How should we interpret the popular objection that stigmatised subjects are not treated as individuals? The Eidelson View claims that stigma, because of its connection to stereotypes, violates an instance of the general requirement to respect autonomy. The Self-Presentation View claims that stigma inhibits the functioning of certain morally important capacities, notably the capacity for self-presentation. I argue that even if we are right to think that stigma violates a requirement to respect autonomy, this is insufficient to (...) account for the full weight of the charge that stigmatised subjects are not treated as individuals. We need the Self-Presentation View to explain a special threat to agency. I then address the worry that focusing on a concern with being treated as individuals opens the door to the suggestion that treating as superior can be just as morally troubling as stigma. This objection is fatal for the Eidelson View. But the Self-Presentation View has a number of resources for deflating the worry. We should not exclude the possibility of a moral symmetry between some cases of stigma and some cases of treating as superior. Rather, we should provide a nuanced account of the circumstances in which either phenomenon is detrimental for self-presentation. (shrink)

In this paper, I discuss stigma, understood as a category which includes acknowledged, enacted degradation, discreditation and discrimination. My discussion begins with an analysis of HIV stigma, as discussed in a social media post on Twitter. I then analyse a fictionalized clinical stigma scenario. These two analyses are undertaken to highlight aspects of the conceptual anatomy and interactional dynamics of stigma and by extension shame. Brief social media declarations and short, fictionalized clinical interactions are rich with (...) information which helps us understand how stigma—degradation, discreditation and discrimination—is operationalized in interaction. (shrink)

Hermeneutical injustice is being unjustly prevented from making sense of one’s experiences, identity, or circumstances and/or communicating about them. The literature focusses almost exclusively on whether people have access to adequate conceptual resources. In this paper, we discuss a different kind of hermeneutical struggle caused by stigma. We argue that in some cases of hermeneutic injustice people have access to hermeneutical resources apt to understand their identity but reject employing these due to the stigma attached to the identity. (...) We begin with a reinterpretation of one of the cases discussed in the literature, Edmund White’s novel A Boy’s Own Story. We argue that in this case hermeneutic resources are available but are rejected due to the stigma attached to homosexuality. We then present two analogous kinds of cases: alcohol addiction and being the victim of intimate partner violence. Here, too, hermeneutic injustice occurs because of stigma attached to an identity rather than unavailability of resources. We close by suggesting that these cases may, additionally, involve the wrong of Tightlacing: by meddling with their self-conception, stigma can manipulate individuals into a view of themselves that licenses inappropriate demands on them and makes them complicit in an erasure of their identities. (shrink)

The concept of organizational stigma has received significant attention in recent years. The theoretical literature suggests that for a stigma to emerge over a category of organizations, a “critical mass” of actors sharing the same beliefs should be reached. Scholars have yet to empirically examine the techniques used to diffuse this negative judgment. This study is aimed at bridging this gap by investigating Goffman’s notion of “stigma-theory”: how do stigmatizing actors rationalize and emotionalize their beliefs to convince (...) their audience? We answer this question by studying the stigma over the finance industry since 2007. After the subprime crisis, a succession of events put the industry under greater scrutiny, and the behaviors and values observed within this field began to be publicly questioned. As an empirical strategy, we collected opinion articles and editorials that specifically targeted the finance industry. Building on rhetorical analysis and other mixed methods of media content analysis, we explain how the stigmatizing rhetoric targets the origins of deviant organizational behaviors in the finance industry, that is, the shareholder value maximization logic. We bridge the gap between rhetorical strategies applied to discredit organizations and ones used to delegitimize institutional logics by drawing a parallel between these two literatures. Taking an abductive approach, we argue that institutional contradiction between field and societal-level logics is sufficient, but not necessary to generate organizational stigma. (shrink)

Challenges to psychiatric stigma fall between a rock and a hard place. Decreasing one prejudice may inadvertently increase another. Emphasising similarities between mental illness and ‘ordinary’ experience to escape the fear-related prejudices associated with the imagined ‘otherness’ of persons with mental illness risks conclusions that mental illness indicates moral weakness and the loss of any benefits of a medical model. An emphasis on illness and difference from normal experience risks a response of fear of the alien. Thus, a ‘likeness-based’ (...) and ‘unlikeness-based’ conception of psychiatric stigma can lead to prejudices stemming from paradoxically opposing assumptions about mental illness. This may create a troubling impasse for anti-stigma campaigns. (shrink)

I offer a preliminary examination on the importance of narrative for helping to overcome the issue of stigma surrounding mental illness, specifically schizophrenia. I maintain that engaging with first-person accounts of schizophrenia allows caregivers, and the broader general public, to better understand the phenomenological lived experiences of persons living with this mental health challenge and to better understand the experience of dealing with stigma. In doing so, I maintain that both caregivers and the public can begin developing more (...) accepting views of schizophrenia and begin to support those who need it the most. (shrink)

This paper explains how discrimination and COVID-19 related stigmas are intertwined. When people stigmatize COVID-19 victims, they act in ways for which the victims suffer status loss and discrimination. As a result, they do not enjoy participatory parity in various aspects of their life making COVID-19 related stigmatization a deplorable instance of discrimination. But a society already fraught with discrimination is a breeding ground of stigmatization often because of people’s fear and anxiety about their life once they become a patient (...) of a disease like COVID-19. (shrink)

As social and interdependent beings, we have responsibilities to each other. One of them is to recognize each other appropriately. When we fail to meet this responsibility, we often stigmatize. In this paper, I argue that the COVID-19-related stigmatization is a variation of the lack of recognition understood as an orientation to our evaluative features. Various stereotypical behaviors regarding COVID-19 become stigmatized practices because of labeling, stereotyping, separation, status loss and discrimination, and power. When people stigmatize COVID-19 victims, they orient (...) themselves to their evaluative quality of being vulnerable to the SARS-CoV-2 virus by internalizing the victims as dangerous, understanding them as separable, and being motivated to act with them differently. All this causes the COVID-19 victims to lose status and suffer discrimination for which they do not experience participatory parity in different facets of their lives, rendering the COVID-19-related stigmatization an appalling example of misrecognition. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research suggests that (...) practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

Investigators increasingly need high quality face photographs that they can use in service of their scholarly pursuits—whether serving as experimental stimuli or to benchmark face recognition algorithms. Up to now, an index of known face databases, their features, and how to access them has not been available. This absence has had at least two negative repercussions: First, without alternatives, some researchers may have used face databases that are widely known but not optimal for their research. Second, a reliance on databases (...) comprised only of young white faces will lead to science that isn't representative of all the people whose tax contributions, in many cases, make that research possible. The “Face Image Meta-Database” (fIMDb) provides researchers with the tools to find the face images best suited to their research, with filters to locate databases with people of a varied racial and ethnic backgrounds and ages. Problems of representation in face databases are not restricted to race and ethnicity or age – there is a dearth of databases with faces that have visible differences (e.g., scars, port wine stains, and cleft lip and palate). A well-characterized database is needed to support programmatic research into perceivers' attitudes, behaviors, and neural responses to anomalous faces. The “ChatLab Facial Anomaly Database” (CFAD) was constructed to fill this gap, with photographs of faces with visible differences of various types, etiologies, sizes, locations, and that depict individuals from various ethnic backgrounds and age groups. Both the fIMDb and CFAD are available from cliffordworkman[dot]com/resources/. (shrink)

Die Einführung der HIV-Prophylaxe PrEP ist ein Beispiel für demokratische Biopolitik und macht Hoffnung auf eine Beendigung von Sexnegativität und Stigmatisierung, findet Dr. Karsten Schubert.

Epidemiological crisis during recrudescence of pandemic like COVID-19 may stir fear and anxiety leading to prejudices against people and communities, social isolation and stigma. Such behavioral change may wind up into increased hostility, chaos and unnecessary social disruptions. A qualitative exploratory approach was utilized to conduct an extensive review of secondary literature. The case-studies were gathered from academic literature like articles, opinions and perspective pieces published in journals and in grey literature like publications in humanitarian agencies and media reports. (...) Grey literature was included in the scope as the COVID-19 situation is still evolving. I discuss some of the mechanisms of stigmatization and how social connectedness and empathetic understandings can be a way out of negative stereotyping and discrimination met out to the sufferer of the communicable diseases as COVID-19. Empathetic understanding paves a way to approach a problem from the perspective of ‘we’ not limiting one only to ‘I’. The moment when we make an approach from ‘I’ to ‘We’ actually then we embark on a journey of illness to wellness. Keywords: COVID-19, pandemic, stigma, discrimination, mental health, empathy, India, Face-to-face communication, social distancing, suicide. (shrink)

In this commentary, I will consider the implications of the argument made by Christopher Stratman (2020) in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, that virtually everything we already know about unintended pregnancies, abortion and adoption does not (...) prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion then there is unlikely to be any radical transformation of the practice of abortion. Second, abortion is already associated with stigma and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the fetus to the human subject of the artificial womb—the gestateling. Therefore, creating a new category of killing—gestaticide—and this would only reorient the debate rather than end it. (shrink)

Willpower is a metaphor that is widespread in both common usage and expert literature across disciplines. This paper looks into willpower as a ‘metaphor we live by’, analyzing and exploring the consequences of the tacit information content of the willpower metaphor for agentive self-understanding and efficacy. In addition to contributing to stigma associated with self-control failures, the metaphor causally contributes to self-control failures by obscuring available self-control strategies and instructing agents to superfluous self-control efforts.

Aim: Low professional help-seeking intention (PHSI) hinders effective treatment of mental illness. PHSI among Chinese students is still understudied and under-recognized. This study aimed to evaluate the status of PHSI and its associated risk factors among Chinese medical students. -/- Methods: A cross-sectional survey was conducted in Hainan province, South China, between January 1, 2021, and May 31, 2021. A total of 2182 medical students were recruited and surveyed via an anonymous structured questionnaire. Logistic regression analyses were performed to identify (...) the factors associated with PHSI. -/- Results: Among the 2182 medical students (mean age 21.0 years (SD = 3.70), 61.5% females), those with and without PHSI were 72.0% and 28.0%, and 16.4% with moderate to severe depression. Male students, those with a high level of depression stigma, serious family dysfunction, and heavy dependence on mobile phones were significantly less likely to seek professional mental health help, with odds ratios (ORs) of 1.5, 2.0, 2.1, and 1.7, respectively. -/- Conclusion: A significant proportion of Chinese medical students demonstrate low PHSI, influenced by factors such as gender, depression stigma, family dysfunction, and mobile phone dependence. Future interventions aimed at increasing medical students’ PHSI should prioritize reducing depression stigma, mitigating reliance on mobile phone use, and enhancing family function to address these key barriers to seeking professional mental health support. (shrink)

Background The worldwide increase in older persons demands technological solutions to combat the shortage of caregiving and to enable aging in place. Smart home health technologies (SHHTs) are promoted and implemented as a possible solution from an economic and practical perspective. However, ethical considerations are equally important and need to be investigated. Methods We conducted a systematic review according to the PRISMA guidelines to investigate if and how ethical questions are discussed in the field of SHHTs in caregiving for older (...) persons. Results 156 peer-reviewed articles published in English, German and French were retrieved and analyzed across 10 electronic databases. Using narrative analysis, 7 ethical categories were mapped: privacy, autonomy, responsibility, human vs. artificial interactions, trust, ageism and stigma, and other concerns. Conclusion The findings of our systematic review show the (lack of) ethical consideration when it comes to the development and implementation of SHHTs for older persons. Our analysis is useful to promote careful ethical consideration when carrying out technology development, research and deployment to care for older persons. Registration We registered our systematic review in the PROSPERO network under CRD42021248543. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing (...) mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

The dispute about the role of class in understanding the life situations of people of color has tended to be overpolarized, between a class reductionism and an “it's only race” position. Class processes shape racial groups’ life situations. Race and class are also distinct axes of injustice; but class injustice informs racial injustice. Some aspects of racial injustice can be expressed only in concepts associated with class (e.g., material deprivation, inferior education). But other aspects of racial injustice or other harms, (...) such as racial discrimination or stigma, are not reducible to class concepts and cannot be fully addressed through class-focused policies. Overall, any attempt to fully secure racial justice for a racial group will require a combination of race-focused and class-focused policies. Anti-racist outlooks often neglect or downplay either the normative or the explanatory significance of class, or both—for example, by overlooking or downplaying the dignitary harms of class and the material harms of race; missing the historical dimension of class injustice; masking class by a narrowing of the complex normative structure of racial disparities; or not recognizing that a class-focused initiative (like raising the minimum wage) can address substantial racial justice concerns, even though not all of them. “Systemic racism” terminology recognizes class explanatorily but suppresses it normatively. Charles Mills's influential notion of “white supremacy,” while a powerful tool for conceptualizing and illuminating racial injustice, can also contribute to minimizing or masking the justice-related impact of class, as do some of Mills's specific discussions of class in various writings. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as friends and lovers. (...) There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The (...) system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

The eugenics movement was not the anomaly of just one country. In its day, it enamoured industrialized nations throughout the Western world. In the end, the eugenics movement ultimately did not recover from the stigma it sustained as a result of the Second World War. However, with the advancement of genetic engineering and the researches into embryonic stem cells, discussions about eugenics are becoming relevant once more, and it will be the responsibility of the informed (and not merely reactionary) (...) to cultivate reasoned argument about eugenics based on a sound knowledge of biology and ethics. The potential to rid humanity of so many hereditary ailments may rest on such a rational dialogue and, as such, we should hope to heed the lessons of history more carefully than perhaps we have. (shrink)

This is a theoretical treatment of the term "Sha Zhu Pan" (杀猪盘) in Chinese, which translates to “Pig-Butchering” in English. The article critically examines the propagation and validation of "Pig Butchering," an animal metaphor, and its implications for the dehumanisation of victims of online fraud across various discourses. The study provides background information about this type of fraud before investigating its theoretical foundations and linking its emergence to the dehumanisation of fraud victims. The analysis highlights the disparity between academic literature, (...) subjected to rigorous peer-review processes, and sensationalised narratives prevalent in the media. While academic works subject "pig butchering" to critical scrutiny and refrain from endorsing derogatory terms to depict fraud victims, numerous media outlets employ this term uncritically, further worsening the predicament of these victims. "Pig butchering" is firmly rooted in the concept of dehumanisation, and this article underscores how language moulds perceptions of fraud and behaviour, extending to the development of preventive strategies. The role of law enforcement agencies in generating and disseminating materials is also a central theme, emphasising their responsibility as trusted sources of information. We suggest that these agencies should adopt non-victim shaming language to encourage victims to report crimes and alleviate the stigma attached to victimisation. Additionally, the article offers valuable cross-cultural insights by comparing metaphors from Chinese and Nigerian contexts. This comparative analysis enriches our comprehension of the global dimensions of online fraud and its cultural diversities, highlighting the substantial impact of language on perceptions and behaviours. We advocate for a departure from victim-blaming tendencies perpetuated by select media outlets, urging a more compassionate and accurate portrayal of those affected by online fraud. We, therefore, call for a more empathetic and accurate portrayal of individuals affected by online fraud, aligning with the broader objective of promoting understanding and support for these victims. (shrink)

This paper critically interrogates the anti-fat beliefs that are employed in environmental bioethics, particularly in response to climate change. Fat bodies have been associated with climate change because they are presumed to consume more resources and produce more greenhouse gas emissions. In this paper, we argue that such interpretations employ mistaken assumptions to justify placing disproportionate blame on already oppressed individuals, reinforcing weight stigma, which increases the vulnerability of fat people to a range of harms and disproportionately affects communities (...) of color. For these reasons, conceiving fat bodies as harmful to the environment is both misguided and unjust. (shrink)

[This piece is written for those working in communication studies and in healthcare writ large, with the aim of bringing insights from disability studies and philosophy of disability to bear on discussion concerning disability in those fields.] Despite being assailed for decades by disability activists and disability studies scholars spanning the humanities and social sciences, the medical model of disability—which conceptualizes disability as an individual tragedy or misfortune due to genetic or environmental insult—still today structures many cases of patient–practitioner communication. (...) Synthesizing and recasting work done across critical disability studies and philosophy of disability, I argue that the reason the medical model of disability remains so gallingly entrenched is due to what I call the “ableist conflation” of disability with pain and suffering. In an effort to better equip healthcare practitioners and those invested in health communication to challenge disability stigma, discrimination, and oppression, I lay out the logic of the ableist conflation and interrogate examples of its use. I argue that insofar as the semiosis of pain and suffering is structured by the lived experience of unwelcome bodily transition or variation, experiences of pain inform the ableist conflation by preemptively tying such variability and its attendant disequilibrium to disability. I conclude by discussing how philosophy of disability and critical disability studies might better inform health communication concerning disability, offering a number of conceptual distinctions toward that end. (shrink)

The biopsychosocial (BPS) model in psychiatry has come under fire for being too vague to be of any practical use in the clinic. For many, its central flaw consists in lack of scientific validity and philosophical coherence: the model never specified how biological, psychological and social factors causally integrate with one another. Recently, advances in the cognitive sciences have made great strides towards meeting this very ‘integration challenge.’ The paper begins by illustrating how enactivist and predictive processing frameworks propose converging (...) accounts of biopsychosocial integration that are far superior to those of previous theories. It argues, however, that the main problem of implementing the BPS model has less to do with integration than with the lack of a social etiology. Psychiatric practice leans heavily towards ‘bio’ and ‘psycho’ approaches, without an equally developed set of explanatory and therapeutic resources for dealing with the ‘social’ dimension of illness. This leaves psychiatry essentially internalist in orientation. As illustrated most poignantly by conditions such as functional neurological disorders, internalism comes with the risks of stigma and the curtailment of therapeutic possibilities. The paper argues that the answer to the failings of the BPS model lies in combining the integration challenge with the development of an ‘externalist psychiatry,’ which casts both causes and treatment of psychiatric illness onto the social environment. The following two papers explore the conditions that might make this idea a reality. (shrink)

In this paper, I consider Ripstein and Dan-Cohen's critiques of the 'harm principle'. Ripstein and Dan-Cohen have asserted that the harm principle should be jettisoned, because it allegedly fails to provide a rationale for criminalising certain harmless wrongs that ought to be criminalised. They argue that Kant's second formulation of the categorical imperative and his concept of 'external freedom' are better equipped for ensuring that criminalisation decisions meet the requirements of fairness. Per contra, I assert that Kant's deontological theory is (...) about identifying morally wrongful and rightful conduct: it does not tell the legislature which of those wrongs justify a criminal law response in accordance with the requirements of fairness and justice. Some wrongdoers deserve censure and the stigma that results from criminalisation, but others do not. Kant's deontological theory does not limit the scope of the criminal law merely to those wrongs that deserve a criminal law response. Fair and principled criminalisation requires more than mere wrongdoing. I assert that it is only fair to criminalise wrongs when further normative reasons can be invoked to justify the use of the criminal law as a means for deterring the unwanted conduct. While 'harm to others' is not the only normative reason that can be used to demonstrate that it is fair to criminalise a given act, it is the justification that has the greatest reach. It would not be fair to criminalise mere wrongdoing (that is, every violation of freedom: trespass to goods etc. or every violation of the categorical imperative: every false promise etc.). Nor is it possible to distinguish one violation of freedom from the next, as freedom is not measurable. Thus, murder and trespass to goods would be equally wrong and equally criminalisable in Kant's scheme. A further problem with Dan-Cohen's use of the second formulation of Kant's categorical imperative is that it aims to be an inclusive criterion for identifying conduct that is prima facie criminalisable, but this inclusive approach does not explain the wrongfulness (or in Dan-Cohen's use of the categorical imperative the criminalisableness) of harming animals. In this paper, I demonstrate that the harm principle is able to meet the challenges raised by Ripstein and Dan-Cohen. I also demonstrate that it offers superior criteria for ensuring that criminalisation decisions are fair, just and principled than is offered by Kant's deontological theory. (shrink)

Facing marginalization under the Awami League and historical stigma, the BNP’s recent outreach to India signals a pivotal shift. This commentary explores how the BNP seeks to establish legitimacy, distance itself from past associations, and connect with a younger electorate by advocating for democratic principles, social justice, and individual empowerment. It argues that a renewed commitment to ethical leadership and social justice will allow the BNP to bridge socio-economic divides and appeal to a disillusioned, younger electorate. This reorientation could (...) shape a more inclusive, equitable political landscape, offering a foundation for Bangladesh’s democratic future. (shrink)

Philosophical speculation about how psychiatric externalism might function in practice has yet to fully consider the multitude of externalist psychiatric systems that exist beyond the bounds of modern psychiatry. Believing that anthropology can inform philosophical debate on the matter, the paper illustrates one such case. The discussion is based on 19 months of first-hand ethnographic fieldwork among Akha, a group of swidden farmers living in highland Laos and neighboring borderlands. First, the paper describes the Akha set of medicinal, ritual, and (...) shamanic practices, analyzing issues of stigma and medical pluralism within it. Second, it makes the case that the Akha realize a functioning biopsychosocial system which comes with a well-developed set of resources for treating the social dimension of illness. Externalism among the Akha re-frames psychiatric illness as a ‘problem in living,’ which becomes manageable as such. The paper claims that, in so doing, the Akha system succeeds in many of the areas where modern internalist psychiatry falls short, and that it does so because Akha society is structured in such a way so that its practitioners can shift the social environment around the patient. As a takeaway for philosophers, it suggests that the development of an externalist psychiatry must begin from questioning the accepted ontology of the social causes of psychiatric illness. (shrink)

This article analyses how child victims of abuse may be subjected to hermeneutical injustice. I start by explaining how child victims are hermeneutically marginalised by adults’ social and epistemic authority, and the stigma around child abuse. In understanding their abuse, I highlight two epistemic obstacles child victims may face: (i) lack of access to concepts of child abuse, thereby causing victims not to know what abuse is; and (ii) myths of child abuse causing misunderstandings of abuse. When these epistemic (...) obstacles cause the child victims to fail to see themselves as being abused and/or to get adults to recognise that they are being abused, I argue that this constitutes hermeneutical injustice. While some may justify obstructing epistemic access to concepts of abuse on the grounds of parental rights and protection of children’s innocence, I reply that both grounds are unjust in light of children’s basic rights and the fact that children can easily be taught such concepts in a child-appropriate manner. The case of child abuse prompts important reflections on existing epistemic injustice literature, particularly on the ways in which hermeneutical injustice materialises, the epistemic responsibilities of institutional bodies and individuals, and the interrelationship between testimonial and hermeneutical injustice. (shrink)

ABSTRACT Objectives There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design The study used a qualitative approach (...) to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. Setting The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. Participants Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. Results PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. Conclusions The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs. (shrink)

In accordance with a recent statement released by the World Health Organization, the Canadian province of Ontario is moving to ban payment for plasma donation. This is partially based on contentions that remuneration for blood and blood products undermines autonomy and personal dignity. This paper is dedicated to evaluating this claim. I suggest that traditional autonomy-based arguments against commodification of human body parts and substances are less compelling in the context of plasma donation in Canada, but that there is another (...) autonomy-based objection to paid plasma donation that has not received sufficient attention. Namely, the stigma that surrounds exchanging plasma for payment makes it difficult to make an autonomous decision to engage in this activity. I suggest that this problem can be overcome in one of two ways; by banning payment for plasma, or by reducing the stigma surrounding this practice. I provide an indication of how we might work to achieve the latter, contending that this possibility should be taken seriously, due to the difficulties in achieving a sufficient supply of plasma without remuneration. (shrink)

Autism is a psychopathological condition around which there is still much prejudice and stigma. The discrepancy between third-person and first-person accounts of autistic behavior creates a chasm between autistic and neurotypical (non-autistic) people. Epistemic injustice suffered by these individuals is great, and a fruitful strategy out of this predicament is much needed. I will propose that through the appropriation and implementation of methods and concepts from phenomenology and ecological-enactive cognitive science, we can acquire powerful tools to work towards greater (...) epistemic justice for autistic individuals. I will use the resources found in the skilled intentionality framework, integrated with various phenomenological theories. From these approaches, we can view autistic impairments and disability relationally and how epistemic enablement and disablement form. Phenomenology and its methods help us learn more about the perceptual and social experiences of autistic individuals. The voices of the autistics themselves will be of the greatest importance here. I will show that, through restructuring our landscape of affordances and with a greater phenomenological understanding of the autistic inner world, we can devise new strategies that afford greater epistemic enablement and epistemic justice. (shrink)

Recent studies demonstrating epigenetic and developmental sensitivity to early environments, as exemplified by fields like the Developmental Origins of Health and Disease (DOHaD) and environmental epigenetics, are bringing new data and models to bear on debates about race, genetics, and society. Here, we first survey the historical prominence of models of environmental determinism in early formulations of racial thinking to illustrate how notions of direct environmental effects on bodies have been used to naturalize racial hierarchy and inequalities in the past. (...) Next, we conduct a scoping review of postgenomic work in environmental epigenetics and DOHaD that looks at the role of race/ethnicity in human health (2000–2021). Although there is substantial heterogeneity in how race is conceptualized and interpreted across studies, we observe practices that may unwittingly encourage typological thinking, including: using DNA methylation as a novel marker of racial classification; neglect of variation and reversibility within supposedly homogenous racial groups; and a tendency to label and reify whole groups as pathologized or impaired. Even in the very different politico-economic and epistemic context of contemporary postgenomic science, these trends echo deeply held beliefs in Western thinking which claimed that different environments shape different bodies and then used this logic to argue for essential differences between Europeans and non-Europeans. We conclude with a series of suggestions on interpreting and reporting findings in these fields that we feel will help researchers harness this work to benefit disadvantaged groups while avoiding the inadvertent dissemination of new and old forms of stigma or prejudice. (shrink)

Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical (...) analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement. (shrink)

This study investigated the prevalence, perceived risk factors and effects of enuresis among school-age children in Nsukka local government area. The study adopted a descriptive cross-sectional survey research design with a population of 7,794 Junior Secondary Students within the age range of 9-12years in the study area. Multi-stage sampling technique was employed to select a sample of 820 students from 10 selected schools. A structured questionnaire was the instrument for data collection. The reliability of the questionnaire was 0.86 Cronbach’s alpha (...) showing a good internal consistency of the test items. Data were analysed using frequencies, percentages means and standard deviations. Findings showed that prevalence of bedwetting among the respondents was 17.8%, 14.6% among males and 24.4% among females. The prevalence of primary bedwetting was 12.7%, 5.0% experienced secondary bedwetting, 15.0% experienced nocturnal enuresis and 2.6% experienced diurnal bedwetting. Dreaming of urinating, drinking a lot of fluid before bed and cold weather were some of the risk factors of bedwetting identified by the respondents. Some of the effects of bedwetting identified by the respondents were that bedwetting children often smell bad and bedwetting makes children feel sad. Preventive, curative, hygiene management and reinforcement strategies for enuresis were identified by the respondents. It was concluded that bedwetting negatively affects children in such ways as making them have an offensive smell, sad feelings, mockery and loss of respect from friends. School authorities should therefore make out time within the school year, to create awareness and teach school children about enuresis to reduce the stigma and embarrassment they face. (shrink)

In this article, we discuss the continued circulation and use of retracted science as a complex problem: Multiple stakeholders throughout the publishing ecosystem hold competing perceptions of this problem and its possible solutions. We describe how we used a participatory design process model to co-develop recommendations for addressing this problem with stakeholders in the Alfred P. Sloan-funded project, Reducing the Inadvertent Spread of Retracted Science (RISRS). After introducing the four core RISRS recommendations, we discuss how the issue of retraction-related (...) class='Hi'>stigma gives rise to recommendation #4, Educate stakeholders about retraction and pre- and post-publication stewardship of the scholarly record. This recommendation is important for training publishing professionals and realizing this recommendation will require further collaborative design work across scholarly communications. We highlight ongoing stakeholder work which is now re-starting the design cycle. We conclude with a discussion of ongoing activities facilitating uptake and refinement of RISRS research and the implementation agenda. (shrink)

In ‘What Makes Killing Wrong?’ Sinnott-Armstrong and Miller make the bold claim that killing in itself is not wrong, what is wrong is totally-disabling. In ‘After-Birth Abortion: Why Should the Baby Live?’ Giubilini and Minerva argue for allowing infanticide. Both papers challenge the stigma commonly associated with killing, and emphasize that killing is not wrong at some margins of life. In this paper, we first generalize the above claims to the thesis that there is nothing morally wrong with killing (...) per se, so long as it is instant and unannounced. Then, from the perspective of social evolution, we explain why people refrain from killing others, the general guideline being that it is unadvisable to kill someone with whom you associate a Second Person Perspective (SPP). Finally, drawing from a seminal paper of Press and Dyson on the Iterated Prisoner’s Dilemma, we stress that an SPP without an SP (Second Person), or the other way around, can both lead to unwelcome results. (shrink)

[This piece is written for those working in social gerontology and aging studies, with the aim of bringing insights from disability studies and philosophy of disability to bear on enduring debates in those fields.] The guiding question of humanistic age-studies—What does it mean to grow old?—cannot be answered without reflecting on disability. This is not simply because growing old invariably means becoming impaired in various ways, but also because the discriminations and stigmas involved in ageism are often rooted in ableism. (...) We here draw on research in the philosophy of disability as well as the interdisciplinary field of disability studies to explore the relationship between ageism and ableism. (shrink)

In her book, Illness as Metaphor, Susan Sontag focuses on metaphors and myths on diseases such as cancer and tuberculosis, which occur in different historical periods. Sontag argues that the metaphors produced related to illness overhaul illness and the things that define illness now have become metaphors produced related to them rather than their concrete and physical aspects. Illness becomes not just an illness, but a phenomenon defined by evil, mystery, fear, evil, madness, passions, wealth and poverty, temporal loginess or (...) speed, and a set of metaphors or myths that are spatially identified with the space. Metaphors and myths turn into means of socially stigmatizing the illness itself rather than giving a meaning to illness. The disease literally turns into a situation that needs to be hidden in order to avoid social stigma. The explanation of mass diseases through metaphors and myths has been seen since ancient times and this understanding of mass diseases continues to exist today. As a matter of fact, the Covid-19 pandemic has also ceased to be the subject of only medical science since it first emerged, and it has turned into an issue that concerns many areas from politics to economics, from sociology to psychology. The metaphors generated on the Covid-19 disease, which we have witnessed its reflections in many areas from the discourses of daily life to the discourse of politicians, from art to literature, have a similar function with the metaphors attributed to diseases like cancer and tuberculosis that Sontag discussed. Covid-19 is not only seen as a disease, but as a disease defined by a series of metaphors such as mysterious, evil, invisible enemy, insidious danger, and democratic virus. The metaphors generated on the disease cause the struggle against the disease itself to be explained with various metaphors. The metaphors derived from Covid-19 such as "invisible enemy" and "biological war" cause the struggle against it to be turned into a military terminology, and the metaphor of "Chinese virus" is a means of social stigmatization / marginalization by racializing the virus directly. This study tackles the issue of how Covid-19, which is the subject of medical science, has become the subject of unscientific myths and metaphors attributed to the disease, and that the disease is perceived through metaphors rather than itself in the context of Susan Sontag's thought. In the study, answers for the questions of what kind of effects appeared due to the stigmatizing power of metaphors derived from the Covid-19 and whether the metaphors are the outcomes of the strategy for coping with the pandemic will be sought. (shrink)

There continues to be a debate on whether addiction is best understood as a brain disease or a moral condition. This debate, which may influence both the stigma attached to addiction and access to treatment, is often motivated by the question of whether and to what extent we can justly hold addicted individuals responsible for their actions. In fact, there is substantial evidence for a disease model, but the disease model per se does not resolve the question of voluntary (...) control. Recent research at the intersection of neuroscience and psychology suggests that addicted individuals have substantial impairments in cognitive control of behavior, but this “loss of control” is not complete or simple. Possible mechanisms and implications are briefly reviewed. (shrink)

In the academic world, despite their corrective nature, there is still a negative stigma attached to retractions, even more so if they are based on ethical infractions. Editors-in-chief and editors are role models in academic and scholarly communities. Thus, if they have multiple retractions or a record of academic misconduct, this viewpoint argues that they should not serve on journals’ editorial boards. The exception is where such individuals have displayed a clear path of scholarly reform. Policy and guidance is (...) needed by organizations such as the Committee on Publication Ethics. (shrink)

Abstract Aim: The COVID-19 infection is transmitted either by human-to-human contact, social-physical contact, and respiratory droplets or by touching items touched by the infected. This has triggered some conflicted behaviors such as stigma, violence, and opposite behavior applause. The aim of this study is to explore several newspaper articles about stigma, violence, or insensitive behavior against healthcare professionals and to analyze the reason for these behaviors during these COVID-19 pandemics. Method: The website of the Turkish Medical Association "Press (...) Releases News" and online newspaper articles have been scanned using keywords and have been classified and analyzed according to the content of articles between the periods of March 11 to April 28, 2020. This is a qualitative study with content analysis. No official ethical permission was obtained as the study was conducted through open access internet news sites. Result: 16 reports were selected from online reports that matched the keywords of the study. 13 of these reports included desensitization, violence, lack of precaution, stigmatization, and applause, and 3 reports included doctors’ statements. After being categorized, content analyses were conducted. Conclusion: This study revealed the necessity of a multi-faceted evaluation of the problems faced by healthcare professionals who are at the forefront of the COVID-19 outbreak. This study has a primary role in the detection, diagnosis, and treatment of the pandemic and reveals that doctors are trying to fulfill their duties in an ethical framework despite stigmatized behavior. Authorities should provide various supports to protect healthcare professionals before, during, and after the epidemic for the success of the COVID-19 outbreak struggle. (shrink)

Students with visual impairments (VI) are among the groups of students needing specialized resources and supports for their school success. Using a scoping review, the institutional support services needed by visually impaired students were examined in this paper. It looked at different strategies for putting these students' institutional support into practice and collated such strategies into levels that can inform inclusive practices in higher institutions of learning. The study followed a PRISMA protocol to present a descriptive analysis of peer-reviewed publications (...) gathered from PubMed, Scopus, Google Scholars, and PsychInfo. Eight peer reviewed papers with a sample of 316 (303 post-secondary school students with VI and 13 teachers) were drawn for the study after eligibility assessment. It was found that post-secondary school students with VI still requires a number of institutional support modalities for their smooth career transition. Institutional support needs were described under the career challenges experienced by students with visual impairments and the needs for institutional support for building on smooth transition from school to career. It was deduced that student with VI still experiences barriers such as inadequately trained teachers, ill-equipped schools to address their needs, financial challenges, public stigma, accessibility, peer-to-peer acceptance and difficulties in learning at the university. The support needed from the institution were found to be those associated with academic support, integration into the social environment, need for institutional structural support services, and career transition intervention support. Practical implications demonstrates that educational institutions play a big part in helping visually impaired students in career transition. These implications can be built into a framework of action for institutional support for students with VI in schools as proposed in this paper. (shrink)

Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research results. Ethical (...) issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. (shrink)

Whilst media and political rhetoric in Britain is sceptical and often outright damning of the (presumed) morals and behaviours of the White marginalized poor, our aim is to explore the conditions under which successful communities are nevertheless built. Specifically, we examine the features of community and stress its importance both for belonging and bonding around shared norms and practices and for fostering the necessary bridging essential for interacting and cooperating with others. In considering what it means to foster a community (...) that acts as a breakwater against the tides of stigma or disadvantage, we pay special attention to what we will call enabling conditions – essential features that communities either can or should be able to provide or that exist independent of communities and are indispensable for accessing opportunities in the wider society. We detail the dynamics of White poverty and exclusion before turning our attention to possible responses to these challenges. In searching for viable responses to stigma and disadvantage, we compare some different typologies of community presently available to the White poor in Britain and examine whether these are sufficient to satisfy the enabling conditions associated with more robust forms of group membership. (shrink)

Gay men have been severely affected by the AIDS crisis, and gay subjectivity, sexual ethics, and politics continue to be deeply influenced by HIV to this day. PrEP (Pre-Exposure Prophylaxis) is a new, drug-based HIV prevention technique, that allows disentangling gay sex from its widespread, 40 yearlong association with illness and death. This article explores PrEP's fundamental impact on gay subjectivity, sexual ethics, and politics. It traces the genealogy of gay politics regarding homophobia and HIV stigma, suggesting a new (...) biopolitical and body political framework that accounts for the agency of activists as well as pharmapower, and proposing that PrEP is an example of democratic biopolitics. Highlighting the entanglement of medical technology, sexual ethics, and politics, the article shows how conservative and homonormative gay politics developed as a reaction to HIV stigma and how, by overcoming this stigma, PrEP enables a new era of intersectional queer politics and solidarities. It thereby develops a Foucauldian account of sexual liberation beyond the repression hypothesis that accounts for the ambivalence of sexual subjectification and the political potential of sexuality. (shrink)

This dissertation aims to develop a program resource for helping and mental health professionals to foster proactive coping and diminish dysfunctional coping from work stressors. Professionals succumb to chronic stressors and secondary traumatic stress due to their vocation, often disregarding self-care. Should this type of resource be implemented, psychological and social resources would be required. The need for proactive coping is a generally accepted concept, but helping and mental health professionals often lack resources, limiting advocacy and resilience. Self-help resources are (...) frequently perceived as self-indulgence, in addition to the concept that professionals provide care, not the clients receiving care. Moreover, victimization by stigmas and emotional contagion surrounds helping and mental health professions. Addressing these concerns by implementing an accessible and advocate-heavy website may mitigate experienced ramifications by increasing retention, psychological well-being, resilience, and support. Most importantly, it may reduce maladaptive behaviors and standardize professional self-care. (shrink)

Three chapters from the book by A.L. Gurtovtsev "Genetics through the eyes of a philosopher" (2024). A brief history of the formation in Soviet biology of the 1930s and 60s of the attitude towards classical genetics as a bourgeois, reactionary pseudoscience with the stigma of "Weismanism-Mendelism-Morganism". The origins of classical genetics (Mendel's and Morgan's laws). Michurinsky biology and Lysenkoism. Party repressions against Soviet biologists and geneticists.

Presently, there is a lack of psychological and quantitative studies in Singapore about discriminatory attitudes. This paper aimed to contribute to this aspect. However, to examine actual behavior can be difficult due to the sensitive nature of the needed data. Hence, this study approached discrimination at an attitudinal level. Six vulnerable groups were examined in this study. They consisted of people of a different race, immigrants or foreign workers, homosexuals, people living with HIV/AIDS, people of a different religion, and unmarried (...) couples living together. Two research questions were posed: 1) What is the prevalence of having discriminatory attitude toward vulnerable groups? and 2) What are the predictors of these discriminatory attitudes? Using a sample population of 1,972 Singaporeans, descriptive analysis and binomial logistic regression analysis were conducted. Firstly, based on the results, the prevalence ranged between 10.76% to 42.46%. Singaporeans have discriminatory attitude toward vulnerable groups who can be categorized into two: the least discriminated (three groups ranging between 10.76% to 15.48%) and the highly discriminated (three groups ranging between 30.86% to 42.46%). Secondly, binomial logistic regression showed support for several significant predictors such as emphasis on the importance of religion and tradition, and employment status, depending on the model assessed. However, one pattern was observed in all the models, that a person who discriminates one group is more likely to discriminate another group. The findings were then discussed and explained within the context of Singapore. (shrink)

Abstract: After 2017 NY Times publication, the stigma of the scientific discussion of the problem of so-called UAP (Unidentified Aerial Phenomena) was lifted. Now the question arises: how UAP will affect the future of humanity, and especially, the probability of the global catastrophic risks? To answer this question, we assume that the Nimitz case in 2004 was real and we will suggest a classification of the possible explanations of the phenomena. The first level consists of mundane explanations: hardware glitches, (...) malfunction, hoaxes and lies. The second level involves explanations which are not changing completely our model of the world, but only updating it: new military tech, large psyop operation or new physical effect like ball lightning. The third level of explanations requires a complete overhaul of our world model and includes a large set of fantastic hypothesis: alien starships, interdimensional beings, glitches in the matrix, projections from the collective unconsciousness, Boltzmann brain’s experiences etc. The higher is the level of the hypothesis, the less probable it is, but the bigger is its consequences for possible global catastrophic risks. Thus, “integrating” over the field of all possible explanations, we find that UAP increases catastrophic risks. Technological progress increases our chances of direct confrontation with the phenomena. If the phenomenon has intelligence, the change of its behavior could be unexpected after we pass some unknown threshold. But we could lower the risks if we assume some reasonable policy of escaping confrontations. (shrink)