Justice Everywhere

a blog about philosophy in public affairs

Author: Fay Niker (Page 2 of 2)

‘Truman Care’ for Dementia

On the outskirts of Amsterdam, there is a small village called Hogewey, notable because all of its 152 residents have severe or extreme dementia. Hogewey is a gated model village, complete with town square, post office, theatre, hair salon, café-restaurant and supermarket – as well as cameras monitoring residents around the clock, and well-trained staff working incognito, holding a myriad of occupations such as post-office clerks and supermarket cashiers. Every detail of this ‘fake reality’ has been meticulously designed to ensure that the residents can experience life as close to ‘normal’ as possible. Critics have drawn parallels with the deception depicted in the 1998 ‘social science fiction’ film The Truman Show; but many Alzheimer’s experts have praised the pioneering facility for being the first to adjust ‘our’ reality to allow those with dementia to be in a safe and comforting environment – one built around life rather than death.

Taking inspiration from Hogewey, the Grove Care nursing home in Winterbourne, Bristol have developed ‘Memory Lane’; a recreation of a 1950s high street, including a Post Office, pub, bus stop, phone box and shop windows full of memorabilia.

I’d like to briefly outline two sets of reasons for thinking we should move towards this model of care (all-day reminiscence therapy, or ‘Truman Care’ if you like), and to then briefly discuss what I assume to be the main problem facing this kind of move.

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21st Century Smoking

 

At the British Medical Association’s (BMA) annual representatives meeting this week, doctors voted overwhelmingly to push for a permanent ban on the sale of cigarettes to those born after 2000.* What are the different reasons that might motivate, and potentially justify, the state intervening in citizens’ smoking behaviour? Broadly speaking, the main distinctions are those drawn between: (1) welfare- (both individual and collective) and autonomy-based reasons; (2) ‘harm to self’ and ‘harm to others’, that is, for the sake of smokers versus for the sake of non-smokers generally; and, relatedly, (3) an aim to increase tobacco use cessation (i.e., stop smokers smoking) versus an aim to reduce tobacco use initiation (stop people from starting to smoke in the first place). Accordingly, an initial taxonomy of reasons might have the following six cells:

Welfare-based reasons
Autonomy-based reasons
Smokers
Welfare of smokers
Autonomy of smokers
Non-smokers
Welfare of non-smokers
Autonomy of non-smokers
Potential smokers
Welfare of potential smokers
Autonomy of potential smokers

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Nudge, Nudge? Privatizing Public Policy

“Like all major changes to democratic accountability, it happened with a minimum of fuss. By the time we heard about it, it was already over.”

Photo: Illustration by Bill Butcher 

This week the government announced that the Behavioural Insights Team (BIT), commonly referred to as the ‘nudge unit’, has been ‘spun out’ of Whitehall into a mutual joint venture. The new “social purpose company” is now owned, in roughly equal shares, by BIT employees, the government, and Nesta (an independent charity established by the previous government using £250 million of National Lottery money). The privatisation deal has been described as “one of the biggest experiments in British public sector reform” (Financial Times), on account of this being the first time that privatisation has reached beyond public services and utilities to include an actual government policy team. My intuition, like many other people’s I would imagine, is that this marks a dangerous new precedent in the rise of private power over the public. But what precisely is it that is doing the work for this intuition?

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Moral Motivation and Sustainable Behaviour Change

‘Climate change’ and ‘behaviour change’ are both central themes in the policy landscape, academic research, and media discourse of the twenty-first century. The former has been described by the former Secretary-General of the UN, Kofi Annan, as “the greatest humanitarian challenge facing mankind today”, a statement that carries added weight in light of the complete devastation inflicted upon the Philippines by Typhoon Haiyan – one of the strongest storms ever to make landfall. The latter, ‘behaviour change’, has become a ubiquitous phrase in policymaking circles, representing a radical shift towards a non-regulatory policymaking paradigm, often referred to as nudging.

The 2008 Climate Change Act established the world’s first legally binding climate change target. This has committed the UK to reducing its greenhouse gas emissions by at least 80% by 2050 – a target that requires a major change in the way we live, representative of an unprecedented reversal of a universal trend among industrialised nations concerning the relationship between economic growth and carbon emission. The key question going forward, therefore, is: How is such a radical behavioural/cultural transformation going to be brought about? The current government’s answer appears to rest heavily upon behaviour change techniques that seek to nudge (implicitly encourage, incentivise, etc.) citizens’ toward more sustainable behaviour patterns.

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