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A short autobiographical piece on different coping strategies for handling psychosis symptoms.

Contemporary population ethics is dominated by views that aggregate by summing, whether of well-being or of some construct based on well-being. In contrast, average well-being is generally considered axiologically irrelevant. To many of us, however, the number of future people does not seem important, as long as it is sufficient to enable rich and varied life experiences, and as long as the population continues throughout time. It therefore seems relatively plausible to aggregate future well-being by averaging. In particular, it seems plausible to value high average well-being at any particular time, and to do so for all future times. I present a time-sensitive version of the Average View that underpins such axiological intuitions. I also address a series of issues and objections that confront such a view.

How is someone who seeks a reflective equilibrium to respond upon learning that others disagree with her? Regrettably, not much attention has been devoted to that question despite the extensive general discussion about the epistemic significance of disagreement that has taken place in recent years. This paper helps fill the lacuna by exploring possible connections between the relevant bodies of literature. More specifically, I claim that how users of the method of reflective equilibrium should respond to disagreement is crucial to the assessment of the method. According to a common objection, it is flawed because it may lead competent and rational inquirers to arrive at widely divergent and inconsistent equilibria. What I argue is that defensible assumptions about the significance of disagreement permit an advocate of the method to resist that objection.

A common anti-realist strategy is to argue that moral realism (or at least the non-naturalist form of it) should be abandoned because it cannot adequately make room for moral knowledge and justified moral belief, for example in view of an evolutionary account of the origins of moral beliefs or of the existence of radical moral disagreement. Why is that (alleged) fact supposed to undermine realism? I examine and discuss three possible answers to this question. According to the answer that I think holds most promise, it undermines realism because it renders realism “epistemically incoherent” (in a sense explicated in the paper), and a central aim of the paper is to elaborate and defend that suggestion against certain objections. I end by briefly commenting on the more general significance of the discussion, by considering some other areas (epistemology and vagueness) where similar questions might be raised.

Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals.

Total views imply what Derek Parfit has called ‘the repugnant conclusion’. There are several strategies aimed at debunking the intuition that this implication is repugnant. In particular, it goes away when we consider the principle of unrestricted instantiation, according to which any instantiation of the repugnant conclusion must appear repugnant if we should be warranted in relying on it as evidence against total theories. However, there are instantiations of the conclusion where it doesn't seem to be at all repugnant. Hence there is nothing repugnant about the repugnant conclusion as such. The faults with total views have nothing to do with large numbers or with the conclusion as such. It is possible, if you like, to correct these putative faults even if you adopt some total view (different from utilitarianism).

Advances in genetic diagnostics lead to more patients being diagnosed with hereditary conditions. These findings are often relevant to patients’ relatives. For example, the success of targeted cancer prevention is dependent on effective disclosure to relatives at risk. Without clear information, individuals cannot take advantage of predictive testing and preventive measures. Against this background, we argue that healthcare professionals have a duty to make actionable genetic information available to their patients’ at-risk relatives. We do not try to settle the difficult question of how this duty should be balanced against other duties, such as the duty of confidentiality and a possible duty not to know one’s genetic predisposition. Instead, we argue for the importance of recognising a general responsibility towards at-risk relatives, to be discharged as well as possible within the limits set by conflicting duties and practical considerations. According to a traditional and still dominant perspective, it is the patient’s duty to inform his or her relatives, while healthcare professionals are only obliged to support their patients in discharging this duty. We argue that this perspective is a mistake and an anomaly. Healthcare professionals do not have a duty to ensure that their patients promote the health of third parties. It is often effective and desirable to engage patients in disseminating information to their relatives. However, healthcare professionals should not thereby deflect their own moral responsibility.

ObjectivesHereditary cancer has implications not only for patients but also for their at-risk relatives (ARRs). In current clinical practice, risk disclosure to ARRs involves collaboration between patients and healthcare providers (HCPs). However, the specific responsibilities of each party are intertwined and at times unclear. In this study, we explored public attitudes regarding moral and legal responsibilities to disclose familial risk information to uninformed ARRs.DesignIn an online cross-sectional survey, participants were prompted with a hypothetical scenario where a gender-neutral patient learnt about their familial risk of colorectal cancer. The patient was advised to regularly undergo colonoscopy screening, and this recommendation was extended to both their siblings and cousins. While the patient informed their siblings, they had not spoken to their cousins in 20 years and did not want to contact them. The survey assessed respondents’ views on the patient’s and HCPs’ ethical responsibility and legal obligation to inform the cousins (ARRs).ParticipantsA random selection of 1800 Swedish citizens 18–74 years of age were invited. Out of those, 914 (51%) completed the questionnaire.ResultsIn total, 75% believed that HCPs had a moral responsibility to inform ARRs, while 59% ascribed this moral responsibility to the patient. When asked about the ultimate responsibility for risk disclosure to ARRs, 71% placed this responsibility with HCPs. Additionally, 66% believed that HCPs should have a legal obligation to inform ARRs, while only 21% thought the patient should have such an obligation. When prompted about a scenario in which the patient actively opposed risk disclosure, a majority believed that HCPs should still inform the ARRs.ConclusionOur study indicates that the Swedish public ascribes moral responsibility for informing ARRs to both the patient and HCPs. However, contrary to current practice, they believe HCPs hold the ultimate responsibility. The majority of respondents support disclosure even without patient consent.

Abstract The debate for and against making e-cigarettes available to smokers is to a large extent empirical. We do not know the long-term health effects of vaping and we do not know how smokers will respond to e-cigarettes over time. In addition to these empirical uncertainties, however, there are difficult moral issues to consider. One such issue is that many smokers in some sense choose to smoke. Though smoking is addictive and though many start young, it does not seem impossible to plan for and implement cessation. Yet many choose not to do so and we arguably have some reason to respect this choice. I propose that liberal opposition to strict tobacco control, based on respect for choice, is mitigated when e-cigarettes are available, since they are such a close substitute. Making e-cigarettes available to smokers might therefore not only enable switching in practice, but may make tougher tobacco control more justified. Another moral issue is that making e-cigarettes widely available might induce many people to vape, who would otherwise have neither vaped nor smoked. If this is so, the price of using e-cigarettes to accelerate smoking cessation may be a long-term vaping epidemic. Since vaping is less harmful than smoking, both individuals and society will have less reason to end this epidemic and so it may endure longer than the smoking epidemic would otherwise have done. This raises further questions around the weighing of reduced harm to current smokers against increased harm to future vapers. Implications: Because they are a close substitute, e-cigarettes makes tougher tobacco control more morally and politically feasible. Because e-cigarettes are less harmful than combustibles, making them available may accelerate smoking cessation but also lead to a long-term vaping epidemic, as we have less reason to combat vaping, once established. Moral evaluation of this possible scenario requires considering at least three things: (1) the cost of addiction to autonomy, in addition to health effects, (2) possible distributional effects due to differences between current smokers and future vapers, and (3) the fact that a possible vaping epidemic affects mainly future people and future society.