retooling the The authors contributed equally to this article; the order listed is alphabetical and should not be construed as implying differing contributions. 1. The terms “survivalist” and “prepper” apply to anyone committed to honing the skills and acquiring the resources required to survive in any context, including disasters, and are used interchangeably in Offgrid. 432 Cynthia Belmont and Angela Stroud face of apocalyptic survival as a regular-guy protagonist whose low-profile normalcy disguises the smoldering heroic potential that will ignite within him when disaster strikes. In this article, drawing upon insights from the sociology of masculinity, environmental feminism, and ecocriticism, we examine the representation of gender, nature, and disaster in issues of Offgrid, spanning nearly three years, from June 2015 through February 2018. While vivid depictions of cataclysm might seem provocative enough to captivate the Offgrid reader, we argue that its principal appeal is that it gives its ninety -one-percent male audience the opportunity to engage directly in what Casey Kelly terms “apocalyptic manhood,” an emergent version of American masculinity that “confirm[s] the necessity of masculine skills as society meets its demise.”2 Thus, Offgrid provides an occasion for readers to salvage a masculinity that feels perpetually threatened within contemporary American culture—a highly effective strategy in promoting the expansion of what we term disaster consumerism. We concur with ecofeminist Greta Gaard’s contention that “masculine gender identity has been constructed as so very antiecological, and thus its interrogation and transformation seem especially crucial” at this time of environmental crisis; this concern resonates particularly poignantly with regard to the apocalyptic imaginary.3 Marketing Disaster, Selling Masculinity Scholars have long argued that commercial media play an important role in circulating gender ideals that are “rooted in consumer capitalism wherein profit can be produced by generating insecurity about one’s body and one’s consumer choices.”4 Of course, despite their influence, advertisers do not create insecurities out of whole cloth; rather, they operate within the context of shifting gender discourses and cultural anxieties. Whereas the authors of a 2005 study found that alcohol ads portrayed men as affable losers who, rejected by strong women, 2. “2018 Recoil Offgrid Media Kit,” Recoil Offgrid; Casey Ryan Kelly, “The Man-pocalypse: Doomsday Preppers and the Rituals of Apocalyptic Manhood,” Text and Performance Quarterly 36, no. 2–3 (2016): 96. 3. Greta Gaard, Critical Ecofeminism (New York: Lexington Books, 2017), 167 (italics in original). 4. Susan M. Alexander, “Stylish Hard Bodies: Branded Masculinity in Men’s Health Magazine,” Sociological Perspectives 46, no. 4 (2003): 551. Cynthia Belmont and Angela Stroud 433 were driven to drink with their buddies, an analysis of Super Bowl commercials just five years later demonstrated that the tone had become “a simpler, angrier one [that was] crafted to galvanize men to buy.”5 The authors of the latter study suggest that the masculine aggression in the ads they analyzed reflects men’s economic insecurities, which advertisers exploit by encouraging men to feel nostalgic for and frustrated about their diminished power. Ads telling men to “wear the pants” and take a stand... (shrink)

This paper questions the ethicality of commercial relationships between universities and external donors. By examining cases such as technology transfer and the outside funding of research interests, we identify possible conflicts of interest between the external provider of financial support and academic institutions. The reality today is that university administrators, who have significant decision-making powers, proactively seek large corporate sources of funding that may compromise academic values including academic freedom and the ability to make institutional decisions without the influence of (...) commercial interests. For example, Coca-Cola and Pepsi-Cola have provided extensive funding to universities in return for exclusivity rights to market their product on campuses even though such products may not be healthy alternatives to other soft drinks. Pharmaceutical and biotechnology companies may have opposing interests to faculty and universities if the results of research do not meet the expectations of the sponsors. Curricula issues may be slanted to promote the interests of a corporation or other provider of outside funding. Corporate partnerships between universities and companies such as Nike raise ethical questions when students or other members of the campus community object to the acceptance of financial support from a company that allegedly practices anti-social labor practices in developing countries. On the other hand, corporate funding can be used to supplement diminishing financial resources available to academic institutions, especially for public universities. One benefit of external funding is that it supports pharmaceutical and technology-oriented research and development into new products and processes that have the potential to serve the public good. One cost of such funding arrangements is that the acceptance of financial support from commercial interests solely to market their products on campus restricts the choices available to students that should exist in a free market economy such as in the U.S. The ethicality of the relationship between universities and commercial interests is a matter of concern because of the potential influence of providers of external funds to universities that can compromise academic freedom and objective decision making. (shrink)

This good-humoured book offers an antidote to the pretentious clap-trap that is written about wine today and a profound apology for the drink on which..

This study explored how social representations of food and health fit into the development of masculinities. In what ways does the transition into Higher Education impact on students’ eating and drinking behaviours? And where do representations of food and health fit into the development of masculinities? A total of thirty-five students from two separate higher education establishments in Ireland took part. Fourteen semi-structured individual interviews (7 males, 7 females) and four focus groups (6 males in one, 5 males in (...) two and 6 females in another) were conducted. A thematic analysis indicated that increasing unhealthy behaviour among young people is not just about their disinclination to engage with an active comprehension of the implications of their behaviour for their future. Rather, their choice of food and drink, and the quantity of alcohol they consume has more to do with attaining and maintaining their gendered identities within a community of students. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Drinking Rules! Byron and BaudelaireJoshua Wilner (bio)This essay 1 takes up two nineteenth-century texts on the theme of intoxication in which the poetic word can no longer, if it ever could, stably figure itself as the metaphoric other of the drug, that is, as a legitimate means of imaginative transport, and in which the writer’s enthrallment by the transporting substance of words shows us its addictive and, one (...) might say, prosaic face.The first of these pieces is a pair of stanzas from Canto II of Byron’s Don Juan, the other, Baudelaire’s brief prose poem “Enivrez-vous,” pieces that Jean Pommier [341] and, following Pommier, Robert Kopp [314–15] have suggested may be connected, though neither reader enters into much more detail than to note that both bits of writing, in Kopp’s words, “chant[e] l’ivresse.” Now the praise of drunkenness is of course a poetic commonplace, and the mere fact of its appearance in these two bits of text argues about as intimate a bond of kinship as that involved in pointing out that you and I are both Noah’s children. But there are, I would argue, compelling reasons for looking at these pieces in relation to one another and to which I believe Pommier was responding.That Byron mattered to Baudelaire is attested to by a number of references scattered throughout the latter’s work and letters, references which, while faulting Byron for garrulousness, praise him for having the thing that makes poets: “une diabolique personnalité” [OC 2: 232]. Perhaps the most interesting of these references occurs in a well-known letter that Baudelaire wrote to his mother in July 1857, shortly after Les fleurs du mal had been published and while the storm of controversy that was to culminate in the prosecution and expurgation of the collection for obscenity was rapidly gathering:On me refuse tout, l’esprit d’invention et même la connaissance de la langue française. Je me moque de tous ces imbéciles, et je sais que ce volume, avec ses qualités et ses défauts, fera son chemin dans la mémoire du public lettré, à côté des meilleurs poésies de V. Hugo, de Th. Gautier et même de Byron.[CP 1: 411][They deny me everything, the spirit of invention and even knowledge of the French language. I could care less about all these imbeciles, and I know that this volume, with its qualities and its faults, will make its way in the memory of the [End Page 34] lettered public, along with the best poetry of V. Hugo, of Th. Gautier, and even of Byron.]The pride of place Baudelaire reserves for Byron in this list was somewhat dated even in its time 2 and odd in other ways, especially given the more qualified expressions of admiration we meet elsewhere in his writings. But it becomes more understandable if one considers that for Baudelaire’s mother, who was of Byron’s generation and had early ties to England 3 (in fact, she apparently taught Charles English during his childhood [E. Crépet 30], making it, strangely enough, part of his “mother tongue”), Byron’s would have been the emblematic case of a writer for whom a reputation for depravity was overtaken by poetic honor, perhaps at the cost of his death in a noble cause.Apart from this evidence of a felt affinity, there are specific formal grounds for associating the two pieces. Since they are fairly brief, allow me first of all to cite them both. Here are the stanzas from Canto II of Don Juan: 179 Man, being reasonable, must get drunk; The best of life is but intoxication: Glory, the grape, love, gold, in these are sunk The hopes of all men, and of every nation; Without their sap, how branchless were the trunk Of life’s strange tree, so fruitful on occasion! But to return, - Get very drunk; and when You wake with head-ache, you shall see what then. 180 Ring for your valet - bid him quickly bring Some hock and soda-water, then you’ll know A pleasure worthy Xerxes the... (shrink)

This essay examines the multifaceted roles of drinking parties in early Greece and in medieval China. It takes as paradigm examples descriptions of ritual intoxication in Plato’s Laws and in the poetry of Ouyang Xiu and Mei Yaochen, arguing that these divergent cultural and philosophical traditions can be both related and made distinct through concepts of pleasure, creativity, and social harmony.

We argue that the occurrence of puritanical norms cannot simply be explained by appealing to the need for cooperation. Anthropological and archaeological studies suggest that across history and cultures self-indulgent behaviours, such as excessive drinking, eating, and feasting, have been used to enhance cooperation by enforcing social and group identities.

Drinking water quality has drawn enormous attention from scientific communities, the industrial sector, and the common public in several countries during the last couple of decades. The scholarship in science and technology studies somehow overlooked this crucial domain. This article attempts to contribute to this gray area by exploring how drinking water quality is understood in Indian water policies, laws, and courtrooms. The article argues that water policies and laws in India were significantly shaped by international treaties and (...) global environmental stewardship. In the courtrooms, the Indian judiciary employed minimum science-based evidence in decision making in the context of drinking water–related cases; rather they used a rights-based approach and minimally engaged with the issue of drinking water quality/standards. Whatever little science used as valid science by the judges in the decision making was entirely expert-based. The reliance of the judges on the scientific expertise of the experts representing regulatory organizations and public institutions was another unique characteristic of the relationship between science and law in India. (shrink)

Thomas Hurka has recently proposed a utilitarian theory which would effect a compromise between Average and Total utilitarianism, the better to deal with issues in population ethics. This Compromise theory would incorporate the principle that the value which an extra happy person contributes to a possible world is a decreasing function of the total population of that world: that happy people are of diminishing marginal value. In spite of its initial plausibility I argue against this principle. I show that (...) the Compromise theory is actually no improvement over the two original versions of utilitarianism; in particular, it is subject to almost all the objections which are fatal to Average utilitarianism, and more besides. And I attempt to dispell the appearance that intuition supports the Compromise theory as against Total utilitarianism, by arguing that the latter's Repugnant Conclusion, when properly understood, is not intuitively unacceptable. Total utilitarianism remains a plausible ethical theory, while both the Average and the Compromise theories should be definitely rejected. (shrink)

In my (2004), I argued that it is possible to drink any finite amount of alcohol without ever suffering a hangover by completing a certain kind of supertask. Assume that a drink causes drunkenness to ensue immediately and to last for a period proportional to the quantity of alcohol consumed; that a hangover begins immediately at the time the drunkenness ends and lasts for the same length of time as the drunkenness; and that at any time during which you are (...) drunk you do not suffer any hangover you might have at that time. Starting at a time at which you are not drunk and not hung over, drink a half pint of beer. Wait until you are just about to get a hangover (30 minutes, say), and then drink a quarter pint. Wait until you are just about to get a hangover again, and then drink an eighth, and so on.... After an hour you have drunk a pint, and you do not have a hangover. Every hangover you incurred happened within the hour you spent drinking; but you were drunk that whole time, so you didn’t suffer the hangovers. It seems that the old drunkard’s method of a “hair of the dog” can be effective in completely avoiding a hangover. (shrink)

In the coming decades, highly treated wastewater, known as reclaimed water, is slated to be a major element of municipal water supplies. In particular, planners propose supplementing drinking water with reclaimed water as a sustainable solution to the growing challenge of urban water scarcity. Public opposition is currently considered the primary barrier to implementing successful potable water reuse projects; nonetheless, public responses to reclaimed water are not well understood. Based on a survey of over 250 residents of Tucson, Arizona, (...) this article assesses the relationship between trust in the professional institutions responsible for municipal water development and willingness to drink reclaimed water. Results demonstrate that public acceptance of potable reuse is contingent on trust in the authorities who influence design of sociotechnical systems for water supply and reuse—including water and wastewater utilities, regulators, consultants, academics, and elected local officials. Findings emphasize the highly interdependent social and political factors that inform personal decisions to support or reject potable reuse. The authors suggest that achieving greater acceptance of potable reuse will require bringing local and regional water policy in line with public values, as well as finding ways to incorporate these values into the planning process. (shrink)

Geoffrey Sayre-McCord puts before us an interesting and original line of thought. Here is its main structure: Naturalist semantics would bring important benefits to ethics. But it has very high costs. Fortunately, we can secure such benefits without the costs, by substituting, for the natural kinds of naturalist semantics, a set of moral kinds determined not by scientific but by moral theory. I find myself stumped by the preliminaries at , however, which need further support, or so I will argue (...) in section I. Section II will assume that the concerns of section I can be met, and will discuss the rest of the argument independently of that. (shrink)

The fallacy of diminished responsibility (DR), a variant of the fallacy of accident, is common enough to warrant being treated on its own. The fallacy of DR occurs when a principle that could be applicable as a positive defense in common law trials is applied in cases that are typically excluded from the scope of the principle. Whether the fallacy of DR is committed or not depends on the context in which the claim for DR is made. If the factor (...) that is offered as diminishing one's (moral) responsibility is something that results from a voluntary choice, then the claim is fallacious. In terms of avoiding the fallacy, there are some instances where an individual's moral (or legal) responsibility can be diminished due to factors beyond the individual's control. However, in none of these instances is the causal responsibility diminished. (shrink)

The 18th century philosopher and Anglican bishop, George Berkeley, is chiefly known to posterity for advocating the radical thesis that there is no unthinking stuff in the world. According to Berkeley, bar stools, kegs, mugs and the all paraphernalia of ordinary life (plus everything else) are merely ideas and have no existence outside the mind of those seated on the stools, tapping the kegs, and drinking from the mugs. What is less well-known is that Berkeley devoted much of his (...) energy in later life to promoting the use of a concoction he called tar-water for the treatment of a wide variety of health ailments. Fortunately, Berkeley thought that many of the same virtues were found in some beers. It may seem paradoxical that one and the same man could both claim that beer only exists as an idea in the minds of those consuming it and that it could cure all known afflictions. Berkeley's resolution of this paradox will be explored and it will be seen that it is possible to both appreciate and benefit from beer even if it is only an idea. (shrink)

This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician–patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that (...) are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients—in this case, pregnant women—become what I call “epistemic peers.”. (shrink)

The alarming rise in heavy drinking on college campuses has resulted in a new federal law allowing colleges to notify parents of infractions of alcohol related laws and policies. Before mandating such notifications a college should remember its “nurturing role” vis-a-vis students. Since no proffered reason is strong enough to justify mandatory notification, colleges should engage only in selective notification based on carefully established criteria. Finally, since “binge drinking” is the major new factor within the larger problem of (...) heavy drinking, efforts should be made at the legislative level to lower the legal age to eighteen. This change will lead to more responsible drinking on the part of students. (shrink)

Simonet, Emanuel Nicolas Cortes The widespread over-consumption of alcohol in Australia has shaped its high tolerance to drinking culture. Australia has a complex socio-cultural relationship with alcohol and it is challenging to reduce high alcohol intake when it is so ingrained in our society. The substantial harms associated with over-consumption not only affect the drinker, but also impact upon the wider community. This article discusses the available evidence about the health and social harms for individuals that may result from (...) an over-consumption of alcohol and how these impact on society. More so, it discusses how effective alcohol policy strategies such as decreasing the availability of alcohol, increasing its price as well as promoting public awareness of the associated risks may help to reduce these harms. (shrink)

The conventional approach to developing disease‐modifying treatments for neurodegenerative conditions has been to identify drivers of pathology and inhibit such pathways. Here we discuss the possibility that the efficacy of such approaches may be increasingly attenuated as disease progresses. This is based on experiments using mouse models of spinocerebellar ataxia type 1 and Huntington's disease (HD), where expression of the dominantly acting mutations could be switched off, as well as studies in human HD, which suggest that the primary genetic driver (...) of age‐of‐onset of disease is a much weaker determinant of disease progression in affected individuals. The idea that one may approach a point in the disease course where such rational therapeutic strategies based on targets which determine onset of disease have minimal efficacy, suggests that one needs to consider other approaches to therapies and clinical trial design, including initiation of therapies in presymptomatic individuals. (shrink)

The article argues that in the Symposium, but also the Phaedrus and the Protagoras, Plato instructs us on the correct way of engaging in discourse by adducing examples from the activities of drinking and singing (/performing poetry). By presenting Socrates as grappling with the use of wine, rhetoric and poetry, almost failing at times, but always able to recollect himself and identify the faults in his methods (as well as of others), Plato recognizes the difficulties of the process, while (...) acknowledging Socrates’ extraordinary intellect. (shrink)

In this paper, I discuss whether it is ever morally permissible to diminish the cognitive abilities or capacities of some cognitively gifted offenders whose ability to commit their crimes successfully relies on them possessing these abilities or capacities. I suggest that, given such cognitive diminishments may prevent such offenders from re-offending and causing others considerable harm, this provides us with at least one good moral reason in favour of employing them. After setting out more clearly what cognitive diminishment may consist (...) of, I then critically discuss variations of four plausible arguments against a proposal of using them on cognitive gifted offenders related to autonomy, harm, narrative identity, and a right to mental self-determination. I argue that none of these concerns should have us reject the use of cognitive diminishments. (shrink)

In this paper I analyze Kant’s ideas about eating and drinking. First, I show that gluttony and drunkenness are considered ways to oppose to the duty to oneself as an animal being. Second, I claim that for Kant there is a healthy way of having meals, which consists in eating together with friends. Then I indicate that Kant accepts that one can drink at dinner parties but has to avoid drinks that lead to drunkenness and unsocial behavior. In this (...) sense, he draws a classification of the various kinds of alcoholic drinks, according to their potential harm. Afterwards, I illustrate how Kant’s own intimate life was a daily practice of his thoughts on dietetic conceptions and on what is better for digestion and health. To conclude, I mention the idea of a philosopher’s medicine of the body and why a strict diet should be avoided. (shrink)

Some theories of language, thought, and experience require their adherents to say unpalatable things about human individuals whose capacities for rational activity are seriously diminished. Donald Davidson, for example, takes the interdependence of the concepts of thought and language to entail that thoughts may only be attributed to an individual who is an interpreter of others’ speech. And John McDowell's account of human experience as the involuntary exercise of conceptual capacities can be applied easily only to individuals who make some (...) reasonable judgments, because conceptual capacities are paradigmatically exercised in judgments. In both cases, we seem forced towards an error theory about any ordinary understanding of impaired human individuals as minded, or as undergoing human experience. (shrink)

This article reviews the extent to which illegal and abusive alcohol consumption on college campuses negatively affects students and campus communities, outlines strategies for dealing with heavy student use of alcohol, reviews how federal law now permits colleges and universities to notify parents when students are found responsible for illegal alcohol use, and presents the arguments for and against parental notification.

The Architecture of the Mind is itself built on foundations that deserve probing. In this brief commentary I focus on these foundations—Carruthers’ conception of modularity, his arguments for thinking that the mind is massively modular in structure, and his view of human cognitive architecture.

A growing body of theory has focused on privacy as being contextually defined, where individuals have highly particularized judgments about the appropriateness of what, why, how, and to whom information flows within a specific context. Such a social contract understanding of privacy could produce more practical guidance for organizations and managers who have employees, users, and future customers all with possibly different conceptions of privacy across contexts. However, this theoretical suggestion, while intuitively appealing, has not been empirically examined. This study (...) validates a social contract approach to privacy by examining whether and how privacy norms vary across communities and contractors. The findings from this theoretical examination support the use of contractual business ethics to understand privacy in research and in practice. As predicted, insiders to a community had significantly different understandings of privacy norms as compared to outsiders. In addition, all respondents held different privacy norms across hypothetical contexts, thereby suggesting privacy norms are contextually understood within a particular community of individuals. The findings support two conclusions. First, individuals hold different privacy norms without necessarily having diminished expectations of privacy. Individuals differed on the factors they considered important in calculating privacy expectations, yet all groups had robust privacy expectations across contexts. Second, outsiders have difficulty in understanding the privacy norms of a particular community. For managers and scholars, this renders privacy expectations more difficult to identify at a distance or in deductive research. The findings speak directly to the needs of organizations to manage a diverse set of privacy issues across stakeholder groups. (shrink)

BackgroundSome people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical (...) interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team.MethodsA three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process?ResultsDecision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: Risks, burdens and benefits; Treatment goals; Normative ethical values; Interested parties.ConclusionsDecision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of ‘who decides’ cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum. (shrink)

In this paper, we analyse the recent rapid growth of ‘binge’ drinking in the UK. This means the rapid consumption of large amounts of alcohol, especially by young people, leading to serious anti-social and criminal behaviour in urban centres. British soccer fans have often exhibited this kind of behaviour abroad, but it has become widespread amongst young people within Britain itself. Vomiting, collapsing in the street, shouting and chanting loudly, intimidating passers-by and fighting are now regular night-time features of (...) many British towns and cities. A particularly disturbing aspect is the huge rise in drunken and anti-social behaviour amongst young females. Increasingly, policy makers in the West are concerned about how not just to regulate but to alter social behaviour. Smoking and obesity are obvious examples, and in the UK ‘binge’ drinking has become a focus of acute policy concern. We show how a simple agent based model approach, combined with a limited amount of easily acquired information, can provide useful insights for policy makers in the context of behavioural regulation. We show that the hypothesis that the rise in binge drinking is a fashion-related phenomenon, with imitative behaviour spreading across social networks, is sufficient to account for the empirically observed patterns of binge drinking behaviour. The results show that a small world network, rather than a scale-free or random one, offers the best description of the data. (shrink)

The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive (...) justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people's relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed. (shrink)

Medicine is still largely a pre-Darwin, pre-Newton enterprise…. We do not yet understand the underlying mechanisms of the major illnesses which plague humanity, and therefore much of what is done in the treatment of illness must still be empirical, trial and error therapy. We are compelled by our limitations to resort to shoring things up, applying halfway technology, trying to fix things after the fact.