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Rebecca Brown

Bad Ads And Stereotypes

Written by Rebecca Brown

In June this year, the Advertising Standards Authority (ASA) brought into effect a ban on harmful gender stereotypes in advertising. In response to public outcry about adverts such as the 2015 ‘Are you beach body ready?’ campaign by Protein World, and growing discomfort with outdated depictions of gender roles in the media, the ASA undertook a project to consider whether existing regulation is fit for purpose. They concluded that “evidence suggests that a tougher line needs to be taken on ads that feature stereotypical gender roles and characteristics, which through their content and context may be potentially harmful to people.” (ASA, 2017: 3)

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The Ethics of Social Prescribing: An Overview

Written by Rebecca Brown, Stephanie Tierney, Amadea Turk.

This post was originally published on the NIHR School for Primary Care Research website which can be accessed here. 

Health problems often co-occur with social and personal factors (e.g. isolation, debt, insecure housing, unemployment, relationship breakdown and bereavement). Such factors can be particularly important in the context of non-communicable diseases (NCDs), where they might contribute causally to disease, or reduce that capacity of patients to self-manage their conditions (leading to worse outcomes). This results in the suffering of individuals and a greater burden being placed on healthcare resources.

A potential point of intervention is at the level of addressing these upstream contributors to poor health. A suggested tool – gaining momentum amongst those involved in health policy – is the use of ‘social prescribing’. Social prescribing focuses on addressing people’s non-medical needs, which it is hoped will subsequently reduce their medical needs. In primary care, social prescribing can take a range of forms. For example, it may involve upskilling existing members of staff (e.g. receptionists) to signpost patients to relevant local assets (e.g. organisations, groups, charities) to address their non-medical needs. It is also becoming common for GPs to refer patients (or people may self-refer) to a link worker (sometimes called a care navigator) who can work with them to identify their broader social and personal needs. Together, they then develop a plan for how those needs could be met through engagement with activities, services or events in the local community. The resources that link workers direct people towards are often run by voluntary organisations and might include, among other things, sports groups, arts and crafts, drama, gardening, cookery, volunteering, housing advice, debt management, and welfare rights.

Supporting people to establish more stable and fulfilling social lives whilst at the same time reducing healthcare costs seems like a win-win. However, it is essential to evaluate the justifications for the introduction of social prescribing schemes, including their effectiveness. This raises a number of complicating factors, including some questions that require not just a consideration of empirical evidence, but a commitment to certain philosophical and ethical positions.

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Criticising Stigma Whilst Reinforcing it: the Case of the Response to CRUK’s Anti-Obesity Campaign

Written by Rebecca Brown

There has been recent concern over CRUK’s (Cancer Research UK) latest campaign, which features the claim ‘obesity is a cause of cancer too’ made to look like cigarette packets. It follows criticism of a previous, related campaign which also publicised links between obesity and cancer. Presumably, CRUK’s aim is to increase awareness of obesity as a risk factor for cancer and, in doing so, encourage people to avoid (contributors to) obesity. It may also be hoped to encourage public support for policies which tackle obesity, pushing the Overton window in a direction which is likely to permit further political action in this domain.

The backlash is mostly focused around the comparison with smoking, and the use of smoking-related imagery to promote the message (there is further criticism of the central causal claim, since it is actually quite difficult to establish that obesity causes cancer). 

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Responsibility Over Time And Across Agents

Rebecca Brown and Julian Savulescu

Cross-posted from the Journal of Medical Ethics blog, available here.

There is a rich literature on the philosophy of responsibility: how agents come to be responsible for certain actions or consequences; what conditions excuse people from responsibility; who counts as an ‘apt candidate’ for responsibility; how responsibility links to blameworthiness; what follows from deciding that someone is blameworthy. These questions can be asked of actions relating to health and the diseases people may suffer as a consequence. A familiar debate surrounds the provision of liver transplants (a scarce commodity) to people who suffer liver failure as a result of excessive alcohol consumption. For instance, if they are responsible for suffering liver failure, that could mean they are less deserving of a transplant than someone who suffers liver failure unrelated to alcohol consumption.

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Medical Nihilism: When A Dose Of Scepticism Can Be Healthy

In his 2018 book, the philosopher of science, Jacob Stegenga defends the view “that we should have little confidence in the effectiveness of medical interventions.” (Stegenga 2018) On the face of it, he acknowledges, this position seems unreasonable: most of us can think of myriad ways in which modern medicine has improved – perhaps saved – our own lives and the lives of those close to us. The asthma attack I had as a baby, effectively treated at the time and subsequently managed through the use of seemingly magical medications which relax the muscles around the airways, opening them up and allowing air to pass freely again. Or the schoolfriend whose ruptured appendix could have resulted in a fatal infection, but for emergency surgery and the administration of antibiotics. Or the countless lives made less painful by the availability of cheap and safe painkillers. 

Medical sceptics tend to get a bad rep – anti-vaxxers who risk the lives of children by regurgitating debunked myths about the links between vaccines and autism, leading to dips in herd immunity and disease outbreaks; credulous folk who believe in the mystical powers of homeopathy and eschew conventional therapies in favour of potions that contain little more than water. This is not the sort of company one wishes to associate with.Read More »Medical Nihilism: When A Dose Of Scepticism Can Be Healthy

Hard Choices, Fredkin’s Paradox and is Ethics a Waste of Time?

Think back to the last time you were faced with a really great menu in a restaurant. Loads of options, all of them appealing. Plus you’re very hungry. Culinary choices, though typically trivial, can also be hard. This is because it can be tricky to make comparisons – and to judge what’s best – across different options, all with particular qualities. The philosopher Ruth Chang describes hard choices as arising when ‘reasons run out.’ Often this is credited to one of three things: ignorance (we lack some of the information needed to choose between options); incommensurability (we can’t find a common currency with which to compare the value/disvalue of different options); incomparability (the options are of such drastically different kinds that we cannot compare across them). But, Chang argues, sometimes we face hard choices in the absence of these factors: we sometimes face hard choices because of parity (the options are on a par). This might be the case when we’re faced with hard food choices (lasagne or risotto), and also much more significant life choices (move to a new country or stay put; prioritise career advancement or start a family).Read More »Hard Choices, Fredkin’s Paradox and is Ethics a Waste of Time?

Music Streaming, Hateful Conduct and Censorship

Written by Rebecca Brown

Last month, one of the largest music streaming services in the world, Spotify, announced a new ‘hate content and hateful conduct’ policy. In it, they state that “We believe in openness, diversity, tolerance and respect, and we want to promote those values through music and the creative arts.” They condemn hate content that “expressly and principally promotes, advocates, or incites hatred or violence against a group or individual based on characteristics, including, race, religion, gender identity, sex, ethnicity, nationality, sexual orientation, veteran status, or disability.” Content that is found to fulfil these criteria may be removed from the service, or may cease to be promoted, for example, through playlists and advertisements. Spotify further describe how they will approach “hateful conduct” by artists: 

We don’t censor content because of an artist’s or creator’s behavior, but we want our editorial decisions – what we choose to program – to reflect our values. When an artist or creator does something that is especially harmful or hateful (for example, violence against children and sexual violence), it may affect the ways we work with or support that artist or creator.

An immediate consequence of this policy was the removal from featured playlists of R. Kelly and XXXTentacion, two American R&B artists. Whilst the 20 year old XXXTentacion has had moderate success in the US, R. Kelly is one of the biggest R&B artists in the world. As a result, the decision not to playlist R. Kelly attracted significant attention, including accusations of censorship and racism. Subsequently, Spotify backtracked on their decision, rescinding the section of their policy on hateful conduct and announcing regret for the “vague” language of the policy which “left too many elements open to interpretation.” Consequently, XXXTentacion’s music has reappeared on playlists such as Rap Caviar, although R. Kelly has not (yet) been reinstated. The controversy surrounding R. Kelly and Spotify raises questions about the extent to which commercial organisations, such as music streaming services, should make clear moral expressions. 
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Doing Good and Being Bad: The Presidents Club, Charity and Moral Licensing.

Last January, an article in the Financial Times broke a story about a men-only charity event run by the Presidents Club, a charitable trust set up to raise money for “worthy children’s causes.” Allegations were made by undercover journalists who attended the black tie event as ‘hostesses,’ 130 of whom were hired to attend the event where they were required to wear a uniform of short tight black dresses, “sexy” black high heels and matching black underwear in order to “keep [the attendees] happy – and fetch drinks when required.” According to the FT, the selection criteria for women to work at the event were that they be “tall, thin and pretty”. Women interviewed by the FT described being repeatedly groped, propositioned for sex, and instructed to “down that glass, rip off your knickers and dance on that table.” The Presidents Club has closed as a result of the negative attention following the article, and many prominent figures in business, entertainment and politics have been publicly named as attending the dinner, and required to defend their involvement.

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In Defence of Impulsivity

Written by Dr Rebecca Brown

It has become commonplace to identify a lack of impulse control as a major cause of poor health. A popular theory within behavioural science tells us that our behaviour is regulated via two systems: the fast, impulsive system 1 (the ‘impulsive’ or ‘automatic’ system) and the slower, deliberative system 2 (the ‘reflective’ system). Much of our behaviour is routine and repeated in similar ways in similar contexts: making coffee in the morning, travelling to work, checking our email. Such behaviours develop into habits, and we are able to successfully perform them with minimal conscious input and cognitive effort. This is because they come under the control of our impulsive system.

Habits have become a focus of health promoters. It seems that many of these routine, repeated behaviours actually have a significant impact on our health over a lifetime: what we eat and drink and how active we are can affect our risk of developing chronic diseases like type II diabetes, heart disease, lung disease and cancer. Despite considerable efforts to educate people as to the risks of eating too much, exercising to little, smoking and drinking, many people continue to engage in such unhealthy habits. One reason for this, it is proposed, is people’s limited ability to exert conscious (reflective) control over their habitual (impulsive) behaviour.

Given this, one might think that it would be preferable if people were generally able to exhibit more reflective control; that behaviour was less frequently determined by impulsive processes and more frequently determined by reflective deliberation. Perhaps this could form part of the basis for advising people to be more ‘mindful’ in their everyday activities, such as eating, and regimes for training one’s willpower ‘muscle’ to ensure confident conscious control over one’s behaviour.Read More »In Defence of Impulsivity

Organ Donation: Presumed Consent and Focusing on What Matters

Recent newspaper reports covered the story of Jemima Layzell, a 13 year old who died suddenly of a brain aneurysm in 2012. According to reports, shortly before Jemima died, the subject of organ donation had come up in discussions with her family, prompted by the death of a family friend in a car accident. As a result, Jemima’s family were confident she would have wanted her organs to be donated. Subsequently, Jemima’s kidneys, liver, lungs, pancreas, small bowel and heart were transplanted. This meant that a record eight people’s lives were saved, prolonged or dramatically enhanced as a consequence of Jemima’s and her family’s decision.

Decisions about organ donation are extremely difficult. Family members are approached about the prospect of donating their loved one’s organs at a time of extraordinary distress. Uncertainty about the wishes of the person who has died, along with confusion or scepticism about brain death criteria, religious or other spiritual beliefs about bodily integrity, fear about how donated organs will be used, and inability or unwillingness to engage with any form of decision-making can result in the refusal of family members to allow organs to be donated. In England, family members can prevent donation even when the individual has expressed a wish to donate her organs, for instance, by signing up to the organ donor register.Read More »Organ Donation: Presumed Consent and Focusing on What Matters