When should global health actors prioritise more uncertain interventions?

Global health actors use economic evaluations, including cost-effectiveness analyses, to estimate the effect of different interventions they might fund. However, producing reliable cost-effectiveness estimates is difficult, meaning organisations must often choose between funding interventions for which reliable predictions of efficacy exist and those for which they do not. In practice, many organisations appear to be risk-averse, favouring more certain interventions simply because they are more certain. We argue that this practice is not justifiable. Prioritising projects backed by greater evidence might often produce greater health benefits. However, a general tendency to prefer more certain interventions will cause global health actors to overlook opportunities to help less well-studied populations, support promising but complex interventions, address the upstream causes of illness, and conduct the most important impact evaluations. We argue that global health actors should instead adopt nuanced attitudes towards uncertainty and be willing to fund highly uncertain interventions in some cases. We further describe the considerations they should take into account in rendering these judgements.

[Who is afraid of Ockham's razor? : A discourse analysis on resilience in palliative care (2000-2021)]

BACKGROUND

The concept of resilience is becoming increasingly disseminated from material science into various fields of science. It is infiltrating medical fields predominantly via psychology and is also recommended for coping with the special burdens in pain management and palliative care. A precise definition of the term and its operationalization pose problems.

AIM

A critical stocktaking of the use of this term in the discourse of palliative care research.

METHOD

Analytical discourse analysis of a text corpus from palliative medical care publications in the time period from 2000 to 2021, obtained by means of a systematic literature search.

RESULTS

In the research discourse of palliative care, resilience is a topic primarily as a strategy for self-optimization of employees (e.g., burnout prophylaxis with the aim of preserving the workforce). Only rarely does the question of whether it offers potential for patients and their families take center stage, and then more as a catchword than as a concrete concept. The reason is that there is so far no adequate operationalization of the concept of resilience. Furthermore, there is a lack of sufficient justification for the relevance of the concept in patient care of palliative medicine.

CONCLUSION

There is a lack of qualified contributions of palliative research to the metadiscourse about resilience, especially in the context of affected patients. A successful operationalization of the term requires a highly complex multidimensionality of the palliative path of an interdisciplinary approach. There is a lack of ethical standards that prevent an affirmative instrumentalizing application of the term.

Please wear a mask: a systematic case for mask wearing mandates

This paper combines considerations from ethics, medicine and public health policy to articulate and defend a systematic case for mask wearing mandates (MWM). The paper argues for two main claims of general interest in favour of MWM. First, MWM provide a more effective, just and fair way to tackle the ongoing COVID-19 pandemic than policy alternatives such as laissez-faire approaches, mask wearing recommendations and physical distancing measures. And second, the proffered objections against MWM may justify some exemptions for specific categories of individuals, but do not cast doubt on the justifiability of these mandates. Hence, unless some novel decisive objections are put forward against MWM, governments should adopt MWM.

Value Fulfillment from a Cybernetic Perspective: A New Psychological Theory of Well-Being

Value Fulfillment Theory (VFT) is a philosophical theory of well-being. Cybernetic Big Five Theory (CB5T) is a psychological theory of personality. Both start with a conception of the person as a goal-seeking (or value-pursuing) organism, and both take goals and the psychological integration of goals to be key to well-being. By joining VFT and CB5T, we produce a cybernetic value fulfillment theory in which we argue that well-being is best conceived as the fulfillment of psychologically integrated values. Well-being is the effective pursuit of a set of nonconflicting values that are emotionally, motivationally, and cognitively suitable to the person. The primary difference in our theory from other psychological theories of well-being is that it does not provide a list of intrinsic goods, instead emphasizing that each person may have their own list of intrinsic goods. We discuss the implications of our theory for measuring, researching, and improving well-being.

Review: Connecting circularity to animal welfare calls for a 'novel' conceptual framework based on integrity

The current food system is not sustainable. Circular agriculture aims to save the environment and produce food sustainably by closing nutrient cycles, possibly without improving animal welfare. This paper proposes a new conceptual framework, called a circular welfare economy (CWE), to facilitate a transition towards a sustainable agriculture based on integrity. The CWE framework explains how welfare relates to circular agriculture, how potential conflicts can be solved and what future livestock farming could look like. CWE applies the notion of circularity to welfare defined as the quality of life as perceived by the individual itself. CWE also identifies human integrity, defined as being open and honest, as a sine qua non for sustainability. Animal-welfare problems arise when animals are merely used as a means, e.g., for profits. Instead, profits and circular agriculture are means to the end of welfare. In a CWE, welfare is promoted sustainably, without causing undue need frustration in other individuals. This requires informed moral decision-making involving human integrity and the closure of welfare-related feedback loops. Conflicts between circular agriculture and animal welfare are solved by weighing all welfare needs impartially. Three future scenarios are presented: Animal-welfare-exclusive circular agriculture, which resembles modern intensive livestock farming, animal rights agriculture without livestock farming, and a CWE-based agriculture which integrates circular agriculture and animal welfare. In the latter case, we will not use animals merely as a means to close nutrient cycles, but take every effort, openly and honestly, to understand and benefit their points of view as we do our own.

Oppression and internalized oppression as an emerging theme in accessing healthcare: findings from a qualitative study assessing first-language related barriers among the Kurds in Turkey

BACKGROUND

Language has been well documented to be a key determinant of accessing healthcare. Most of the literature about language barrier in accessing healthcare is in the context of miscommunication. However, it is critical to consider the historical and political contexts and power dynamics underlying actions. The literature in this matter is short. In this paper we aimed to find out how first-language affects access to healthcare for people who do not speak the official language, with a particular focus on language oppression.

METHODS

We conducted this qualitative study based on patient-reported experiences of the Kurds in Turkey, which is a century-long oppressed population. We conducted 12 in-depth interviews (all ethnically Kurdish, non-Turkish speaking) in Şırnak, Turkey, in 2018-2019 using maximum variation strategy. We used Levesque's 'Patient-Centred Access to Healthcare' framework which addresses individual and structural dimensions to access.

RESULTS

We found that Kurds who do not speak the official language face multiple first-language related barriers in accessing healthcare. Poor access to health information, poor patient-provider relationship, delay in seeking health care, dependence on others in accessing healthcare, low adherence to treatments, dissatisfaction with services, and inability to follow health rights were main issues. As an unusual outcome, we discovered that the barrier processes in accessing healthcare are particularly complicated in the context of oppression and its internalization. Internalized oppression, as we found in our study, impairs access to healthcare with creating a sense of reluctance to seek healthcare, and impairs their individual and collective agency to struggle for change.

CONCLUSIONS

A human-rights-based top-down policy shift, and a bottom-up community empowerment approach is needed. At the system level, official recognition of oppressed populations, acknowledgement of the determinants of their health; and incorporating their language in official capacities (particularly education and healthcare) is crucial. Interventions should include raising awareness among relevant professions and stakeholders that internalized oppression is an issue in accessing healthcare to be considered. Given that internalized oppression can be in other forms than language or ethnicity, future research aimed at examining other aspects of access to healthcare should pay a special attention to internalized oppression.

Public Policy Experiments without Equipoise: When Is Randomization Fair?

Government agencies and nonprofit organizations have increasingly turned to randomized controlled trials (RCTs) to evaluate public policy interventions. Random assignment is widely understood to be fair when there is equipoise; however, some scholars and practitioners argue that random assignment is also permissible when an intervention is reasonably expected to be superior to other trial arms. For example, some argue that random assignment to such an intervention is fair when the intervention is scarce, for it is sometimes fair to use a lottery to allocate scarce goods. We investigate the permissibility of randomization in public policy RCTs when there is no equipoise, identifying two sets of conditions under which it is fair to allocate access to a superior intervention via random assignment. We also reject oft-made claims that alternative study designs, including stepped-wedge designs and uneven randomization, offer fair ways to allocate beneficial interventions.

Health-oriented leadership’s impact on the well-being of healthcare workers: Assessment with a mediated model

. In the face of growing stress in the workplace, employers are particularly interested in management practices focused on maintaining the psychological health of employees. This study examines the effect of the perception of health-oriented leadership (HoL) on the well-being of healthcare workers who have severe psychosocial working conditions in order to increase interest in employee well-being and provide leadership with a central role in this regard. The paper examined psychological wellbeing (PWB), job satisfaction, and life satisfaction together while attempting to determine whether HoL directly and indirectly (via PWB) affected work and life satisfaction based on the JD-R model. The methodological basis of the study was the provisions of the human resource theory management and the theory of leadership. Data was collected from 187 employees (convenience sampling) of a healthcare organization operating in a province in Turkey with the survey technique and analyzed using the SPSS and Smart PLS software. The findings revealed that HoL affects job satisfaction and life satisfaction both directly and through PWB. Therefore, the perception of HoL increased PWB, which in turn increased job satisfaction and life satisfaction. The study ultimately deducted that it was important to exhibit HoL behaviors for employee well-being. Among possible directions for further research could be a longitudinal design of analysis, as well as expanding the sample by including private healthcare organizations and additional locations.

Maximizing Well-Being in the Context of Long-Term Services and Supports: A Q Methodological Approach

OBJECTIVES

The goal of this study was to investigate diversity in stakeholders' perspectives on how best to maximize older adults' well-being when they use long-term services and supports (LTSS).

METHODS

We used Q methodology, an exploratory method, to investigate preference patterns among a purposive sample of older adults, family members, and leadership professionals (n = 57). Participants categorized 52 items related to 9 domains of LTSS quality relevant to well-being into categories of importance. We used factors analysis and qualitative methods to identify groups of individuals who identified similar priorities.

RESULTS

The analysis identified four shared viewpoints, each prioritizing different aspects of well-being: 1) physical health and safety; 2) independence; 3) emotional well-being; and 4) social engagement. Individual and contextual factors, including stakeholder role, care needs, and expectations for LTSS, appeared to influence participants' perspectives.

CONCLUSIONS

Distinct viewpoints on how to maximize well-being when older adults use LTSS exist. Our results affirm the importance of person-centered care yet demonstrate that shared preference patterns LTSS exist.

CLINICAL IMPLICATIONS

Engaging with older adults' values and preferences is critical to improving their experiences with LTSS. Better understanding common preference patterns could help providers deliver person-centered care more efficiently and effectively.

Virtuous leadership, moral behavior, happiness and organizational citizenship: the mediating effect of virtues-centered moral identity

Purpose

Guided by the importance ascribed to the self-cultivation of virtue, the authors examined virtues-centered moral identity (VCMI) as a mediator of the positive relationship between virtuous leadership and several valued personal and organizational outcomes.

Design/methodology/approach

Hypotheses were tested using data from 131 leader–subordinate dyads based in the USA and Canada, using the SPSS Statistics Software 27.0 PROCESS Macro v 3.5.

Findings

Leaders’ VCMI mediates the positive effects of virtuous leadership (subordinate-rated) on leaders’ moral behavior (subordinate-rated) and their self-rated happiness. Followers’ VCMI mediates the positive effects of virtuous leadership on organizational citizenship (as judged by leaders) and self-rated happiness of followers. Followers’ VCMI did not mediate between virtuous leadership and followers’ moral behavior.

Research limitations/implications

Although participants of this study were from a variety of industries, the sample was based in the USA and Canada; hence, any culture-specific leader behaviors and processes were likely missed. Moreover, some of the relationships examined involved data from the same source such that these associations may have been artificially inflated by common method variance. Even so, in each case, the sources we used (leader and follower) were appropriate to the research question. Nonetheless, for example, to collect Virtuous Leadership Questionnaire (VLQ)-based assessments from other stakeholders (e.g. peers and customers) remains of interest.

Practical implications

A practiced strong sense of VCMI has the potential to short-circuit unethical behavior and contribute to happiness among both subordinates and leaders. VCMI is implicated in the fostering of subordinates’ organizational citizenship as well.

Social implications

The authors' findings imply that leaders and followers can acquire knowledge structures associated with moral virtues and virtuous acts through formal and informal learning, suggesting an affirmative answer to the question, “Are virtuous acts teachable? This is an important starting point in developing theoretically sound programs for promoting virtuous acts as called for by many scholars and practitioners. The authors' study highlights the importance of virtues-related education because VCMI is likely developed through formal learning.

Originality/value

The authors' VCMI mediation-based findings offer a completely new explanation for the positive functioning of virtuous leadership, which formerly had been grounded in attribution and social learning processes only.

Applying Two-level Utilitarianism and the Principle of Fairness to Mandatory Vaccination during the COVID-19 Pandemic: the Situation in South Korea

In response to the COVID-19 pandemic, Korean society has sought to vaccinate most of its population. Consequently, the Korean government has attempted to make vaccination compulsory by promoting awareness of its benefits. The administration has pushed for mandatory vaccination by claiming that vaccination is more beneficial than harmful, based on a utilitarian view. However, this view is difficult to justify based on the two levels of utilitarianism presented by R. M. Hare. Compulsory vaccination cannot satisfy the universalizability, nor the satisfaction of preference, and exposes the difficulties of utilitarianism. In addition, mandatory vaccination is difficult to justify based on the perspective of fairness theory, that is, "justice as the fairness" of John Rawls and H. L. A. Hart's principle of fairness. From the point of view of Hare's utilitarianism and fairness theory, it has been shown that mandatory vaccination is not easily justified. In reality, the power of the state continues to strengthen, and we should examine this situation from a critical point of view.

Enhancing Global Health Impact—Beyond the Basic Minimum, Metrics and Ethical Consumption

How should we measure medicines’ global health impact to set targets, monitor performance and improve health around the world? Can such a metric provide a philosophically well-grounded basis for an ethical consumption campaign that will create incentives for pharmaceutical companies and other agents to expand (equitable) access to essential medicines? And if such metrics exist, how should we think about our individual obligations to support ethical consumption campaigns on this basis? This paper reflects on these questions in light of Tim Campbell’s, Yukiko Asada’s, and Andreas Albertsen’s worries about the answers I provide in Global Health Impact: Extending Access on Essential Medicines. I explain how reflecting on treatments consequences for individuals’ ability to live minimally well supports the creation of the Global Health Impact (GHI) index (https://global-health-impact.org/). I also consider how the index might be modified to better support efforts to promote everyone’s human rights. Finally, I argue that individuals should often promote positive change through GHI and other ethical consumption campaigns.

Genetic, Social, and Lifestyle Drivers of Healthy Aging and Longevity

Purpose of Review

"Healthy aging" is the state of the aging process in which a person can maintain physical, social, mental, and spiritual wellness. This literature review presents an overview of recent studies that explore how biological, social, and environmental factors contribute to healthy aging.

Recent Findings

A number of genome-wide association studies have been conducted recently for traits related to healthy aging, such as frailty index, healthspan, muscle strength, and parental longevity, leading to the discovery of dozens of genetic variants associated with these traits. In parallel, associations between healthy aging measures and multiple non-biological environmental elements have been identified as key moderators of the aging process, indirectly influencing day-to-day homeostatic processes.

Summary

Individual variations in lifespan and healthspan are influenced by genetic factors, with a heritability of ~ 25% in developed countries. Non-genetic risk variance is explained in part by social, cultural, and lifestyle conditions. Altogether, these factors contribute to a multifaceted state of wellness over time, shaping individual risk to frailty and resilience during the aging process. Notably, "Blue Zone" populations, which are characterized by an abundance in healthy lifestyles across generations, share some commonalities regarding determinants of health.

Career Development, Institutional Factors, Social Factors and Urban Young Returnees’ Happiness in the Context of Healthy China

In the context of the Healthy China 2030 Plan, the importance of the happiness of urban young returnees should not be underestimated. Based on a large-scale social survey of social practices in China, this paper applies a hierarchical linear regression model (HLM) and a structural equation model (SEM) to investigate the determinants of urban young returnees’ happiness. The results show that the happiness of urban young returnees in China is not only influenced by their socio-demographic characteristics, such as age and education, but mainly by their occupational development, institutional factors (especially the employment and entrepreneurship policy system) and social factors (physical environment and urban rural relationship), which are different from those of ordinary residents. Further study shows that occupational development indirectly affects the happiness of urban young returnees through relationship adaptation, collective adaptation and material adaptation, the indirect effects accounts for 42.18%, 21.64% and 36.18%, respectively. Institutional factors exert an indirect effect on the happiness of urban young returnees through relationship adaptation (46.80%) and material adaptation (53.20%). Social factors indirectly affect the happiness of urban young returnees through relationship adaptation (44.20%), collective adaptation (16.96%) and material adaptation (38.84%). Policies to improve the happiness of urban young returnees are suggested.

Situated Affectivity and Mind Shaping: Lessons from Social Psychology*

Proponents of situated affectivity hold that “tools for feeling” are just as characteristic of the human condition as are “tools for thinking” or tools for carpentry. An agent’s affective life, they argue, is dependent upon both physical characteristics of the agent and the agent’s reciprocal relationship to an appropriately structured natural, technological, or social environment. One important achievement has been the distinction between two fundamentally different ways in which affectivity might be intertwined with the environment: the “user-resource-model” and the “mind-invasion-model.” The twofold purpose of this paper is to complement the debate about situated affectivity in general and about “mind invasion” in particular by, firstly, connecting it to situationist research in social psychology and, secondly, broadening the perspective to not only accommodate decidedly detrimental “invasions” but also potentially beneficial forms of “mind shaping” that include the manipulation of an agent’s experiential life and behaviour through the moulding of both the agent’s environment and the agent’s body.

Ethical Solutions to the Problem of Organ Shortage

Organ shortage is a major survival issue for millions of people worldwide. Globally 1.2 million people die each year from kidney failure. In this paper, we critically examine and find lacking extant proposals for increasing organ supply, such as opting in and opt out for deceased donor organs, and parochial altruism and paired kidney exchange for live organs. We defend two ethical solutions to the problem of organ shortage. One is to make deceased donor organs automatically available for transplant without requiring consent from the donor or their relatives. The other is for society to buy nonvital organs in a strictly regulated market and provide them to people in need for free.

On the person in personal health responsibility

In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car's damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes.

Sharing Rewards Undermines Coordinated Hunting

Coordinated hunting is widely observed in animals, and sharing rewards is often considered a major incentive for its success. While current theories about the role played by sharing in coordinated hunting are based on correlational evidence, we reveal the causal roles of sharing rewards through computational modeling with a state-of-the-art Multi-agent Reinforcement Learning (MARL) algorithm. We show that counterintuitively, while selfish agents reach robust coordination, sharing rewards undermines coordination. Hunting coordination modeled through sharing rewards (1) suffers from the free-rider problem, (2) plateaus at a small group size, and (3) is not a Nash equilibrium. Moreover, individually rewarded predators outperform predators that share rewards, especially when the hunting is difficult, the group size is large, and the action cost is high. Our results shed new light on the actual importance of prosocial motives for successful coordination in nonhuman animals and suggest that sharing rewards might simply be a byproduct of hunting, instead of a design strategy aimed at facilitating group coordination. This also highlights that current artificial intelligence modeling of human-like coordination in a group setting that assumes rewards sharing as a motivator (e.g., MARL) might not be adequately capturing what is truly necessary for successful coordination.

Where psychological science meets moral theory: Linking up motivational primitives with normative ethics

The main normative moral theories in Western thought, from deontology to virtue and consequentialist ethics, revolve around conceptions of the moral right, good, and worth. However, a few elementary psychological motives lie at a deeper level. In the present article, I outline the key tenets of regulatory focus, regulatory mode, and the hedonic principle (approach/avoidance), which I define as “motivational primitives,” and provide a conceptual analysis of their links with specific ethical systems. I unveil how moral judgment in each of them is psychologically construed on the basis of the motivational primitives and their underlying self-regulatory processes. The credibility of the proposed framework will be fully brought to life when researchers, having agreed on satisfactory operationalizations and manipulations of the primitives, will be able to reconcile the speculative and the empirical planes.

The QALY is ableist: on the unethical implications of health states worse than dead

INTRODUCTION

A long-standing criticism of the QALY has been that it would discriminate against people in poor health: extending the lives of individuals with underlying health conditions gains fewer QALYs than extending the lives of 'more healthy' individuals. Proponents of the QALY counter that this only reflects the general public's preferences and constitutes an efficient allocation of resources. A pivotal issue that has thus far been overlooked is that there can also be negative QALYs.

METHODS AND RESULTS

Negative QALYs are assigned to the times spent in any health state that is considered to be worse than dead. In a health economic evaluation, extending the lives of people who live in such states reduces the overall population health; it counts as a loss. The problem with this assessment is that the QALY is not based on the perspectives of individual patients-who usually consider their lives to be well worth living-but it reflects the preferences of the general public. While it may be generally legitimate to use those preferences to inform decisions about the allocation of health care resources, when it comes to states worse than dead, the implications are deeply problematic. In this paper, I discuss the (un)ethical aspects of states worse than dead and demonstrate how their use in economic evaluation leads to a systematic underestimation of the value of life-extending treatments.

CONCLUSION

States worse than dead should thus no longer be used, and a non-negative value should be placed on all human lives.

Framing Climate Change Impacts as Moral Violations: The Pathway of Perceived Message Credibility

Climate change has been increasingly discussed in moral terms in public discourse. Despite the growing body of research on the effectiveness of moral frames in bridging the ideological divide, few studies have examined the role that perceived credibility, an important element of any persuasive appeal, plays in facilitating the framing effect. With the objective of further understanding how moral frames may engage individuals with different ideologies in climate change and refining climate change messaging strategies, two experimental surveys were conducted to examine the effects of moral violation frames on climate engagement. Specifically, a moderated mediation model was tested. The model posits that message credibility mediates the relationship between moral frames and policy support, as well as the relationship between moral frames and behavior intention. Moreover, political ideology moderated the indirect effects of message credibility. Based on moral foundations theory, seven messages were designed to activate individualizing and binding moral foundations. The results indicated that credibility consistently mediated the effects of the moral violation frame on climate engagement and that liberal-leaning individuals were more likely to perceive an individualizing frame as more credible than a binding frame. However, this difference was smaller among conservative-leaning individuals, with evidence for this moderated mediation model found only for policy support among college students. This study suggests that credibility is key for effective moral violations arguments of climate change.

Das Verständnis von Wohl im Betreuungsrecht – eine Analyse anlässlich der Streichung des Wohlbegriffs aus dem reformierten Gesetz

Mit der 2023 in Kraft tretenden Reform des Betreuungsrechts wird der Begriff „Wohl“ aus dem Gesetz gestrichen. Hierdurch soll stärker hervorgehoben werden, dass sich der Betreuer an den subjektiven Wünschen des Betreuten statt an einem objektiven Wohlverständnis orientieren soll. In diesem Beitrag wird ermittelt, welches Verständnis von Wohl das reformierte Betreuungsrecht in Abgleich zu gängigen medizinethisch-philosophischen Auffassungen des Wohls implizit enthält. Indem untersucht wird, in welchem Verhältnis das betreuungsrechtliche und das medizinethische bzw. philosophische Verständnis von Wohl zueinanderstehen, soll die interdisziplinäre Verständigung zwischen Recht und Ethik gefördert werden.

In der Begründung zur Reform wird betont, dass dem Betreuungsrecht weiterhin ein subjektives Verständnis von Wohl zugrunde liege. Dieses Verständnis deckt sich jedoch nicht mit philosophischen subjektiven Theorien des Wohlergehens, nach denen nur das zum Wohl einer Person beiträgt, was diese sich wünscht. Das Betreuungsrecht nimmt hingegen an, dass die Befolgung bestimmter Wünsche zu objektiven Schädigungen der Person führen und damit ihr Wohl beeinträchtigen kann. Negative Konsequenzen für das objektive Wohl eines Betreuten sind betreuungsrechtlich insofern relevant, als dass sie eine Grenze für die Befolgung aktueller Wünsche aufzeigen, die auf einem natürlichen Willen basieren und nicht Ausdruck von Selbstbestimmung sind. Dies ähnelt einer hybriden Konzeption des Wohls aus medizinethisch-philosophischer Sicht, nach der grundsätzlich angenommen wird, dass die Befolgung der Wünsche einer Person zu ihrem Wohl beiträgt, während aber auch gewisse objektive Kriterien als relevant für ihr Wohl angesehen werden.

Wellbeing Competence

This article presents and analyzes the basic features of wellbeing competence. Following a procedural approach to wellbeing, I propose wellbeing competence as a significant object of focus in the philosophical debate on wellbeing. Instead of being concerned one-sidedly with abstract ideals and explicit, theoretical knowledge about what constitutes wellbeing, wellbeing competence is the ability to handle the concrete process of living well and helping others live well in a generally qualified way. This article presents a theory that considers wellbeing competence a complex form of knowing how. Further, it outlines central aspects and components of wellbeing competence. I suggest four components to play central functional roles in wellbeing competence when supplementing each other: empathy, emotional awareness, flexible perspective, and metacognition.

Was lockdown life worth living?

Lockdowns in Australia have been strict and lengthy. Policy-makers appear to have given the preservation of quantity of lives strong priority over the preservation of quality of lives. But thought-experiments in population ethics suggest that this is not always the right priority. In this paper, I'll discuss both negative impacts on quantity of lives caused by the lockdowns themselves, including an increase in domestic violence, and negative impacts on quality of lives caused by lockdowns, in order to raise the question of whether we each had reason to choose quantity over quality in our own lives in a way that would justify the lockdowns we had.

What if some patients are more “important” than others? A possible framework for Covid-19 and other emergency care situations

Background

The Covid-19 pandemic caused situations where, in some hospitals, there were more patients in need of urgent treatment in intensive care units (ICU) than were available. In particular, there were not sufficient ventilators or critical care resources for all patients in danger of dying from respiratory failure or other organ failures.

Discussion

As the “first come, first served” criterion was not considered adequate, more nuanced and fairer clinical criteria were proposed to assess whom to treat first. One type of patients that has not been considered in the literature so far is that of “important patients”, individuals that many people might consider worthy of priority treatment for the contribution they made or might make to society as a whole.

Summary

In this article, we discuss the moral insights behind the possible treatment of “important patients” and suggest a supererogatory solution of voluntary renunciation/withdrawal. Details of the proposal are explained, and potential objections are addressed.

Exploring the ethics of genetic prioritisation for COVID-19 vaccines

There is evidence to suggest that host genomic factors may account for disease response variability in COVID-19 infection. In this paper, we consider if and how host genomics should influence decisions about vaccine allocation. Three potential host genetic factors are explored: vulnerability to infection, resistance to infection, and increased infectivity. We argue for the prioritisation of the genetically vulnerable in vaccination schemes, and evaluate the potential for ethical de-prioritisation of individuals with genetic markers for resistance. Lastly, we discuss ethical prioritisation of individuals with genetic markers for increased infectivity (those more likely to spread COVID-19).

The Mathematics of Desert: Merit, Fit, and Well-Being

Here, we argue for a mathematical equation that captures desert. Our procedure consists of setting out principles that a correct equation must satisfy and then arguing that our set of equations satisfies them. We then consider two objections to the equation. First, an objector might argue that desert and well-being separately contribute to intrinsic goodness, and they do not separately contribute. The concern here is that our equations treat them as separate contributors. Second, our set of desert-equations are unlike equations in science because our equations involve multiple desert-equations with the applicable equation depending on how the variables are filled out. Neither objection succeeds.

Distributive Justice and Animal Welfare

Besides the focus on the various approaches developed until now within animal ethics, perhaps it would be interesting to consider also what ethical theories have ruled out any moral concern for the interests of non-human beings. This article aims to rise some questions about the exclusion of (sentient) animals in the philosophical debates on distributive justice. The introduction briefly provides an overview on the current debate on distributive justice. The author focuses on those theories that adopt welfare as the currency of distribution (so-called “welfare ethics”), underlining how there seem to be a contradiction between the theory of value they rely on and their approach, exclusively focused on humans. The essay analyses the main issues related to the inclusion of animals in welfare ethics, i.e. (a) the alleged incommensurability between human and animal welfare, and (b) the “problematic conclusion”. The paper sketches a hypothesis of research to solve the “inter-species wellbeing comparisons” issue by proposing a model based on species-typical potentialities. Then, it tries to address the problem of demandingness by suggesting a sympathy-based foundation of welfare ethics. The last section singles out the moral issue of laboratory animals as an appropriate field of application for a welfarist approach.

An Intergenerational Issue: The Equity Issues Due to Public–Private Partnerships; The Critical Aspect of the Social Discount Rate Choice for Future Generations

This paper investigates the impact of Social Discount Rate (SDR) choice on intergenerational equity issues caused by Public–Private Partnerships (PPPs) projects. Indeed, more PPPs mean more debt being accumulated for future generations leading to a fiscal deficit crisis. The paper draws on how the SDR level taken today distributes societies on the Social Welfare Function (SWF). This is done by answering two sub-questions: (i) What is the risk of PPPs’ debts being off-balance sheet? (ii) How do public policies, based on the envisaged SDR, position society within different ethical perspectives? The answers are obtained from a discussion of the different SDRs (applied in the UK for examples) according to the merits of the pertinent ethical theories, namely libertarian, egalitarian, utilitarian and Rawlsian. We find that public policymakers can manipulate the SDR to make PPPs looking like a better option than the traditional financing form. However, this antagonises the Value for Money principle. We also point out that public policy is not harmonised with ethical theories. We find that at present (in the UK), the SDR is somewhere between weighted utilitarian and Rawlsian societies in the trade-off curve. Alas, our study finds no evidence that the (UK) government is using a sophisticated system to keep pace with the accumulated off-balance sheet debts. Thus, the exact prediction of the final state is hardly made because of the uncertainty factor. We conclude that our study hopefully provides a good analytical framework for policymakers in order to draw on the merits of ethical theories before initiating public policies like PPPs.

Is Concern With Overpopulation a Good Argument Against Radical Life Extension?

Projects of radical life extension have been discussed amongst scientists for years. Some bioethicists express reservations about this endeavor. A common objection appeals to demography: if the human lifespan is dramatically expanded, humanity would face an overpopulation problem. In this essay, the authors reply to this objection. They posit that radical life extension is unlikely to lead to overpopulation because overpopulation is determined more by fertility rates than by longevity, and as a result of the advanced phases of industrialization, fertility rates are likely to be reduced, and therefore, population size would become stable. However, they argue that although overpopulation is not a concern for the foreseeable future, it is still important to acknowledge its potential harms. Finally, they argue that even if overpopulation becomes a problem caused by radical life extension, there are plausible ways to solve it.

The Missing Measure of Loneliness: A Case for Including Neededness in Loneliness Scales

Prominent tools used to measure loneliness such as the UCLA Scale and DJGS include no items related to being needed, i.e., neededness. More recent scales such as the DLS and SELSA do include items on neededness, but only within their romantic loneliness subscales. This paper proposes that new iterations of loneliness scales should include in all subscales two items on neededness: (a) whether a person feels important to someone else and (b) whether that person has good ways to serve others’ well-being. The paper surveys cognate studies that do not rely on loneliness scales but establish a link between neededness and feelings of social connection. It then highlights ways in which neededness items would improve the ability of loneliness scales to specify the risk profile, to delineate variations in the emotional tone and quality of loneliness, and to propose suitable interventions. The paper outlines a theoretical argument—drawing on moral philosophy—that prosociality and being needed are non-contingent, morally urgent human needs, postulating that the protective benefits of neededness vary according to at least four factors: the significance, persistence, non-instrumentality, and non-fungibility of the ways in which a person is needed. Finally, the paper considers implications for the design of appropriate remedies for loneliness.

Sports Participation and Value of Elite Sports in Predicting Well-Being

This work contributes to an emerging literature focused on the role of physical activity on the subjective well-being of populations. Unlike the existing literature, it proposes an approach that uses algorithms to predict subjective well-being. The aims of this study were to determine the relative importance of sports participation and perceived value of elite sports on the subjective well-being of individuals. A total of 511 participants completed an online questionnaire. The statistical analysis used several machine learning techniques, including three algorithms, Decision Tree Classifier (DTC), Random Forest Classifier (RFC), and Gradient Boosting Classifier (GBC). In the three algorithms tested, sports participation, expressed as the weekly frequency and the time spent engaging in vigorous physical activity, showed a greater importance (between 47% and 53%) in determining subjective well-being. It also highlights the effect of perceived value of elite sport on the prediction of subjective well-being. This study provides evidence for public sport policy makers/authorities and for managers of physical activity and sport development programs. The surprising effect of the perceived value of elite sport on the prediction of subjective well-being.

The basic income: Initiating the needed discussion in industrial, work, and organizational psychology

The basic income (BI) involves regular and unconditional cash payments to all members of a political community, without the requirement or expectation to work in return. Whereas the BI is increasingly discussed by political parties, organizational practitioners, and in other academic disciplines, the field of industrial, work, and organizational (IWO) psychology has so far remained silent on the concept. In this article, we first explain why there is a growing interest in the BI and outline potential reasons why the BI, despite its topical relevance, has not been discussed by IWO psychologists. Next, to initiate the needed discussion on the BI, we outline the most important background information on the concept, including its definition, history, financial aspects, main criticisms, and potential advantages. We further provide first answers to common questions about the BI from an IWO psychology perspective, such as “(Why) would people still work if they received a BI?” We conclude with a discussion of potential positive and negative consequences of the BI as well implications for future theory development, empirical research, and practical applications.

Many heads are more utilitarian than one

Moral judgments have a very prominent social nature, and in everyday life, they are continually shaped by discussions with others. Psychological investigations of these judgments, however, have rarely addressed the impact of social interactions. To examine the role of social interaction on moral judgments within small groups, we had groups of 4 to 5 participants judge moral dilemmas first individually and privately, then collectively and interactively, and finally individually a second time. We employed both real-life and sacrificial moral dilemmas in which the character's action or inaction violated a moral principle to benefit the greatest number of people. Participants decided if these utilitarian decisions were morally acceptable or not. In Experiment 1, we found that collective judgments in face-to-face interactions were more utilitarian than the statistical aggregate of their members compared to both first and second individual judgments. This observation supported the hypothesis that deliberation and consensus within a group transiently reduce the emotional burden of norm violation. In Experiment 2, we tested this hypothesis more directly: measuring participants' state anxiety in addition to their moral judgments before, during, and after online interactions, we found again that collectives were more utilitarian than those of individuals and that state anxiety level was reduced during and after social interaction. The utilitarian boost in collective moral judgments is probably due to the reduction of stress in the social setting.

Disability and the Goods of Life

The so-called Disability Paradox arises from the apparent tension between the popular view that disability leads to low well-being and the relatively high life-satisfaction reports of disabled people. Our aim in this essay is to make some progress toward dissolving this alleged paradox by exploring the relationship between disability and various "goods of life"-that is, components of a life that typically make a person's life go better for them. We focus on four widely recognized goods of life (happiness, rewarding relationships, knowledge, achievement) and four common types of disability (sensory, mobility, intellectual, and social) and systematically examine the extent to which the four disability types are in principle compatible with obtaining the four goods of life. Our findings suggest that there is a high degree of compatibility. This undermines the widespread view that disabilities, by their very nature, substantially limit a person's ability to access the goods of life, and it provides some guidance on how to dissolve the Disability Paradox.