Covid-19 lockdown restrictions constitute a population-wide “life-change event” disrupting normal daily routines. It was proposed that as a result of these lockdown restrictions, physical activity levels would likely decline. However, it could also be argued that lifestyle disruption may result in the formation of increased physical activity habits. Using a longitudinal design, the purpose of this study was to investigate changes in physical activity of different intensities, across individuals who differed in activity levels prior to lockdown restrictions being imposed, and (...) across three time periods: pre-, during- and post-lockdown. This study also examined the extent to which the experience of daily hassles explained any changes in physical activity. A convenience sample recruited through social media, provided data from an online survey administered during weeks 2–3 of a 5-week lockdown and 231 participants provided complete data again 6 weeks post-lockdown. Participants completed the International Physical Activity Questionnaire–Short Form and the Daily Hassles Scale. Results showed that vigorous and moderate intensity PA were significantly lower during- and post-lockdown compared to pre-lockdown in those individuals who had been highly active pre-lockdown. In contrast, for moderately active individuals pre-lockdown, vigorous and moderate intensity PA was significantly higher during-lockdown compared to pre-lockdown, and these increased levels of vigorous PA were maintained post-lockdown. Participants experienced daily hassles due to inner concerns, time pressures, family, and financial concerns to the same extent during- and post-lockdown. Those daily hassles had a small negative predictive effect on post-lockdown PA. It appears that to understand the effect of COVID-19 restrictions on PA, the activity status of individuals pre-lockdown needs to be taken into account. The daily hassles appeared to play a role in post-lockdown PA behavior, but future research should investigate why these results occurred. (shrink)

This chapter contains section titled: “Imagining Oneself Otherwise”.

This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, including self-conception, self-worth, memory, and the (...) imagination. (shrink)

The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...) and Genomics England.3 A recent review commissioned by the UK’s Department of Health and Social Care (hereafter referred to as the ‘Goldacre Review’) places TREs at the heart of its recommendations around the future of National Health Service (NHS) health data sharing for research, describing them as the ‘clear path forward’ to a health data system in which trust is ‘earned’ through ‘provable, credible steps to protect patient privacy, and by being transparent with everyone about everything that is done with their deepest medical secrets’.4 We argue that rather than building public trust, the TRE model actually reduces the need for trust in the use and sharing of patient health data. This is because trust is importantly connected to vulnerability and uncertainty; an essential part of trusting someone is accepting that one’s trust could be disappointed or betrayed. In attempting to provide assurances or guarantees of data privacy and security, TREs strive to remove this vulnerability, and so remove the need for trust. We do not see this as a problem and are broadly supportive of this kind of data sharing model because of the increased security and oversight it provides. However, having argued that TREs are not actually concerned with trust, we consider the importance of being precise about the words that we use …. (shrink)

Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need (...) not, and should not, be based on trust. Rather, they should be based on confidence. I begin by elucidating the differences between trust, reliability, and confidence, and argue that trust is not the appropriate attitude to adopt when it comes to sharing data with commercial companies. I argue that what we really should want is confidence in a system of data sharing. I then provide an outline of what a confidence-worthy system of data sharing with commercial companies might look like, and conclude with some remarks about the role of trust within this system. (shrink)

When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...) distress that I call “role conflict distress.” Rather than view role conflict distress as a sign that we are falling short, I suggest that it actually speaks to the commitment that we have to the loving relationship that grounds our duty of care. (shrink)

In this paper, I defend the view that self-deception is a moral failure. Instead of saying that self-deception is bad because it undermines our moral character or leads to morally deleterious consequences, as has been argued by Butler, Kant, Smith, and others, I argue the distinctive badness of self-deception lies in the tragic relationship that it bears to our own values. On the one hand, self-deception is motivated by what we value. On the other hand, it prevents us from valuing (...) those things properly. I argue that we owe it ourselves to take seriously our own values, by striving to properly value them. This gives us both prudential and moral reasons to avoid self-deception. (shrink)

We often feel survivor guilt when the very circumstances that harm others leave us unscathed. Although survivor guilt is both commonplace and intelligible, it raises a puzzle for the standard philosophical account of guilt, according to which people feel guilt only when they take themselves to be morally blameworthy. The standard account implies that survivor guilt is uniformly unfitting, as people are not blameworthy simply for having fared better than others. In this paper, we offer a rival account of guilt, (...) the relational account of guilt, which makes sense of survivor guilt and other forms of guilt without self-blame while preserving the intelligibility of guilt about culpable wrongdoing. According to this account, guilt involves the feeling of being unable to justify ourselves to others, and we lack self-justification when we (however blamelessly) stand on the positive side of an undesirable asymmetry with them. When someone survives something that those around her do not, the disparity in outcome constitutes an asymmetry that is often undesirable, because it arises from luck or violates a requirement of solidarity. Thus, survivor guilt is often fitting. (shrink)

A general obligation to make aggregate research results available to participants has been widely supported in the bioethics literature. However, dementia research presents several challenges to this perspective, particularly because of the fear associated with developing dementia. The authors argue that considerations of respect for persons, beneficence, and justice fail to justify an obligation to make aggregate research results available to participants in dementia research. Nevertheless, there are positive reasons in favor of making aggregate research results available; when the decision (...) is made to do so, it is critical that a clear strategy for communicating results is developed, including what support will be provided to participants receiving aggregate research results. (shrink)

The aim of this article is to give an account of a methodological link between drama and political theory. This account is drawn primarily from the early philosophical work of Deleuze. Following Deleuze, we will refer to it as ‘the method of dramatization’. We will argue that dramatization is a method aimed at determining the quality of political concepts by ‘bringing them to life’, in the way that dramatic performances bring to life the characters and themes of a play-script. We (...) demonstrate that this can be specified in relation to the development of this method in Deleuze's early philosophical work as a practical, critical and artistic method and, in relation to the ontological assumptions he articulated and defended in Difference and Repetition, as a process of intensification of the Idea of the political. By way of example, we discuss how the dramatization of the concept of ideology functions in Deleuze and Guattari's Anti-Oedipus and A Thousand Plateaus. We conclude with some lines of inquiry that could be pursued by political theorists looking to investigate further the dramatic nature of method in political theory. (shrink)

This volume breaks new ground by investigating the ethics of vulnerability. Drawing on various ethical traditions, the contributors explore the nature of vulnerability, the responsibilities owed to the vulnerable, and by whom.

Patients with disorders of consciousness after severe brain injury need surrogate decision makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decisionmaking generally instruct decision makers to first appeal to a patient’s written advance directive, followed by making a substituted judgment of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. Substituted judgment is preferable because it is taken to preserve patient autonomy, by (...) using a patient’s past wishes and values to reconstruct what they would have chosen for themselves. In this paper, the author argues that for a certain population of patients, the standard interpretation of substituted judgment cannot ensure the preservation of patient autonomy. Patients with “covert awareness” may continue to have values and an authentic sense of self, which may differ from their past values and wishes. Accordingly, surrogate decision makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values. (shrink)

Patients in the vegetative state are wholly unaware of themselves, or their surroundings. However, a minority of patients diagnosed as vegetative are actually aware. What is the well-being of these patients? How are their lives going, for them? It has been argued that on a reasonable conception of well-being, these patients are faring so poorly that it may be in their best interests not to continue existing. I argue against this claim. Standard conceptions of well-being do not clearly support the (...) conclusion that these patients would be better off having life-sustaining treatment withdrawn, and in fact, it may be possible for these patients to retain a passable level of well-being. I suggest that further research into the subjective experiences of these patients will allow us to better promote their well-being. (shrink)

Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’. Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to (...) experience pain or pleasure is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being. (shrink)

Agent-regret seems to give rise to a philosophical puzzle. If we grant that we are not morally responsible for consequences outside our control (the ‘Standard View’), then agent-regret—which involves self-reproach and a desire to make amends for consequences outside one’s control—appears rationally indefensible. But despite its apparent indefensibility, agent-regret still seems like a reasonable response to bad moral luck. I argue here that the puzzle can be resolved if we appreciate the role that agent-regret plays in a larger social practice (...) that helps us deal with bad moral luck. That agent-regret is a component in a social practice limits the questions that we can reasonably ask about it. While we can ask whether an experience of agent-regret is rational given the norms of this practice, we cannot ask the question that motivates the puzzle of agent-regret, viz. whether agent-regret is rationally defensible according to the Standard View. (shrink)

In 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association declared a national emergency in child and adolescent mental he...

Some meditative experiences are reported to involve a change in the meditator’s sense of self. For instance, some practitioners of body-scan meditation report a felt dissolution of bodily boundaries and a corresponding change in their bodily sense of self. In ‘pure-consciousness-events’ some subjects report a sense of self as pure consciousness, while others report a loss of the sense of self. In this chapter, I use recent philosophical and empirical work on the phenomenal self and the variability of self-experience to (...) explore possible connections with particular types of meditative experience. In particular, I differentiate minimal subjectivity from the more complex and plastic phenomena of self-identification, self-location, and a strong first-person perspective. I discuss how certain reported meditative experiences transform key aspects of phenomenal self-experience, such as phenomenal (dis-)identification with the body, agency, spatial location, and the phenomenal field. I then discuss philosophical implications for the study of consciousness, the self, and meditation. (shrink)

In this paper, I discuss rape myths and mythologies, their negative effects on rape and sexual assault complainants, and how they prejudicially construct women qua women. The backdrop for the analysis is the Belfast Rugby Rape Trial, which took place in 2018. Four men, two of whom were well-known rugby players, were acquitted of rape and sexual assault in a nine-week criminal trial that dominated local, national and international attention. The acquittal resulted in ‘I Believe Her’ rallies and protests across (...) Northern Ireland. Of concern were the deeply sexist and misogynistic text exchanges among the acquitted about the complainant and women more generally. One month after the trial, the Criminal Justice Board of Northern Ireland commissioned an independent review of the arrangements to deliver justice in cases of serious sexual offences. The Gillen Review proposed 16 key recommendations, among them measures to dispel rape myths and the role that Relationship and Sex Education in schools could play in combatting these myths. I will explore these issues using Miranda Fricker's construction of epistemic injustice. I argue that there is little appreciation of the profound impact that routine testimonial injustice—where the credibility of a speaker is deflated or undermined on account of her social identity—can have on the wellbeing of speakers and how it ramifies with other forms of injustice. To illustrate, I draw on neurological explanations to show why attributions of sexual consent are unjustly sustained in cases of rape and sexual assault. (shrink)

Four studies tested the hypothesis that a weaker belief in free will would be related to feeling less gratitude. In Studies 1a and 1b, a trait measure of free will belief was positively correlated with a measure of dispositional gratitude. In Study 2, participants whose free will belief was weakened (vs. unchanged or bolstered) reported feeling less grateful for events in their past. Study 3 used a laboratory induction of gratitude. Participants with an experimentally reduced (vs. increased) belief in free (...) will reported feeling less grateful for the favor. In Study 4, a reduced (vs. increased) belief in free will led to less gratitude in a hypothetical favor scenario. This effect was serially mediated by perceiving the benefactor as having less free will and therefore as being less sincerely motivated. These findings suggest that belief in free will is an important part of being able to feel gratitude. (shrink)

The historical context of body and tissue donation is deeply problematic, with patriarchal and colonial narratives. The contemporary context of molecular and genetic biology further complicates issues of bodily donation through narratives of abstraction and extraction. As practitioners working outside the conventional boundaries of scientific study learn the tools and techniques to extract and use bodily materials, they are also learning and challenging the procedures and processes. This article approaches questions of bodily donation through the edited transcript of a conversation (...) between artists who regularly use body fluids and cellular bodily materials in their practice, moderated by Louise Mackenzie and Ilke Turkmendag as part of the Taboo–Transgression–Transcendence in Art & Science Conference held online with the support of the University of Applied Arts, Vienna, 2020. The panel challenged the ethical and conceptual assumptions made in biotechnological research and reconsidered where the boundaries of the body lie, what ‘authority’ research carries and what choices researchers make when using the bodies of others. The transcribed conversation addresses taboos of the female body, specifically menstruation, the commodification of tissue from female human bodies, human milk politics and questions biopolitical treatment of the female body. The full, unedited panel conversation, including questions from the audience, and an accompanying video of edited interviews with panellists, is available online at https://www.loumackenzie.com/offering-the-body. (shrink)

Philosophers have often understood self-knowledge's value in instrumentalist terms. Self-knowledge may be valuable as a means to moral self-improvement and self-satisfaction, while its absence can lead to viciousness and frustration. These explanations, while compelling, do not fully explain the value that many of us place in self-knowledge. Rather, we have a tendency to treat self-knowledge as its own end. In this article, I vindicate this tendency by identifying a moral reason that we have to value and seek self-knowledge that is (...) independent of the reason that we have to value the beneficial ends that it helps us achieve. I argue that we are in an inescapable relationship with ourselves that requires both self-love and self-respect. Self-love gives us a noninstrumental reason to know ourselves, while self-respect demands that we take this reason seriously. To pursue a project of self-discovery carefully and for its own sake, then, is part of what it is to stand in a loving and respectful relationship with ourselves. -/- . (shrink)

While some trust theorists have adverted to the vulnerabilities involved in trust, especially vulnerability to betrayal, the literature on trust has not engaged with recent work on the ethics of vulnerability. This paper initiates a dialogue between these literatures, and in doing so begins to explore the complex interrelations between vulnerability and trust. More specifically, it aims to show how trust can both mitigate and compound vulnerability. Through a discussion of two examples drawn from literary sources, the paper also investigates (...) the effects of pathogenic vulnerability on the psychic economies of trust and distrust. (shrink)

Neuroimaging research regularly yields “incidental findings”: observations of potential clinical significance in healthy volunteers or patients, but which are unrelated to the purpose or variables of the study.

Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain aware. These patients, designated as having “cognitive motor dissociation”, can demonstrate awareness by imagining specific tasks, which generates brain activity detectable via functional neuroimaging. The discovery of consciousness in these patients raises difficult questions about their well-being, and it has been argued that it would be better for these (...) patients if they were allowed to die. Conversely, I argue that CMD patients may have a much higher level of well-being than is generally acknowledged. It is far from clear that their lives are not worth living, because there are still significant gaps in our understanding of how these patients experience the world. I attempt to fill these gaps, by analyzing the neuroscientific research that has taken place with these patients to date. Having generated as comprehensive a picture as possible of the capacities of CMD patients, I examine this picture through the lens of traditional philosophical theories of well-being. I conclude that the presumption that CMD patients do not have lives worth living is not adequately supported. (shrink)

Based upon the Decision Field Theory (Busemeyer and Townsend 1993), we tested a model of dynamic reasoning to predict the effect of time pressure on analytical and experiential processing during decision-making. Forty-six participants were required to make investment decisions under four levels of time pressure. In each decision, participants were presented with experiential cues which were either congruent or incongruent with the analytical information. The congruent/incongruent conditions allowed us to examine how many decisions were based upon the experiential versus the (...) analytical information, and to see if this was affected by the varying degrees of time pressure. As expected, the overall accuracy was reduced with greater time pressure and accuracy was higher when the experiential and analytical cues were congruent than when they were incongruent. Of great interest was the data showing that under high time pressure participants used more experiential cues than at other time pressures. We suggest that the dynamic reasoning paradigm has some future potential for predicting the effects of experiential biases in general, and specifically under time pressure. (shrink)

Bioethicists who seek to defend commercial transactions that intuitively seem exploitative, such as organ sales and commercial surrogacy, typically pair a liberal analysis of exploitation with a libertarian analysis of autonomy. In this paper, I argue that the liberal analysis of exploitation, which focuses primarily on two party transactions between individuals, occludes the structural dimensions of exploitation. This occlusion then paves the way for the transaction to be understood in terms of libertarian autonomy. I propose that a vulnerability analysis paired (...) with a multidimensional and relational theory of autonomy highlights the structural dimensions of exploitation and exposes the myth-making that underlies claims that these forms of exploitation are autonomy-enhancing. (shrink)

Prognosis after severe brain injury is highly uncertain, and decisions to withhold or withdraw life‐sustaining treatment are often made prematurely. These decisions are often driven by a desire to avoid a situation where the patient becomes ‘trapped’ in a condition they would find unacceptable. However, this means that a proportion of patients who would have gone on to make a good recovery, are allowed to die. I propose a shift in practice towards the routine provision of aggressive care, even in (...) cases where the probability of survival and acceptable recovery is thought to be low. In conjunction with this shift, I argue in favour of a presumption towards withdrawing life‐sustaining treatment, including artificial nutrition and hydration, when it becomes clear that a patient will not recover to a level that would be acceptable to them. I then respond to three potential objections to this proposal. (shrink)