Although the limitarian reflection may revise its applied ethical objectives, we believe it will remain fertile ground for the study of ideas on democratic participation from the point of view of material possession. The merit of this volume is that it illustrates this conclusion with in-depth and comprehensive studies that also shed light on the steps to be taken.

Book Reviews Miriam Teschl, Economics and Philosophy, FirstView Article.

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

An Upper Limit on Wealth? Should (extreme) wealth be seen as an undesirable situation? This question is called for by a number of social developments, but also from theories of justice in political philosophy and from economic ethics. Answering this question requires first and foremost a proper conceptualisation of wealth. In this paper, I propose such a conceptualisation. In addition, two reasons are advocated for an upper limit on wealth, and possible objections are investigated. The paper ends with some suggestions (...) for future philosophical research on an upper limit on wealth. (shrink)

Are global poverty and inequality on the rise or are they declining? And is the quality of life of the world's poorest people getting worse or better? These questions are often given conflicting answers by economists, the World Bank, and social activists. One reason for this is that assessments of quality of life can be made in terms of people's income, their resources, or their functionings and capabilities. This essay discusses the pros and cons of these evaluative approaches, and it (...) argues that all approaches have complementary strengths and should therefore in principle all be considered. Moreover, being aware that assessments of poverty and inequality can be made using these different frameworks helps us to understand the conflicting claims. (shrink)

In the philosophy of well-being, there is hardly anything written on the lives of people with autism or on the question whether existing philosophical theories of well-being are suited for understanding how well the lives of autistic persons are going. This paper tries to make some progress towards filling this gap. I start by giving a concise account of autism, which highlights the huge heterogeneity among autistics. I discuss some basic features of autism, ask whether there are good reasons why (...) we would need an account of well-being specifically for autistics and what philosophical well-being research could learn from being informed by autistic experiences and phenomenology. I then investigate to what extent the capability approach gives us a helpful theory of well-being for autistics, and what looking through an autism-lens can contribute to the further development of the capabilitarian well-being. In particular, I show that some capabilities that are crucially relevant for autistics are also relevant for the lives of non-autistic people. The final part of the paper looks at an important difficulty in using the capabilitarian account of well-being for autistics, namely: should the normative focus be on achievements (functionings) or real opportunities (capabilities)? (shrink)

This book brings together a team of leading theorists to address the question 'What is the right measure of justice?' Some contributors, following Amartya Sen and Martha Nussbaum, argue that we should focus on capabilities, or what people are able to do and to be. Others, following John Rawls, argue for focussing on social primary goods, the goods which society produces and which people can use. Still others see both views as incomplete and complementary to one another. Their essays evaluate (...) the two approaches in the light of particular issues of social justice - education, health policy, disability, children, gender justice - and the volume concludes with an essay by Amartya Sen, who originated the capabilities approach. (shrink)

In this paper we provide a critical discussion of how the most progressive parental leave policies are doing with respect to three goods which we identify as essential for liberal egalitarian feminists interested in parental leaves: the good of parental care, the good of gender fairness, and the good of individual choice. Then we offer our own model, based on the power of defaults, which promotes the goods of parental care and gender justice by sacrificing as little as possible of (...) the good of individual choice. (shrink)

This paper provides a defence of a lifetime limit on how much a person can receive in the form of gifts and inheritances, that is, a person's accessions. I argue that any accessions above that limit should be taxed at a rate of 100%. The analysis shows how this proposal can bring into equilibrium the core values and other goals at stake in the design of taxation on inheritances and gifts. To counter the low level of support for inheritance taxation (...) in general, the analysis must include a proposal concerning what will be done with the tax revenues. I propose turning the accession tax revenues into an unconditional citizen's stake that is granted to young adults. Such an institutional design would create additional value by reducing unfair inequalities between age groups. (shrink)

The complexities of how justice comes to be realized, and by which agents, is a relatively neglected element in contemporary theories of justice. This has left several crucial questions about agency and justice undertheorized, such as why some particular agents are responsible for realizing justice, how their contribution towards realizing justice should be understood, and what role agents such as activists and community leaders play in realizing justice. We aim to contribute towards a better understanding of the landscape of these (...) kinds of questions. First, we argue that theorists should distinguish between (i) agents who are responsible for realizing justice, but not committed to it, (ii) agents who are not responsible for realizing justice, but who are committed to it, and (iii) agents who are both responsible for and committed to realizing justice. Second, we discuss how to incorporate agents of justice more robustly into theorizing about justice. (shrink)

We explore the desirability of an idea that has not received the attention it deserves by political philosophers: that governments should bring privately-owned fossil fuel companies into public ownership with a view to managing their wind-down in the public interest – often simply referred to as ‘nationalising the fossil fuel industry’. We aim to make a conditional case for public ownership of fossil fuel companies. We will assume certain conditions about government motivations and capacities that are similar to assumptions made (...) generally in the philosophical and economic analysis of climate policies: that the government is suitably motivated, has effective control over the companies it acquires, and is able to sustain this motivation and control for long-enough to wind-down acquired companies in the public interest. We argue that bringing fossil fuel companies into public ownership, under these conditions, allows the government to take ten actions that are in the public interest, which will enhance social justice, enable a fair division of burdens and benefits, and strengthen democracy. We consider four plausible objections. While some of these point to the need for further research, they do not undermine our claim that nationalising the fossil fuel industry is a policy option that merits serious consideration. (shrink)

This article addresses the question whether a basic income will be a just social policy for women. The implementation of a basic income will have different effects for different groups of women, some of them clearly positive, some of them negative. The real issues that concern feminist critics of a basic income are the gender-related constraints on choices and the current gender division of labour, which are arguably both playing at the disadvantage of women. It is argued that those issues (...) are not adequately addressed by a basic income proposal alone, and therefore basic income has to be part of a larger packet of social policy measures if it wants to maximise real freedom for all. (shrink)

ABSTRACT:Increasing research attention to the ways that firms seek to influence the emotions of employees, consumers, and other stakeholders has not been accompanied by systematic attention to the ethical dimensions of emotion management. In this article we review and discuss research that informs the morality of influencing and regulating the emotions of others. What are the moral limits of the use of emotion as a management tool for shaping workplace behavior and influencing the thoughts and actions of consumers? Do the (...) ethics of emotional labor and emotional appeals (e.g., in consumer advertising) depart from moral rules that apply in “non-emotional” contexts? To explore these questions we examine research on the means by which individuals’ emotions are shaped and on the organizationally relevant consequences of individual emotional experience. We then discuss a number of potential ethical issues that are implicit or explicit in the organizationally sanctioned use of emotion management, incorporating existing literature in management and business ethics that has addressed the moral obligations of organizations in this context, and highlighting areas where there is yet work to be done. We conclude by discussing the implications of our analysis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 42.1 (2004) 115-116 [Access article in PDF] Robert J. Dostal, editor. The Cambridge Companion to Gadamer. New York: Cambridge University Press, 2002. Pp. xiii + 317. Cloth, $65.00. Paper, $23.00. This twelve-essay collection should introduce Gadamer to new readers while engaging those familiar with his work. Essays treat central elements of Gadamer's hermeneutical philosophy: his concept of understanding; tradition and authority; the ontology (...) of language; and the centrality of dialogue. A varied group of scholars trace Gadamer's major philosophical influences and situate him in debates with rival critics of modernity.The book opens with Robert Dostal's biographical sketch, from Gadamer's Marburg years, fascination with Heidegger's interpretation of Aristotle, and the Leipzig rectorship, through his productive Heidelberg period, reception of Truth and Method, and later engagement with issues like globalization and health. Dostal rejects claims of Nazi collusion, and characterizes as superficial critiques of Gadamer's writings at this time on Plato and Herder. Dostal might have gone further: Gadamer's writings develop a politics of recognition among equal, different and autonomous subjects, and his central notions of conversation and I-Thou dialogue are deeply anti-authoritarian.For a general audience, Charles Taylor best communicates the humane relevance of Gadamer's thought, astutely captured as the challenge of trying to understand others without absorbing them into our interpretive frameworks but by letting them challenge those frameworks. New readers might also benefit from accounts of Gadamer's notion of understanding (Jean Grondin) and its ethical dimensions (Georgia Warnke).For readers more familiar with Gadamer, Brice Wachterhauser illustrates the critical dimensions of Gadamer's views of tradition and authority, drawing on John McDowell's work, illuminating the intentional character of belief justification. Falling into neither skepticism nor objectivism, Wachterhauser shows that Gadamer's claim, "Being that can be understood is language," is inextricably tied to epistemic realism: while our beliefs are formed through interpretations, they remain answerable to the world. "Our world has an 'inherent' intelligibility that is... 'independent' of the languages, traditions and standpoints through which the world is mediated" (73). Otherwise, the world could not challenge us—Wachterhauser's reading thus has the virtue of accounting for the experience of the tug of, e.g., nature or a text against willful or incorrect claims to know it.Quite different is an essay by J. M. Baker, who explores Gadamer's view that the relevance of poetry for philosophy is its speculative content. Contrasting Hegel's claim that poetry no longer reveals truth and is superceded by the prose of philosophy, Baker illustrates Gadamer's view with readings of Mallarmé and Rilke. Mallarmé, says Baker, "elaborated a language that at once brings things otherwise inaccessible into presence yet defeats any attempt to name that presence," his "pure poetry" repudiating reference yet suggesting a kind of revelation. Poetry expresses the "invisible," by which is meant not the opposite of the material, but "... things [that] have in their same material exteriority an invisibility that has first of all to be articulated" (158). This articulation, for Gadamer, is the first task of a post-Hegelian aesthetic.Richard Bernstein outlines the intersections of hermeneutics, critical theory, and deconstruction, using each to reveal the others' aporia. For Habermas, phronesis does not go far enough in understanding modernity's pathologies, showing the need for democratic political theory. For Gadamer, efforts to build a universal political theory lack an appreciation of human finitude. Derrida's skepticism about slippage and misprisions of language challenges Gadamer's account of the "fusion of horizons," which emphasizes [End Page 115] dialogical achievement in understanding. Yet Derrida's deconstruction depends (to have effect through language) on a concern for coherence, as his view of the "undecidability" of ethical decisions shares the risk to identity of Gadamer's commitment to the "openness of experience."In a provocative essay, Robert Pippin analyzes Gadamer's complex relation to Hegel. Gadamer shares a view of Hegel as mired in a philosophy of consciousness, i.e., the "problem of reflection." Tracing the trajectory of this problem from Locke... (shrink)

Who said manifestos are dead? Some thirty years after the publication of Donna Haraway's illustrious A Cyborg Manifesto, fifty years after Valerie Solanas's angry and delightful SCUM Manifesto, and 170 years after Karl Marx and Friedrich Engels's influential Communist Manifesto, a new manifesto in town in fact bears traces of all these and then some: The Xenofeminist Manifesto. This manifesto, which comes in a gorgeously designed booklet version as well as in a colorful and nostalgic 80s computer-culture website with nerdy (...) hexadecimal page numbers and related Twitter account, is a work from the “xenofeminist” collective Laboria Cuboniks. The name of this collective, whose members are from various parts of the globe, is actually an anagram of “Nicolas Bourbaki,” a largely French collective of mathematicians in the early 1900s who sought to affirm abstraction, rigor, and generalization. Together with a firm foot in cyberfeminism and a strong penchant for the abstract and universal by way of the logic of computing against the arguably flawed universal of “nature,” the manifesto also clearly bears the marks of feminist ecocriticism, new materialism, queer theory, and technological accelerationism. The two books under review bring various activisms and insights together in an original way, and do so clearly with an eye toward reviving the cyberfeminist spirit through, among others, ideas from Shulamith Firestone's Dialectics of Sex. This pairing certainly had me excited, since, as I argue elsewhere, I am, together with Haraway's original cyborg manifesto, firmly of the opinion that feminisms of all kinds should intervene in and contribute even more radically to contemporary techno-culture and philosophy of technology. This is because clearly, new media and genetic technologies are at present some of the most powerful techniques by which we live and probably will live in the near future, and because these technologies are intimately interwoven with Eurocentric masculinism, heterosexism, militarism, and capitalism. (shrink)

Background: According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are communicated through them. One widely discussed issue is existential loneliness. However, much of the debate dealing with existential loneliness concludes that both the phenomenon and the concept are quite vague. Aim: To clarify what constitutes existential loneliness, and to describe its lived experiences. A further aim was to provide a definition of existential (...) loneliness that can function as a tool for identifying the phenomenon and for differentiating it from other kinds of loneliness. Method: A literature review including theoretical and empirical studies. Different search strategies were used to gather the articles included in the study. The analysis of the empirical studies had an interpretative approach. The articles were also analysed with the aim of providing a definition of existential loneliness. This was done by means of criteria such as language, uniqueness, theory and usefulness. This study is not empirical and does therefore not require an ethics review. Results: The analysis resulted in two main characteristics. The first one was perceiving oneself as inherently separated (disconnected) from others and from the universe. The second one brings out emotional aspects of EL, such as isolation, alienation, emptiness and a feeling of being abandoned. The empirical findings were divided into two categories: experiences of EL and circumstances in which EL arises. A definition of EL is also suggested, based on the two main characteristics identified. Conclusion: In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner. This in turn demands knowledge about existential issues and skills to deal with them. (shrink)

On appearing in 1949, The Second Sex provoked violent controversy in the world of French literary reviews and in the popular press. It was attacked by the religious right wing for daring to speak frankly about female sexuality and by the Communists for taking women's emotional and sexual well‐being as seriously as their economic welfare. Reactions to Beauvoir's text indicate the depth of misogyny at the time of its publication and the ways in which class and educational prestige were used (...) to silence women's subjectivity. (shrink)

Social enterprises are seen as innovative towards solving societal problems, but little research exists on possible negative aspects, the so‐called dark sides. In this study, the emphasis is on dark sides of social entrepreneurship, how they are managed, and how systems thinking can contribute towards managing these effects. Dark sides of social entrepreneurship can take many forms, like unethical or insincere motives and unintended outcomes like the negative impact on the well‐being of founders and employees, but they are also a (...) call for a critical reflection on the role of the government in society and the economic system social enterprises have to operate in. This paper aims to contribute to the dark side theory of social entrepreneurship by linking system archetypes to themes of dark side thereby stressing how management strategies act as balancing feedback loops to mitigate or prevent dark sides. A qualitative research was conducted by interviewing 21 respondents who play an important role in the world of social entrepreneurship in Belgium. The results show that dark sides of social enterprises manifest itself mostly in the form of trade‐offs and financial, business, and management related issues. Taking over the habits of profit‐oriented companies emerged as a new dark side element. Management strategies include anchoring goals, transparency, obtaining external views, changing the system, and above all reflection. The latter is an important first step to become aware of these issues to be able to change the negative dynamism of these dark sides. (shrink)

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

Industrial food systems are being increasingly challenged by alternative food movements globally that advocate for better environmental, social, economic, and political outcomes as part of societal transitions to more sustainable food systems. At the heart of these transitions are local food producers operating within shorter food supply chains, their experiences, and their knowledge of ecologically sustainable food production, biodiversity and climate, and their communities. Despite their important contributions to the resilience of food systems, society and ecology, local food producers' experiences (...) and knowledges are often undervalued, ignored, or inaccurately reflected. This systematic literature review identifies the values, motivations, and concerns as key elements of the experiences of local food producers within short food supply chains across literature globally, their contributions to social-ecological resilience, and discusses how these experiences and contributions can influence transitions to sustainable food systems. Eighty-five research articles were distilled from 5 databases and thematic analysis revealed four major themes: (1) concerns for exploitative operating contexts and hidden labor expectations within short food supple chains, (2) local food producers’ value and need for social networks, (3) their environmental values, connections, and concerns, and (4) how they can value and be motivated by alternative models but are concerned by their economic viability. This review also observed an important paradox within local food producers’ experiences showing that whilst farming is a demanding profession and lifestyle, they can feel a deep fulfilment when they live and work in harmony with their values and motivations. This systematic review is significant for how it values and synthesizes the experiences of local food producers and the diverse personal, social, ecological, and economic contributions that local food production has for social-ecological resilience of communities. By better communicating these experiences and contributions to decision-makers, policy makers and planners, this research can have major implications for enabling societal transitions that are fairer and more just in ways that empower, protect, and privilege local food producers’ voices. (shrink)

This commentary focuses upon the ‘fetishism of persons’ in Marx which Balibar claims both mirrors and animates the better-known fetishism of things. Revisiting the chapter on exchange in which Balibar grounds his thesis, the essay attends to the theatrical metaphors by which Marx presents legal personhood as a pantomime of commodity fetishism. The essay demonstrates how the movable immobility of the commodity comes to life in its inverse, the mobile and immovable figure of the legal person; it then claims that (...) this inversion positions legal persons as animate props for property. But if legal persons, the essay asks, merely personify economic relations, by what means are they sufficiently distanced from commodities to be able to become their reflex and puppet? In other words, what vestibule keeps personal liberty’s analogy with economic relations from collapsing into identity? A significant historical answer, the essay asserts, is transatlantic chattel slavery—not only because this institution is both ideological foil to, and material basis for, liberal capital, but also because the slave herself, as animate property, undoes the distinction between persons and commodities. The essay concludes by insisting upon the significance of this neglected figure in philosophies of the transindividual, while also taking first steps toward a transindividual analysis of slavery. (shrink)

Drawing on insights found in both philosophy and psychology, this paper offers an analysis of hate and distinguishes between its main types. I argue that hate is a sentiment, i.e., a form to regard the other as evil which on certain occasions can be acutely felt. On the basis of this definition, I develop a typology which, unlike the main typologies in philosophy and psychology, does not explain hate in terms of patterns of other affective states. By examining the developmental (...) history and intentional structure of hate, I obtain two variables: the replaceability/irreplaceability of the target and the determinacy/indeterminacy of the focus of concern. The combination of these variables generates the four-types model of hate, according to which hate comes in the following kinds: normative, ideological, retributive, and malicious. (shrink)

Despite the expansion of post-school education and incentives to participate in lifelong learning, institutions and labour markets continue to interlock in shaping life chances according to starting social position, family and private resources. The dominant view that the economic and social returns to public investment in adult learning are too low to warrant large-scale public funding has been challenged by recent LLAKES research that shows significant returns to participants in lifelong learning with improvements in both their employability and employment prospects. (...) It is argued that, under conditions of growing social polarisation and economic uncertainty, lifelong learning can have a significant protective effect by keeping adults close to a changing labour market. In this paper we review research from different disciplinary and epistemological traditions, providing evidence of the beneficial effects of lifelong learning, especially when taking into account the dynamics of the life course. Transitions and turning-points in youth and in adult life are markers of diversification of the life course; how far these diversifications amount to 'de-standardisation' of the life course is debated. They involve biographical negotiation, in which any decision is consequential upon previous decisions and involves the exercise of contextualised preferences as well as the calculations of 'rational choice'. Gaining a better understanding of how changing demands are negotiated at different life stages offers a new perspective, moving from narrow versions of rational choice theory towards models of biographical negotiation as promising avenues for effective policy-making. (shrink)

Depression has been widely studied by researchers from different fields, but its causes, and mechanism of action are still not clear. A difficulty emerges from the shifting from objective diagnosis or analysis to exploration of subjective feelings and experiences that influence the individuals' expression, communication and coping in facing depression. The integration of the experiential dimension of the first-person in studies on depression–and related methodological recommendations–are needed to improve the validity and generalizability of research findings. It will allow the development (...) of timely and effective actions of care. Starting from providing a summary of the literature on theoretical assumptions and considerations for the study of the mind, with particular attention to the experiential dimension of patients with depression, this contribution is aimed to provide practical suggestions for the design of research able to incorporate first- and third-person accounts. It is also aimed to review qualified phenomenological methods for the acquisition and interpretation of experiential data in patients with depression. Recognizing the first-person perspective in the study of depression is a major step toward a better understanding and treatment of this disorder. Theoretical constructs and technique suggestions that result from this review offer a valid starting point for the inclusion of the experiential dimension to common third-person research in the study of the mind. (shrink)

Industrial food systems are being increasingly challenged by alternative food movements globally that advocate for better environmental, social, economic, and political outcomes as part of societal transitions to more sustainable food systems. At the heart of these transitions are local food producers operating within shorter food supply chains, their experiences, and their knowledge of ecologically sustainable food production, biodiversity and climate, and their communities. Despite their important contributions to the resilience of food systems, society and ecology, local food producers' experiences (...) and knowledges are often undervalued, ignored, or inaccurately reflected. This systematic literature review identifies the values, motivations, and concerns as key elements of the experiences of local food producers within short food supply chains across literature globally, their contributions to social-ecological resilience, and discusses how these experiences and contributions can influence transitions to sustainable food systems. Eighty-five research articles were distilled from 5 databases and thematic analysis revealed four major themes: (1) concerns for exploitative operating contexts and hidden labor expectations within short food supple chains, (2) local food producers’ value and need for social networks, (3) their environmental values, connections, and concerns, and (4) how they can value and be motivated by alternative models but are concerned by their economic viability. This review also observed an important paradox within local food producers’ experiences showing that whilst farming is a demanding profession and lifestyle, they can feel a deep fulfilment when they live and work in harmony with their values and motivations. This systematic review is significant for how it values and synthesizes the experiences of local food producers and the diverse personal, social, ecological, and economic contributions that local food production has for social-ecological resilience of communities. By better communicating these experiences and contributions to decision-makers, policy makers and planners, this research can have major implications for enabling societal transitions that are fairer and more just in ways that empower, protect, and privilege local food producers’ voices. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

BackgroundThe use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of (...) genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023.MethodsA realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available.DiscussionThe A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. (shrink)