It is a commonly expressed sentiment that the science and philosophy of well-being would do well to learn from each other. Typically such calls identify mistakes and bad practices on both sides that would be remedied if scientists picked the right bit of philosophy and philosophers picked the right bit of science. We argue that the differences between philosophers and scientists thinking about well-being are more difficult to reconcile than such calls suggest, and that pluralism is central to this task. (...) Pluralism is a stance that explicitly drives towards accommodating and nurturing the richness and diversity of well-being, both as a concept and as an object of inquiry. We show that well-being science manifests a contingent pluralism at the level of methodology, whereas philosophy of well-being has largely rejected pluralism at the conceptual level. Recently, things have begun to change. Within philosophy, conceptual monism is under attack. But so is methodological pluralism within science. We welcome the first development, and bemoan the second. We argue that a joined-up philosophy and science of well-being should recognise the virtues of both conceptual and methodological pluralism. Philosophers should embrace the methodological justification of pluralism that can be found in the well-being sciences, and scientists should embrace the conceptual reasons to be pluralist that can be found in philosophical debate. (shrink)

People who have not experienced diseases and health conditions tend to judge them to be worse than they are reported to be by people who have experienced them. This phenomenon, known as the disability paradox, presents a challenge for health policy, and in particular, healthcare resource distribution. This divergence between patient and public preferences is most plausibly explained as a result of hedonic adaptation, a widespread phenomenon in which people tend to adapt fairly quickly to the state they are in, (...) good or bad, and adjust their baseline utility accordingly.If patient utilities can be shown to be inappropriate for use in public policy decision making, the disability paradox fades away. This paper offers a critique of one such attempt: the idea that adaptation leads to adaptive preferences. I argue that none of the main accounts of adaptive preferences in fact characterise adapted patient preferences as irrational. Adapted preferences should not, therefore, be treated as synonymous with adaptive preferences. I suggest that much patient adaptation should be understood as a form of the ubiquitous human ability to respond to environmental change. Consequently, we ought not to discount patient preferences. (shrink)

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, (...) be treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality. (shrink)

Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety (...) as a field of practice. We argue that dignitary harms in health care are—at least sometimes—preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality. (shrink)

Drawing together researchers from diverse theoretical positions, the aim of this book is to work towards a coherent and unified account of how we develop an understanding of one's and others' mental states.

This book offers a thorough investigation into the development of the cognitive processes that underpin judgements about mental states (often termed 'theory of ...

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a (...) focus on respecting people’s autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition. (shrink)

It has been found that children appreciate the limited substitutability of co-referential terms in opaque contexts a year or two after they pass false belief tasks (e.g. Apperly and Robinson, 1998, 2001, 2003). This paper aims to explain this delay. Three- to six-year-old children were tested with stories where a protagonist was either only partially informed or had a false belief about a particular object. Only a few children had problems predicting the protagonist’s action based on his partial knowledge, when (...) he was only partially informed about a property of the desired object (e.g. he knew that it was a Lego® block, but not that it was a red Lego® block). But many had problems making the correct action prediction when he was only partially informed about dual identities (e.g. he knew it was a dog, but not that it was also an eraser). About as many children made an incorrect action prediction for partial knowledge problems involving dual identity as answered higher-order belief questions incorrectly. In contrast many more children answered first-order false belief questions correctly, as many as correct action predictions when the protagonist was partially informed about a property of an object. The results support the claim that children have a specific problem with dual identity, rather than a broader problem representing partial knowledge. (shrink)

Illustrated throughout, Peter Mitchell's highly readable and non-technical Introduction to Theory of Mind focuses on the latest research in the field and integrates work carried out on humans, apes and children with autism.

'Quality' is a widely invoked concept in healthcare, and 'quality improvement' is now a central part of healthcare service delivery. However, these concepts and their associated practices represent relatively uncharted territory for applied philosophy and bioethics. In this paper, we explore some of the conceptual complexity of quality in healthcare and argue that quality is best understood to be conceptually plural. Quality is widely agreed to be multidimensional and as such constitutively plural. However, we argue that quality is plural in (...) two further senses. First, quality is competitively plural : that is, different high-level conceptions of quality can be appropriately invoked in different contexts and serve... (shrink)

Are incorrect judgments on false belief tasks better explained within the framework of a conceptual change theory or a bias theory? Conceptual change theory posits a change in the form of reasoning from 3 to 4 years old while bias theory posits that processing factors are responsible for errors among younger children. The results from three experiments showed that children who failed a test of false belief took as long to respond as those who passed, and both groups of children (...) took longer to respond to belief questions than to questions about prior states of reality. These results seem to support the bias theory. (shrink)

One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we (...) consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed. (shrink)

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ’normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ’explanatory complexity’. In brief, normative complexity relates to (...) the inherent difficulty of deciding what kinds of changes are ’improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (’orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination. (shrink)

In his 1987 paper “Truth or Consequences,” Dan Brock describes a deep conflict between the goals and virtues of philosophical scholarship and public policymaking: whereas the former is concerned with the search for truth, the latter must primarily be concerned with promoting good consequences. When philosophers are engaged in policymaking, he argues, they must shift their primary goal from truth to consequences—but this has both moral and methodological costs. Brock’s argument exemplifies a pessimistic, but not uncommon, view of the possible (...) shape and nature of applied philosophy. The present paper paints a richer and more optimistic picture. It argues that the difference between theoretical philosophy and applied philosophy is not best understood as a choice between truth and consequences. On the contrary, applied philosophers engage in forms of truth‐seeking that are properly concerned with consequences—including the consequences of philosophical practice itself. (shrink)

Person-centred care is a cornerstone of contemporary health policy, research and practice. However, many researchers and practitioners worry that it lacks a 'clear definition and method of measurement,' and that this creates problems for the implementation of person-centred care and limits understanding of its benefits. In this paper we urge caution about this concern and resist calls for a clear, settled definition and measurement approach. We develop a philosophical and conceptual analysis which is grounded in the body of literature concerning (...) the theory and practice of person-centred care. We consider a range of influential definitional frameworks of person-centred care, highlighting their differences and showing that they do not correspond to a clearly circumscribed and consistent underlying concept. We argue that a degree of indeterminacy and vagueness should not be seen as a problem with the concept of person-centred care; these are features of a rich and contested concept which exists prior to and outside of practical and technical operational definitions and applications. We defend the value of operating with multiple accounts of person-centred care, arguing that what counts as being person-centred can vary across different care contexts, in relation to different patient groups, and as a reflection of different, defensible ethical perspectives. Although the idea of a single, agreed definition is attractive and may seem to be a practical or even necessary step towards meaningful and coordinated action, we argue that this is only the case in a qualified sense. Comprehensive attempts to narrow down the concept in this way should be resisted, as they risk undermining what it is that makes person-centredness a valuable concept in healthcare. (shrink)

If anything, Carpendale & Lewis's (C&L's) target article could have gone even further in challenging the view that a radical conceptual shift equips children with a theory of mind. Also, the authors should have elaborated on why their social constructivist account is more plausible than nativism. Their argument against simulation theory is perhaps the least-developed part of their thesis, and does little service to their cause.

Various researchers have suggested that below 7 years of age children do not recognize that they are the authority on knowledge about themselves, a suggestion that seems counter-intuitive because it raises the possibility that children do not appreciate their privileged first-person access to their own minds. Unlike previous research, children in the current investigation quantified knowledge and even 5-year-olds tended to assign relatively more to themselves than to an adult (Studies 1 and 2). Indeed, children's estimations were different from ratings (...) made by their mothers: Their mothers sometimes rated themselves as knowing more about their child than they rated their child as knowing (Study 2). While previous research seemed to suggest that children shift from viewing their mother to viewing themselves as the authority on knowledge about them (the children), these new findings surprisingly suggest the opposite. (shrink)

The defence of qualified privilege emerged in the 1760s in cases involving domestic servants suing their masters for bad references. Its function was to reverse the burden of proof of malice—transferring it from the defendant to the plaintiff—and it was based on the ‘occasion’ of speaking. The evidence suggests that this meant ‘cause’, but later cases interpreted it as meaning ‘situation’ and appeared to hold that there must be a duty or interest in both the publisher and publishee in order (...) for the defence to be raised. This interpretation proved controversial because it denied a defence when the defendant mistakenly believed that he had a duty or interest. In the 1890s it was finally settled that a duty or interest in both publisher and publishee was an essential requirement of the defence; perhaps this was due to parallel developments relating to similar concepts in the torts of deceit and negligence. (shrink)

This text provides a unique collection of case studies across a wide range of organizations (higher education, K-12 education, military, state and local government administration, non-profit institutions, and agency management, etc.). These cases examine ethical decision-making and organizational and leadership behavioral concepts that are practiced in these organizations. The cases cover topics facing our workforce today and ask the reader to solve the dilemma. Through a discussion of these cases, students apply decision making and organizational and leadership strategies to analyze (...) each case and therefore gain a better understanding of how to effectively lead and manage within their organizations. This text challenges students to think critically and analytically. Students are encouraged to reflect on options a practitioner could use to solve the problem. All of the cases end with an open scenario and a set of questions, allowing students to offer a wide range of opinions and participate in reflective and robust discussions. (shrink)

Mitchell, Patricia Review of: Meaning, Self and the human potential: An appeal for humanism, by Kristine Millar, Janus Publishing Company Led London 2013.

This paper analyses the ethics of routine measurement for healthcare improvement. Routine measurement is an increasingly central part of healthcare system design and is taken to be necessary for successful healthcare improvement efforts. It is widely recognised that the effectiveness of routine measurement in bringing about improvement is limited—it often produces only modest effects or fails to generate anticipated improvements at all. We seek to show that these concerns do not exhaust the ethics of routine measurement. Even if routine measurement (...) does lead to healthcare improvements, it has associated ethical costs which are not necessarily justified by its benefits. We argue that the practice of routine measurement changes the function of the healthcare system, resulting in an unintended and ethically significant transformation of the sector. It is difficult to determine whether such changes are justified or offset by the benefits of routine measurement because there may be no shared understanding of what is ‘good’ in healthcare by which to compare the benefits of routine measurement with the goods that are precluded by it. We counsel that the practice of routine measurement should proceed with caution and should be recognised to be an ethically significant choice, rather than an inevitability. (shrink)

To understand why autistic people are misperceived in the way Jaswal & Akhtar suggest, we should embrace concepts like the “double empathy problem” and camouflaging and recognize the negative consequences these have for mental health in autism. Moreover, we need to value expertise from experience so that autistic people have a voice and indeed a stake in research into autism.

C.S. Lewis and Austin Farrer were friends and fellow academics for more than 20 years, sharing both their Anglican faith and similar concerns about their modern world. Lewis, as Christian apologist and popular novelist, and Farrer, as philosophical theologian and college priest, sought to defend a metaphysically thick universe in contrast to the increasingly secular culture all about them. The Shared Witness of C.S. Lewis and Austin Farrer explores a number of areas that demonstrate the ways in which Lewis and (...) Farrer both intersected and influenced each other's thought. Both insisted that myth prepared the heart for a sense of divine glory and even had a place in the Christian scriptures. Farrer and Lewis prized virtue ethics as a key to human character and ethical problem solving, and they explored the relationship of nature and grace. In regard to the problem of evil, the two men shared much but also disagreed how best to account for an all-powerful loving God and a world full of suffering, and both writers were engaged with apocalyptic thinking--not only in Farrer's commentaries and Lewis's fiction but also in essays and sermons that addressed the eternal end and purpose of humanity. Finally, as Philip Irving Mitchell shows, the worldview espoused and explored by Lewis and Farrer still speaks to our contemporary world, a post-secular society in which the super-natural may again be taken seriously. (shrink)

The mobile internet provides new and easier ways for people to organise themselves, raise issues, take action, and interact with their city. However, lack of information or motivation often prevents citizens from regularly contributing to the common good. In this paper, we present DoGood, a mobile app that aims at motivating citizens to join civic activities in their local community. Our study asks to what extent gamification can motivate users to participate in civic activities. The term civic activity is not (...) yet well defined, so we collect activities citizens consider to be civic to work towards a broadly accepted definition of the term. The DoGood app uses gamified elements that we studied to gauge their role in encouraging citizens to submit and promote their civic activities as well as to join the activities of others. DoGood was implemented and deployed to citizens in a five-week-long user study. The app succeeded in motivating most of its users to do more civic activities, and its gamified elements were well received. (shrink)

Background: Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative into paediatric practice (...) using the discourse and methodology of healthcare quality improvement. -/- Discussion: Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. -/- Conclusions: We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods. (shrink)