On Engster's care-justification of the specialness thesis about healthcare

To say health is ‘special’ is to say that it has a moral significance that differentiates it from other goods (cars, say or radios) and, as a matter of justice, warrants distributing it separately. In this essay, I critique a new justification for the specialness thesis about healthcare (STHC) recently put forth by Engster. I argue that, regrettably, Engster's justification of STHC ultimately fails and fails on much the same grounds as have previous justifications of STHC. However, I also argue that Engster's argument still adds something valuable to the debate around STHC insofar as it reminds us that the moral significance of healthcare may be wider than simply its effect on the incidence of disability and disease: one further reason we may think healthcare is morally significant is because it concerns the treatment and care of those who are already unwell

Towards a More Particularist View of Rights’ Stringency

For all their various disagreements, one point upon which rights theorists often agree is that it is simply part of the nature of rights that they tend to override, outweigh or exclude competing considerations in moral reasoning, that they have ‘peremptory force’ (Raz in The Morality of Freedom, Oxford University Press, Oxford, 1986, p. 192), making ‘powerful demands’ that can only be overridden in ‘exceptional circumstances’ (Miller, in Cruft, Liao, Renzo (eds), Philosophical Foundations of Human Rights, Oxford University Press, Oxford, 2016, p. 240). In this article I challenge this thought. My aim here is not to prove that the traditional view of rights’ stringency is necessarily false, nor even that we have no good reason to believe it is true. Rather, my aim is only to show that we have good reason to think that the foundation of the traditional position is less stable than we might have otherwise supposed and that an alternative conception of rights—one which takes the stringency of any given right as particular to the kind of right it is—is both viable and attractive. In short, to begin to move us towards a more ‘particularist’ conception of rights’ standing in moral reasoning and judgement

Does your electronic butler owe you a duty of confidentiality?

As artificial intelligence (AI) advances the legal issues have not progressed in step and principles that exist have become outdated in a relatively short time. Privacy is a major concern and the myriad of devices that store data for wide ranging purposes risk breaches of privacy. Treating such a breach as a design defect or technical fault, does not reflect the complexities of legal liability that apply to robotics. Where advanced levels of AI are involved, such as with electronic butlers and carers used increasingly to assist vulnerable and ageing populations, the question of whether a robot owes a duty of confidentiality to the person for whom they are caring is becoming ever more pertinent. This question is considered in detail and it is concluded that a duty may be owed in some cases. After a brief introduction (I.) the article picks up on the aspects of legal agency and AI (II.) and examines robots as social beeings (III.), their relation- ship to duty (IV.) as well as their capacity as "extended cognition" (V.). These aspects are then brought in con- text with issues of data protection (VI.) and the general relationship between civil law, ethics and robotics (VII.) before conclusions (VIII.) are drawn

Patient data ownership

Response of article in JAMA advocating patient data ownershi

Spinoza’s genealogical critique of his contemporaries’ axiology

Among Spinoza’s principal projects in the Ethics is his effort to “remove” certain metaethical prejudices from the minds of his readers, to “expose” them, as he has similar misconceptions about other matters, by submitting them to the “scrutiny of reason”. In this article, I consider the argumentative strategy Spinoza uses here – and its intellectual history – in depth. I argue that Spinoza’s method is best characterised as a genealogical analysis. As I recount, by Spinoza’s time of writing, these kinds of arguments already had a long and illustrious history. However, I also argue that, in his adoption of such strategies, we have good reason to think Spinoza’s primary influence was Gersonides. Elucidating this aspect of Spinoza’s critique of his contemporaries’ axiologies brings a number of explicatory and historical boons. However, regrettably, it also comes at a cost, revealing a significant flaw in Spinoza’s reasoning. Towards the end of this article, I consider the nature of this flaw, whether Spinoza can avoid it and its ramifications for Spinoza’s wider philosophical project

Bridging the gaps in palliative care bereavement support: An international perspective

A review of palliative care policies and bereavement support practices in the United States, Canada, United Kingdom, Australia, and Japan demonstrated 4 challenges: questions over providing universal versus targeted support; a lack of clear evidence driving service delivery; informal or no risk assessment; and limited or no evaluation of services. Bridging the gaps between the policy and practice of palliative care bereavement support requires acknowledging the challenges of medical and public health models, improving bereavement need assessment processes, enhancing the role of primary care providers, and extending research to provide an evidence-base for interventions

Matching response to need: What makes social networks fit for providing bereavement support?

© 2019 Aoun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The objectives of this study were to explore the goodness of fit between the bereaved peoples’ needs and the support offered by their social networks; to ascertain whether this support was experienced as helpful or unhelpful by bereaved people; and to explore both the types of social networks that offer effective support and the characteristics of the communities that encourage and nurture such networks. This study was based on qualitative interviews from twenty bereaved people, in Western Australia, interviewed in 2013. A framework analysis of these interviews was undertaken using a deductive approach based on the goodness of fit framework. Much of this support is provided informally in community settings by a range of people already involved in the everyday lives of those recently bereaved; and that support can be helpful or unhelpful depending on its amount, timing, function and structure. Improving the fit between the bereaved person’s needs and the support offered may thus involve identifying and enhancing the caring capacity of existing networks. An important strategy for achieving this is to train community members in mapping and developing these naturally occurring networks. Some such networks will include relationships of long standing, others may be circles of care formed during a period of caring. Peer support bereavement networks develop from these existing networks and may also recruit new members who were not part of the caring circle. The findings endorse social models of bereavement care that fit within a public health approach rather than relying solely on professional care. As exemplified by Compassionate Communities policies and practices, establishing collaboration between community networks and professional services is vital for effective and sustainable bereavement care

Effects of spiritual care training for palliative care professionals

Little is known about the effects of spiritual care training for professionals in palliative medicine. We therefore investigated prospectively the effects of such training over a six-month period. All 63 participants of the three and a half-day training were asked to fill out three questionnaires: before and after the training, as well as six months later. The questionnaires included demographic data, numeric rating scales about general attitudes towards the work in palliative care, the Self-Transcendence Scale (STS), the spiritual subscale of the Functional Assessment of Chronic Illness Therapy (FACIT-Sp) and the Idler Index of Religiosity (IIR). Forty-eight participants (76) completed all three questionnaires (91 women, median age 49 years; 51 nurses, 16 hospice volunteers, 14 physicians).Significant and sustained improvements were found in self-perceived compassion for the dying (after the training: P =0.002; 6 months later: P=0.025), compassion for oneself (P < 0.001; P =0.013), attitude towards one's family (P =0.001; P =0.031), satisfaction with work (P < 0.001; P =0.039), reduction in work-related stress (P < 0.001; P =0.033), and attitude towards colleagues (P =0.039; P =0.040), as well as in the FACIT-Sp (P < 0.001; P =0.040). Our results suggest that the spiritual care training had a positive influence on the spiritual well-being and the attitudes of the participating palliative care professionals which was preserved over a six-month period

Who cares for the bereaved? A national survey of family caregivers of people with motor neurone disease

Background: Although Motor Neurone Disease (MND) caregivers are most challenged physically and psychologically, there is a paucity of population-based research to investigate the impact of bereavement, unmet needs, range of supports, and their helpfulness as perceived by bereaved MND caregivers. Methods: An anonymous national population-based cross-sectional postal and online survey of bereavement experiences of family caregivers who lost a relative/friend to MND in 2016, 2017, and 2018. Recruitment was through all MND Associations in Australia. Results: 393 valid responses were received (31% response rate). Bereaved caregiver deterioration in physical (31%) and mental health (42%) were common. Approximately 40% did not feel their support needs were met. Perceived insufficiency of support was higher for caregivers at high bereavement risk (63%) and was associated with a significant worsening of their mental and physical health. The majority accessed support from family and friends followed by MND Associations, GPs, and funeral providers. Informal supports were reported to be the most helpful. Sources of professional help were the least used and they were perceived to be the least helpful. Conclusions: This study highlights the need for a new and enhanced approach to MND bereavement care involving a caregiver risk and needs assessment as a basis for a tailored “goodness of fit” support plan. This approach requires continuity of care, more resources, formal plans, and enhanced training for professionals, as well as optimizing community capacity. MND Associations are well-positioned to support affected families before and after bereavement but may require additional training and resources to fulfill this role