Results: We analyzed 1,402 surveys and 15 in-depth interviews. Many (32%) CL participants reported greater difficulty refilling medications and a minority (14%) reported greater difficulty accessing HIV care during the pandemic. Most (99%) Opt4Mamas participants reported no difficulty refilling medications or accessing HIV/pregnancy care. Among the CL participants, older women were less likely (aOR = 0.95, 95% CI: 0.92–0.98) and women with more children were more likely (aOR = 1.13, 95% CI: 1.00–1.28) to report difficulty refilling medications. Only 2% of (...) CL participants reported greater difficulty managing FP and most (95%) reported no change in likelihood of using FP or desire to get pregnant. Qualitative analysis revealed three major themes: (1) adverse organizational/economic implications of the pandemic, (2) increased importance of pregnancy prevention during the pandemic, and (3) fear of contracting COVID-19. (shrink)

Communication and cultivation accounts of responsibility argue that blaming has an important communicative and agency-cultivating function when addressed at someone we consider to be deserving of blame. On these accounts, responsible agents are agents who can understand negative reactive attitudes and are sensitive to their moral-agency cultivating function. In this paper I examine our reproachful engagements with agents whose moral agency is underdeveloped or compromised. I discuss how these engagements compare to blaming on CC accounts and argue reproachful engagements can (...) have an important communicative and agency-cultivating pointe. I then go on to propose an addition to CC-accounts that explains how underdeveloped and compromised agents can be held responsible. I will show how this addition resolves ambiguities in accounts from McKenna, Vargas and McGeer. I conclude the paper by anticipating an objection CC accounts could raise: that reproach and blame are co-extensive. (shrink)

Abstract: In this article, we explore what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this conduct in a detached (...) sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing. (shrink)

In this paper I provide a forward-looking account of the difference between the responsibility of children and the responsibility of adults. I do so by means of criticizing agency-cultivation accounts of responsibility. According to these accounts, the justification for holding a person to a norm is the cultivation of their moral agency, and children are, just like adults, considered responsible to the extent that they can have their moral agency cultivated in this manner. Like many forward-looking accounts, these accounts claim (...) that the purpose of holding adults to norms is similar to the purpose of holding children to norms. I argue that the justifications for holding adults to norms are different because of the particular ways in which adults can be in moral disagreement with one another, and the consequences that this has. Moral disagreement is relevant to consequentialist accounts because it impacts on whether and how we can secure beneficial outcomes via holding someone to a norm. One of the upshots of this analysis is that the forward-looking justification for holding adults to norms is qualitatively different from how and why we should hold children to norms. (shrink)

This Ideas and Opinions article revisits an argument from Judith Jarvis Thomson in her essay “A Defense of Abortion” that abortion can be an ethical choice even if we assume that fetuses have full moral personhood and moral rights. The authors examine the implications of laws that require a pregnant person to care for another with their body and what other impositions states may also require of citizens to care for others.

A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people’s degree of guilt-proneness versus shame-proneness. In this (...) paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person’s quality of self-blame (retributive or ‘scaffolding’), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding ‘reproach’, thereby enabling them to manage their experiences of both shame and guilt in a more generative way. (shrink)

Progress in addiction science is hampered by disagreements and ambiguity around its core construct: addiction. Addiction Ontology (AddictO) offers a path to a solution of the kind that has addressed similar problems in other areas of science: a set of clearly and uniquely defined entities to which terms such as ‘addiction’, addictive disorder’ and ‘substance dependence ’can be applied for ease of reference while recognizing that it is the construct definitions and their unique IDs that are central, not the terms.

Recently, there has been some discussion of how Dutch Book arguments might be used to demonstrate the rational incoherence of certain hidden variable models of quantum theory. In this paper, we argue that the 'form of inconsistency' underlying this alleged irrationality is deeply and comprehensively related to the more familiar 'inconsistency' phenomenon of contextuality. Our main result is that the hierarchy of contextuality due to Abramsky and Brandenburger corresponds to a hierarchy of additivity/convexity-violations which yields formal Dutch Books of different (...) strengths. We then use this result to provide a partial assessment of whether these formal Dutch Books can be interpreted normatively. (shrink)