Vulnerability, Insecurity and the Pathologies of Trust and Distrust

While some trust theorists have adverted to the vulnerabilities involved in trust, especially vulnerability to betrayal, the literature on trust has not engaged with recent work on the ethics of vulnerability. This paper initiates a dialogue between these literatures, and in doing so begins to explore the complex interrelations between vulnerability and trust. More specifically, it aims to show how trust can both mitigate and compound vulnerability. Through a discussion of two examples drawn from literary sources, the paper also investigates the effects of pathogenic vulnerability on the psychic economies of trust and distrust

Embodying autonomy : women and moral agency

This thesis has three connected aims: to argue that, despite recent feminist criticisms, the ideal of autonomous self-constitution is essential to a feminist account of women's moral agency; to show that, within our philosophical and cultural heritage, we have no adequate ideal of what it is for women qua women to be autonomous agents; and to attempt to articulate an ideal of autonomy which can incorporate a recognition both of the embededness of moral agents and of their different bodily perspectives. My argument is that such a recognition does not entail a commitment to a sexually specific ethic. However it does entail that in articulating what it means for women to act as autonomous moral agents in circumstances which are sexually specific we must recognise the specificity of women's bodily perspectives. The thesis comprises four parts and six chapters. In Part I (Chapter One), I sketch out an initial account of the ideal of autonomy, drawing on both contemporary philosophical analyses and feminist criticisms of the ideal. In Part II (Chapters Two and Three), through a discussion of the ideal of autonomous agency in the work of Simone de Beauvoir, I examine some of the reasons why autonomy has been seen as an achievement which it is difficult for women to attain: because autonomy has often been defined as control over the passive body by the active will; and because women's bodies have become a cultural metaphor for unconscious passivity. I argue however that, despite some of the difficulties with her work, de Beauvoir's idea that subjectivity is constituted in and through both our bodily perspectives and our relations with others, also points in the direction of a more adequate understanding of autonomy. Part III (Chapters Four and Five) investigates some of the historical origins of the opposition between autonomy and femininity - in the contrasts between public and private; reason and feeling; and reason and nature. Chapter Four consists mainly of a detailed examination of the different ideals of autonomy, but overlapping accounts of women's ethical life, in the works of Rousseau and Hegel. My argument here is that in their works the contrast between autonomy and women's ethical life arises out of an attempt to resolve deep tensions within the Enlightenment conception of social life. Their attempted resolutions however entail the political subordination of women and give rise to a representation of women's bodies as passive 'natural' bodies. Chapter Five is a reading of the writings of Mary Wollstonecraft in which I show that the main concerns of Wollstonecraft's life and writings were to try to articulate what it means for women to act as autonomous moral agents, and to envisage the social and political changes necessary for them to do so. In contrast to some contemporary feminist commentators, I argue that Wollstonecraft does not merely preserve the oppositions between public and private, reason and feeling, and masculine and feminine ethical life but, especially in her later writings, realises that somehow these oppositions must be integrated. In the Introduction to Part IV I outline a conception of subjectivity as intersubjective and as constituted through the constitution of a bodily perspective. My claim is that this view of subjectivity opens up the space for a conception of autonomy that can recognise the different situations and bodily perspectives of different moral agents. Chapter Six provides an example of what such a recognition might entail, through the example of women's autonomous agency in the context of pregnancy and abortion

The effect of tonsillectomy on the morbidity from recurrent tonsillitis

Background Tonsillitis is a common condition with an incidence in UK general practice of 37 per 1000 population a year.1 Recurrent tonsillitis results in significant morbidity and impacts on individuals’ quality of life. This study assesses the morbidity and quality of life of adults with recurrent tonsillitis, and the impact of surgical intervention on their health state. Objectives To describe disease-specific and global quality of life for adults with recurrent tonsillitis 6 months after tonsillectomy, using two instruments: the health impact of throat problems (HITP) and EuroQol-visual analogue scale questionnaire. To assess the overall health benefit from tonsillectomy as an intervention using the Glasgow Benefit Inventory (GBI). To assess potential predictors of tonsillectomy benefit. Design A prospective, observational cohort audit of patients who have fulfilled Scottish Intercollegiate Guideline Network (SIGN) criteria for tonsillectomy.2 Setting Secondary care, teaching hospital. Participants Seventy patients (57 female), median age 20 years (range 13-41). Results Median preoperative HITP was 47 (range 15-67), compared to 4 (0-72), (P<.001) 6 months following surgery. Median HITP difference was 39.5 (range −20 to 75). There was no significant change in global Quality of Life. Median overall 6 months GBI was 39 (−3 to 100). Patients had an average of 27 episodes of tonsillitis over a period of seven years before “achieving” tonsillectomy, significantly higher than the SIGN guidelines of three or more episodes over three years. Conclusions Recurrent tonsillitis causes a poor disease-specific quality of life. Patients experienced a median of three episodes per year for seven years before tonsillectomy. Following tonsillectomy, patients had a significant improvement in their disease-specific quality of life. Baseline HITP significantly improved after tonsillectomy. The results imply patients with recurrent acute tonsillitis may be experiencing undue dela

Determinants of long-term survival in a population-based cohort study of patients with head and neck cancer from Scotland

Background: We investigated long‐term survival from head and neck cancer (HNC) using different survival approaches. Methods: Patients were followed‐up from the Scottish Audit of Head and Neck Cancer. Overall survival and disease‐specific survival were calculated using the Kaplan–Meier method. Net survival was calculated by the Pohar‐Perme method. Mutually adjusted Cox proportional hazards models were used to determine the predictors of survival. Results: A total of 1820 patients were included in the analyses. Overall survival at 12 years was 26.3% (24.3%, 28.3%). Disease‐specific survival at 12 years was 56.9% (54.3%, 59.4%). Net survival at 12 years was 41.4% (37.6%, 45.1%). Conclusion: Determinants associated with long‐term survival included age, stage, treatment modality, WHO performance status, alcohol consumption, smoking behavior, and anatomical site. We recommend that net survival is used for long‐term outcomes for HNC patients—it disentangles other causes of death, which are overestimated in overall survival and underestimated in disease‐specific survival

Inequality in the survival of patients with head and neck cancer in Scotland

Background: Socioeconomic inequalities impact on the survival of head and neck cancer patients, but there is limited understanding of the explanations of the inequality, particularly in long-term survival. Methods: Patients were recruited from the Scottish Audit of Head and Neck cancer from 1999 to 2001 and were linked to mortality data as at 30th September 2013. Socioeconomic status was determined using the area-based Carstairs 2001 index. Overall and disease-specific survival were calculated using the Kaplan-Meier method with 95% confidence intervals (CI’s) at one-, five- and 12-years. Cox proportional hazard models with 95% CIs were used to determine the explanations for the inequality in survival by all-cause mortality and disease-specific mortality with 95% CIs. Net survival at one-, five- and 12-years was also computed with 95% CIs. Results: Most patients were from the most deprived group, and were more likely to smoke, drink, have cancer of a higher stage and have a lower WHO Performance Status. A clear gradient across Carstairs fifths for unadjusted overall and disease-specific survival was observed at one-, five- and 12-years for patients with HNC. Multiple patient, tumour and treatment factors play a part in the inequality observed, particularly by five- and 12-years when the inequality could be explained in fully adjusted models. However, the inequality at one-year survival remained. The inequality in 12-year net survival was very small, suggesting that the inequality in the long-term may be partly attributable to background mortality. Conclusion: Explanations for the inequality in the survival of patients with HNC are not straightforward, and this study concludes that many factors play a part including multiple patient, tumour and treatment factors

Perspectives on “Giving Back”: A Conversation Between Researcher and Refugee

Our chapter—“Perspectives on ‘giving back’: A conversation between researcher and refugee”—offers personal reflections on the ethics of research with refugees and what it means for researchers to “give back” to refugee participants beyond “policy impact”. Written as a dialogue between an academic and a Rohingya refugee youth leader, we explore the blurry lines between academic work and advocacy when the issues of refugee protection are pressing, as well as the appropriateness of researchers giving monetary donations and volunteering for refugee causes as payback for data. In this chapter, we also examine what it means to build trust and relationships between researchers and refugees, and how too often researchers fail to develop meaningful research interactions with refugee participants who share their time, energy and personal stories of vulnerability

Access to and experience of later abortion: accounts from women in Scotland

Context: Except in the presence of significant medical indications, the legal limit for abortion in Great Britain is 24 weeks’ gestation. Nevertheless, abortion for nonmedical reasons is not usually provided in Scotland after 18–20 weeks, meaning women have to travel to England for the procedure. Methods: In-depth interviews were conducted with 23 women presenting for "later" abortions (i.e., at 16 or more weeks’ gestation) in Scotland. Participants were women who sought an abortion at a participating National Health Service clinic between January and July 2013. Interviews addressed reasons for and consequences of later presentation, as well as women's experiences of abortion. Thematic analysis attended to emerging issues and employed the conceptual tool of candidacy. Results: Delayed recognition of pregnancy, changed life circumstances and conflicting candidacies for motherhood and having an abortion were common reasons for women's presentation for later abortion. Women perceived that the resources required to travel to England for a later abortion were potential barriers to access, and felt that such travel was distressing and stigmatizing. Participants who continued their pregnancy did so after learning they were at a later gestational age than expected or after receiving assurances of support from partners, friends or family. Conclusions: Reasons for seeking later abortion are complex and varied among women in Scotland, and suggest that reducing barriers to access and improving local provision of such abortions are a necessity. The candidacy framework allows for a fuller understanding of the difficulties involved in obtaining abortions