Justice Everywhere

a blog about philosophy in public affairs

Category: Health (Page 1 of 6)

How Should We Talk About the Pandemic?

In this post, Mark Bowker (Lund University) discusses their recent article in Journal of Applied Philosophy on our responsibility to be careful with scientific generalisations.


In a pandemic it is extremely important for the public to know how they can keep themselves and others safe. This requires effective communication to circulate information about scientific developments. In a recent article, I argue that even the most basic statements can be misleading, so we must think very carefully about the words they use. You may have heard, for example, that children do not transmit coronavirus, but this statement is not as simple as it may seem.

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From the Vault: Philosophy in the Covid-19 Pandemic

While Justice Everywhere takes a short break over the summer, we recall some of the highlights from our 2021-22 season. 

 

A lot has been written about Covid-19 and Justice Everywhere has contributed to this on several fronts. Here are some links from the last year on philosophical  issues raised by the pandemic that you may have missed or be interested to re-read:

Stay tuned for even more on this topic in our 2022-23 season!

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Justice Everywhere will return in full swing on 1st September with fresh weekly posts by our cooperative of regular authors (published on Mondays), in addition to our Journal of Applied Philosophy series (published on Thursdays). If you have a suggestion for a topic or would like to contribute a guest post on a topical subject in political philosophy (broadly construed), please feel free to get in touch with us at justice.everywhere.blog@gmail.com.

From the Vault: Journal of Applied Philosophy Collaboration

While Justice Everywhere takes a short break over the summer, we recall some of the highlights from our 2021-22 season. This post focuses on our ongoing collaboration with the Journal of Applied Philosophy.

 

In 2019, Justice Everywhere began a collaboration with the Journal of Applied Philosophy. The journal is a unique forum that publishes philosophical analysis of problems of practical concern, and several of its authors post accessible summaries of their work on Justice Everywhere. These posts draw on diverse theoretical viewpoints and bring them to bear on a broad spectrum of issues, ranging from the environment and natural resources to freedom, empathy, and medical ethics.

For a full list of these posts, visit the JOAP page on Justice Everywhere. For a flavour of the range, you might read:

Stay tuned for even more from JOAP authors in our 2022-23 season!

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Justice Everywhere will return in full swing on 1st September with fresh weekly posts by our cooperative of regular authors (published on Mondays), in addition to our Journal of Applied Philosophy series (published on Thursdays). If you have a suggestion for a topic or would like to contribute a guest post on a topical subject in political philosophy (broadly construed), please feel free to get in touch with us at justice.everywhere.blog@gmail.com.

Withdrawing and withholding treatment are not always morally equivalent

In this post, Andrew McGee (Queensland University of Technology) and Drew Carter (University of Adelaide) discuss their recent article in Journal of Applied Philosophy on the moral difference between withdrawing and withholding medical interventions.


Some health ethics writers and clinical guidelines claim that withdrawing and withholding medical treatment are morally equivalent: if one is permissible or impermissible, so too the other.

Call this view Equivalence. It is heir of a related view that has held sway in ethical and legal debate for decades, in support of the withdrawal of treatment that is no longer beneficial.  The thinking was that if treatment no longer benefits a patient, then whether it is withheld or withdrawn does not matter – so there is no morally relevant difference between the two.

Equivalence goes beyond this. It applies to beneficial treatment, where two patients compete for one resource. The reasoning is: To save as many lives as possible, we would have no qualms about withholding a beneficial treatment from one person to give it to another who can benefit more. We should therefore have no qualms about withdrawing it either. In a recent article, we argue that Equivalence is false.

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Why should we protect the vulnerable?

In this post, Emma Curran & Stephen John discuss their recent article in Journal of Applied Philosophy on duties to prioritise vaccinating the vulnerable.


In the December of 2020, the UK seemed to breathe an, albeit small, sigh of relief as the first COVID-19 vaccinations were administered. After almost nine months of lockdowns, the vaccine roll-out was the first concrete sign that life might return to – at least something like – normality. Indeed, throughout 2020, the promise of a vaccine seemed to be the end to which lockdown pointed. Lockdown was tough but necessary to protect the lives of those most vulnerable to COVID-19, until they could be helped by a vaccine. Unsurprisingly, then, the vaccine roll-out started with the most vulnerable, with a primary focus on age. In this post, however, we explore a  seemingly small alteration to the Government’s vaccine strategy which concerned and confused many. Using this policy, we explore the reasons we have to protect the vulnerable, the complexity of ethical discourse around the distribution of vaccines, and the need for transparent, open debate.

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Why we should think twice about persons who struggle to empathize

In this post, Daphne Brandenburg discusses her recent article in Journal of Applied Philosophy on empathy, communication, and responsibility.


In the TV detective series Bron/Broen, one of the main characters, Saga Norén, delivers the bad news to family members after a murder has been discovered. She does so by abruptly announcing the victim’s death, and starting a thorough interrogation without giving the family member any time to gather themselves. She gets impatient when they do not immediately answer, and does not hide her impatience.

Maybe you feel shocked or even angered by this lack of responsiveness. We tend to expect more concern in these types of situations. However, her behavior may (at least partly) be explained by a difficulty to pick up on, and respond to the emotions of others.

These difficulties are commonly described as empathy deficits which should excuse a person from the general expectation to attend to the feelings of others. But, in a recent article I argue we should reconsider our assumptions about why and how these persons are excused.

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How The God Committee gets Organ Allocation and Xenotransplantation Wrong and Why it Matters

This is a guest post by Kailyn Price and Jacob Zionts. It discusses their thinking on some of the ethical dilemmas faced by organ transplant committees through the lens of The God Committee.

(Note: this post contains spoilers)


It is 2021 and Dr. Jordan Taylor (played by Julia Stiles) sighs relievedly as she sees the genetically modified pig heart that she has just transplanted into the chest of a baboon beat and come back to life. The apparently successful operation serves as the climax to Austin Stark’s The God Committee, a fast-paced medical drama that grapples with the ethics of transplant committees, xenotransplantation (cross-species transplantation), and benefit calculations.

Despite the achievement, the scene is haunted by Dr. Taylor and her transplant committee’s decision a decade earlier to accept a bribe from a suspiciously wealthy man whose adult son desperately needed a heart. Prior to learning of the twenty- something’s condition and prospect of a bribe, the committee had been coalescing around a decision between two other candidates: 1) a middle-aged Black man who struggled with bipolar disorder but is also a loving father of three daughters, and 2) a curmudgeonly 70-year-old white woman who demeans her nurses, has little extant family, and seems ambivalent about receiving the heart. The bribe required the committee to ignore the son’s typically disqualifying drug use and deprioritize the other candidates but, ultimately, funded the research that culminated in the pig-to-baboon heart transplant and enabled the hospital to care for more patients.

The God Committee wants its audience to walk away thinking that the ends justified the means—that the hard-nosed consequentialism of the committee and their willingness to shoo aside the more deontological and virtue-oriented constraints of standard bioethics were necessary to secure the greater good. But we don’t think that’s the right message to take home. In this post, we will explicate and reject both of the committee’s reasons for accepting the bribe: (1) saving the hospital and (2) securing xenotransplantation funding. In the end, we argue that (1) accepting the bribe undermines the committee’s ability to act in the best interest of the hospital’s patients; and (2) the film’s narrow focus on xenotransplantation occludes the upstream causes of heart failure that are imminently targetable with status quo technologies and, critically, have the upshot of positively interacting with the demands of racial, environmental, and animal justice.

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Self-control and socio-economic disadvantage: trickier than it seems

In social psychology, there is a small industry for articles reporting positive correlations between measures of self-control and various measures of socio-economic status and achievement. For example, Tangney, Baumeister and Boone (2008) found that self-control, measured on a self-report scale they devised, is correlated with better grades, somatic and mental health, and stable social relationships such as marriage. Moffitt et al. (2011) conducted a longitudinal study that followed children who had participated in the Mischel “marshmallow tests” to the age of 32 years old, and found childhood performance in that delayed gratification assignment to be correlated with measures of health and economic success, interpersonal adjustment, and  with criminal justice outcomes, even after controlling for childhood socio-economic factors.

Studies like these have been widely publicised, and the message in popular science media often leads with the idea that self-control is a stable trait that some have, some don’t. The ones who were dealt a losing hand in self-control got a losing hand overall, ending up with poor health, poverty, unstable relationships, and crime not out of ill will, but because they simply can’t hold it together. In short, the causal arrow goes from poor self-control to socioeconomic disadvantage.

This line of thinking has received plenty of criticism. Some have pointed out that the studies have been designed from a perspective assuming a middle-class lifestyle, and that self-control may not be as adaptive for people from all backgrounds.

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Why We Can’t Have It All When It Comes to the Future of Work

This is a guest post by Deryn Thomas, PhD Student in Philosophy, Benjamin Sachs, Senior Lecturer, and Alexander Douglas, Senior Lecturer, at University of St. Andrews. It discusses their recent research on a future with fair work for all and some of the trade-offs it involves. 


Two years into a world turned upside down by lockdowns, travel restrictions, and viral mutations, the way people work and make a living has changed dramatically. New challenges are being presented by rising childcare costs, increases in automation, the digitisation of the workplace, and the gig economy. So we need to ask: how do we make the future of work better for everyone?

At the Future of Work and Income Research Network, we’ve been thinking hard about this problem. As part of these efforts, we recently participated in a consultation for the Scottish Government on its Fair Work Goals, set to be implemented by 2025. The consultation document and stated goals offer an optimistic vision for the future of work in Scotland. But it risks being too idealistic: many of the stated goals conflict with each other.

We noticed at least four sets of incompatible goals. As it stands, the documents say nothing about how these compromises will be decided. But we think this leaves out an important step in the process. Therefore, we offer some reflections from philosophy about how to weigh up the values at stake.  In the end, we think that decisions like these need to be made in the context of a national conversation about the trade-offs surrounding work.

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Mental Illness and Microaggression

Not only do people with mental illness frequently encounter negative stereotypes in news, films, books and in everyday speech, others often give misguided advice or are dismissive towards their mental distress. Yet claims by people with mental illness to have experienced discrimination in the form of microaggression might also be too easily dismissed: could not mental distress lead to increased emotional sensitivity, leading them to overreact?

Microaggressions, the small slights regularly experienced by marginalised people, are near daily reminders that someone is an outsider or a second-class citizen. On their own they may be slight, but their cumulative impact is anything but.  As part of a wider social pattern of oppression, they are deeply harmful. Microaggression can be behavioural such as when a store security guard is more likely to accuse a black customer of shoplifting; verbal, such as when a racialised person is regularly asked where they are “really” from; or environmental, such as when all buildings are named after white people and whiteness is assumed as the norm. (Examples of microaggressions related to race, gender, sexuality can be found here.)

People with mental illness regularly encounter negative stereotypes about themselves. Consistently depicting a group negatively, with limited access to positive role models, is an example of environmental microaggression. In both news and fiction, people living with schizophrenia or bipolar disorder are often depicted as violent or as bad parents. In crime novels, the culprit is often mentally disturbed. In her autoethnographic essay documenting how repeated exposure to this material affects her, Jennifer Eisenhauer writes: “The ways in which mothers who have bipolar disorder are portrayed in popular media becomes part of my daily lived experience. This is not because I see these portrayals everyday, but because these images and narratives become part of how I see myself and how others view me.”

Beyond these common negative stereotypes, people experiencing mental illness often encounter comments and behaviour which are insensitive or unhelpful. The many lists and articles about “what not to say to someone with mental illness” can be seen as guides to avoiding microagression. The Australian mental health charity SANE recommends avoiding the following:

– “Get over it / snap out of it”
– “It’s all in your head”
– “Stop whinging”
– “You have the same illness as my…”
– “You don’t seem unwell”
– “They’re so OCD!”
– “Have you thought of trying this, that or the other?”
– “You don’t need medication”
– “You need to be honest”
– “Get a good night’s sleep, exercise and look for the positives”
– “Oh yeah, that’s quite common isn’t it?”
– “Time heals. It will get better”

While stating that a mental illness is quite common seems to indicate acceptance, it can be experienced as minimising one’s distress. “You have the same illness as my…” is not that different from telling a black person that you are ok with black people and are not a racist because you have black friends. Other apparently well-meaning comments are problematic because they place the responsibility for recovery on the sufferer. Telling people to “think positive”, “what do you have to be upset about when your life is so good” or assuming that taking up yoga and eating large quantities of blueberries will solve someone’s problems, make it sound as if people could simply “snap out of it” if only they could be bothered to try. Such examples of insensitivity and rudeness accumulate into a pattern of social assumptions that mental illness can be overcome with application and self-management. This, in turn, moralises mental illness – you would not be depressed if only you tried harder, you are not trying that hard, therefore you are doing something wrong. Such moralisation further undermines the confidence of those with mental illness.

Appeals to microaggression are often dismissed with the claim that people are simply oversensitive. The complainers are snowflakes, self-deluded by victim culture. This criticism appears even more forceful here, as people with mental illness are often prone to interpreting events in a negative light or ruminating on the comments of others. We need not go as far as assuming completely delusional thinking. Depressed people often feel disproportionate guilt, feel as if they have failed or feel unloved. Anxiety can lead us to blow the importance of things out of proportion, or to worry about events that are unlikely to occur. Even psychologists sometimes assume that those with mental illness primarily experience self-stigma and expect discrimination that outweighs the actual stigma and discrimination from others. They claim that the negative attitudes are mostly in people’s imagination. Given this background how can we be sure that experiences of microaggression are not simple misinterpretations of well-meaning acts?

This is where the work of philosopher Regina Rini comes in extremely useful (even though mental illness is not a case she discusses). In her book-length analysis of the concept of microaggression, she gives an “ambiguous experience account of microaggression: what makes an act or event count as microaggression is that it is perceived by a member of an oppressed group as possibly but not certainly instantiating oppression.” Her definition takes into account that microaggressions are both subtle and ambiguous. Part of the damage they do is to make already marginalised people suspicious of their own interpretation of events. While their own interpretations are not always correct, Rini argues that as long as on balance members of a marginalised social group are likely to correctly notice subtle discrimination, we should accept that microaggression does happen, even if we sometimes disagree about whether any individual case is an instance of it.

Are people with mental illness reliable in this way? They are usually knowledgeable about their symptoms, medications and medication side effects. Moreover, most people, even with chronic mental illnesses, are not always unwell and out of touch with reality. Even when unwell, mental illness does not affect all domains of thinking. Experiencing irrational guilt does not imply an inability to recognise condescending remarks. The extensive overlap among “what not to say” lists (not all of which are blatant copies of each other) also indicates a consensus over what constitutes microaggression for people with mental illness.

So, rather than worrying whether an individual instance counts as a microaggression, we should be concerned with identifying the most common forms of microaggression that affect people with mental illness. If people with mental illness identify a set of unhelpful and discriminatory remarks, behaviours or environmental factors, we can safely say that microaggression does affect people with mental illness, regardless of any tendency of some people with mental illness to find social slights particularly painful. Even in these cases, the painfulness of these experiences must not be discounted. Another strength of Rini’s account is that it puts the focus on the experiences of marginalised people. Even though they may at times be mistaken about their interpretation of events, we should still accept the word of those experiencing mental illness about how those events made them feel.

Research shows that microaggression does affect people with mental illness in systematic ways. For example, Yanos et al found that there were “three main categories of experiences in this regard: assumptions of inferiority (for example, statements indicating that it was assumed that the person is not capable of doing what most people can do), patronizing microaggressions (for example, dismissive statements suggesting assumptions that people with mental illness are child-like), and subtle behaviors indicating fear of mental illness (for example, moving away from a person who is known to have a mental illness).”

Thus, we have every reason to accept general claims of microaggression in the case of mental illness. What can we do about this? Rini recommends avoiding, or at least questioning, material with harmful stereotypes in order to avoid internalising these ourselves. For their own part, writers, whether of fiction, non-fiction or journalism, can reduce lazy stereotyping in their work. (There is plenty of advice available. As an example, philosopher Sofia Jeppsson has written a blog post on the common problems with the way mental illness is depicted in science-fiction.) We can follow the advice of “what not to say to people with mental illness” lists. We can assume that someone who lives with an illness has already tried all the obvious remedies. Most importantly, we should listen and if someone says something is unhelpful, accept this instead of trying to convince them that they are mistaken about their own experiences.

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