BackgroundAs the range of therapeutic options in the field of oncology increases, so too does the strain on health care budgets. The imbalance between what is medically possible and financially feasible is frequently rendered as an issue of tragic choices, giving rise to public controversies around health care rationing.Main bodyWe analyse the Norwegian media discourse on expensive cancer drugs and identify four underlying premises: (1) Cancer drugs are de facto expensive, and one does not and should not question why. (2) (...) Cancer drugs have an indubitable efficacy. (3) Any lifetime gained for a cancer patient is an absolute good, and (4) cancer patients and doctors own the truth about cancer. Applying a principle-based approach, we argue that these premises should be challenged on moral grounds. Within the Norwegian public discourse, however, the premises largely remain unchallenged due to what we find to be unjustified claims of moral superiority. We therefore explore alternative framings of the issue of expensive cancer drugs and discuss their potential to escape the predicament of tragic choices.ConclusionsIn a media discourse that has seemingly stagnated, awareness of the framings within it is necessary in order to challenge the current tragic choices predicament the discourse finds itself in. In order to allow for a discourse not solely concerned with the issue of tragic choices, the premises that underlie it must be subjected to critical examination. As the field of oncology advances rapidly, we depend on a discussion of its opportunities and challenges that is meaningful, and that soberly addresses the future of cancer care—both its potential and its limits. (shrink)

There is limited consensus about what constitutes humanly sensitive care, or how it can be sustained in care settings. A new humanised care assessment tool may point to caring practices that are up to the task of meeting persons as humans within busy healthcare environments. This paper describes qualitative development of a tool that is conceptually sensitive to human dimensions of care informed by a life‐world philosophical orientation. Items were generated to reflect eight theoretical dimensions that constitute what makes care (...) feel humanly focused. An action research group process in 2014–2015 with researchers, service users, healthcare professionals in two diverse clinical settings (stroke rehabilitation and dermatology) was used. Feedback on conceptual content, transparency of meaning and readability was then gained from a panel in Sweden and third‐year student nurses in the UK. The tool can be applied to attune staff to human dimensions of care, offering items which point to concrete examples of humanising and dehumanising features of practice in ways that have not yet been fully captured in the caring literature. Based on theoretically led experiential items, with dedicated focus on what makes people feel more, or less than human, it may offer improvement on available assessments of care. (shrink)

Dans ce court livre, alerte et élégant, Caroline Ford poursuit sous l’angle du genre une interrogation concernant les rapports entre religion et politique en France. Deux thématiques traversent les cinq chapitres que propose l’historienne : l’impact de la féminisation du catholicisme sur le statut civil et social des femmes et la façon dont les débats concernant cette féminisation vont contribuer à la formation d’un discours politique laïc au sein du républicanisme français. Elle précise dans...

It is a commonplace to observe that we have been living through an extraordinary pan-European and trans-Atlantic populist moment. But do the heterogeneous phenomena lumped under the rubric “populist” in fact belong together? Or is “populism” just a journalistic cliché and political epithet? In the first part of the article, I defend the use of “populism” as an analytic category and the characterization of the last few years as a “populist moment,” and I propose an account of populism as a (...) discursive and stylistic repertoire. In the second part, I specify the structural trends and the conjunctural convergence of a series of crises that jointly explain the clustering in space and time that constitutes the populist moment. The question in my title is thus twofold: it is a question about populism as a term or concept and a question about populism as a phenomenon in the world. The article addresses both the conceptual and the explanatory question, limiting the scope of the explanatory argument to the pan-European and trans-Atlantic populist conjuncture of the last few years. (shrink)

Populist protests against Coronavirus-related restrictions in the US appear paradoxical in three respects. Populism is generally hostile to expertise, yet it has flourished at a moment when expertise has seemed more indispensable than ever. Populism thrives on crisis and indeed often depends on fabricating a sense of crisis, yet it has accused mainstream politicians and media of overblowing and even inventing the Corona crisis. Populism, finally, is ordinarily protectionist, yet it has turned anti-protectionist during the pandemic and challenged the allegedly (...) overprotective restrictions of the nanny-state. I address each apparent paradox in turn before speculating in conclusion about how populist distrust of expertise, antipathy to government regulation, and skepticism toward elite overprotectiveness may come together – in the context of intersecting medical, economic, political, and epistemic crises – in a potent and potentially dangerous mix. (shrink)

An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change—both are common pool resource challenges that require massive, long-term political commitments—the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for (...) AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support. (shrink)

Digital hyperconnectivity is a defining fact of our time. In addition to recasting social interaction, culture, economics, and politics, it has profoundly transformed the self. It has created new ways of being and constructing a self, but also new ways of being constructed as a self from the outside, new ways of being configured, represented, and governed as a self by sociotechnical systems. Rather than analyze theories of the self, I focus on practices of the self, using this expression in (...) a looser, more general sense than that used by Foucault. I begin by considering and reformulating two early lines of argument about the web as a medium for exploring and emancipating the self. Subsequent sections show how digital hyperconnectivity has engendered new ways of objectifying, quantifying, producing, and regulating the self—considered both as active, reflexive practices and as systemic, data- and algorithm-driven processes. I conclude by reflecting on the broader implications of contemporary modes of governing the self and by underscoring the ways in which hyperconnectivity has colonized the territories of the self, conscripting the self into the service of techno-social systems. (shrink)

Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and (...) several strategies for achieving these goals using existing “legal hooks” that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR. (shrink)

If within the borders of human life the truth is, as Vico has said, what is made, then the task of a student of human life can be and should be to find out from what human beings have made what manner of makers they are and what sorts of production their circumstance allows.

In this paper we consider the use of cases in medical ethics research and teaching. To date, there has been little discussion about the consent or confidentiality requirements that ought to govern the use of cases in these areas. This is in marked contrast to the requirements for consent to publish cases in clinical journals, or to use personal information in research. There are a number of reasons why it might be difficult to obtain consent to use cases in ethics. (...) Many cases concern people who are incompetent, and thus unable to give consent. Often the material is of a sensitive nature, it is not clear who should give consent, or the ethicist has no access to those involved. We argue that the use of cases in ethics research and teaching can be justified by appeal to the public interest argument, and suggest a number of areas for discussion and clarification. (shrink)

This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable (...) of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health. (shrink)

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust (...) at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors. (shrink)

Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning (...) children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families. (shrink)

This article examines the implicit promises of fairness in evidence based medicine , namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups is examined. Several aspects of EBM are explored: the way evidence is created , and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow (...) biomedical and individualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is diverted away from activities that might have a much greater impact on their health. (shrink)

Distributed Cognition is a hybrid approach to studying all aspects of cognition, from a cognitive, social and organisational perspective. The most well known level of analysis is to account for complex socially distributed cognitive activities, of which a diversity of technological artefacts and other tools and representations are an indispensable part.

According to David Hume our idea of a necessary connection between what we call cause and effect is produced when repeated observation of the conjunction of two events determines the mind to consider one upon the appearance of the other. No matter how we interpret Hume's theory of causation this explanation of the genesis of the idea of necessity is fraught with difficulty. I hope to show, looking at the three major interpretations of Hume's causal theory, that his account is (...) contradictory, plainly wrong, or inherently impossible to verify. (shrink)

This paper argues that, in addition to humanitarian concerns, policies toward immigrants should also be shaped by recognition of special responsibilities toward some populations of noncitizens. National governments acquire such responsibilities in part through their histories of coercive impositions on those populations. Former imperial powers, in particular, often possess special obligations toward the inhabitants of their foreign colonies that go beyond their general humanitarian responsibilities. Those obligations might be met in various ways; but if national governments of wealthy, formerly imperial (...) states granted greater access for immigration to the poor of their former colonies, migration flows might significantly contribute to reductions in global levels of inequality. (shrink)

Determining whether a person who appears to have committed an offence should then be prosecuted for it requires a number of assessments and weighing of interests. Yet, to read the latest Code for Crown Prosecutors, one would think that the exercise of prosecutorial discretion is a relatively unstructured process. This is because the Code does not require prosecutors to identify an aim in seeking the punishment of the accused, and because it does not distinguish between the harms caused to the (...) defendant by punishment and the distinct harms which are caused to him by prosecution. I shall argue that the aim of the prosecutor (assuming that guilt will be proven) should be to decide whether the aims of punishment of the accused would be justified by the likely costs of the proceedings, but that this aim may be constrained by considering the harms which may be caused to the defendant by prosecution. If this structure were to be accepted, then it would both be easier to draft a Code for Crown Prosecutors which has useful guiding value and to identify to whom the prosecutor should be accountable for his decisions. (shrink)

Why do we labour so hard to sustain relationships that are fundamentally harmful to our wellbeing? That is the question which lies at the heart of Maja Borg’s poetic and alternatively distributed documentary film, Future My Love. The detrimental bonds on which the film focuses are those that maintain our connection to an economic system that has thrown us into an acute state of crisis and the stillborn emotions that keep us hopefully attached to a romantic partnership that we have (...) already outgrown; this elision imbricates and implicates the personal in the political. Through a prism of painful and, at times, unbearable emotion, and by blurring the boundaries between the public and the private, the real and the fictional, this film urges us to imagine ourselves into a future in which it might be possible to live otherwise; but this requires us to abandon the future we have already imagined and, as the film evinces through archival imagery from the 1950s or golden age of capitalism, imaged ourselves into. By drawing on the work of Lauren Berlant and Sara Ahmed on the cultural politics of emotion, Judith Butler’s work on the act of mourning, and the writing of Eva Illouz, Luce Irigaray and Alain Badiou on love in the age of late capitalism, this article contends that Future My Love pleads with us to abandon, in Ahmed’s words, ‘happiness for life’, to forsake an ideology that is invested in a highly specific notion of what it means to flourish and to thrive, to mourn and name our losses, and to think about the future creatively and without cynicism. (shrink)

This book presents McLuhan as both an activist and a speculative urbanist who endeavored to alter human perception and imagine a sustainable future based on collective participation in a responsive urban environment—a techno-sensorium—in which technology is designed and programmed to be favorable to life and capable of engaging multiple senses.

ABSTRACT Few denials of tolerance are more severe than rejection of the moral worth of another’s way of life. In the U.S. today, many traditional religious believers, especially fundamentalist Christians, and many LGBQT+ persons see each other’s ways of life as deeply evil in important respects. These gulfs probably cannot be bridged; but public policies can and should seek to accommodate all claims of conscience as far as this can be done without denying anyone meaningful possession of basic rights. By (...) placing religious and moral consciences equally in a constitutionally “preferred position,” governments can foster a wider sense that citizens are engaged in a shared enterprise of helping everyone to pursue their distinctive forms of happiness. (shrink)