Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tests to screen for T2DM. These discussions have focused on the relative benefits for individual patients, with some attention directed towards reduced costs to healthcare systems and benefits to society. We argue that (...) there are strong ethical reasons for adopting HbA1C-based diagnosis and T2DM screening that have not yet been articulated. The rationale includes the differential impact of HbA1C-based diabetic testing on disadvantaged groups, and what we are beginning to learn about HbA1C vis-à-vis population health. Although it is arguable that screening must primarily benefit the individual, using HbA1C to diagnose and screen for T2DM may promote a more just distribution of health resources and lead to advances in investigating, monitoring and tackling the social determinants of health. (shrink)

We examine the relation between worker substance abuse and workplace fraud in a sample of medical doctors. Relative to their peers, we observe that doctors engaging in substance abuse are between 50 and 100 times more likely to commit fraud in a given year. This result is consistent with research suggesting that substance abuse both creates financial pressures and impairs the functioning of cognitive self-regulatory mechanisms. Our results are robust in within-subject tests and between-subject tests, as well as in tests (...) using instrumental variables that exploit exogenous variation in the state-level availability of opioids, a commonly abused substance. (shrink)

ABSTRACTAnxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (...) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report... (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)

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)

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)

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)

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)

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)

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)

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)

Americans have always been divided over whether to welcome or to discourage immigration. But virtually all American leaders have rested their views on notions that the United States has unique providential or world-historical significance-as an asylum for the world's oppressed, as a model to the world, or even as the world's leader. Today, it is normatively desirable for the U.S. to view itself not as the world's "city on a hill" but simply as one worthy political society among many others. (...) Whether such a view can be made politically appealing to most Americans, however, remains in doubt. (shrink)

Political theorists have argued for and against the propriety of a civic ethics of “public reason” that would set normative bounds on the expression of religious views in the public discourse of government officials and, to a lesser degree, citizens. This essay explores whether critics of ethical restraints on religious discourse have grounds to criticize the religious rhetoric of President George W. Bush. Quantitative and qualitative studies show that Bush has used a distinctive “prophetic” mode of religious expression more often (...) than any modern predecessor. This sort of religious discourse is argued to be ethically dubious from the standpoints of most public reason advocates and most of their critics. Even as it champions democracy and adherence to the plans of divine providence, it discourages and de-legitimates democratic dissent and fails to provide the religious guidance it promises. (shrink)

Authoritarian nationalism is on the rise in many countries around the world, threatening liberal democracies. Many on the left rightly fear that any and all celebrations of national identities risk heightening these dangers. It is questionable, however, whether illiberal nationalism can be defeated politically without some reliance on progressive stories of national identity that advance themes of equality, freedom, and inclusion in ways that resonate with many of the traditions in which those whom progressives seek to mobilize have been raised.

_The Undiscovered Dewey_ explores the profound influence of evolution and its corresponding ideas of contingency and uncertainty on John Dewey's philosophy of action, particularly its argument that inquiry proceeds from the uncertainty of human activity. Dewey separated the meaningfulness of inquiry from a larger metaphysical story concerning the certainty of human progress. He then connected this thread to the way in which our reflective capacities aid us in improving our lives. Dewey therefore launched a new understanding of the modern self (...) that encouraged intervention in social and natural environments but which nonetheless demanded courage and humility because of the intimate relationship between action and uncertainty. Melvin L. Rogers explicitly connects Dewey's theory of inquiry to his religious, moral, and political philosophy. He argues that, contrary to common belief, Dewey sought a place for religious commitment within a democratic society sensitive to modern pluralism. Against those who regard Dewey as indifferent to moral conflict, Rogers points to Dewey's appreciation for the incommensurability of our ethical commitments. His deep respect for modern pluralism, argues Rogers, led Dewey to articulate a negotiation between experts and the public so that power did not lapse into domination. Exhibiting an abiding faith in the reflective and contestable character of inquiry, Dewey strongly engaged with the complexity of our religious, moral, and political lives. (shrink)

Can human beings be free and responsible if there is an all-powerful God? Anselm of Canterbury offers viable answers to questions which have plagued religious people for at least two thousand years. Katherin Rogers examines Anselm's reconciliation of human free will and divine omnipotence in the context of current philosophical debates.