The Ethics of Delusional Belief

In this paper we address the ethics of adopting delusional beliefs and we apply consequentialist and deontological considerations to the epistemic evaluation of delusions. Delusions are characterised by their epistemic shortcomings and they are often defined as false and irrational beliefs. Despite this, when agents are overwhelmed by negative emotions due to the effects of trauma or previous adversities, or when they are subject to anxiety and stress as a result of hypersalient experience, the adoption of a delusional belief can prevent a serious epistemic harm from occurring. For instance, delusions can allow agents to remain in touch with their environment overcoming the disruptive effect of negative emotions and anxiety. Moreover, agents are not blameworthy for adopting their delusions if their ability to believe otherwise is compromised. There is evidence suggesting that no evidence-related action that would counterfactually lead them to believe otherwise is typically available to them. The lack of ability to believe otherwise, together with some other conditions, implies that the agents are not blameworthy for their delusions. The examination of the epistemic status of delusions prompts us to acknowledge the complexity and contextual nature of epistemic evaluation, establish connections between consequentialist and deontological frameworks in epistemology, and introduce the notion of epistemic innocence into the vocabulary of epistemic evaluatio

The relationship between ingroup identity and Paranoid ideation among people from African and African Caribbean backgrounds.

OBJECTIVES: People from ethnic minority groups experience higher rates of paranoid delusions compared with people from ethnic majority groups. Identifying with social groups has been shown to protect against mental health symptoms; however, no studies have investigated the relationship between social identification and paranoia in ethnic minority populations. Here, we investigated the association between British identification and paranoia in a sample of people from African and African Caribbean backgrounds living in the United Kingdom. We also assessed the role of potential mediating (self-esteem and locus of control) and moderating (contact with White British people) factors. DESIGN: Cross-sectional quantitative survey design. METHODS: We recruited 335 people from African and African Caribbean backgrounds who completed online self-report measures of identification with Great Britain, self-esteem, locus of control, positive and negative contact with White British people, and paranoia. RESULTS: A parallel moderated mediation model indicated that British identification was associated with lower paranoia when participants experienced primarily positive contact with White British people. British identification was associated with higher paranoia when participants had primarily negative contact with White British people. Both effects were mediated by changes in locus of control, but self-esteem was not implicated in either pathway. CONCLUSIONS: Identification with the majority culture is associated both positively and negatively with paranoid beliefs depending on the types of social interactions people experience. The findings have implications for preventative social prescribing initiatives and for understanding the causes of the high rates of psychosis in ethnic minority populations. PRACTITIONER POINTS: People from African and African Caribbean backgrounds experience high rates of paranoia, which may stem from social causes such as lack of belonging and negative social experiences. Among people from African backgrounds living in the UK, British identification is associated with lower paranoia when people's social experiences with White British people are positive and higher paranoia when their social experiences with White British people are negative. It is recommended that social interventions designed to reduce paranoia in vulnerable groups foster positive social contact and community belonging, which should enhance feelings of personal control. Understanding the complex interplay between social identity and social contact in the development of paranoia may help therapists and researchers better understand the phenomenology and risk factors of paranoid symptomology

Factors Influencing Surgeons' Decisions in Elective Cosmetic Surgery Consultations

Background. Current guidelines for surgeons' decisions about whether to offer cosmetic surgery are ineffective. Therefore, surgeons have to make difficult decisions on a case-by-case basis. The authors sought to identify the patient variables that influence surgeons' decisions in practice. Design. A qualitative study first delineated, from observation of consultations and interviews with surgeons and other staff, variables that might influence their decisions. Then, in a cross-sectional survey of patients seeking cosmetic surgery, the authors measured these variables and tested whether they predicted the surgeons' decisions to offer surgery. Participants. Participants were 6 consultant plastic surgeons who assess cosmetic surgery referrals and 276 new patients aged 16 years or older referred to these surgeons. Results. The qualitative study suggested that, as well as clinical factors (the probability of a satisfactory surgical outcome and the risks v. benefits of surgery), surgery was more likely to be offered where it was of low cost (i.e., minor skin surgery), physical symptoms or dysfunction were present, and abnormality of appearance was extreme. The role of patients' quality of life was unclear. The quantitative study confirmed that the probability of surgery was increased where requests were for minor skin procedures and by abnormality of patients' appearance. In patients seeking major body procedures, surgery was less likely when patients reported poor quality of life. Conclusion. Surgeons' decisions about whether to offer elective cosmetic surgery follow systematic rules. By incorporating the factors that surgeons use in their decision making, more effective guidelines about elective cosmetic surgery provision than are presently available could be developed

Development, teaching, and evaluation of a consultation structure model for use in veterinary education

Introduction It is now widely accepted that veterinary graduates should enter their profession with high-quality communication skills. Until recently, however, this has not been reflected in undergraduate training. Recently, the Veterinary Faculty at the University of Liverpool, in collaboration with the profession's indemnity insurers (the Veterinary Defence Society), has developed one of the first specific communication skills training courses for veterinary undergraduates. For the first three years it has been run, the aim of this course has been to increase students’ awareness of the importance of good communication in the veterinary profession. The course is based on best practice as currently defined in medical education, making extensive use of actors as simulated clients. As well as watching acted-out consultations, the students also role-play scenarios designed to expose them to all aspects of the veterinary consultation (including introductions, history taking, breaking bad news, fee issues, and dealing with anger). Feedback on the role plays is facilitated by members of stbio. Evaluation of the first year of this course has been published and has shown it achieves its aims of increasing the students’ awareness of the importance of good communication with their clients.1 However, regular facilitators became aware that the students’ learning experience was very variable and, perhaps more importantly, could not be defined. This was felt to be a critical limitation to further development of the course, particularly in the area of student learning and assessment. It was recognized that one of the major obstacles to further development was the lack of a teaching model suitable for the veterinary consultation. Such models are routinely used in medical education. However, their direct application to veterinary education is limited because they do not reflect the diversity of clients with whom the veterinarian/veterinary surgeon communicates (e.g., farmers, companion animal owners), nor do they take into account the two important, and often difficult, areas of euthanasia and finances. The aim of this project was to develop a consultation model for veterinary education based on the Calgary-Cambridge model of the medical consultation. The model was adapted, recognizing both the considerable overlap and also the likely differences between the veterinary and medical consultations. Subsequently, this model has been used to train communication skills facilitators and undergraduates. Here we present the model and provide results of evaluation of its use within the communication skills program for veterinary undergraduates at the University of Liverpool