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Health-care systems within most countries are resource-limited – budgets are ﬁnite and not every service one would like to provide can be funded. In publicly funded health systems, those responsible for procuring health-care need to be able to explain how taxpayers’ money has been spent. Decisions are made at both individual patient and population levels. At an individual level, the decision might be: which statin should this patient get a prescription for to lower her blood cholesterol? At a population level, the decision might be: will a health and social care commissioning organization purchase a heart-failure specialist nurse or an additional sexual health clinic?
This chapter focuses on how such decisions are made and considers a framework for priority setting, a discussion of what factors should be taken into account when comparing options, a consideration of basic health economic concepts, and an overview of ethical principles which influence decisions.
The potential for artificial intelligence (AI) still attracts polarising views. There are clear benefits and dangers. The key is being aware of what these are and understanding that it is possible to utilise AI in psychiatry safely. There has to be to a will to do so as it is far more expensive to develop AI applications safely than it is to develop them at all. As shown however, there are hidden costs that make this a false economy. Ultimately, transparency about the inner workings of AI and machine learning tools makes increasing their safety realistic. It reduces the sense of magic but that is a small price to pay.
This chapter concretizes the present as an ethos and sketches out elements of a future research agenda. It further develops the idea of the present as an analytical orientation, conceptual approach, and set of assumptions as well as offers a glimpse of a future where we take the present seriously when theorizing global politics.
This chapter places the scholar and their scholarship in time, exploring their temporal positionality, responsibilities, and political relevance. If the past is a construct of the present, the position of the scholar shifts from that of an actor engaged in a value-neutral, transhistorical process of knowledge accumulation to that of an actor intervening in a particular present. Thinking about this positionality from a temporal perspective centers scholarly reflexivity, elevating questions of intellectual responsibility alongside analytical concerns.
This article discusses advance statements in mental health care, which allow individuals with mental disorders to express their preferences for treatment during mental health crises. Despite the evidence supporting their effectiveness, their implementation in clinical practice remains limited. This article explores variations among advance statements, such as psychiatric advance directives (PADs), joint crisis plans (JCPs) and self-binding directives (SBDs), highlighting their content, development process and legal status. We outline the benefits of advance statements, including empowerment, early intervention, improved therapeutic relationships and reduced compulsory admissions. We then draw attention to the challenges that may contribute to their lack of implementation, including legal complexities, communication issues, cultural factors, potential inequities, healthcare provider knowledge, changing preferences, resource constraints, crisis responses, data privacy, family involvement, and long-term evaluation. In conclusion, advance statements offer significant benefits but require addressing these critical aspects to ensure ethical and effective use. Bridging the evidence-to-practice gap is essential, with a focus on implementation science. Integrating these tools into routine clinical practice can significantly benefit individuals with severe mental disorders and mental health systems.
Systematic killing has long been associated with some of the darkest episodes in human history. Increasingly, however, it is framed as a desirable outcome in war, particularly in the context of military AI and lethal autonomy. Autonomous weapons systems, defenders argue, will surpass humans not only militarily but also morally, enabling a more precise and dispassionate mode of violence, free of the emotion and uncertainty that too often weaken compliance with the rules and standards of war. We contest this framing. Drawing on the history of systematic killing, we argue that lethal autonomous weapons systems reproduce, and in some cases intensify, the moral challenges of the past. Autonomous violence incentivizes a moral devaluation of those targeted and erodes the moral agency of those who kill. Both outcomes imperil essential restraints on the use of military force.
The UN Convention on Certain Conventional Weapons (CCW) can, on the one hand, be considered vital for the global governance process—in the sense of urging international cooperation on the ethical, developmental, and standards aspects of lethal autonomous weapon systems (LAWS). On the other hand, the CCW may also embody a global trend that does not augur well for international solidarity, namely the lack of credible and comprehensive collaboration to advance global objectives of peace and security. In 2022, a majority of the 125 nations that belong to the CCW requested limits on a specific type of lethal autonomous weapons: “killer robots.” Yet, most of the major global powers—namely the United States, Russia, and China—opposed not only a ban on LAWS but also on any restrictions on the development of these weapons, not least because the United States, Russia, and China are actively developing this weapons technology. While there is currently much focus on the technological evolution of LAWS, less has been written about how ethical values can exert influence on a growing global consciousness around factors such as power, technology, human judgment, accountability, autonomy, dehumanization, and the use of force. This introduction lays the groundwork for dealing with these issues. It does so by showing that all these factors warrant a pluralist approach to the global governance of LAWS, based on multiple grounds, including the military, tech, law, and distinctive theoretical-ethical orientations; the rationale being to combine this expertise into a collection for publication. Reflecting the contributing authors’ firsthand experiences of the ethics surrounding the management of LAWS to address decisive and critical questions at an expert level, it provides a framing for the collection, showing that the use of international legal mechanisms like the CCW are crucial to considering both the potential and the limits of LAWS, as well as what it can contribute to areas such as international law, human rights, and national security.
Accountability for developing, deploying, and using any emerging weapons system is affirmed as a guiding principle by the Group of Governmental Experts on Emerging Technologies in the Area of Lethal Autonomous Weapons Systems. Yet advances in emerging technologies present accountability challenges throughout the life cycle of a weapons system. Mindful of a lack of progress at the Convention on Certain Conventional Weapons since 2019, this essay argues for a mechanism capable of imputing accountability when individual agent accountability is exceeded, forensic accountability unreliable, and aspects of political accountability fail.
Rapid technological change is resulting in the development of ever increasingly capable autonomous weapon systems. As they become more sophisticated, the calls for developing restrictions on their use, up to and including their complete prohibition, are growing. Not unlike the call for restrictions on the sale and use of drones, most proposed restrictions are well-intentioned but are often ill-informed, with a high likelihood of degrading national security and putting additional lives at risk. Employed by experienced operators well-versed in the laws of armed conflict, autonomous weapons can advance the objectives of those who would prohibit their use. This essay takes an operational perspective to examine the role that autonomous weapon systems can play while complying with the laws of armed conflict. With responsible design and incorporation of applicable control measures, autonomous weapons will be able not just to comply but also to enhance the ethical use of force. This essay contends that efforts by the international community to use international legal means and/or institutions to over-regulate or even ban lethal autonomous weapons are counterproductive. It considers and describes the end-game results of the use of autonomous weapons in enhancing the application of both international law and human ethical values.
Chapter 8 examines the way in which the life of the Buddha was ‘demythologised’ so that he was then worthy of comparison with other great men of history. He became the Light of Asia, the Indian Luther, a competitor of Jesus, and the philosopher of a new rational philosophy and a this-worldly ethics for a disenchanted age. This was now a very human Buddha, neither a god nor a superman. This historical Buddha was to become normative within the West in the twentieth century, available for absorption into new forms of enchanted and disenchanted Western spirituality. The chapter ends with a discussion of the relation between myth and legend in the life of the Buddha in the modern West. It argues that the ’historical Buddha’ cannot be found behind the Buddhist texts.
Mathematician and astronomer Eudoxus of Cnidus was a younger contemporary of Plato and an older contemporary of Aristotle, on both of whom he exerted some influence during his stays in Athens. This is perhaps most apparent with regard to his ethical doctrine that identifies the good as pleasure (hedonism). While Plato seems rather unsure how seriously to take this proposal, Aristotle provides the materials for reconstructing the battery of ingenious arguments that Eudoxus brought forward in its defence. Taken together in this Element, these arguments foreshadow almost everything that has been said in the Western tradition in favour of the positive value of pleasure, and, if taken aright, point in the direction of a hedonism that sets store by the cultivation of activities akin to those for which Eudoxus has been most renowned: mathematics and astronomy.
Heidegger, in the 1946 essay Letter on Humanism, famously remarks that the tragic dramas of Sophocles are in some sense superior to the philosophical ethics of Aristotle in their ability to “preserve” the site of human dwelling in language. This chapter first offers a reading of Aristotle’s Ethics, suggesting in what sense they might be deficient, from Heidegger’s perspective. Next, Heidegger’s reading of Sophocles’ Antigone in the 1942 lecture course Hölderlin’s Hymn “The Ister” provides our focus, and we find there a poetization of the site of human dwelling, as opened up by a play between homeliness and unhomeliness, familiar order and uncanniness, presencing and absencing. Thirdly and finally, we ask precisely how Sophocles’ poetizing manages to preserve this dynamic play and, moving beyond Heidegger, we suggest that Antigone herself, as she moves through the plot of Sophocles’ play, eventually and dramatically models how humans properly inhabit this site as such, in her questioning way of thinking and in her hesitating way of taking action.
This commentary argues that industrial-organizational psychology can be a conduit for greater good by focusing on the United Nations sustainable development goal number 8 which calls for decent work for all. However, before industrial-organizational (I-O) psychology can truly be used for the greater good it must reckon with our identity crisis: who does I-O psychology serve, the worker or organization? We argue that under a capitalistic model, there is no clear path to working with organizations to provide decent work and economic growth simultaneously. Thus, it is critical that the I-O psychology field clarifies its purpose and identity.
Either/Or is Kierkegaard's first major work and arguably his most virtuosic. It introduces many of the most important philosophical themes that define the rest of his authorship and showcases - through its several pseudonyms and genres - Kierkegaard's prodigious literary scope. In this Critical Guide, a diverse group of scholars strike new ground in our understanding of both this work, and Kierkegaard's authorship as a whole. Their essays highlight the text's philosophical range, with substantial discussions of issues in aesthetics, epistemology, ethics, metaphysics, phenomenology, and philosophy of religion. The volume will be essential reading for any person seeking to deepen their understanding of Either/Or and Kierkegaard's work more generally.
The Introduction argues that Faulkner discovered an epistemology for networked systems in the creation of his own imagined landscape. I present two major stages in which Faulkner’s discovery took place: (1) an earlier vision portraying how networks scale, circulate information, centralize, and produce potentially tyrannical paradigms of top-down vertical power; and (2) another view of dynamical networks that are constantly adapting to produce novel forms of movement and behavior. The Faulkner that this study evokes is at once the modernist developing a spatial narrative practice describing the emergence of complex social networks and the Romantic for whom the immanent life was paramount and even sacrosanct. That these two trajectories of inquiry and spiritual belief are not easily reconcilable gives philosophical and moral weight to the landscape and characters that Faulkner invented. They also provide a striking meditation on what it means for human beings to find themselves in systems so vast and ubiquitous that they can no longer remember what it was like to live outside them and, thus, to think outside of their ideological dicta.
This chapter continues the defense of ethical environmentalism by introducing the integration thesis. This thesis holds that the ethical, interpersonal and impersonally valuable dimensions of morality interlock in ways that frustrate efforts to focus exclusively on one without attending to the others. The case for ethical environmentalism would be considerably strengthened by the truth of the integration thesis. This chapter presents a series of arguments in support of the integration thesis, each of which builds on the integral connection between distributive fairness and the common good of a society. Policies and laws that at first pass do not appear to be distributive are shown to have distributive effects on the lives of those who are subject to them that merit consideration at the bar of fairness. Given the truth of the integration thesis, the chapter next argues that the project of ethical environmentalism lends substantial support to certain forms of legal paternalism, state support for impersonal goods, such as natural beauty and human excellence, and state support for the goods of tradition. The chapter concludes by relating the project of ethical environmentalism to Devlin’s thesis that a society may use the law to preserve itself.
Liaison psychiatrists have identified that conducting capacity assessments in general hospital patients with alcohol-related brain damage (ARBD) can be challenging. This educational article uses the fictitious case of a man with ARBD, alcohol dependence and significant self-neglect, focusing on assessment of his capacity to decide about moving into a care home on discharge. We provide an overview of clinical, legal and ethical literature relevant to decision-making and capacity assessment in individuals with ARBD, with the aim of guiding clinicians approaching complex capacity assessments.
My introduction makes four closely related arguments: that the promise functions as the governing trope of James’s work, that James rearranges the moral landscape of the nineteenth-century novel, that the depictions of promise-giving in James’s fiction challenge a number of moral philosophy’s accounts of the nature of obligation, and that the relation between morality and literature is better posed in terms of form than in terms of content. I explore a range of ethical dilemmas posed by philosophers working in moral philosophy, speech act theory, and the philosophy of identity. In addition I sketch out a short history of the nineteenth-century novel, focusing on the centrality of the promise to British, French, and American writers.
Computational models offer promising potential for personalised treatment of psychiatric diseases. For their clinical deployment, fairness must be evaluated alongside accuracy. Fairness requires predictive models to not unfairly disadvantage specific demographic groups. Failure to assess model fairness prior to use risks perpetuating healthcare inequalities. Despite its importance, empirical investigation of fairness in predictive models for psychiatry remains scarce.
To evaluate fairness in prediction models for development of psychosis and functional outcome.
Using data from the PRONIA study, we examined fairness in 13 published models for prediction of transition to psychosis (n = 11) and functional outcome (n = 2) in people at clinical high risk for psychosis or with recent-onset depression. Using accuracy equality, predictive parity, false-positive error rate balance and false-negative error rate balance, we evaluated relevant fairness aspects for the demographic attributes ‘gender’ and ‘educational attainment’ and compared them with the fairness of clinicians’ judgements.
Our findings indicate systematic bias towards assigning less favourable outcomes to individuals with lower educational attainment in both prediction models and clinicians’ judgements, resulting in higher false-positive rates in 7 of 11 models for transition to psychosis. Interestingly, the bias patterns observed in algorithmic predictions were not significantly more pronounced than those in clinicians’ predictions.
Educational bias was present in algorithmic and clinicians’ predictions, assuming more favourable outcomes for individuals with higher educational level (years of education). This bias might lead to increased stigma and psychosocial burden in patients with lower educational attainment and suboptimal psychosis prevention in those with higher educational attainment.