Accommodating religion and belief in healthcare: Political threats,agonistic democracy and established religion

This paper considers what concept of accommodation is necessary to identify and address discrimination, disadvantages and disparities in such a way that the plurality of religious people with their beliefs, values and practices may be justly accommodated in healthcare. It evaluates threats to the possibility of such accommodation pertaining by considering what beliefs and practices might increase the risk of unjust discrimination against and disadvantage for religious people, whether as individuals or as groups; and the risk of disparities between the care provided to religious people. The claim is that there is an important cluster of risks that are political in kind and emergent within philosophical bioethics. While not amounting (yet) to a trend, they are sufficiently threatening to a just civic life for patients and healthcare staff as to warrant scrutiny. After an Introductory Section 1, Section 2 evaluates a criticism of ‘accommodation’ and the apparently additional health-related requirements that those of religious faith demand, when compared with other people. It does so by comparing Lori Beaman's idea of agonism with that of a distinct and somewhat complementary approach in Jonathan Chaplin's political philosophy, before examining the role of established religion in setting the conditions for the accommodation of religion and belief in healthcare. Section 3 examines risks to such accommodation by engaging critically with three health-related instantiations of political philosophy that differ radically from both Beaman and Chaplin. A concluding Section 4 focusses on appropriate modes of communicating about religious and other beliefs in healthcare.     

The importance of considering human well-being to understand social preferences of ecosystem services

Evaluations about social preferences for ecosystem services do not always include human well-being. Using a case study in South-Central Chile, we showed how the human well-being approach might reveal social preferences on ecosystem services. We used a socio-cultural approach to compare social preferences for provisioning, regulating, and cultural services and the links people establish to human well-being. From an online questionnaire, we collected 214 responses, balanced in gender (49/51 % men/women, respectively), diverse in age (18 to 62 years), but with 68 % under 30 years. Water for human consumption and agriculture, food, and native forest products were the most preferred provisioning services (40, 28, and 21 %, respectively). In contrast, products from tree plantations were considered the lowest ones. Pollution control (40 %) and water provision during summer (18 %) were the preferred regulating services, while biodiversity conservation (25 %) and environmental education (22 %) were primarily selected cultural ones. We found a clear preference pattern for provisioning services but not for regulating and cultural services. Even though people linked multiple ES to human well-being, some links’ patterns mirrored preferences for provisioning services but not for regulating and cultural services. However, although cultural services did not show a clear preference pattern, people perceived their importance by linking them to various benefits. Understanding social preferences of ES based on their links with human well-being helps to address their relevance and potential trade-offs for land planning and management decision-making and convert the ES concept into decision-making instruments.     

The concept of precedent autonomy

Does respect for autonomy imply respect for precedent autonomy? The principle of respect for autonomy requires us to respect a competent patient’s treatment preference, but not everyone agrees that it requires us to respect preferences formed earlier by a now‐incapacitated patient, such as those expressed in an advance directive. The concept of precedent autonomy, which concerns just such preferences, is problematic because it is not clear that we can still attribute to a now‐incapacitated patient a preference which that patient never disaffirmed but can no longer understand. If we cannot make that attribution, then perhaps we should not respect precedent autonomy – after all, how can you respect patient autonomy by giving patients what they no longer want, even if they never disaffirmed those wants? I argue that whether an earlier preference can still be attributed to a now‐incapacitated patient depends on the reasons behind the preference, for a preference includes (and is not merely supported by) the reasons behind it. When the considerations that served as reasons no longer exist, neither does the preference which included those reasons. In particular, if the considerations that served as reasons for the patient exist only under conditions where the patient retains full mental capacity, then once that capacity is lost, so are those reasons and the preference based upon them. I use this analysis of precedent autonomy to ascertain the merits of various approaches to advance medical decisionmaking, including Nancy Rhoden’s approach, approaches based on a Parfitian personal identity analysis, approaches based on soft paternalism, and approaches based on the stability and longevity of preferences. Despite the apparent absurdity of respecting patient autonomy by giving patients what they no longer prefer but have never disaffirmed, I conclude with some programmatic remarks on when and why respect for (precedent) autonomy nonetheless requires us to respect former preferences.     

Dignity,conscience and religious pluralism in healthcare: An argument for a presumption in favour of respect for religious belief

Religious pluralism in healthcare means that conflicts regarding appropriate treatment can occur because of convictions of patients and healthcare workers alike. This contribution argues for a presumption in favour of respect for religious belief on the basis that such convictions are judgements of conscience, and respect for conscience is core to what it means to respect human dignity. The human person is a subject in relation to all that is. Human dignity refers to the worth of human persons as members of the species with capacities of reason and free choice that enable the realisation of dignity as self-worth through morally good behaviour. Conscience is both a feature of inherent dignity and necessary for acquiring dignity as self-worth. Conscience enables a person to identify objective values and disvalues for human flourishing, the rational capacity to reason about the relative importance of these values and the right way to achieve them and the judgement of the good end and the right means. Human persons are bound to follow their conscience because this is their subjective relationship to objective truth. Religious convictions are decisions of conscience because they are subjective judgements about objective truth. The presumption of respect for religious belief is limited by the normative dimension of human dignity such that a person's beliefs may be overridden if they objectively violate inherent dignity or morally legitimate acquired dignity.     

Welfarism versus 'free enterprise': considerations of power and justice in the Philippine healthcare system

The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and 'free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of 'power' proposed here as 'access to and control of resources.'     

Differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation

There has been little discussion in the published literature regarding breast shape preferences. This study was conducted to ascertain previously undocumented differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation, with respect to upper-pole contour. Sixty-six respondents, grouped into three cohort categories (plastic surgeons, breast augmentation patients, and lay people), were asked to evaluate a series of 12 nonptotic breast profiles representing a range of upper-pole contours. Five profiles exhibited convex upper-pole contours, five exhibited concave contours, and two exhibited upper poles with flat slopes. A five-point Likert-type scale was used to rate attractiveness, naturalness, how close the shape was to each respondent's personal ideal, and how close the shape was to what the respondent believed was our society's ideal. Statistical comparisons were made among the three cohorts. The plastic surgeon cohort (n = 11) rated concave upper-pole contours significantly higher than did the patient cohort (n = 13) for attractiveness, naturalness, and personal ideal (p < 0.01). For convex contours, the plastic surgeon cohort gave significantly lower scores than did the patient cohort (p < 0.01). The lay category (n = 42) demonstrated preferences intermediate between those of the other groups. There are no known studies in the literature documenting the breast shape preferences of plastic surgeons and their patients. This study suggests that plastic surgeons and patients seeking breast augmentation may have drastically different images in mind regarding what constitutes an attractive, natural, and ideal breast shape. These findings have potential implications for patient treatment and satisfaction.     

Participation in Mass Gatherings Can Benefit Well-Being: Longitudinal and Control Data from a North Indian Hindu Pilgrimage Event

How does participation in a long-duration mass gathering (such as a pilgrimage event) impact well-being? There are good reasons to believe such collective events pose risks to health. There are risks associated with communicable diseases. Moreover, the physical conditions at such events (noise, crowding, harsh conditions) are often detrimental to well-being. Yet, at the same time, social psychological research suggests participation in group-related activities can impact well-being positively, and we therefore investigated if participating in a long-duration mass gathering can actually bring such benefits. In our research we studied one of the world''s largest collective events – a demanding month-long Hindu religious festival in North India. Participants (comprising 416 pilgrims who attended the gathering for the whole month of its duration, and 127 controls who did not) completed measures of self-assessed well-being and symptoms of ill-health at two time points. The first was a month before the gathering commenced, the second was a month after it finished. We found that those participating in this collective event reported a longitudinal increase in well-being relative to those who did not participate. Our data therefore imply we should reconceptualise how mass gatherings impact individuals. Although such gatherings can entail significant health risks, the benefits for well-being also need recognition. Indeed, an exclusive focus on risk is misleading and limits our understanding of why such events may be so attractive. More importantly, as our research is longitudinal and includes a control group, our work adds robust evidence to the social psychological literature concerning the relationship between participation in social group activities and well-being.     

Holistic care in healthy aging: Caring for the wholly and holy human

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long-term outcomes.     

Dream Practices in Medieval Tibet

This essay presents a variety of medieval Tibetan Buddhist dream practices culled from many different sources, such as medical texts, biographies, religious texts, and folklore. Some of this material is here translated into English for the first time. The dreaming techniques presented in these texts bring out religious and philosophical connections between body and consciousness. The range and diversity of the original sources required a broad interdisciplinary approach using literary studies, religious studies, philosophy, linguistics, and other disciplines.     

THE NATURE AND EVOLUTION OF INTERSTELLAR ICES

The evolution of icy grain mantles is governed by the environment in which they exist. This review presents an overview of the study of the molecules that make up the mantles and discusses their relevance to the origin of life. Models predict two phases of mantle growth during cloud collapse: simple polar and nonpolar molecules dominate the mantle layers at early and late times, respectively (Section 1). The effect of processing on grain mantle composition and the connection between organics in grain mantles and prebiotic chemistry is introduced. Section 2 describes how infrared spectroscopy of dense cloud sources, combined with theoretical models and laboratory data, gives us information on the composition and abundance of the ices in varying regions. The observed features and how they are used as diagnostics of mantle evolution are discussed in Section 3. This section also discusses the importance of these molecules to prebiotic chemistry. Section 4 compares grain mantle composition in different low-mass star forming regions, which best represent the solar birthplace. The final section (Section 5) summarizes the information presented, emphasizing the link between the study of interstellar dust and the origin of life.     

Consequentialism, reasons, value and justice

Over the past 10 years, John Harris has made important contributions to thinking about distributive justice in health care. In his latest work, Harris controversially argues that clinicians should stop prioritising patients according to prognosis. He argues that the good or benefit of health care is providing each individual with an opportunity to live the best and longest life possible for him or her. I call this thesis, opportunism. For the purpose of distribution of resources in health care, Harris rejects welfarism (the thesis that the good of health care is well-being) and argues that utilitarianism in general may lead to de facto discrimination against groups of people needing health care. I argue that well-being is a superior theory of the good of health care to Harris' opportunism. Harris' concerns about utilitarianism can be better addressed by: (i) relating justice more closely to reasons for action; (ii) by conceptualising the relationship between reasons for action and the value of the consequences of those actions as a plateau rather than scalar relationship. Justice can be understood as satisfying as many equally rational claims on resources as possible. The rationality of a person's claim on health resources turns on the strength of that person's reasons to promote certain health-related states of affairs. I argue that the strength of that reason does not track the expected value of that state of affairs in a fully scalar fashion. Rather a person can have most reason to promote some state of affairs, even though he or she could promote other more valuable states of affairs. Thus there can be equal reason for a distributor of public resources to save either of two people, even though one will have a better and more valuable life. This approach, while addressing many of Harris' concerns about utilitarianism, does not imply that doctors should give up prioritising patients according to prognosis altogether, but it does allow that patients with lower but reasonable prognosis should have a share of public resources.     

Genetic variation in social influence on mate preferences

Patterns of phenotypic variation arise in part from plasticity owing to social interactions, and these patterns contribute, in turn, to the form of selection that shapes the variation we observe in natural populations. This proximate–ultimate dynamic brings genetic variation in social environments to the forefront of evolutionary theory. However, the extent of this variation remains largely unknown. Here, we use a member of the Enchenopa binotata species complex of treehoppers (Hemiptera: Membracidae) to assess how mate preferences are influenced by genetic variation in the social environment. We used full-sibling split-families as ‘treatment’ social environments, and reared focal females alongside each treatment family, describing the mate preferences of the focal females. With this method, we detected substantial genetic variation in social influence on mate preferences. The mate preferences of focal females varied according to the treatment families along with which they grew up. We discuss the evolutionary implications of the presence of such genetic variation in social influence on mate preferences, including potential contributions to the maintenance of genetic variation, the promotion of divergence, and the adaptive evolution of social effects on fitness-related traits.     

Biofeedback in medicine: who,when, why and how?

Biofeedback is a mind-body technique in which individuals learn how to modify their physiology for the purpose of improving physical, mental, emotional and spiritual health. Much like physical therapy, biofeedback training requires active participation on the part of patients and often regular practice between training sessions. Clinical biofeedback may be used to manage disease symptoms as well as to improve overall health and wellness through stress management training. Research has shown that biofeedback interventions are efficacious in treating a variety of medical conditions, and many Americans are turning to biofeedback and other less traditional therapies for their routine healthcare.Clinical biofeedback training is growing increasingly popular in the USA, as many people are seeking out relatively new approaches to healthcare. This article provides an overview of clinical biofeedback training, outlines two models of training, details research which has established how effective biofeedback is in patients with a given disease, and describes who should be referred for biofeedback training.     

Integration and religiosity among the Turkish second generation in Europe: a comparative analysis across four capital cities

Drawing on recent cross-national surveys of the Turkish second generation, we test hypotheses of secularization and of religious vitality for Muslim minorities in Europe. Secularization predicts an inverse relationship between structural integration and religiosity, such that the Turkish second generation would be less religious with higher levels of educational attainment and intermarriage. The religious vitality hypothesis predicts the maintenance of religion in the second generation, highlighting the role of religious socialization within immigrant families and communities. Taking a comparative approach, these hypotheses are tested in the context of different national approaches to the institutionalization of Islam as a minority religion in four European capital cities: Amsterdam, Berlin, Brussels and Stockholm. Across contexts, religious socialization strongly predicts second-generation religiosity, in line with religious vitality. The secularization hypothesis finds support only among the second generation in Berlin, however, where Islam is least accommodated.     

Immigrants' religious participation in the United States

Using New Immigrant Survey 2003 data, I examine immigrants' religious participation once in the United States. This is the first large-scale study to consider this question quantitatively and to compare across origin groups; the findings are key to informing our knowledge of the religious lives of the foreign born. Results indicate that, after accounting for participation before coming to the US, time in the US exhibits a robust, positive association with an increase in religious participation, suggesting the continuing importance of religion in immigrants' adjustment, in spite of the disruptive event of migration.     

Why aren’t we all hutterites?

In this paper I explore the psychology of ritual performance and present a simple graphical model that clarifies several issues in William Irons’s theory of religion as a “hard-to-fake” sign of commitment. Irons posits that religious behaviors or rituals serve as costly signals of an individual’s commitment to a religious group. Increased commitment among members of a religious group may facilitate intra-group cooperation, which is argued to be the primary adaptive benefit of religion. Here I propose a proximate explanation for how individuals are able to pay the short-term costs of ritual performance to achieve the long-term fitness benefits offered by religious groups. The model addresses three significant problems raised by Irons’s theory. First, the model explains why potential free-riders do not join religious groups even when there are significant net benefits that members of religious groups can achieve. Second, the model clarifies how costly a ritual must be to achieve stability and prevent potential free-riders from joining the religious group. Third, the model suggests why religious groups may require adherents to perform private rituals that are not observed by others. Several hypotheses generated from the model are also discussed. Richard Sosis is an assistant professor of anthropology at the University of Connecticut. His research interests include the evolution of cooperation, utopian societies, and the behavioral ecology of religion. In collaboration with Bradley Ruffle (Ben Gurion University) he is currently investigating the impact of privatization and religiosity on intra-group trust within Israeli Kibbutzim.     

Focus: Health Equity: Lung Disease in Central Appalachia: It’s More than Coal Dust that Drives Disparities

The population living in Central Appalachia is disproportionately impacted by lung disease. This is driven, in part, by occupational hazards and environmental exposures. However, it is more than coal dust that is driving the ongoing disparity of lung disease in the region. This review describes how the decline of the coal mine industry and subsequent rise of unemployment, poverty, and educational disparities have increased risk for worse pulmonary health outcomes in the region. Additional challenges related to healthcare access, substance use, cultural characteristics, and social capital are highlighted in their relation to pulmonary health within Central Appalachia. Lastly, the review describes strategies that hold promise to reduce regional health disparities. Several healthcare and community-centered initiatives are highlighted as successful examples of collaborative efforts working towards improving pulmonary health outcomes in the region. However, significant challenges related to social, economic, and environmental factors remain. Addressing these social determinants of health must be a paramount concern for healthcare, community and political leaders seeking to impact change and improve the health and well-being of this vulnerable population.     

Does French Islam Have Borders? Dilemmas of Domestication in a Global Religious Field

Although many accounts of transnational religious movements emphasize mobility and communication, equally important are efforts by both political actors and religious leaders to carve out distinctive national forms of religion. In this article I examine dilemmas faced by Muslims in France who seek both to remain part of the global Muslimcommunity and to satisfy French demands for conformity to political and cultural norms. I consider the history of immigration and the importance of French notions of laïcité but emphasize the structural problem of articulating a global religious field onto a self-consciously bounded French nation-state. I then draw on recent fieldwork in Paris to analyze two recent public events in which attempts by Muslim public intellectuals to develop an "Islam of France" are frustrated by internal, structural tensions concerning religious authority and political legitimacy, and not simply by a conflict between "Muslims" and "France."     

Health seeking behavior after the 2013–16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District,Sierra Leone

BackgroundThe West African Ebola epidemic of 2013–2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone’s Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone.Methodology/Principal findingsPresentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011–2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare.Conclusions/SignificanceAnalysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.