Wednesday, 25 February 2015

New Article on the Ethics, Philosophy and Practice of Person-centred Care and Shared Decision-making

One topic that's been part of my research activities for some years now is the ethical and philosophical implications of movements to transform health care practices towards more of what's often called a "patient-" or "person-centred" perspective, sharing clinical decisions with patients to a larger extent. I've been lucky to publish a few analytical works in this area in collaboration with, e.g., Lars Sandman and Daniela Cutas, which have attracted quite some attention, partly as an outcome of an ongoing research collaboration with the pediatric diabetes centre at the Sahlgrenska University Hospital, involving medicine, psychology, organisation, communication, care and human factors risk research, besides philosophy and ethics. Now I'm happy to announce the first of a number of planned articles coming out of empirical and multi-disciplinary investigations of communicative aspects of adolescent diabetes care undertaken in this project, authored by Anders Herlitz, myself, Marianne Törner and Gun Forsander. This article uses outtakes from a video-study of continuous doctor-patient consultation sessions forming the bulk of adolescent diabetes inpatient care (the rest is self-care performed by the younsters themselves) to question received assumptions in standard notion of what person-centredness and shared decision-making should involve, basing our arguments in received results from behavioural science and moral psychology. Instead, we advocates a new approach for patients who are at risk of suffering from weak decision capacities when performing self-care, while being in need of significant portions of such care. We also argue, that this new model exposes an hitherto ignored ethical tension within the person-centredness and shared decision-making advocacy, which needs to be adressed and managed for care to be defensible.

The article is entitled "The Counselling, Self-care, Adherence Approach to Person-centred Care and Shared Decision-making: Moral Psychology, Executive Autonomy and Ethics in Multi-dimensional Care Decisions", and has been accepted for publication in the journal Health Communication, to appear shortly. Meanwhile, interested parties may sample our final draft after the critical review that lead to acceptance (a so-called postprint), which has been made available here. In the pipeline are at least two more works based on this study, one of which on the role of parents and family in adolescent care, and one on conrete strategies to promote what in the article promoted here is called "robust decision capacity". In the future lingers further yet undecided things, as I am part of a group that has just received a nice bit of funding for continuing working on this topic.

Saturday, 21 February 2015

There Is A Question of What We Should Say To Each Other, But It Has Nothing To Do With Limits To Freedom Of Speech

Following recent bloody events in Copenhagen and Paris, with two very similar coordinated deadly attacks against symbolic targets of freedom of speech and religion, there has ensued a completely confused public discussion on the limits of freedom of speech, not seldom implicitly suggesting that maybe the cartoonists at Chalie Hebdo and Lars Vilks (the Swedish artist who co-organised the debate on blasphemy and freedom of speech that was one of the targets of the Copenhagen shooting) had it coming to them. I note that the other two targets in both cases where symbols of Jewish religious practice – a kosher store and a synagogue, respectively – so, I suppose this regards these two as well (?).

The problem with these debates, however, is that they consistently confuse two completely separate normative issues about public communication of information and expressions:

1. What should one publicly communicate / express?

2. What should one be allowed to publicly communicate / express?

Somehow, it seems that almost all of the debaters who have found reason to raise the issue about what the butchered cartoonists in Charlie Hebdo have expressed with this or that picture (mostly in total ignorance of French satirical tradition and using heavily biased selections of images) and Lars Vilks' various actions as an artist and debater (especially the latter is far from nice, aligning himself with semi-fascist groupings, such as Dispatch International), think that this somehow actualises a question of the limits of the freedom of speech. Of course it does not. Not in any way whatsoever.

Freedom of speech is a legal institutional arrangement, whereby the state takes upon itself not to prosecute public communications / expressions (and to protect people from other people's attempts to prevent or punish such acts with unlawful means). All liberal democratic states have limits to these arrangements, but as a rule, these limits are only about independently defined crimes, such as libel or unlawful harassment or threat, or endangering public order, instigating riots, violence or other criminal acts of others. The issue of whether or not a public communication / expression is morally OK has nothing to do with it. Of course, these limits mean that all people enjoying this type of right have a reason to moderate their behaviour. Moreover, if they want to have as wide license as possible, they have reason to act in their public communication in ways not approaching the legal limits, e.g., in line with the classic example of J.S. Mill, avoiding inflammatory tones and biases in front of large masses of angry people in order not to stir up a riot, while still expressing criticism of some person of phenomenon. However, the issue of whether or not this expression is morally warranted or not is of no consequence at all for determining such limits of free speech.

Having said that, there is, of course, a moral question of how we, as individuals, should behave towards each other. We may have reasons to be considerate and to moderate our ways of communicating our opinions and feelings. In general, we have reason not to harm each other in any way, unless there are good reasons for it. This includes things such as upsetting others, making them feel disrespected and so on. In other words, when communicating publicly we all owe consideration to each other, in a way no different from other kinds of actions. And, of course, it holds equally for all agents (in proportion to the good and the damage they may do) – e.g., religious clerics, political campaigners, journalists, and so on. But, of course, this reason may be balanced by other ones, such as the value of undermining the authority of oppressing institutions and practices, of having victims of such institutions experiencing public support and so on, of promoting worthy causes, and so on. But, and here we are, none of this has anything at all to do with the limits of the freedom of speech. To demonstrate that beyond all doubt, we may only reflect on the simple fact that the moral considerations just described hold entirely independent of whether or not a state enforces freedom of speech or not. We would owe each other consideration also under the most oppressing of tyrannies.

So, in light of the obvious fact that the recent attacks are deliberately directed against the institution of the freedom of speech – they tell us: if you keep this freedom, we will murder you for using it – in light of this, raising the moral issue is completely out of place. Its only fathomable function can be to muddle the water as to the weight and importance of standing up for the freedom of speech. In effect, it unwittingly (I hope!) sides with the attackers. For, to side with the victims of the murders – to declare "Je Suis Charlie!" or whatever other expression of solidarity is – of course! – not to condone them as morally splendid people, but to take stand for the freedom of speech. The same holds, of course, for the victims of the attacks against religious Jewish targets – to side with their right to practice their religion without being murdered is not to side with or even like Judaism, or religion at all for that matter.

Friday, 20 February 2015

Brian Leiter: from Online Harrassment and Ridiculous Legal Threats to Simple False Flag Bullying

You thought it was over, but of course it was not. Like a dung beetle will eventually find its way to a suitable habitat, where it can enjoy itself royally, University of Chicago philosopher and law professor Brian Leiter is now finally finding his way home, resorting to slander and bullying, pure and simple rural redneck style. You may inform yourself about foregone events regarding professor Leiter's manners and manoeuvres here and through the links there provided.

Then move on to read the latest tidings on how the dear professor tries to get back at one of his self-perceived nemesis, Leigh Johnson: Here and here. Given the increasingly sorry figure Brian Leiter is in these ways making of himself, you may ask yourself if you might commit the mistake of the Black Mamba / Beatrix Kiddo judging the motivational features of Bill:

... and whether the dear professor commits that of Bill misjudging "Kiddo", of course.

As for myself, wise from my own experience of anonymous comments on matters Leiter (see first link above), there is at least no mystery with regard to the identity of "AnonUntenured", an observation of which I'm far from alone.