How stable are moral judgements? A longitudinal study of context dependency in attitudes towards patient responsibility.

BACKGROUND: Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views. AIM: To study how clinical doctors' attitudes to questions of patient responsibility and priority vary over time. METHOD: Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only in 2014). RESULTS: Attitudes were fairly stable between 2008 and 2021. 17%/14% agreed that patients' lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing. CONCLUSION: A substantial minority of doctors agreed that lifestyle should be a priority criterion, possibly contrary to Norwegian legislation and professional ethics. The finding might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. We conclude that attitudes to normative questions are unstable and depend on context. A substantial minority of doctors seems to be positive to deprioritizing patients allegedly responsible for their illness. However, what deprioritization implies in practice is not clear.

Discrimination Based on Personal Responsibility: Luck Egalitarianism and Healthcare Priority Setting.

Luck egalitarianism is a responsibility-sensitive theory of distributive justice. Its application to health and healthcare is controversial. This article addresses a novel critique of luck egalitarianism, namely, that it wrongfully discriminates against those responsible for their health disadvantage when allocating scarce healthcare resources. The philosophical literature about discrimination offers two primary reasons for what makes discrimination wrong (when it is): harm and disrespect. These two approaches are employed to analyze whether luck egalitarian healthcare prioritization should be considered wrongful discrimination. Regarding harm, it is very plausible to consider the policies harmful but much less reasonable to consider those responsible for their health disadvantages a socially salient group. Drawing on the disrespect literature, where social salience is typically not required for something to be discrimination, the policies are a form of discrimination. They are, however, not disrespectful. The upshot of this first assessment of the discrimination objection to luck egalitarianism in health is, thus, that it fails.

Salud, complejidad y enfermedades no transmisibles

La ciencia y la producción del saber científico están cambiando, las partes no son el objetivo, es el todo y sus interrelaciones. La salud enfrenta nuevos retos que no pueden ser explicados por concepciones reduccionistas. Se reconoce el intento de agrupar variadas afecciones en las enfermedades no transmisibles que ocasionan las tres cuartas partes de las muertes en el mundo y en Cuba, constituyen uno de los grandes retos del desarrollo sostenible. Muchas de ellas, a pesar de su heterogeneidad y multicausalidad, comparten factores de riesgo -y protectores- comunes, que pueden ser revertidos con acciones integradas. Se comenta la frecuente comorbilidad de estas enfermedades con otras entidades, la polimorbilidad y el rol del envejecimiento en su aparición. Se resalta la presencia del estado inflamatorio crónico del endotelio y la disfunción de este órgano como posible vía final común de la patogenia, evolución y posterior expresión clínica de muchas de las conocidas como enfermedades no transmisibles, verdaderos síndromes sistémicos. Se dan un grupo de recomendaciones para mejorar su prevención y su control, con énfasis en la participación comunitaria, donde las ciencias sociales pueden aportar mucho para lograr mejores resultados, sin olvidar la susceptibilidad individual o de grupos a padecer determinadas enfermedades no transmisibles. Se considera que directivos, profesionales sanitarios, líderes formales e informales, personas, grupos y comunidades, deben capacitarse y actualizarse, en los conceptos y los enfoques de estas enfermedades para lograr el propósito de revertir sus efectos nocivos para la salud.

Science and the production of scientific knowledge are changing, the parts are not the objective, it is the whole and its interrelationships. Health faces new challenges that cannot be explained by reductionist conceptions. The attempt to group various conditions in non-communicable diseases that cause three quarters of deaths in the world and in Cuba is recognized as one of the great challenges of sustainable development. Many of them, despite their heterogeneity and multi-causality, share common risk -and protective- factors, which can be reversed with integrated actions. The frequent comorbidity of these diseases with other entities, polymorbidity, and the role of aging in their appearance are discussed. The presence of the chronic inflammatory state of the endothelium and the dysfunction of this organ are highlighted as a possible final common path of the pathogenesis, evolution and subsequent clinical expression of many of the so-called non-communicable diseases, true systemic syndromes. A group of recommendations are given to improve its prevention and control, with emphasis on the community participation of all, where the social sciences can contribute a lot to achieve better results, without forgetting individual or group susceptibility to suffering certain non-communicable diseases. It is considered that managers, health professionals, formal and informal leaders, people, groups and communities must be trained and updated in concepts and approaches to these diseases to achieve their purposes.

A qualitative exploration of fear of cancer recurrence in caregivers.

OBJECTIVE: Fear of cancer recurrence (FCR) is one of the most common unmet needs for cancer patients and caregivers. Yet little is known about the potentially unique nature of caregiver FCR. Our research aimed to address this gap by qualitatively exploring the features and impact of caregiver FCR. METHODS: Eighteen semi-structured telephone interviews with cancer caregivers were conducted to explore the content and impact of caregiver fears and worries about cancer recurrence or progression. Data analysis used a Framework Approach. RESULTS: Qualitative analysis identified three themes (1) fear of the patient suffering, (2) the need to protect the patient from a recurrence and/or cancer-related distress, and (3) caregiver's sense of unpreparedness and uncertainty. Underpinning these themes was an overarching sense of personal responsibility for the life of the patient. This overarching theme was identified as a key driver of caregivers' personal and patient-centred fears. CONCLUSIONS: Our findings confirm the conceptual differences between patient and caregiver FCR. Future research must therefore acknowledge the unique experiences of caregivers and prioritise the development of empirically driven theoretical models, instruments, and interventions for caregiver FCR.

The Covid-19 pandemic in context of climate change perception and resource-saving behavior in the European Union countries.

The resource-saving behavior in the recent period is escalating particularly due to the energy and prices crises in all of the European Union (EU). The COVID-19 pandemic not only caused changes in health concerns but also in environmental awareness and behavior. Thus, this paper aims to reveal whether the COVID-19 pandemic contributed to the resource-saving behavior, and how this pandemic changed the climate change perception and personal responsibility in the EU countries. Referring to two surveys conducted in all EU countries in 2019 and 2021, the results revealed that the level of climate change perception during this period significantly decreased in all EU. Meanwhile, the level of responsibility placed on the government to solve the climate change problem increased the most. A level of the personal responsibility increased negligibly. Considering resource-saving behaviors, only the lesser usage of disposable items from 2019 to 2021 increased statistically significantly. The results of an analysis of the main determinants of resource-saving behavior during the COVID-19 pandemic period revealed that personal responsibility and the climate change solution's benefit for health positively and significantly determined all the analyzed actions. The climate change perception and climate change solution's benefit for the economy statistically significantly influenced waste reduction, the purchase of efficient appliances, and the usage of pro-environmental transportation mode instead of personal cars. Health benefits instead of the economic benefits statistically significantly contributed to the resource-saving behaviors, except for actions that require more monetary investments. The satisfaction with the COVID-19 pandemic management had an insignificant negative impact on all resource-saving actions. Thus, the tools assigned to manage this pandemic did not motivate people to save natural resources.

The Role of Moral Foundations, Anticipated Guilt and Personal Responsibility in Predicting Anti-consumption for Environmental Reasons.

In response to the growing importance of environmental issues, more and more consumers are turning to anti-consumption by reducing, rejecting, or avoiding consumption. Covering the intersection of sustainable consumption and anti-consumption, previous studies relied on socio-cognitive models to explain this decision. In order to extend their findings, we consider the moral and emotional perspectives to examine reducing consumption for environmental reasons in a particular context, i.e. air travel. It is against this backdrop that we propose a conceptual model that includes moral foundations as the main antecedent, followed by anticipated guilt and personal responsibility, while intention to reduce consumption (i.e. air travel) for environmental reasons, positive word of mouth about reducing air travel (WOM) and environmental activism represent the outcomes. The proposed model is tested on a sample of 511 respondents from a UK online consumer panel. Our results confirm the importance of moral foundations, anticipated guilt and personal responsibility and their interplay in the prediction of intention to reduce consumption for environmental reasons. Anticipated guilt influences WOM, while personal responsibility influences activism. In addition, intentions to reduce consumption for environmental reasons have a positive impact on WOM and environmental activism. There are several implications for public policy makers and NGOs that fight against climate change that derive from these findings, as well as research opportunities for academics interested in this topic.

Public perceptions of responsibility for alcohol control actions by actor type in seven countries.

Many governments are failing to systematically introduce evidence-based alcohol control policies, and debate continues around issues of market freedom and personal responsibility. The aim of this international study was to assess the extent to which the public considers a range of alcohol control policies to be the responsibility of three different categories of actors: government, the private sector, and individuals. Around 1000 respondents from seven countries (Australia, Canada, China, India, New Zealand, the UK, and the US; n = 7559) completed an online survey assessing demographic characteristics, alcohol consumption status, and perceived responsibility for four alcohol harm-reduction actions relating to alcohol availability, advertising, and public education campaigns. Across the total sample and all assessed actions, governments were selected as an appropriate actor in 66 % of instances, the private sector in 39 %, and individuals in 28 %. Respondents from New Zealand were most likely to consider the actions to be government responsibility and respondents from the US the least. In relatively few instances (8 %), respondents considered the actions unworthy of attention by any actor. Across all seven countries, governments were considered to be the most appropriate actors to undertake actions relating to restricting alcohol availability, regulating alcohol advertising, and disseminating campaigns to educate the public about alcohol-related harm. The results indicate that the public may be receptive to greater intervention in these areas.

Impact of system approach and personal performance on preventable morbidity and mortality events in neurosurgery patients.

PURPOSE: Adverse events in neurosurgery are a serious problem. The approach for seeking solutions for adverse events has shifted from a personal approach to a systemic approach. However, to some extent, preventable morbidity events could be related to personal performance. This study aimed to clarify the impact of personal performance and systematic failure on the occurrence of morbidity and mortality events in neurosurgery patients. METHODS: All morbidity and mortality conference data stored within our department over a 9-year period were analyzed. There were 4580 admitted patients and 3262 surgical procedures performed. We performed a three-step classification of morbidity and mortality events based on the possibility of prevention, root of the event, and personal or systemic issues. RESULTS: As a result of the first step, 214 preventable and 278 unpreventable events were identified. Of the preventable events, two mortality and 212 morbidity events were analyzed. In the second step, 155 (72.4%), 34 (15.9%), 13 (6.1%), and 12 (5.6%) events were categorized as technical complications, critical events, judgment errors, and human factors, respectively. There were 179 events (83.6%) classified as personal performance issues and 35 events (16.4%) as systemic issues. The ratio of personal performance to systemic issues varied widely, with significant differences among the four categories (P < 0.01). CONCLUSIONS: Among neurosurgery patients who have preventable morbidity, issues related to personal performance were more frequent than systemic issues. Efforts to improve systems should be unwavering. However, the personal responsibility of neurosurgeons to avoid preventable complications should not be ignored.

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.

Gamblers' perceptions of responsibility for gambling harm: a critical qualitative inquiry.

BACKGROUND: Gambling has traditionally been conceptualised as an issue of addiction and personal responsibility. While there are now clear public health models that recognise that gambling harm is caused by a range of socio-cultural, environmental, commercial and political determinants, government and industry messages about gambling are still largely personal responsibility focused. Given the well-recognised issues associated with personal responsibility paradigms, this study sought to understand how gamblers themselves conceptualised responsibility for gambling harm. METHODS: A qualitatively led online panel survey was conducted with 363 adult gamblers in New South Wales and Victoria, Australia. Participants were asked to respond to what they thought were the causes of gambling harm, and what could be done to prevent harm. A reflexive thematic analysis was conducted. RESULTS: Six common tropes were constructed from gamblers' responses: (1) Gambling in moderation; (2) Personal responsibility for rational behaviour; (3) Character flaws; (4) Personal responsibility to seek help; (5) More education is needed; and (6) Governments are responsible for action - but motivation and efficacy are questioned. Gamblers primarily understood gambling harm as being a matter of personal responsibility, and government responsibility was generally seen as limited to providing information to facilitate informed gambling choices. CONCLUSIONS: This study demonstrates that gamblers' perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from 'responsible gambling' messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.

Positive Development Based on the Teaching of Personal and Social Responsibility: An Intervention Program With Institutionalized Youngsters.

From the standpoint of the school settings, sport participation constitutes a key strategy concerning the manifestation of positive behaviors that result from the development of personal and social responsibility. Based on the TPSR model, the goal of this study was to evaluate the effects of an intervention geared toward teaching life skills through sport to youngsters who had been committed. The participants were evaluated before and after the intervention. After the initial evaluation, they were randomly assigned to the experimental and control groups. The experimental group took part in the community football program, while the control group attended physical education classes not based on the TPSR model. The experimental model consisted of 3 weekly sessions over the course of 6 weeks, which totaled 18 sessions. This investigation supplied empirical evidence concerning the potential of community sport programs in the teaching and development of life skills deemed necessary for an adequate reintegration of such at-risk youngsters. The model was shown to be valid both in stimulating changes of attitudes and in promoting the adherence to socially positive behaviors. The effectiveness of the model, as well as its unique approach, make its application attractive to both the youngsters and the professionals. This program facilitates the training of youngsters to act, in the sense of promoting both their autonomy and the acquisition of a system of ethics and moral values within a culture of responsibility for how decisions affect the individual and the community. Finally, this intervention generated empirical support in favor of the argument that sport constitutes a unique opportunity within the educational process to establish values, beliefs, attitudes, and practical habits pertaining relationships and cooperation that generate social responsibility in individuals.

Risk perception, illusory superiority and personal responsibility during COVID-19: An experimental study of attitudes to staying home.

Little is known about how different government communication strategies may systematically affect people's attitudes to staying home or going out during the COVID-19 pandemic, nor how people perceive and process the risk of viral transmission in different scenarios. In this study, we report results from two experiments that examine the degree to which people's attitudes regarding the permissibility of leaving one's home are (1) sensitive to different levels of risk of viral transmission in specific scenarios, (2) sensitive to communication framings that are either imperative or that emphasize personal responsibility, or (3) creating 'loopholes' for themselves, enabling a more permissive approach to their own compliance. We find that the level of risk influences attitudes to going out, and that participants report less permissive attitudes to going out when prompted with messages framed in imperative terms, rather than messages emphasizing personal responsibility; for self-loopholes, we find no evidence that participants' attitudes towards going out in specific scenarios are more permissive for themselves than for others. However, participants report they are more rigorous in staying home than others, which may cause moral licensing. Additionally, we find that age is negatively associated with permissive attitudes, and that male participants are more permissive to going out. Thus, during phases where it is important to promote staying home for all scenarios, including those perceived to be low-risk, imperative communication may be best suited to increase compliance.

Responsibility Considerations and the Design of Health Care Policies: A Survey Study of the Norwegian Population.

The objective of this article is to explore people's attitudes toward responsibility in the allocation of public health care resources. Special attention is paid to conceptualizations of responsibility involving blame and sanctions. A representative sample of the Norwegian population was asked about various responsibility mechanisms that have been proposed in the theoretical literature on health care and personal responsibility, from denial of treatment to a tax on unhealthy consumer goods. Survey experiments were employed to study treatment effects, such as whether fairness considerations affect attitudes about responsibility. We find that, overall, a substantial minority of the respondents find it fair to let the health care system sanction people-in one way or another-for voluntary behaviors that increase the risk of becoming ill. Quite surprisingly, we find that people are more prone to report that they should themselves be held responsible for unhealthy lifestyles than others.

Perceptions of body weight that vary by body mass index: Clear associations with perceptions based on personal control and responsibility.

This project aimed to identify the perceptions of body weight that vary by body mass index. First, a qualitative study explored body weight perceptions in 17 individuals with overweight. Second, a questionnaire was developed and completed by a UK sample with body mass index from 16.6 to 59.7 kg/m2 (N = 328). A higher body mass index was associated with perceptions of less personal control and responsibility. Body mass index in females was also associated with three other questionnaire factors and body mass index in males with illness/medication. Thus, body mass index was associated with different perceptions of body weight. Focussing on personal control and responsibility may be useful for treatment and prevention.

Exploring the determinants of reinvestment decisions: Sense of personal responsibility, preferences, and loss framing.

Two potentially costly errors are common in sequential investment decisions: sticking too long to a failing course of action (escalation of commitment), and abandoning a successful course of action prematurely. Past research has mostly focused on escalation of commitment, and identified three critical determinants: personal responsibility, preferences for prior decisions, and decision framing. We demonstrate in three studies using an incentivized poker inspired task that these determinants of escalation reliably lead decision makers to keep investing even when real money is on the line. We observed in Experiments 1, 2 and 3 that reinvestments were more likely when decision makers were personally responsible for prior decisions. This likelihood was also increased when the decision makers had indicated a preference for initial investments (Experiments 2 and 3), and when outcomes were framed in terms of losses as compared to gains (Experiment 3). Both types of decision errors - escalation of commitment and prematurely abandoning a course of action - could be traced to the same set of determinants. Being personally responsible for prior decisions, having a preference for the initial investment, and loss framing did increase escalation, whereas lacking personal responsibility, having no preference for the initial investment, and gain framing increased the likelihood of prematurely opting out. Finally, personal responsibility had a negative effect on decision quality, as decision-makers were still more likely to reinvest when they were personally responsible for prior decisions, than when prior decisions were assigned optimally by an algorithm (Experiments 2 and 3).

The Health of Health Care Professionals.

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Examining the relationship between weight controllability beliefs and eating behaviors: The role of internalized weight stigma and BMI.

Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, ß = 0.135, p < .001, and more disinhibited eating, ß = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.

COVID-19 information on social media and preventive behaviors: Managing the pandemic through personal responsibility.

In the face of a pandemic, social media have found to be vital information channels that might exert a positive influence on people's preventive behaviors. However, little is known about the underlying processes that may mediate or moderate the relationship. The present study examined the relation between novel coronavirus disease (COVID-19) information consumption on social media and preventive behaviors, as well as the mediation role of personal responsibility and moderation role of health orientation. A sample of 511 online participants (mean age = 32.47 years) responded to anonymous questionnaires regarding COVID-19 information consumption on social media, health orientation, personal responsibility, and preventive behaviors. Bias-corrected bootstrap method was used to test the moderated mediation model. Results indicated that after controlling for participants' age, gender, education, income, and insurance, personal responsibility mediated the relationship between COVID-19 information consumption on social media and preventive behaviors. Meanwhile, the direct relation between COVID-19 information consumption on social media and preventive behaviors, and the mediation effect of personal responsibility were moderated by health orientation. The present study can extend our knowledge about how risk information consumption on social media is related to one's behavioral outcomes. Implications and limitations about the present study are also discussed.

Assuming Personal Responsibility for Sexual Victimization: Harmful But Potentially Adaptive for College Women?

Survivors of sexual trauma often experience pervasive adverse cognitive attributions, such as assuming responsibility for victimization. In fact, these negative outcomes were recently included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criterion for posttraumatic stress disorder (PTSD) and have garnered substantial research attention devoted toward investigating the effectiveness of empirically supported trauma treatments in altering and reducing maladaptive belief systems. However, less is known about the ways that these negative cognitions may be inadvertently serving an adaptive role in young women's healing and recovery from sexual trauma. The present study examined relationships between situational aspects of sexual victimization, personal responsibility, self-esteem, perceived future control, and perceived future likelihood of assault recurrence using path analysis in a sample of college women (n = 347) who had experienced sexual victimization. Increased physical harm, decreased intoxication of the male, increased survivor intoxication, and decreased clarity of nonconsent were associated with increased personal responsibility, which was positively associated with self-esteem and perceived future control. Self-esteem mediated a negative relationship between personal responsibility and perceived future likelihood of assault recurrence, while perceived future control mediated a positive relationship. Findings suggest that college women's tendency to assume personal responsibility for sexual victimization experiences is a complicated double-edged sword with both harmful and adaptive effects. Innovative, comprehensive, and sophisticated approaches to sexual assault prevention and treatment are needed to more effectively address this issue and support young women's healing and recovery from victimization.