responsibility

Responsibility and Victim-Blaming

Written by Dr Rebecca Brown

The recent sentencing of Wayne Couzens for the murder of Sarah Everard, along with the murder of Sabina Nessa last month, has prompted discussion in the UK of the prevalence of violence against women and the shortcomings of the criminal justice system. Prime Minister Boris Johnson has himself criticised the police for failing to take cases of violence against women sufficiently seriously. In particular, there has been outrage at comments made by some regarding steps women can take to ‘keep themselves safe’. Continue reading

Healthcare, Responsibility, and Golden Opportunities

Written by Gabriel De Marco

This blog post is based on a co-authored paper (w. Tom Douglas and Julian Savulescu) recently published in Ethical Theory and Moral Practice.

 

When it comes to determining how healthcare resources should be allocated, there are many factors that could—and perhaps should—be taken into account. One such factor is a patient’s responsibility for his or her illness, or for the behavior that caused it; e.g. whether a lifetime smoker is responsible for developing his lung cancer, or whether someone is responsible for heart disease on the basis of having an unhealthy diet. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account—responsibility-sensitive policies, or RSPs, for short—have been a matter of debate for some time.

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Compromising On the Right Not to Know?

Written by Ben Davies

Personal autonomy is the guiding light of contemporary clinical and research practice, at least in the UK. Whether someone is a potential participant in a research trial, or a patient being treated by a medical professional, the gold standard, violated only in extremis, is that they should decide for themselves whether to go ahead with a particular intervention, on the basis of as much relevant information as possible.

Roger Crisp recently discussed Professor Gopal Sreenivasan’s New Cross seminar, which argued against a requirement for informational disclosure in consenting to research participation. Sreenivasan’s argument was, at least in its first part, based on a straightforward appeal to autonomy: if autonomy is what matters most, I should have the right to autonomously refuse information.

I have previously outlined a related argument in a clinical context, in which I sought to undermine arguments against a putative ‘Right Not to Know’ that are themselves based in autonomy. In brief, my argument is, firstly, that a decision can itself be autonomous without promoting the agent’s future or overall autonomy and, second, that even if there is an autonomy-based moral duty to hear relevant information (as scholars such as Rosamond Rhodes argue), we can still have a right that people not force us to hear such information.

In a recent paper, Julian Savulescu and I go further into the details of the Right Not to Know, setting out the scope for a degree of compromise between the two central camps.

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This Machine Kills Viruses

Written by Stephen Rainey

If we had a machine that could eradicate coronavirus at the press of a button, there would likely be a queue to do the honours. Rather than having such a device, we have a science-policy interface, and a general context of democratic legitimacy. This isn’t a push-button, but a complex of socio-political liberties and privations. We can’t push the button, but we can learn how to use the technology we do have – by collectively following policies like staying inside, wearing masks outside, and keeping distance from others.

Because of the coronavirus pandemic a novel form of this scientific research, technological application, and influence or control of nature (including humans) is emerging. In this case, the application is public policy, as based on multitudes of scientific advice. That over which control is sought is twofold: the virus, and people. Control of the virus is not really possible without some control over the people. Likewise, control of the people becomes harder where the virus is not controlled. Public trust in tough policies wanes if there is no end in sight, or no clear rationale in place. Continue reading

Following the Science Without Forgetting Values

Written by Stephen Rainey

It is presently feared that ‘lockdown’ may be beginning to fray at the edges, as people tire of their restrictions. From the start of the emergency, discussion focussed upon the ability of the public to stay the course where restrictions were at stake. This neatly ignores the public’s being ahead of the government in acknowledging the severity of the situation before the 23rd March announcement to restrict social freedoms. At any rate, concerns over policy effectiveness were addressed through faith in behavioural science (via ‘Behavioural Insights’, née ‘The Nudge Unit’), and communications devices such as the repeated phrase, ‘following the science’.

‘Following the science’ raises reasonable questions including, which science and why? In what sense ‘follow’? To what degree? The idea of creating arguments ‘from science’ for any given policy is presumed sufficient as a motivation, or a reason for citizens to submit themselves to policy demands. However, given the expert basis for these arguments, it is not a safe bet that any given citizen will share the assumptions or knowledge base of the experts, let alone adopt them as straightforward reasons to alter their behaviour. Few people like to be told what to do without at least understanding what is being asked of them and why, so this can be a problem.

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Responsibility, Healthcare, and Harshness

Written by Gabriel De Marco

Suppose that two patients are in need of a complicated, and expensive, heart surgery. Further suppose that they are identical in various relevant respects: e.g., state of the heart, age, likelihood of success of surgery, etc. However, they differ on one feature: for one of these patients, call her Blair, the need for the heart surgery is due to her lifestyle (suppose she was a smoker), whereas the other, Ingrid, has not had this lifestyle, nor any other that would lead to the need for the surgery.

Some people think that:

  1. We can be responsible and blameworthy for our actions and their consequences.

Some of those people also think that:

  1. We can, or should, take this into account when making decisions about how to distribute healthcare resources.

For the purposes of this blog post, let’s assume 1 and 2 are true. Commonly, it is thought that, in order to be blameworthy for something, one must be responsible for it. Further, it is commonly thought that, whatever the appropriate response is to blameworthiness for something or other (assuming that there is an appropriate response), it will be negative in some sense or other. Now further suppose that Blair is blameworthy for her illness. Given 1 and 2, this fact about Blair, combined with the fact that Ingrid is innocent with regard to her illness, suggests that, at least in some contexts, we should treat them differently (or at least it would be permissible to do so). Call a healthcare policy that adopts, and reflects, 1 and 2 a Responsibility-Sensitive Policy, or RSP for short.

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Health vs Choice? The Vaccination Debate.

On Sunday 3 November, OUC’s Dr Alberto Giubilini participated in a debate on compulsory vaccination at 2019 Battle of Ideas Festival (Barbican Centre, London). Chaired by Ellie Lee, the session also featured Dr Michael Fitzpatrick (GP and author, MMR and Autism: what parents need to know and Defeating Autism: a damaging delusion); Emilie Karafillakis (Vaccine Confidence Project); and Nancy McDermott (author, The Problem with Parenting: a therapeutic mode of childrearing).

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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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What’s Wrong With Simulation in Football?

Written by Doug McConnell

The 2018 edition of the football world cup has brought with it a renewed bout of hand wringing over ‘simulation’, e.g. players falling, diving, and tumbling under imaginary fouls, rolling around in mock pain, or clasping their faces pretending to have been hit. Stuart James writes in the Guardian that “play-acting has been commonplace at this World Cup. It’s become a cancer in the game, not just a stain on it, and Fifa needs to find a cure.” But what exactly is wrong with this behaviour? Why is the rise of this behaviour ‘a cancer in the game’? Continue reading

Addiction, Desire, and The Polluted Environment – Richard Holton’s 2nd Uehiro Lecture

By Jonathan Pugh

 

In the second of his three Uehiro lectures on the theme of ‘illness and the social self’, Richard Holton turned to the moral questions raised by addiction. In the first half of the lecture, he outlined an account of addictive behaviour according to which addictive substances disrupt the link between wanting and liking. In the second half of the lecture, he discusses the implications of this account for the moral significance of preferences, and for how we might structure environments to avoid triggering addictive desires.

 

You can find a recording of the lecture here

 

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