Gils-Schmidt and Salloch recognise that human and climate health are inextricably linked, and that mitigating healthcare-associated climate harms is essential for protecting human health.1 They argue that physicians have a duty to consider how their own practices contribute to climate change, including during their interactions with patients. Acknowledging the potential for conflicts between this duty and the provision of individual patient care, they propose the application of Korsgaard’s neo-Kantian account of practical identities to help navigate such scenarios. In this commentary, (...) we argue that by focusing attention on this physician–patient level, the authors overlook the complexity of climate change, both within the healthcare sector and beyond. We recognise the importance of individual agency in tackling this issue, and we also recognise that the authors do briefly acknowledge the importance of considering these broader complexities; however, we emphasise the need for climate and health discussions/action to be situated in a wider framework of systemic change. Our concern is that overemphasis on patient-level interactions risks normalising the prioritisation of individual-level approaches to addressing climate change, detracting from such a broader approach. Physician training emphasises the need for trust, confidentiality and shared decision-making in the doctor–patient relationship. …. (shrink)

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: (...) 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

Attentional bias to threat has been almost exclusively examined after participants experienced repeated pairings between a conditioned stimulus (CS) and an aversive unconditioned stimulus (US). This study aimed to determine whether threat-related attentional capture can result from observational learning, when participants acquire knowledge of the aversive qualities of a stimulus without themselves experiencing aversive outcomes. Non-clinical young-adult participants (N = 38) first watched a video of an individual (the demonstrator) performing a Pavlovian conditioning task in which one colour (...) was paired with shock (CS+) and another colour was neutral (CS−). They then carried out visual search for a shape-defined target. Oculomotor measures evidenced an attentional bias toward the CS+ colour, suggesting that threat-related attentional capture can ensue from observational learning. Exploratory analyses also revealed that this effect was positively correlated with empathy for the demonstrator. Our findings extend empirical and theoretical knowledge about threat-driven attention and provide valuable insights to better understand the formation of anxiety disorders. (shrink)

This paper develops a mechanistic account of basic mental agency by identifying similarities between two of its major exemplars: endogenous attention and imagination. Five key similarities are identified: i) that both capacities are driven by currently prioritised goals that are either person-level or apt to become person-level. ii) that both deliver their outputs to the working memory iii) that both range across all and only conceptual contents; iv) that both proceed under the guidance of norms and/or habits; and v) that (...) both directly activate rather than inhibit content. These five features are consolidated by proposing that basic mental agency is essentially the power to call for conceptual content and hold it within our working memories. (shrink)

Mechanisms of attention play a crucial role in filtering sensory inputs from the external world, allowing information to be prioritised for goal directed behaviour. To what extent might these same capacity-limited processes influence grapheme-colour synaesthesia, in which letters, numbers or words evoke concurrent experiences of colour? Asking synaesthetes themselves whether attention seems important in their experiences has provided a range of answers. On the one hand, for some synaesthetes, diverting attention can diminish the quality of their synaesthetic colours. On the (...) other, there are suggestions that synaesthetic experiences can themselves alter the manner in which attention is allocated to sensory stimuli in the environment. Here, we review a range of empirical investigations that have examined the role of attention in grapheme-colour synaesthesia. A particular focus of these studies has been the extent to which an inducing stimulus - such as an achromatic letter or digit - must be attended or consciously perceived to trigger a concurrent synaesthetic experience. In most cases, limiting attention or masking inducers tends to reduce or eliminate behavioural evidence of synaesthetic experiences. We also discuss how synaesthesia might improve performance in visual search tasks through post-attentive processes such as grouping, or by facilitating decision-making processes. (shrink)

ABSTRACTHumans are social beings that often interact in multi-individual environments. As such, we are frequently confronted with nonverbal social signals, including eye-gaze direction, from multiple individuals. Yet, the factors that allow for the prioritisation of certain gaze cues over others are poorly understood. Using a modified conflicting gaze paradigm, we tested the hypothesis that fearful gaze would be favoured amongst competing gaze cues. We further hypothesised that this effect is related to the increased sclera exposure, which is characteristic of (...) fearful expressions. Across three experiments, we found that fearful, but not happy, gaze guides observers’ attention over competing non-emotional gaze. The guidance of attention by fearful gaze appears to be linked to increased sclera exposure. However, differences in sclera exposure do not prioritise competing gazes of other types. Thus, fearful gaze guides attention among competing cues and this effect is facilitated by increased sclera exposure... (shrink)

ABSTRACTThe visual system has been found to prioritise emotional stimuli so robustly that their presence can temporarily “blind” people to non-emotional targets in their direct line of vision. This...

Suppose you want to do as much good as possible. What should you do? According to members of the effective altruism movement—which has produced much of the thinking on this issue and counts several moral philosophers as its key protagonists—we should prioritise among the world’s problems by assessing their scale, solvability, and neglectedness. Once we’ve done this, the three top priorities, not necessarily in this order, are (1) aiding the world’s poorest people by providing life-saving medical treatments or alleviating poverty (...) itself, (2) preventing global catastrophic risks, such as those posed by nuclear war or rogue artificial intelligence, and (3) ending factory farming. These claims are both plausible and striking. If correct, they should prompt a stark revision of how we approach our altruistic activities. However, the project of determining how to do the most good—as opposed to say, whether we should do the most good—has only recently, within the last ten years, become the subject of serious academic attention. Many key claims have not yet been carefully scrutinised. This is a cause for concern: are effective altruists doing good badly? In this thesis, I critique and develop some of the latest claims about how individuals can do the most good. I do this in three areas: the value of saving lives (preventing premature deaths), how best to improve lives (making people happier during their lives), and cause prioritisation methodology (frameworks for determining which problems are the highest priorities). In each case, I raise novel theoretical considerations that, when incorporated, change the analysis. Roughly speaking, my main conclusions are (1) saving lives is not as straightforwardly good we tend to suppose, may not be good at all, and is not clearly a priority; (2) happiness can be measured through self-reports and, based on the self-reported evidence, treating mental health stands out as an overlooked problem that may be an even more cost-effective way to improve lives than alleviating poverty; (3) the cause prioritisation methodology proposed by effective altruists needs to be moderately reconceptualised and, when it is, it turns out it is not as illuminating a tool as we might have thought and hoped. (shrink)

Centring on human perception, attunement to others, and a transcendent conception of the good, Iris Murdoch's intervention in moral philosophy remains an insightful and evocative source for ethical theory. Discerning some pervasive dualisms that hamper its coherence and development, I suggest that her work finds a generative conversation partner in the contemporary metaphysician, William Desmond. Desmond's thought offers promising avenues to overcome these dualisms by repositioning the source and nature of value and by theorising an anti-reductive, relational ontology. Staging a (...) constructive encounter between these two thinkers that preserves Murdoch's distinct prioritisation of attention and individuality within a Desmond-inspired metaphysics, I present a synthetic ethical approach that promotes the ideal of attending to an other—in the givenness of its particularity, manifold surplus, and constitutive relationality—as good in itself. (shrink)

In this article, we aim to map out the complexities which characterise debates about the ethics of vaccine distribution, particularly those surrounding the distribution of the COVID-19 vaccine. In doing so, we distinguish three general principles which might be used to distribute goods and two ambiguities in how one might wish to spell them out. We then argue that we can understand actual debates around the COVID-19 vaccine – including those over prioritising vaccinating the most vulnerable – as reflecting disagreements (...) over these principles. Finally, we shift our attention away from traditional discussions of distributive justice, highlighting the importance of concerns about risk imposition, special duties, and social roles in explaining debates over the COVID-19 vaccine. We conclude that the normative complexity this article highlights deepens the need for decision-making bodies to be sensitive to public input. (shrink)

This chapter explores the state of public and academic discourse about socio-moral issues elicited by the Covid-19 pandemic, through two informal case studies of Facebook statuses and columns in two leading UK newspapers. The Facebook statuses tended to focus on performance virtues as remedies rather than moral virtues, whereas a survey among the general public highlighted the role of moral virtues. Divisions of opinion among columnists in the Guardian and Daily Telegraph turned out to be about different prioritisations of moral (...) virtues rather than a trade-off between virtues and economic values. However, missing from all those discourses was attention to the meta-virtue of phronesis, or practical wisdom, as an adjudicator of virtue conflicts. Recent psychological work on wisdom does not fully ameliorate this lacuna; the paper argues that a retrieval of the Aristotelian concept of phronesis is needed to help us make balanced moral decisions. (shrink)

BackgroundHumanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care—a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, (...) the WHO released a guide on‘Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises’—the first guidance on the topic by an international body.AimsThis paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances.ImplicationsIn parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance. (shrink)

In this paper, I address human-induced environmental ills we face using an ubuntu-inspired ethical lens. I follow ubuntu scholars to stress the significance for moral agents to embody virtues. Virtue development is essential to carry out obligations and address human impacts on the environment. Thaddeus Metz, in particular, has drawn attention to how embodying ubuntu virtues of humility and friendliness can prompt moral agents to be other-regarding. The view I developed in this paper differs from his ubuntu-inspired account in at (...) least two significant ways. First, humans cannot be in harmonious relationships with some species such as Black Mambas, Hyenas and sea urchins even if they can interact. Second, we must acknowledge the consequentialist dimension of ubuntu ethics and prioritise the different aspects of ubuntu ‘mixed’ ethics, ranking them to offer possibilities for a more realistic recommendation to change our moral life. This paper demonstrates that the three dimensions of ubuntu ‘mixed’ ethics are fundamental because we need to think about moral consequences, right action and our virtue in accounting for our actions. (shrink)

Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. (...) Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs. (shrink)

Coronavirus vaccines have made their debut. Now, allocation practices have stepped into the spotlight. Following Centers for Disease Control and Prevention guidelines, states and healthcare institutions initially prioritised healthcare personnel and elderly residents of congregant facilities; other groups at elevated risk for severe complications are now becoming eligible through locally administered programmes. The question remains, however: whoelseshould be prioritised for immunisation? Here, we call attention to individuals institutionalised with severe mental illnesses and/or developmental or intellectual disabilities—a group highly susceptible to (...) the damages of COVID-19, recent research shows, and critical to consider for priority vaccination. The language describing both federal-level and state-level intentions for this population remains largely vague, despite the population’s diversity across age, diagnosis, functional status and living arrangement. Such absence of specificity, in turn, leaves room for confusion and even neglect of various subgroups. We review data stressing this group’s vulnerability, as well as select state plans for priority vaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need. (shrink)

We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many (...) of the processes within an evidence-based practice framework are better accounted for. Further, some of the problems associated with the health research, e.g. external validity of causal findings, dissolve. (shrink)

There is a growing resurgence in the study of psychedelic medicines for the treatment of mental health and substance use disorders. However, certain early investigations are marred by questionable research methods, abuses against research participants, and covert Central Intelligence Agency financial involvement. The purpose of this study was to understand how and to what extent people of colour and other vulnerable populations, specifically, individuals who were incarcerated or incapacitated due to mental health issues, were exploited during the first wave of (...) psychedelic research in the USA. To do so, we reviewed available empirical publications according to current ethical standards. Variables of interest included race and ethnicity of participants, population vulnerability, drug administration conditions, informed consent and undue influence. Our findings draw attention to the history of research abuses against people of colour in Western psychedelic research. In light of these findings, we urge a call-to-action to current psychedelic researchers to prioritise culturally inclusive and socially responsible research methods in current and future studies. All data relevant to the study are included in the article. (shrink)

Non-epistemic values pervade climate modelling, as is now well documented and widely discussed in the philosophy of climate science. Recently, Parker and Winsberg have drawn attention to what can be termed “epistemic inequality”: this is the risk that climate models might more accurately represent the future climates of the geographical regions prioritised by the values of the modellers. In this paper, we promote value management as a way of overcoming epistemic inequality. We argue that value management can be seriously considered (...) as soon as the value-free ideal and inductive risk arguments commonly used to frame the discussions of value influence in climate science are replaced by alternative social accounts of objectivity. We consider objectivity in Longino's sense as well as strong objectivity in Harding's sense to be relevant options here, because they offer concrete proposals that can guide scientific practice in evaluating and designing so-called multi-model ensembles and, in fine, improve their capacity to quantify and express uncertainty in climate projections. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

This paper reconsiders the claim made by mainstream internet platforms that they inherently foster a democratic public sphere, offering reasons why the opposite may be true. It surveys past studies that have supported both views, showing how the position taken by scholars tends to depend on their disciplinary perspectives. Historically, scholarly approaches to the public or political impacts of the internet and social media have been characterised by four main interpretative lenses: technodeterminism, behaviourism, and the prioritising of either ideology, or (...) the economics of media ownership. This article pays particular attention to the last two, and to Facebook, which among mainstream internet platforms has notably associated itself with democratic ideals. The article describes how many of the democratic ideals associated with Facebook’s impacts on society are in fact reversed by the platform’s practices, with effects that directly contradict the platform’s stated principles. The article ends by suggesting that Facebook consciously pretends to favour the public sphere, and that such Orwellian doublethink is a deliberate attempt to divert attention away from its augmentation of private and personal issues at the expense of collective engagement and empowerment. designed differently, Facebook could have had favourable impacts. (shrink)

Many people think there is something objectionable about ‘selective outrage’. After investigating how to best characterise what selective outrage is and what these objections target, this paper argues that many cases of supposedly selective outrage actually have important positive effects. Because we often have limited resources with which to enforce norms, it can be collectively prudent to prioritise enforcing norms that are well-established or collectively recognisable over those that are not. This will sometimes require responding to individual wrongs that seem (...) less immoral, outrageous or in need of attention than others. We argue that when we encounter agents who are outraged about a violation of a genuinely valuable norm but not another relevantly similar violation, we should generally refrain from objecting unless we have good independent evidence the agent’s outrage stems from objectionable motives. (shrink)

This paper reconsiders the claim made by mainstream internet platforms that they inherently foster a democratic public sphere, offering reasons why the opposite may be true. It surveys past studies that have supported both views, showing how the position taken by scholars tends to depend on their disciplinary perspectives. Historically, scholarly approaches to the public or political impacts of the internet and social media have been characterised by four main interpretative lenses: technodeterminism, behaviourism, and the prioritising of either ideology, or (...) the economics of media ownership. This article pays particular attention to the last two, and to Facebook, which among mainstream internet platforms has notably associated itself with democratic ideals. The article describes how many of the democratic ideals associated with Facebook’s impacts on society are in fact reversed by the platform’s practices, with effects that directly contradict the platform’s stated principles. The article ends by suggesting that Facebook consciously pretends to favour the public sphere, and that such Orwellian doublethink is a deliberate attempt to divert attention away from its augmentation of private and personal issues at the expense of collective engagement and empowerment. designed differently, Facebook could have had favourable impacts. (shrink)

Enactivism advances an understanding of cognition rooted in the dynamic interaction between an embodied agent and their environment, whilst new mechanism suggests that cognition is explained by uncovering the organised components underlying cognitive capacities. On the face of it, the mechanistic model’s emphasis on localisable and decomposable mechanisms, often neural in nature, runs contrary to the enactivist ethos. Despite appearances, this paper argues that mechanistic explanations of cognition, being neither narrow nor reductive, and compatible with plausible iterations of ideas like (...) emergence and downward causation, are congruent with enactivism. Attention to enactivist ideas, moreover, may serve as a heuristic for mechanistic investigations of cognition. Nevertheless, I show how enactivism and approaches that prioritise mechanistic modelling may diverge in starting assumptions about the nature of cognitive phenomena, such as where the constitutive boundaries of cognition lie. (shrink)

This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control (...) over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute an attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it. (shrink)

This article represents a response to ‘the problem of women and African philosophy', which refers mainly to the absence of strong women's and feminist voices within the discipline of African philosophy. I investigate the possibility that African women are not so much excluded from the institutionalized discipline of philosophy, as preferring fiction as a genre for intellectual expression. This hypothesis can be supported by some feminists who read the absolute prioritisation of abstraction and generalization over the concrete and the (...) particular as a masculine and western oppressive strategy. Attention to the concrete and the unique which is made possible by literature more readily than by philosophy, could thus operate as a form of political resistance in certain contexts. If fiction is currently the preferred form of intellectual expression of African women, it is crucial that the community of professional philosophers in a context like South Africa should come to terms with the relevance of such a preference for philosophy's self-conception, and it should work to make these intellectual contributions philosophically fruitful. In the process, we may entertain the hope that philosophy itself will move closer to its root or source as ‘love of wisdom'. (shrink)

Despite being increasingly available to us all, retirement pensions remain unequally distributed: between rich and poor, young and old, men and women, and possibly different generations. As this topic receives little attention in moral and political philosophy, the articles in this thesis aim to deliver an original account of justice in retirement pensions along liberal egalitarian lines. The first part defends retirement pensions as a distribution of free time. It shows that including free time in the list of goods that (...) liberal egalitarians prioritise is plausible and avoids problems that would otherwise arise with other candidates, most notably leisure. Retirement as free time is an essential feature of liberal egalitarian societies by (re)distributing the means to pursue any life project, and especially valuable for the poor who work and contribute the longest. The second part makes a case for 'libertirement', a proposal to increase the freedom to enjoy free time across life, as a matter of justice between those who live long and those who die early. Specifically, I propose adding reverse pensions and sabbaticals on top of old-age retirement. Besides showing the importance of longevity for age-group justice, I also draw implications for distributing unconditional basic income and income taxes across life, which I suggest may offer alternative paths to libertirement. Finally, the third part discusses the cases of pension inequality between genders and generations, pushing us to refine our account further. I conclude that there is often a mismatch between liberal egalitarian justice and the design of retirement schemes. The solution is often but not always to reform these systems. Sometimes, we have reasons to revise our very own principles of justice. (shrink)

We are constantly making choices about how to invest our time and resources. From a moral perspective, we must ask which moral concerns are most deserving of our attention. Longtermism, as e.g. defined by Greaves and MacAskill, holds that our moral focus should be on the long-term future, and that current and medium-term moral problems are comparatively insignificant. This theory is centrally based on the assumption that the moral importance of individuals can be aggregated. Since the number of individuals of (...) future generations far exceeds the number of current individuals and those closer in time, future generations are to bemorally prioritised, according to longtermism. This paper explores the implications of rejecting the premise of moral aggregation of individuals and adopting a strongly non-aggregationist position instead. It is argued that, according to strong non-aggregationism, the magnitude of the probability with which our intervention actually make a difference, as well as whether we look at the available interventions from an ex ante or ex post perspective, are relevant factors in their moral assessment. Ultimately, the conclusion is reached that strong non-aggregationism does likely not support strongly longtermist conclusions. (shrink)

This paper examines the dialogical relationship between painting and mindfulness. This premise is explored with reference to the aesthetics of Mikel Dufrenne. Dufrenne’s arguments make use of a number of features that characterise mindful practice and reflect mindfulness philosophy. Dufrenne’s phenomenology of aesthetic experience centres on being present, focused, non-judgemental and attentive to the aesthetic object in order to realise its signification. These concepts are also given primary importance in Buddhist philosophy of mindfulness. Dufrenne’s theory lends itself ideally to understanding (...) aesthetic experience in relation to mindfulness as well as how these experiences complement one another. Although Dufrenne does not prioritise painting, the present paper will explore painting in particular due to its embodied, gestural nature, which utilises the notion of style, reflecting the artist’s mode of being-in- the-world. Dufrenne’s ideas allow both mindfulness and painting to be understood in more comprehensive terms than that of their meanings considered individually. (shrink)

How should actions to redress absolute human deprivation be framed? Current international coordinated actions on absolute poverty are framed by human rights or by goals such as the Millennium Development Goals. But appropriate, effective and sustained responses to needs require localized participation in the definition of those rights/goals/needs and in measures taken to redress them. Human rights or the MDGs do not seem necessarily to require such processes. For this reason some argue that no universal framework can describe economic, social, (...) or cultural rights. Yet to address absolute poverty purely from the local perspective still requires the identification and prioritization of capabilities or needs, and often requires actions by greater-than-local institutions, so in practical terms a framework is not rejected without cost. This paper argues that the identification and prioritisation of rights or MDGs can and should be done at an international level, but that they might be framed as capabilities, and that far greater attention need be given to the iterative specification of these rights, and to the ongoing protection of certain agency freedoms. The paper explores how Wiggins’ account of need can fruitfully inform the specification of needs claims. It also draws significantly on Sen’s work to identify the intrinsic importance of process and opportunity freedoms, and to identify how these can relate to universal priorities. (shrink)

Global health emergencies such as the COVID-19 pandemic are contexts in which it is critical to draw upon learning from prior research and to conduct novel research to inform real-time decision-making and pandemic responses. While research is vitally important, however, emergencies are radically non-ideal contexts for its conduct, due to exceptional uncertainty, urgency, disruption, health needs, and strain on existing health systems, amongst other challenges. This generates novel ethical challenges and a broader conception of research ethics is necessary to effectively (...) address the complexity of pandemic research contexts. Going beyond traditional approaches to research ethics centring on the design of specific studies, this broader conception requires consideration of fundamental questions relating to the exercise of power and influence throughout research pathways, and a broader attention to both salient ethical issues, and the ethical responsibilities of stakeholders. These include important questions about responsibilities to gather evidence and generate knowledge systematically during emergencies, to implement policy responses in ways that are amenable to evaluation, and even potential moral obligations to participate in research. In situations of heightened uncertainty, additional questions arise about what constitutes sufficient evidence to justify the development and implementation of policy responses, and the responsibilities of scientific and social science researchers involved in policy-making processes. The four cases in this chapter prompt reflection on evolving and at times competing values and responsibilities of policy-makers, regulators, health authorities and researchers during the design and conduct of research, and proposed early implementation of research findings. These cases highlight issues arising when conducting research of national importance in a pandemic, where researchers are required to liaise with authorities responsible for pandemic responses and address complex ethical issues, including protecting the interests of participants and publics when tensions arise between prioritising the completion of research and accelerating the rollout of novel health interventions. This chapter invites reflection on the practical ethical implications of commitments to undertake research during emergencies, including the nature and scope of the relevant responsibilities of a range of stakeholders. (shrink)

In 2021, the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing (the ‘Committee’) published its policy recommendations. It proposes, inter alia, a set of nine values and principles to inform the governance of human genome editing (HGE) and makes recommendations regarding how HGE can be regulated. While these proposals contain valuable contributions to the discourse on the global governance of HGE, they also contain elements that call for heightened attention to the risks (...) of the technology, and a countervailing focus on the potential benefits of the technology is missing. The Committee ostensibly prioritises restricting HGE technology in the interest of society as a collective but, in doing so, neglects to consider the interests and rights of individuals. In this article, we suggest that this approach is imbalanced insofar as it fails to give sufficient weight to the promise of this technology in considering the regulation of risks and disregards the importance of the fundamental liberties underlying the use of HGE in its discussion of values and principles that should guide governance. How this is problematic is illustrated with reference to the Committee's openness to using patents as HGE governance tools and its blanket rejection of ‘eugenics’. It is concluded that while the Committee makes some sensible recommendations on global governance, the Committee's approach of emphasising restrictions on HGE without also giving weight to the value of an open and liberal policy space is not something that liberal democratic states ought to follow. (shrink)

Travel for reproductive health care has become a widespread global phenomenon. Within the field, the decision to travel to seek third parties to assist with reproduction is widely assumed to be autonomous. However there has been scant research exploring the application of the principle of autonomy to the experience of the cross-border traveller. Seeking to contribute to the growing, but still small, body of sociological bioethics research, this paper maps the application of the ethical principle of autonomy to the lived (...) experience of infertile individuals who cross borders for reproductive care. It examines their choices as patient, consumer and traveller. It suggests that their experience evidences a contradictory autonomy, which offers them both choice and no choice in their final decision to travel. The paper argues that this lack of meaningful autonomy is enabled by a medicalised framework of infertility which prioritises technology as the cure to infertility. This both shapes expectations of infertile individuals and limits their options of family creation. Ultimately, the paper suggests that sociological bioethics research shows that the liberatory credentials of technology should be questioned, and identifies that this field demands greater scholarly attention. (shrink)

Mental health legislation that requires patients to accept ‘care’ has come under increasing scrutiny, prompted primarily by a human rights ethic. Epistemic issues in mental health have received some attention, however, less attention has been paid to the possible epistemic problems of mental health legislation existing. In this manuscript, we examine the epistemic problems that arise from the presence of such legislation, both for patients without a prior experience of being detained under such legislation and for those with this experience. (...) We also examine how the doctor is legally obligated to compound the epistemic problems by the knowledge they prioritise and the failure to generate new knowledge. Specifically, we describe the problems of testimonial epistemic injustice, epistemic silencing, and epistemic smothering, and address the possible justification provided by epistemic paternalism. We suggest that there is no reasonable epistemic justification for mental health legislation that creates an environment that fundamentally unbalances the doctor–patient relationship. Significant positive reasons to counterbalance this are needed to justify the continuation of such legislation. (shrink)

Introduction Jamie Allen Time, of all the dimensions readily presented to experience, seems to do so most readily through things. Stuff, in supposed counter-valence to the negentropic resilience of living things, appears to us as that which degrades through time, and demarcates a more technical chronometry of sequential events. Situated outside the rotting of fruit and the ticking of clocks, a “deep time” persists. Like the ultra-hearing of the bat, and the infra-vision of the boa-constrictor, there exist living and non-living (...) agents and entities capable of revealing the fixity and finitude of our own perceptual frames for thinking and understanding. The recordings presented here consist of four extracts of documents made in deep geological repository sites (for the storage of nuclear waste). Here re-presented are the Yucca Mountain Repository; HADES, in Mol, Belgium; Gorleben in Germany and a further recording from Forsmark in Sweden (pretty much inaudible behind a loop of a pop song). These recordings are imagined acoustic amplifications of deep time, just as the astronomer’s telescope is (thought of a certain way), also a time machine. Stars and nuclear waste are unapparent objects of temporal thought. Andy Weir is an artist from London researching effects of deprioritised subjectivity and contemporary art. This project draws on work developing sonic fictions, stealthy earworms, and micropolitical agencies. Prompted for further thoughts about the recordings presented here, he offered up the interspersed discussion included. —JA Yucca Mountain Repository, Nevada, USA by continent I became interested in these sites originally as spaces that allude to a time outside of the human (‘deep time’) as they are designed to store waste ‘without future maintenance’. The very fact of thinking about these spaces or working on them—engineering etc.. (as I’m particularly interested them in a kind of practice rather than just an object of thought), in other words, forces a confrontation with thought of the extinction of humanity. I was interested in this as a production of affect at odds with the expected ‘ironic, can be whatever you like’ interpretive condition of contemporary art (art under the condition of neoliberalism, say, where the individual subject is prioritised as a free autonomous producer of the meaning of the work) When I thought about this a bit though it ran into paradoxes—yes, I could allude to deep time, but in doing so I just allude to its un-representability, drawing attention to the limits of representation and so reaffirming it—I was stuck in a representation/non-representational negative dialectic. In trying to somehow create a figure for deep time I was either reducing it to my description of it, or presenting it as irreducible. HADES Facility, Mol, Belgium by continent I don’t think I’ve escaped this in the work but my response to it was to create a sonic-fiction. This was based on the idea of a viral transmission of the affect of deep time (this is the ‘pyroclastic-soaked chrono-dread’) through receiving apparatuses, transforming the screen into an intercessor or mediating lure for the outside, a site of exposure multiplying virulently through its dissemination, invoking as much as trying to represent these spaces, the sounds as durations of exposure to contagious materials, and fictions as a way of excavating the strangeness of a world opaque to subjective reconfiguration... Testing out I suppose ways that art could start thinking about figuring the reality of ecological crisis. Gorleben Repository, Lower Saxony, Germany by continent While everything remains at the level of fiction I think the work is problematic. It doesn’t really model anything, giving too much authority to either romantic abandonment or the recuperation of romantic abandonment under its description by theory/philosophy, all contained and controlled by me within a fairly limited condition of what art can do. Deep Time Contagion is precisely a materialisation of and transmission of this paradox (i.e. with screen-media can only present deep time as unrepresentable or draw attention to an inability to present it) taking the comfort/panic induced by this paradox as its material. I’m working now on some new projects that take this as a point of departure. Forsmark Repository, Sweden (Robitussin Mix) by continent. (shrink)

This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control (...) over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute an attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, “amplification” could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it. Key Words: adaptation; evolutionary psychology; facial expression; pain. (shrink)

In the literature on the subject there is a trend towards understanding the idea of rationing in healthcare very broadly, to include any form of restriction in supply. It is suggested in this paper that there are good reasons to resist this move, since it would both render the concept redundant through being trivially true and displace an earlier, egalitarian one that retains great moral significance for the supply of healthcare. The nature and significance of the narrower, egalitarian conception is (...) set out, drawing particular attention to the fact that it marks a contrast with the idea of prioritising certain people or groups over others and to the fact that it is a form of rationing that is plausibly regarded as a morally desirable response to severe shortages. It is contrasted with the broad conception and arguments in favour of this latter are considered and rejected. (shrink)

As bioethics gains more prominence in public policy debates, it is time to more fully reflect on the following: what is its role in the public square, and what limitations relate to and barriers impede its fulfilment of this role? I contend we should consider the how of bioethics (as a policy influencer) rather than simply focus on the who or what of bioethical enquiry. This is not to suggest considerations of latter categories are not important, only that too little (...) attention has been paid to parallel or resulting policy involvement—involvement that will require specialised skills and knowledge that we can develop with a proactive (vs reactive) stance. Moreover, and equally critically, this how of public policy involvement will require more transparency regarding influences (eg, philosophical, ideological, cultural, socio-political) on what bioethicists bring to the table and what constituency base each represents—a humility as to the scope of one's role. In this vision, bioethics is not one single person or belief system for a policymaker to call to guide or give support to a position; rather, it offers tools—formed and utilised by a diverse disciplinary range of individuals—to help guide ethical analysis of biomedical endeavours, with the goal of infusion and diffusion of ethical enquiry and prioritisation in health policymaking, and greater humility among bioethicists who inform this discussion. (shrink)

There has been an increase of discussion and focus on matters of theological significance in the area of youth ministry. An area that remains neglected concerns the professional youth worker in Southern Africa. This focus on professional youth work has gained a great amount of urgency from the office of the presidency of Southern Africa, who in collaboration with the Commonwealth desk have prioritised the focus on youth work in South Africa. Unfortunately, the focus on the professional youth worker, the (...) career youth pastor, within the church in Southern Africa fails to receive a similar amount of attention. The article will highlight the need to pursue a theological articulation around the office of the career youth pastor by building a practical theological argument for the office of career youth pastor. The article will address a case study of a mainline evangelical denomination regarding its theological articulation of the career youth pastor. (shrink)

Underscoring recurrent calls for the decolonization of university curricula in South Africa are underexplored presumptions that by only disrupting theoretical content, universities might release themselves from a colonialist grasp, that continues to dominate and distort higher education discourse. While it might be the case that certain theories hold enormous authoritative, ‘truthful’ sway, as propagated through western interpretations and norms, there are inherent problems in exclusively approaching the decolonization project as a content-based hurdle, removed from the subjectivities of students’ social, lived (...) and learning realities. The argument advanced in this article is that until the epistemic harm of colonialism and apartheid are afforded careful recognition and attention – as in focusing on the lived experiences, realities, and stories of individuals - the hard work of de-legitimizing coloniality, and its implicit structures of hegemonies and binaries cannot unfold. In addressing these harms, I commence by describing some of the contexts of epistemic harm, promulgated through colonialism and apartheid. This is followed by a consideration of decolonization, both as theory and practice-within-context. Here, I also foreground the #Rhodesmustfall campaign, as a particular moment of painful clarity about why decolonization, as well as transformation have faltered in higher education in South Africa. In the second half, I focus on the necessity of prioritising storytelling as a deep manifestation of decolonization. Stories, I maintain, provide access into unknown lives, and can subvert the invisible, normative framings, which dictate how we live in this world. As a manifestation of decolonization, students’ stories hold profound implications for the recognition and affirmation of pluralist identities, histories, knowledge, values, and worldviews. (shrink)

This article represents a response to ‘the problem of women and African philosophy', which refers mainly to the absence of strong women's and feminist voices within the discipline of African philosophy. I investigate the possibility that African women are not so much excluded from the institutionalized discipline of philosophy, as preferring fiction as a genre for intellectual expression. This hypothesis can be supported by some feminists who read the absolute prioritisation of abstraction and generalization over the concrete and the (...) particular as a masculine and western oppressive strategy. Attention to the concrete and the unique which is made possible by literature more readily than by philosophy, could thus operate as a form of political resistance in certain contexts. If fiction is currently the preferred form of intellectual expression of African women, it is crucial that the community of professional philosophers in a context like South Africa should come to terms with the relevance of such a preference for philosophy's self-conception, and it should work to make these intellectual contributions philosophically fruitful. In the process, we may entertain the hope that philosophy itself will move closer to its root or source as ‘love of wisdom'. South African Journal of Philosophy Vol. 27 (4) 2008: pp. 413-429. (shrink)

Ownership is an important identity marker. It provides people with a sense of autonomy, rootedness and opportunity. This essay examines the oral submissions of civil organisations to the Joint Constitutional Review Committee about the issue of land expropriation without compensation. The discussion pays specific attention to the philosophical understandings of land and identity that emerged during the hearings. Three dominant trajectories came into play, namely land as commodity, land as social space and land as spiritual inheritance. Some submissions espoused more (...) than one view, which indicates that the boundaries between the identified paradigms are permeable. However, even those presentations tended to prioritise one approach above the others. Besides identifying the main approaches to land and identity, this essay also provides an immanent critique of their moral assumptions. In contrast to a transcendental approach, an immanent critique asks questions from 'within' and evaluates paradigms in terms of their plausibility, universal applicability, ethical consistency and moral integrity. (shrink)

The fair distribution of health resources is critical to health justice. But distributing healthcare equitably requires careful attention to the existing distribution of other resources, and the economic system which produces these inequalities. Health is strongly determined by socioeconomic factors, such as the effects of racism on the health of communities of colour, as well as the broader market-oriented healthcare and pharmaceutical systems that put the pursuit of profit above the alleviation of suffering. Two papers in this issue confront health (...) injustices at different scales, and make far-reaching recommendations for more just healthcare allocation policies. Orphan drugs are those that pharmaceutical companies are unwilling to develop unless they are offered financial incentives to do so. When a target patient group is very small, or very poor, producing drugs is unprofitable. If patients are to benefit from these drugs in a marketised pharmaceutical regime, governments must step in to provide incentives for research and development. Yet government spending ought to prioritise value for money, and is generally guided by a utilitarian framework. In the case of neglected tropical diseases, there is no moral conflict: large numbers of people would benefit greatly from these treatments. However, there are practical limitations: the governments of affected populations are often unable to fund incentives for research and development, and solidarity from elsewhere is limited.1 2 In the case of rare diseases, Global North governments usually can afford to incentivise the development of treatments to serve their populations, but given the small numbers of beneficiaries, doing so seems a questionable use of resources. Many Global North governments make an exception to the general utilitarian heuristic to accommodate the moral intuition that the claims of a person with a rare …. (shrink)

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period (...) of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results: These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion: Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery. (shrink)

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient (...) and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)

Arguably one of the strengths of the discipline of medical ethics is its close attention to the context in which ethical dilemmas, questions and issues play out. As a discipline that is concerned with helping and supporting practitioners, policy-makers and the public to address the ethical aspects of healthcare provision and practice in the best way they can, context is crucially important. As McMillan puts it, ‘ethics should be grounded’ in the practical realities of the situation.1 What, where and who (...) are important questions that set the parameters of the debate and, to some extent, frame the subsequent solution or decision. What is happening in a particular case, what is the source of controversy, is it a conflict of values, regulations or professional viewpoints? Where does it take place, under which rules, jurisdiction or in which professional setting? And who does it involve? Whose rights, interests or decision-making capacity do we prioritise? All these contextual questions need to be carefully articulated before it is possible to draw any normative conclusions. The importance of context is clear in this issue’s ‘Engagement without entanglement: a framework for non-sexual patient–physician boundaries’ by Appel.2 What might be seen as entirely appropriate behaviour in one context, for example, when I help out a friend and let them stay in my house for a few weeks while they recover from an operation, is entirely inappropriate in another—in …. (shrink)