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This chapter highlights the interconnection between economic and social values in the contractual realm, rooted in a perception of people as holder of rights and a broad interpretation of autonomy and human dignity that looks beyond individualistic values. With a focus on grossly asymmetrical contracts, it promotes an understanding of vulnerability in the contractual context based on the circumstances of the transaction, rather than on people’s medical conditions. The chapter reflects on the merits and drawbacks of the UN Convention on the Rights of Persons with Disabilities (UNCRPD) as a potential benchmark for promoting a vision of contract law that responds to both economic and social concerns and recognises the equality of all human beings. The second part considers how English contract law could be brought closer to the equality vision promoted by the UNCRPD, proposing an understanding of the contractual realm based on concentric economic and social spheres, shaped by fluid boundaries, and reflecting on the relevance of contract law as part of a broader set of measures to ensure a fairer society.
In theory, compassion lies at the heart of all healthcare. There are, however, many reasons for the erosion of compassion in day-to-day clinical practice: increased demand on services, limited resources, large caseloads, insufficient time to spend with each patient, and a consequent transactional rather than relational approach to each person. Systemic focus on efficiency and throughput can also impede the cultivation of compassion, empathy, understanding, and addressing the individual needs and concerns of each patient and their family. Growing reliance on technology and electronic health records can further depersonalise patient interactions and reduce compassion, despite the many benefits of such technologies. This chapter outlines these and other factors which tend to diminish compassion, reflects on the relevance of overarching values in medical education, focuses especially on the meaning of ‘equanimity’ in this context, and overviews the place accorded to compassion in guides to professional ethics and codes of practice. The role of health systems in limiting compassion and empathy is balanced by evidence supporting the importance and possibilities of compassionate care, especially during times of emergency such as the Covid-19 pandemic in the early 2020s.
This chapter explores why we decided to write this book about compassion in healthcare. Despite choosing our professions in order to help others, many healthcare professionals feel chronically tired, emotionally drained, deeply heart-sore, and ultimately burnt-out. Too often, moments of connection with patients and their families, although magical at the time, also highlight the uncertainties and even the darkness that surrounds them. Commonly, staff struggle to make sense of healthcare systems that seem to value neither ‘health’ nor ‘care’. The message of this book is that we can do better. Perhaps the first step in resolving these matters lies in recognising that while we do not have full control over the shape of the healthcare systems within which we work, or indeed the societies in which we live, we can control how we navigate these contexts, how we respond to them, and how we seek to be in the world. In parallel, we can also seek to change health systems in the direction of more compassionate care. Compassion is always essential in these processes, especially in the settings of health and social care. That is why we wrote this book: to try to make compassionate care a day-to-day clinical reality for everyone: patients, families, and healthcare professionals who constantly seek to do more and better.
At its heart, compassion is the feeling of being motivated to act in the presence of suffering. From a psychological perspective, the construct is conceived as having two dimensions: state and trait. The compassionate state reflects the feeling of compassion or having a compassionate response in the moment, while a compassionate trait is more stable, reflecting a general tendency towards compassion or towards feeling and responding compassionately most of the time. For people who are expected or required to be compassionate in their everyday life or work, compassion requires sustained courage and a continued willingness to engage with suffering, rather than avoid it. This chapter explores compassion from psychological, evolutionary, and physiological viewpoints. Despite a useful and growing literature in this area, a precise definition of compassion in practice can remain elusive. The meaning of compassion is not written in stone; it flows. As a result, what the concept means in healthcare, and how it works in practice, are, perhaps, made most tangible through providing compassionate care to patients, interacting with families, discussing compassion with colleagues, and teaching students about compassionate healthcare. If compassion is defined flexibly and understood wisely, it can shape care in positive ways, improve outcomes, and change lives.
Formal enforcement punishing defectors can sustain cooperation by changing incentives. In this paper, we introduce a second effect of enforcement: it can also affect the capacity to learn about the group's cooperativeness. Indeed, in contexts with strong enforcement, it is difficult to tell apart those who cooperate because of the threat of fines from those who are intrinsically cooperative types. Whenever a group is intrinsically cooperative, enforcement will thus have a negative dynamic effect on cooperation because it slows down learning about prevalent values in the group that would occur under a weaker enforcement. We provide theoretical and experimental evidence in support of this mechanism. Using a lab experiment with independent interactions and random rematching, we observe that, in early interactions, having faced an environment with fines in the past decreases current cooperation. We further show that this results from the interaction between enforcement and learning: the effect of having met cooperative partners has a stronger effect on current cooperation when this happened in an environment with no enforcement. Replacing one signal of deviation without fine by a signal of cooperation without fine in a player's history increases current cooperation by 10%; while replacing it by a signal of cooperation with fine increases current cooperation by only 5%.
Effectively addressing climate change requires new approaches to action, implementation and social change. Urban societies are profoundly shaped by faith, with religion influencing the physical environment, institutional structures and lives of citizens. Consequently, there is a need to consider seriously religion's role in mobilizing or constraining climate action in cities. Research is presented that shows the potential of faith-based organizations and faith perspectives to minimize and adapt to climate impacts. A framework for sensitively engaging faith communities in urban climate policy is developed, based on the power of shared values among diverse stakeholder groups to mobilize climate action through partnerships.
Technical summary
Global environmental research and policy frameworks have begun to emphasize the importance of culture and multi-sector partnerships for urban sustainability governance. However, there has been little explicit attention paid to religion and belief as ubiquitous urban socio-cultural phenomena. This article reviews literature on the intersection of religion and climate change in the context of cities. Religious responses to climate change are presented as a typology spanning physicalities, practices, ‘prophetic’ imagination and policy arenas. Key themes are then intersected with areas of focal activity presented in the most recent IPCC reports. Religion is shown to offer both opportunities and barriers for effective urban climate adaptation and mitigation. A new model of religious-civic partnership is then developed as a framework for guiding urban climate policy implementation. This model presents religion as vital to shaping the ‘value landscape’ of cities and calls for collaborative action based on identifying, enriching and mobilizing shared values. As cities become increasingly more populous, heterogeneous, globally teleconnected and exposed to climate impacts, there is an urgent need for research and policy that effectively engages with the historic and evolving presence and impact of religion within urban environments.
Social media summary
Effective action on climate change in cities requires new modes of engagement with religious perspectives, grounded in shared values.
Hansen and Witkowski introduce a new theory to understand how societal needs are met. The authors develop the cross-sectoral BIAS theory, an adaptation of the BIAS model, to assess factors that lead to persistent unmet needs among marginalized populations. Drawing on postcolonial theory, the authors indicate that the standard economic model of understanding the provision of services by market, government, and nonprofit sectors (three-failures theory) systematically fails to account for the underprivileged in society. The cross-sectoral BIAS theory explains that societal biases drive the persistent insufficient provision of goods to marginalized populations by all three sectors.
Edited by
Alexandre Caron, Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), France,Daniel Cornélis, Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD) and Foundation François Sommer, France,Philippe Chardonnet, International Union for Conservation of Nature (IUCN) SSC Antelope Specialist Group,Herbert H. T. Prins, Wageningen Universiteit, The Netherlands
The African buffalo has interacted with human societies for millennia across its vast African range. It is part of the bestiary of the few African imaginaries and mythologies that have managed to reach us. These representations of the species in African cultures seem to have percolated more recently into the imaginaries of European cultures, especially from the angle of hunting and photographic safaris. The buffalo is also at the centre of services and disservices to different actors, providing uses but also generating conflicts in African landscapes, the species being central in so-called Human–Wildlife Conflicts. For animal health services, the buffalo represents in some instances a public enemy, influencing meat trade policies, land uses and boundaries in many parts of the continent. The African buffalo is therefore an emblem of the coexistence between humans and nature in Africa.
It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper – developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting – seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.
Integrating social values into health technology assessment processes is an important component of proper healthcare priority setting. This study aims to identify social values related to healthcare priority setting in Iran.
Method
A scoping review was conducted on original studies that investigating social values in the healthcare system in Iran. The databases of PubMed, EMBASE, and EBSCO were searched with no restrictions on time and language. The reported criteria were clustered using Sham’s framework of social value analysis in health policy.
Results
Twenty-one studies published between 2008 and 2022 met the inclusion criteria. Fourteen of the included studies followed a quantitative approach with different methods to identify criteria, and the remaining seven studies used a qualitative approach. A total of fifty-five criteria were extracted and clustered into necessity, quality, sustainability, and process categories. Only six studies found criteria that were related to processes. Only three studies used public opinions as a source of value identification and eleven studies investigated the weight of criteria. None of the included studies explored the interdependency of the criteria.
Conclusion
Evidence suggests that several criteria other than cost per health unit also need to be considered in healthcare priority setting. Previous studies have paid little attention to the social values that underlie priority setting and policy-making processes. To reach consensus on social values related to healthcare priority setting, future researches need to involve broader stakeholders’ perspectives as a valuable source of social values in a fair process.
Prior research on self-other differences involving risk have found that individuals make riskier decisions for others than for the self in situations where risk taking is valued. We expand this research by examining whether the direction of self-other differences reverses when risk aversion is valued, as predicted by social values theory (Stone & Allgaier, 2008). Two studies tested for self-other differences in physical safety scenarios, a domain where risk aversion is valued. In Study 1, participants read physical safety and romantic relationship scenarios and selected what they would decide for themselves, what they would decide for a friend, or what they would predict their friend would decide. In Study 2, participants read public health scenarios and either decided or predicted for themselves and for a friend. In keeping with social values theory, participants made more risk-averse decisions for others than for themselves in situations where risk aversion is valued (physical safety scenarios) but more risk-taking decisions for others than for themselves in situations where risk taking is valued (relationship scenarios). Further, we show that these self-other differences in decision making do not arise from incorrectly predicting others’ behaviors, as participants predicted that others’ decisions regarding physical safety scenarios would be either similar (Experiment 1) or more risk taking (Experiment 2) than their own decisions.
The construction of governance frameworks for new health technologies is a complex process for most countries, particularly for developing countries. They must grapple with ‘old’ structures and ways of doing things while striving to plant the seeds of the ‘new’, which will put them on a higher level to promote science as well as access to new drugs and treatments. To achieve these goals, international collaboration is a key element. Argentina issued a regulation for advanced therapy medicinal products at the end of 2018. This chapter describes the objectives and actors involved in that process. It focuses on how internal tensions regarding whether to regulate were solved, considering the regulatory harmonisation process promoted by the European Medicines Agency and the US Food and Drug Administration, and the self-regulatory diversification promoted by China and other countries. Special mention is made of the importance of identifying social values and constructing a vision to guide the exercise of ‘foresight’ in law, which resulted in the design and implementation of the new regulation and governance of the system.
Internet of things (IoT) adds Internet connectivity to familiar devices, such as toasters and televisions, data flows no longer align with existing user expectations about these products. Studying techno-social change in the IoT context involves measuring what people expect of IoT device information flows as well as how these expectations and underlying social norms emerge and change. We want to design and govern technology in ways that adhere to people's expectations of privacy and other important ethical considerations. To do so effectively, we need to understand how techno-social changes in the environment (context) can lead to subtle shifts in information flows. CI is a useful framework for identifying and evaluating such shifts as a gauge for knowledge commons governance. This chapter explores key aspects behind privacy norm formation and evolution.
The ‘death of evidence’ issue in Canada raises the spectre of politicized science, and thus the question of what role social values may have in science and how this meshes with objectivity and evidence. I first criticize philosophical accounts that have to separate different steps of research to restrict the influence of social and other non-epistemic values. A prominent account that social values may play a role even in the context of theory acceptance is the argument from inductive risk. It maintains that the more severe the social consequences of erroneously accepting a theory would be, the more evidence is needed before the theory may be accepted. However, an implication of this position is that increasing evidence makes the impact of social values converge to zero; and I argue for a stronger role for social values. On this position, social values (together with epistemic values and other empirical considerations) may determine a theory's conditions of adequacy, which among other things can include considerations about what makes a scientific account unbiased and complete. I illustrate this based on recent theories of human evolution and the social behaviour of non-human primates, where some of the social values implicated are feminist values. While many philosophical accounts (both arguments from inductive risk and from underdetermination) conceptualize the relevance of social values in terms of making inferences from evidence, I argue for the need for a broader philosophical framework, which is also motivated by issues pertaining to scientific explanation.
With twentieth- and twenty-first-century philosophy of science's unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed concerns regarding Canada's death of evidence controversy. The worry, raised by Stathis Psillos, is that as constructivist accounts of science demoted the previously secure status of evidence for drawing justified conclusions in science, we were left with no rational delineation between the right and wrong values for science. The implication for the death of evidence controversy is that we may have no rational grounds for claiming that the Canadian Government is wrong to interfere with scientific enterprise. But he does offer another avenue for reaching the conclusion that the wrong social values are directing the current stifling of some sectors of Canadian science. Psillos draws from standpoint epistemologies to devise a salient defence of ‘valuing evidence’ as a universalizable social value. That is, government bodies ought to enable scientific research via adequate funding as well as political non-interference. In this paper, I counter that (i) non-epistemic values can be rationally evaluated and that (ii) standpoint epistemology's universalizable standpoint provides an inadequate framework for negotiating social values in science. Regarding (i), I draw from the evidence-based medicine debate in philosophy of medicine and from feminist empiricist investigations into the science–values relationship in order to make the argument for empirically driven value arbitration. If social values can be rationally chosen in the context of justification, then we can have grounds for charging the Canadian leadership with being ‘at war with science’. (ii) I further argue that my recommended empiricist methodology is preferable to Psillos's search for universalizable perspectives for negotiating social values in science because the latter method permits little more than the trivial conclusion that evidence is valuable to science.
This paper is meant to link the philosophical debate concerning the underdetermination of theories by evidence with a rather significant socio-political issue that has been taking place in Canada over the past few years: the so-called ‘death of evidence’ controversy. It places this debate within a broader philosophical framework by discussing the connection between evidence and theory; by bringing out the role of epistemic values in the so-called scientific method; and by examining the role of social values in science. While it should be admitted that social values play an important role in science, the key question for anyone who advocates this view is: what and whose values? The way it is answered makes an important epistemic difference to how the relation between evidence and theory is appraised. I first review various arguments for the claim that evidence underdetermines theory and shows their presuppositions and limitations, using conceptual analysis and historical examples. After broaching the relation between evidence and method in science by highlighting the need to incorporate epistemic values into the scientific method, my discussion focuses on recent arguments for the role of social values in science. Finally, I address the implications of the approach outlined for the current ‘death of evidence’ debate in Canada.
Disaster ethics is a developing field of inquiry recognizing the wide variety of ethical issues confronting various professionals involved in planning for and responding to different types of disasters. This article explores how ethical issues related to floods are addressed in academic literature. The review involved analysis of publications on ethics and floods identified in a systematic literature search of electronic databases that included sociological, biomedical, and geophysical sources. The review methods were guided by the PRISMA Statement on systematic reviews, adapted to this topic area, and followed by a qualitative analysis of the included publications. All articles were analyzed using NVivo software version 11. The qualitative analysis showed that further research is needed on the ethical issues involved in flood disasters. Ethical guidelines are needed for flood planners and responders that are based on the consistent application of well-established ethical principles, values, and virtues to the specific circumstances arising with each flood. Flexibility is required in applying such approaches. The results suggest that interdisciplinary collaboration (sociological, biomedical, geophysical, engineering, and ethical) could contribute significantly to the development of ethics in floods. (Disaster Med Public Health Preparedness. 2019;13:817–828)
This essay brings attention to the recent discursive turn in Russian politics that is reflected in the Kremlin's turn to issues of traditional values and morality. Expressed in Russia's domestic and foreign policies, this new “morality politics” is dated by the Pussy Riot trial in 2012 that the Kremlin used to advance its new discursive frame in the public sphere. Although not entirely new in its orientation, this new stage of “morality politics” differs from the earlier policy initiatives in its intensity, scope and political significance for the regime. The moralizing stance taken by the regime is accompanied by a divide and rule political tactic, whereby the establishment has tried to marginalize the protesters from the rest of the Russian public that the regime is attempting to reconsolidate based on traditional, conservative values. The essay interprets this recent morality turn as a strategy selected by the Kremlin to restore the regime's legitimacy that has been shaken by the protests of 2011–2012 and looks at the social and political consequences of the selected strategy.