Responsibility for Illness

In the effort to address the persistent organ shortage it is sometimes suggested that we should incentivize people to sign up as organ donors. One way of doing so is to give priority in the allocation of organs to those who are themselves registered as donors. Israel introduced such a scheme recently and the preliminary reports indicate increased donation rates. How should we evaluate such initiatives from an ethical perspective? Luck egalitarianism, a responsibility-sensitive approach to distributive justice, provides one possible justification: Those who decide against being organ donors limit the health care resources available to others. As such, a priority rule can be justified by a luck egalitarian approach to distributive justice. Furthermore, a priority rule inspired by luck egalitarianism is well equipped to avoid prominent criticisms of such a procurement system. Luck egalitarianism provides us with reaons to exempt people who are not responsible for their inability to donate from receiving lower priority, provide sufficient information about donation, and mitigate social and natural circumstances affecting people's choice to donate.

The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people's relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed.

This thesis considers how we should allocate scarce, lifesaving healthcare interventions among persons in need. In some situations, clinicians must choose how to allocate scarce lifesaving interventions among their patients, and public health administrators must choose how to allocate scarce prophylaxis among population groups. Not everyone's needs can be met. It is apposite to consider, therefore, how the State should adjudicate between the competing claims that people make on healthcare resources. In discussing this issue, I take as my point of departure the bioethical principle of respect for persons. Respect for persons is understood by many to be synonymous with the need to obtain informed consent from persons who receive medical treatment or participate in biomedical research. This thesis, however, advances an alternative account of respect based on an ethic of mutual accountability and a concern to take moral claims seriously (Darwall 2006). This conception of respect is ...

Statins have been recognized clinically to raise blood glucose and glycated protein (HbA1c) levels enhancing the development of insulin resistance. However, most clinicians appear to adopt the interpretation that the benefit (prevention of CHD)-NTP

To date, there have been few intervention studies concerning the association of metabolic syndrome with beta 3-adrenergic receptor (ADRB3) Trp64Arg polymorphism, although ADRB3 Trp64Arg polymorphism has been reported to be associated with weight gain and insulin resistance by several intervention programs. We examined the influence of ADRB3 Trp64Arg polymorphism on the improvement of metabolic syndrome by an exercise-based intervention program. Thirty-six male employees who satisfied the metabolic syndrome criteria participated in a three-month exercise-based intervention program (average age, 49 ± 6 years old). The improvement rate of metabolic syndrome after the intervention was compared between subjects with and without ADRB3 Trp64Arg polymorphism. The Mantel-Haenszel test was employed to adjust the age, diet, and exercise in analysis of the influence of ADRB3 Trp64Arg polymorphism on metabolic syndrome. The Trp64Arg genotype of the β3-adrenoceptor gene was examined in peripheral...

Setsuzokujoshi is a particle that shows the relationship between sentences, as well as having an important role in sentences. What characterizes setsuzokujoshi is its position which is always located between two sentences. Setsuzokujoshi, which is part of particles in Japanese, has many types. In this study, the researcher will limit the research on the use of それから, そして, それに contained in the newspaper articles of asahi.com website. The research method used is descriptive and library methods. This study intends to determine the function of setsuzokujoshi それ から, そして, それに and whether it can replace each other in a sentence and that Japanese language learners can determine the apparent similarities and differences between sorekara, soshite, and soreni, so that Japanese language learners can use them correctly. After analyzing the data, it is found that some conclusions namelyそして is used to strengthen problems of a topic of conversation because there is awareness of the speaker. It is of...

現代社会において、健康を唯一の至高価値とみなすかのような風潮が世界的に拡大しています。
　健康のためであれば、それ以外のあらゆる価値を排斥してもいい、具体的には、健康目的であるならば人権を制限するのもやむを得ない、健康のためであれば経済活動を抑制してもよい、健康追求のためであれば、国民はいかなる困難をも辛抱するべきである、といった節倹禁欲主義を伴う健康絶対主義を賛える風潮が拡大しています。
　こうした世界的思潮に対しては、
「私はあなたの主張に反対するが、あなたがそれを述べる自由を、私は生命をかけても尊重する。」
と言う自由民主主義を支える思想基盤に准じて、
「私はタバコを吸わないし、タバコの煙が嫌いだが、あなたの喫煙する権利を、私は生命をかけても尊重する。」
と宣うことも可能でありましょう。
　そこで、健康という二字熟語のなりたちの検討をとおしつつ、現代社会における健康価値を考察します。

In today's society, there is a growing trend worldwide that seems to regard health as the only supreme value. Health absolutism is growing, as if all other values can be eliminated for the sake of health. In response to this ideology, we can say, "I hate smoking, but I respect your right to smoke, even at the cost of my life." We could also say, "I hate cigarettes, but I respect your right to smoke, even at the cost of my life.
　In this paper we will examine the meaning of health in today's society.

ON CALL Resources and Responsibility Commentary by Jake Richards Mr. F was a veteran construction worker living with his wife and two children when, in 1989, he developed severe back pain and rapid onset of paresthesias, pain, and limited mobility in his lower extremities. He was diagnosed with a primary spinal epidural non-Hodgkin's lymphoma (NHL) and underwent laminectomy to relieve spinal compression. But the nerve damage was severe and Mr. F continued to experience peripheral neurological deficits, including persistent pain. Mr. F's pain was managed on methadone, which has the advantages of being a long lasting agent as well as inexpensive. His chronic pain prevented him from returning to work, and the family's only source of income was his Social Security disability check, which was frequently not enough to cover all of their expenses. Mr. F's NHL recurred in 1998 as a localized cranial tumor ("the size of an orange"). After undergoing a partial skull excision with follow-up chemotherapy, Mr. F began experiencing depression; financial strains forced him to sacrifice or space out his pain medication refills. During these gaps, he started to rely on alcohol to treat his pain. Methadone accentuates the effects of sedative hypnotics, such as alcohol, so Mr. F quickly developed dependence. The financial stress combined with alcohol use led to his wife's leaving him, and, with only his disability for income, he became homeless.

Health is commonly experienced and understood in a variety of ways, including the absence of disease, but also more positively, as functional vitality or as a resource. Scholarly debates about the definition have evolved around a binary opposition between health as a natural phenomenon and health as a socially constructed category. However, when examining how concepts of health function in society, instead of attempting to rigorously define health, it may be more useful to explore how health is "talked about" in different contexts. The papers collected in this special issue do so with regard to different periods and cultures in East Asia and as such contribute to recent efforts in the health and medical humanities to elucidate the multiple meanings of health.

Are social inequalities in health unjust when brought about by differences in lifestyle? A widespread idea, luck egalitarianism, is that inequality stemming from individuals' free choices is not to be considered unjust, since individuals, presumably, are themselves responsible for such choices. Thus, to the extent that lifestyles are in fact results of free choices, social inequality in health brought about by these choices is not in tension with egalitarian justice. If this is so, then it may put in question the justification of free and equal access to health care and existing medical research priorities. However, personal responsibility is a highly contested issue and in this article we first consider the case for, and second the case against, personal responsibility for health in light of recent developments in philosophical accounts of responsibility and equality. We suggest-but do not fully establish-that at the most fundamental level people are never responsible in such a way that appeals to individuals' own responsibility can justify inequalities in health.

A decrease in visceral fat is essential for preventing cardiovascular disease caused by metabolic syndrome. Health education is important in improving the lifestyle of persons with high levels of accumulated visceral fat. We developed a health education program for such individuals, in which we not only teach a weight loss method but also shed light on their risk of vascular disorders and the relationship between visceral fat and such disorders. We used a medical examination result chart (called the "Where am I?" chart) to enhance the effects of the health education provided in Amagasaki city. After providing health education for 3,174 city staff, the proportion of men with metabolic syndrome decreased from 20.8% in 2003 to 17.2% in 2004 and 14.14% in 2005 (p < 0.001). The proportion of women decreased from 3.0% in 2003 to 2.2% in 2004 and 1.9% in 2005 (p = 0.359). Before health education was provided, 1-3 workers died every year of coronary heart disease. However, there were no such deaths after health education was implemented. Thus, the health education program was considered to be effective in improving metabolic syndrome. Visceral fat area was measured using the body impedance method in people with a body mass index between 18.5 and 24.9 in the medical examination. Results showed that 53.7% of the men and 23.1% of the women had a visceral fat area over 100 cm 2 . Therefore, health education should be tailored to medical examination results, in order to effectively prevent cardiovascular disease.

This thesis considers how we should allocate scarce, lifesaving healthcare interventions among persons in need. In some situations, clinicians must choose how to allocate scarce lifesaving interventions among their patients, and public health administrators must choose how to allocate scarce prophylaxis among population groups. Not everyone&#39;s needs can be met. It is apposite to consider, therefore, how the State should adjudicate between the competing claims that people make on healthcare resources. In discussing this issue, I take as my point of departure the bioethical principle of respect for persons. Respect for persons is understood by many to be synonymous with the need to obtain informed consent from persons who receive medical treatment or participate in biomedical research. This thesis, however, advances an alternative account of respect based on an ethic of mutual accountability and a concern to take moral claims seriously (Darwall 2006). This conception of respect is ...

Sedentary behavior is ubiquitous in modern lifestyles and defined as any waking behavior with an energy expenditure of ≤ 1.5 metabolic equivalents while sitting, reclining, or lying. Epidemiological evidence suggests that high volumes of sedentary behavior are independently associated with an elevated risk of cardiometabolic disease and all-cause mortality. By contrast, a growing body of experimental evidence showing the potential benefits for cardiometabolic risks of reducing and breaking up sedentary time. Therefore, recent physical activity guidelines indicate the importance of reducing and regularly interrupting prolonged sitting. In this narrative review, we summarize the findings from experimental studies that investigated the acute impacts of prolonged, uninterrupted sitting and interrupting sitting on several cardiometabolic risk factors, including vascular function, blood pressure, and glucose metabolism. Here, we highlight experimental evidence from controlled laboratory trials that may lead to a better understanding of biological plausibility, the causal structure of relationships, and potential mechanistic insight on linking sedentary behavior with adverse cardiometabolic outcomes. Our literature review collectively suggests that in addition to increasing moderate-to vigorous-intensity physical activity, reducing sedentary time may contribute to cardiometabolic health. However, the recent evidence remains limited and inconclusive, thus future studies are needed to develop a deeper causal and mechanistic understanding of the biological pathways through which prolonged sitting can adversely influence cardiometabolic health outcomes.

無食欲症(anorexia nervosa) ，自制困難な過食と代償行 動(意図的な嘔吐など)を主症状とする神経 性 大 食 症 (bulimia nervosa) ， これらのカテゴリの診断基準を満た さないものの著しい食行動の異常が見られる特定不能 の摂食障害(eating disorder not otherwise specified)の３ 種 類 に 大 別 さ れ る(American Psychiatric Association, 2000) 。一般の中・高・大学生を対象とした国内の調査 では，1 9 8 2年から 2002年にかけて，女子における摂 食障害の有病率が約 10倍に増加していることが示さ れた (中井,2010) 。200 2年時点の有病率は 15 .2％と推定 されており， その内訳は， 神経性無食欲症が 0.4％，神 経性大食症が 2.3％，特定不能の摂食障害が 12. 5％と なっている。男子の有病率は女子の３分の１以下であ るものの，特定不能の摂食障害の著しい増加が報告さ れている(中井・佐藤・田村,2004) 。発症時期は，欧米の 浜松医科大学子どものこころの発達研究センター 〒4 31 -31 9 2 静岡県浜松市東区半田山 1 -20 -1 ito h＠hama-med.ac.jp 北海道教育大学 佐賀大学 奈良佐保短期大学 大阪教育大学 弘前大学 中京大学 食行動異常に関して，医学領域では，摂食障害の診断カテゴ リに基づく研究が大勢を占めるが，心理学領域では，一般母集 団の中で一定の広がりを持った連続的な変量として捉えた研 究が多い(e.g., Grabe, Ward,& Hyde,2008) 。摂食障害は， 多数の遺伝的要因や環境要因が関与する多因子疾患と考えら れており(中井,2009) ，疾患群と一般健常者の間に明確な質的 差異が存在するというエビデンスは報告されていない。した がって，情報量保持の観点から，食行動異常についてはカテゴ リ化を行わず，連続量のままで扱うことが適切であると考えら れる。また，予防的観点からも，症状の重い摂食障害のみを扱 うより，より軽度の症状を検討の対象に含めることが重要であ ると考えられる。そのため，本研究では食行動異常を連続量と して扱うこととする。ただし，医学領域の研究を参照する際に は，摂食障害という表現を使用する。 2 01 3年に刊行された DSM-5では， これまで特定不能の摂食 障害の一種とされてきた過食性障害(bingeeating disorder) が新たに独立の診断カテゴリとして設定された。

Everyone wants to be healthy, but many of us decline to act in healthy ways. What bearing, if any, should these choices have on the ethics of clinical practice and health policy? Should risk-takers have the same claim on scarce resources, such as organs for transplant, as those whose plight is due to no choices of their own? And is there any reason not to impose fees and taxes on risk-takers, be they smokers or mountain climbers, to defray the added expense of the care they may need? In health resource allocation aimed at reducing the burden of disease, should we regard certain burdens as individual responsibilities: for example, dealing with stigma, or caretaking for family members?Socioeconomic status (SES) and health expectancy are strongly linked. To the extent that this results from risk-taking by the poor, is reduction of SES-linked health inequalities a morally important social goal? International public health aims at improving health on a population level. The World Health ...

Daniel Wikler is Professor in the Department of Medical History and Bioethics and in the Department of Philosophy at the University of Wisconsin, Madison. He was Senior Staff Ethicist at the World Health Organization, Staff Philosopher for the President&#x27;s Commission for the Study of ...

Japan&#39;s fiscal conditions are the most severe of any industrialized nation, moreover, the aging of Japanese society will continue, and an increase in the national burden is inevitable. In part because of the view that the burden of taxes and of social security has a negative impact on the incentive to work and thereby impedes the vitalization of the economy, reforms of public spending and the social security system are being implemented continuously for the purpose of avoiding increases in the national burden rate (or potential national burden rate) as much as possible. That notwithstanding, the fact remains that people derive certain benefits from aspects of the social security system, such as health care, pensions, and nursing care, and there exists social capital beneficial to both current and future generations. Consequently, when discussing the optimal level of the national burden rate, it is also important to consider the benefits received from public spending and the soci...

あいち健康の森健康科学総合センター 113 th Scientific Meeting of the Japanese Society of Internal Medicine：Panel Discussion：Obesity disease and metabolic syndrome-from pathophysiology to concept of management；6. Practice and evaluation of lifestyle intervention on program.

To investigate the impact of body mass index (BMI) of men in their 20s and the effects of subsequent changes in body weight upon medication rates, prevalence of hypertension and diabetes, and medical costs in their 40s. A total of 10,125 men who were in their 20s in 1989 were recruited as subjects and grouped according to their BMI and a combination of BMI and increase in body weight over a 20-year period. A logistic regression analysis was performed to evaluate subsequent medication rates, prevalence of hypertension and diabetes, and consultation rate. Analysis of covariance was performed for mean medical costs on the basis of the BMI value in their 20s. All data were adjusted for age in 1989 and changes in body weight over the subsequent 20 yr. A mean increase of 7 kg in body weight was observed over the 20-year period. Medication rates and prevalence of hypertension and diabetes in the men in their 40s increased significantly in correlation with the BMI values in their 20s (men w...

I am pleased to announce a special issue of Cambridge Quarterly of Healthcare Ethics (2/2023) exploring the theme of: 'Discrimination and prioritization in healthcare'. Prioritizing in healthcare is unavoidable because of the scarcity of resources and everincreasing demand for healthcare services. When, if ever, does such prioritizing become unjust discrimination? Does prioritizing necessarily mean that we discriminate against someone? The journal accepts a wide variety of suitable academic disciplines, approaches and methods
that contribute to bioethics.

In this study, we analyzed the factors that have disrupted the healthy eating behaviors of the elderly, where the study area was a city center in Japan. We estimated that 49% of the elderly residents in the study area had a poor nutritional condition. Many of the subjects were concentrated in the central business district of the city. Our multilevel analysis indicated that weak ties with family and the local community and inadequate access to food had strong effects on a high proportion of the nutritionally depleted elderly subjects in this inner city study area. Thus, we can designate this area as a "food desert." Food deserts are based on social exclusion. Previously, the issue of food deserts was considered to be mainly a social problem affecting rural areas and local cities where small neighborhood shopping areas have closed, thereby making shopping physically difficult for people without private cars. However, our study shows that reduced intimacy in people's relationships also increases the risk of food deserts.

While there are substantial benefits for patients taking role responsibility (Hart) -- "take-charge" responsibility -- for their health care, it is vitally important to separate such responsibility from the moral responsibility of just deserts and blame. The latter should be scrupulously avoided by health care professionals.

Allocating healthcare resources based on personal responsibility is a prominent and controversial idea. This article assesses the plausibility of such measures through the lens of luck egalitarianism, a prominent responsibility-sensitive theory of distributive justice. The article presents a framework of luck egalitarianism in health, which integrates other concerns of justice than health, is pluralist and is compatible with a wide range of measures for giving lower priority to those deemed responsible. Applying this framework to oral health, the allocation of livers among potential transplant recipients and travel insurance demonstrates that this version of luck egalitarianism is a much more attractive and flexible theory than much of the contemporary discussion allows. This also pertains, to its ability to provide plausible answers to two prominent critiques of harshness and intrusiveness. The discussion also shows that the luck egalitarian commitment to eliminating the influence of luck on people’s lives is likely to require substantial redistribution.