Balancing competing interests and obligations in mental health‐care practice and policy

It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, there is a gap in decision‐making support in other mental health‐care domains. This article proposes that a set of targeted, decision‐making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization).     

Bilateral amygdala damage linked to impaired ability to predict others' fear but preserved moral judgements about causing others fear

The amygdala is a subcortical structure implicated in both the expression of conditioned fear and social fear recognition. Social fear recognition deficits following amygdala lesions are often interpreted as reflecting perceptual deficits, or the amygdala''s role in coordinating responses to threats. But these explanations fail to capture why amygdala lesions impair both physiological and behavioural responses to multimodal fear cues and the ability to identify them. We hypothesized that social fear recognition deficits following amygdala damage reflect impaired conceptual understanding of fear. Supporting this prediction, we found specific impairments in the ability to predict others'' fear (but not other emotions) from written scenarios following bilateral amygdala lesions. This finding is consistent with the suggestion that social fear recognition, much like social recognition of states like pain, relies on shared internal representations. Preserved judgements about the permissibility of causing others fear confirms suggestions that social emotion recognition and morality are dissociable.     

Forced migration: morality and politics

Thomas Faist’s contribution lies in wishing to deconstruct political perceptions around forced migration that reduce the protection that refugees can access. One important task we have as academics is exactly to challenge dominant discourses that function to oppress or control, serving the interests of some at the costs of others, and to be aware of our own role in perpetuating such discourses. One important area where Faist’s account fails to deconstruct existing discourse on forced migration is related to the political subjecthood of refugees and the political nature of their experiences. The reasons for flight are highly political, refugees are conscious political subjects, and refugee flows have always been a matter of high politics.     

GENETIC ENGINEERING TO AVOID GENETIC NEGLECT: FROM CHANCE TO RESPONSIBILITY

Currently our assessment of whether someone is a good parent depends on the environmental inputs (or lack of such inputs) they give their children. But new genetic intervention technologies, to which we may soon have access, mean that how good a parent is will depend also on the genetic inputs they give their children. Each new piece of available technology threatens to open up another way that we can neglect our children. Our obligations to our children and our susceptibilities to corresponding legal and moral sanctions may be about to explosively increase. In this paper I argue that we should treat conventional neglect and ‘genetic neglect’– failing to use genetic intervention technologies to prevent serious diseases and disabilities – morally consistently. I conclude that in a range of cases parents will have a moral obligation to use genetic treatments to prevent serious disabilities in their children. My particular focus is on prenatal interventions and their impact of the bodily integrity of expectant mothers. I conclude that although bodily integrity constrains moral obligations, it is outweighed in a range of cases.     

Normalizing Off-Label Experiments and the Pharmaceuticalization of Homebirths in Pakistan

Abstract

The off-label use of the drug misoprostol has effectively turned homebirths in ‘resource-poor’ nations into unmarked and un-enunciated zones of experimentation. Misoprostol has become the public health solution in response to medico-humanitarian discourses that construct homebirths as responsible for high maternal mortality. In the absence of proper safety tests, advocating its routine administration against postpartum haemorrhage in homes around Pakistan functions to erase the distinction between service delivery projects and experimentation. Drawing on ethnographic research in Balochistan, I argue that promoting misoprostol in contexts of structural inequality, particularly where excessive artificial labour induction prevails, constitutes the enactment of a kind of ‘medical relativism’. This medical relativism entails an experimental practice that burdens poor women with undue risk as misoprostol becomes a substitute for required structural and economic transformation of Pakistan's healthcare system. Overall, the paper concludes, the contemporary faith in pharmaceuticals perpetuates a colonial governmentality of bodies, medicines, and healthcare.     

Six minutes to promote change: People,not facts,alter students' perceptions on climate change

Anthropogenic climate change threatens the structure and function of ecosystems throughout the globe, but many people are still skeptical of its existence. Traditional “knowledge deficit model” thinking has suggested that providing the public with more facts about climate change will assuage skepticism. However, presenting evidence contrary to prior beliefs can have the opposite effect and result in a strengthening of previously held beliefs, a phenomenon known as biased assimilation or a backfire effect. Given this, strategies for effectively communicating about socioscientific issues that are politically controversial need to be thoroughly investigated. We randomly assigned 184 undergraduates from an environmental science class to one of three experimental conditions in which we exposed them to short videos that employed different messaging strategies: (a) an engaging science lecture, (b) consensus messaging, and (c) elite cues. We measured changes in student perceptions of climate change across five constructs (content knowledge, acceptance of scientific consensus, perceived risk, support for action, and climate identity) before and after viewing videos. Consensus messaging outperformed the other two conditions in increasing student acceptance of the scientific consensus, perceived risk of climate change, and climate identity, suggesting this may be an effective strategy for communicating the gravity of anthropogenic climate change. Elite cues outperformed the engaging science lecture condition in increasing student support for action on climate, with politically conservative students driving this relationship, suggesting that the messenger is more important than the message if changing opinions about the necessity of action on climate change is the desired outcome. Relative to the other conditions, the engaging science lecture did not support change in students'' perceptions on climate, but appealing to student respect for authority produced positive results. Notably, we observed no decline in students'' acceptance of climate science, indicating that none of the conditions induced a backfire effect.     

生态文明时期道德观的新视角

道德和道德观念是随着人类社会历史发展以及社会实践活动的深化而不断发展变化的。人们依据不同发展阶段的特征,提出符合时代发展趋势的道德原则、道德规范和道德标准,以推动道德进步。现在人类社会开始进入由人工业文明向生态文明迈进的发展新阶段,因而,时代要求转变以往支配人们行动的旧道德观,打破狭隘的视野局限,把原有道德观仅仅局限于人与人之间、人与社会之间扩展到人与自然之间,以人与自然和谐发展作为生态文明时期的道德准则。这种新的道德观要求树立崭新的生态意识,坚持公正和平等的原则。以约束人类行为,提高人的生态道德修养为宗旨。使人类的社会实践活动有利于资源的持续利用和环境保护,倡导过一种适度消费的文明生活。     

In defense of dignity: Reflections on the moral function of human dignity

This paper defends human dignity in two ways. First, by confronting the criticism that human dignity does not serve an important function in contemporary moral discourse and that its function can be sufficiently performed by other moral terms. It is argued that this criticism invites a danger of moral reductionism, which impoverishes moral discourse. The authority of moral philosophy to correct widely shared moral intuitions, rooted in experiences of grave injustices and wrongs, is questioned. Secondly, dignity is defended by showing what is needed to uphold it, both in theory and practice. It is argued, and demonstrated through examples, that human dignity as a universal value ascribed to human beings and the virtue of dignified action are intimately related. This is fleshed out in terms of Kant’s analysis of respect in the practical sense and of virtue as a commitment to the value of dignity as a constitutive end of our moral order. It is furthermore argued that theoretical attempts to ground respect for dignity in human capacities lead to a moral impasse. It is necessary to act as if every human being is worthy of respect. This practical approach requires institutions and specified moral obligations that are integral to the democratic ethos and the rule of law, which guarantees the equal status of human beings. This practical task requires that we consistently tease out and act on the implications of these principles rather than seek deeper justification for the equal worth of humans, articulated in the term human dignity.     

Justice For All? Children’s Moral Reasoning about the Welfare and Rights of Endangered Species

This study reports children’s developing moral concerns for endangered animals. Three questions were addressed: 1) Do children conceive of not harming an endangered animal as a moral obligation? 2) Do children use biocentric (nature-centered) moral reasoning? and 3) Does a developmental shift in biocentrism occur between the ages of 7and 10-years-old? Fifty-two urban children (gender balanced and evenly divided between two ages groups: 7 and 10-year-olds) from the Pacific Northwest were interviewed regarding their understanding of, and beliefs and values about, endangered animals, their moral obligatory concerns, and their conceptions of animal rights. Many questions focused on a single species—the gray wolf— as it presents a canonical example of a local, familiar, charismatic endangered animal. The semi-structured interview methodology and the coding procedures followed well-established methods in social-cognitive psychology. Results were that the 7 and 10-year-olds valued endangered animals, extended moral obligations to gray wolves, and endorsed animal rights. Quantitative analysis of the content responses revealed a typology of seven rights that children spontaneously offered when asked which rights animals have: food, companionship, reproduction, habitat, play/exercise, welfare, and autonomy. The 10-year-olds were significantly more likely to endorse autonomy rights than the 7-year-olds. The findings reveal the highest rates of biocentrism observed in young children, and the 10-year-olds endorsed biocentrism to a greater degree than the 7-year-olds. Children drew on their understanding of human moral concerns to extend these concerns to the animal. Sentiency and biological needs are salient features that allow children to take the perspective of the animal in ways that build upon and diverge from their own experiences. These findings provide a comparative baseline for extending our understanding of biocentrism across cultures, animal kinds, and in human–wildlife conflict scenarios.