Sense or sensibility-Ideological dilemmas in gamblers' notions of responsibilities for gambling problems.

The gambling market is a complex field of conflicting stakeholders and interests involving dimensions, such as economy, health, social inequality and morals. The division of responsibility between gamblers, the gambling industry and the regulating state for limiting the harmful effects of this activity, however, are unclear. The aim of this study was to explore how gamblers in the Swedish market attribute responsibility to various actors within the gambling field. Qualitative interviews were conducted with 37 gamblers experiencing extensive gambling problems. Based on a discourse analytical approach, five ideological dilemmas were identified, highlighting the tension between the, often contradictory, values that the participants need to relate to. On the individual level, the gamblers emphasize their own responsibility for their problem, thereby showing accountability in relation to themselves, their significant others and their peers as agents in recovery. On the corporate- and state levels however, the participants argue for a stronger public health approach, where the gambling companies should take further responsibility by living up to the legal regulations and where the state should ensure compliance and safeguard funding for treatment and research. The essential paradox between the individual responsibility discourse of self-regulation and the prevailing medical discourse of the gambler's incapacity for self-control signifies an impossible equation that imposes feelings of guilt and shame upon an individual who is concurrently considered as both responsible and incapable. In order to reduce harm, the gambling industry must be more proactive with coercive external control measures to fulfill the duty of care they claim to adhere to, and the regulating state must ensure its compliance.

The COVID-19 pandemic and the Swedish strategy: Epidemiology and postmodernism.

The aim is to outline the underlying epidemiological thinking and mentality in post-materialist and postmodern Sweden behind the Swedish strategy. The aim is not to investigate the handling of the pandemic in Sweden in the long-run. Overconfidence in herd immunity, overconfidence in individual responsibility in a pandemic needing community-centered approaches, overconfidence in evidence-based medicine and neglect to coordinate with the WHO and other countries may be associated with post-materialist values and postmodernism including opposition against modern authority, rationality and science, and also an anti-traditionalist stance towards older generations. COVID-19 epidemiology and postmodernism may be a dangerous combination.

Social Responsibility and Healthcare in Finland.

This article examines current trends and prospects in Finnish healthcare literature and discussion. The Finnish healthcare system was long considered to manifest an equal, universal, and solidaristic welfare scheme. However, recent data reveals structural inequalities in access to healthcare that result in health differences among socioeconomic groups. The political will aims at tackling these inequalities, but the ideological trend toward responsibilization of the individual taking place across political spheres elsewhere in Europe creates potential challenges to this goal. The applications of this trend have a theoretical background in the responsibility-sensitive egalitarian-or luck egalitarian-tradition. The theory, which is unfit for real-life policy applications, has explicit appeal in considerations aiming at the responsibilization of the individual within the healthcare sector. It remains to be seen in which direction the Finnish welfare schemes will continue to develop.

Responsabilidad social vs. responsabilidad individual en salud / Social responsibility vs. Individual responsibility in Health Care

En el marco general de la actual "Sociedad de la Información" y en el marco específico de la denominada "gobernanza en salud"; reaparece el viejo problema de la atribución de responsabilidad individual en salud. Se presume que el mayor acceso al conocimiento y a la información sanitaria conlleva mayor responsabilidad individual sobre las elecciones de estilos de vida. Mi hipótesis general es que, bajo el discurso ideal de la autodeterminación informativa y la co­responsabilidad individual en salud ­discurso propio de la gobernanza en salud­; se esconde la estrategia (neoliberal o libertariana) de limitación o negación de la atención de la salud pública en la responsabilidad individual ("the argument of desert"). Dicha estrategia justificaría los consiguientes recortes de poder distributivo del Estado en salud pública, reforzando las desigualdades sociales originales. Este discurso ignora que el acceso al conocimiento constituye un determinante social de la salud, y como tal, exige una estricta responsabilidad social en la prevención de la salud comunitaria

Within the general framework of present­day "Information Society" and in the specific context of so­called "governance in health", the old issue of individual attribution of responsibility in health comes back to the fore. It is presumed that wider access to knowledge and information on health­ related matters implies greater individual responsibility on choices concerning life­styles. My overall hypothesis is that, behind the ideal discourse on informational self­determination and individual co­responsibility in health matters ­a usual discourse in health governance­ lies a (neo­liberal or libertarian) strategy of limitation or denial of public health care based on individual responsibility (the argument of desert). Such strategy would justify the corresponding cuts in the distributive power of the State in matters of public health, thus reinforcing original social inequalities. This discourse ignores the fact that access to knowledge is a social determinant of health and, as such, requires strict social responsibility in preventive care in matters of communitarian health

Luck Egalitarianism, Individual Responsibility and Health.

Luck Egalitarianism has frequently been discussed in the recent literature because of the potential impact of this theory on health financing. Luck Egalitarianism puts forth a theory of distributive justice which says that the fundamental aim of equality is to compensate people for undeserved bad luck such as being born with poor native endowments, having difficult family circumstances or suffering from accidents and illness. On the other hand, if individuals face ill health because of faults of their own, then society has no duty to supply health services to them. Many arguments for and against this theory have been raised since it was first introduced. The proponents of Luck Egalitarianism focus on the concepts that free choice and respecting the autonomy of the individual determine whether health services are deserved. The criticisms against the concept of Luck Egalitarianism are that it is harsh to the needy and abandons the wretched, discriminates against the disabled, is against basic humanitarian principles, is incompatible with human dignity, and is in dissonance with real life. We agree with the basic proposition of Luck Egalitarian theory, which states that "inequalities deriving from unchosen features of people's circumstances are unjust and therefore should be compensated for". Our agreement leads us to an opposite conclusion. We propose that the "unchosen features of people's circumstances" include more than personal disadvantages. The social features to be included in the context of inequalities deriving from unchosen features of peoples circumstances are, socioeconomic status (SES), access to social determinants of health, and the ethnic, cultural and religious identity of individuals. Our other propositions are the mutable character of choices which makes individual responsibility of preferences implausible; the problematic causal relationship between responsibility and ill-health; the disregard of the motives behind decisions; problems with implementation in real health service circumstances; and the contradictory nature of Luck Egalitarianism for principles of medical ethics. These arguments draw attention to possible ethical and practical consequences of implementation of health policies arising from Luck Egalitarian view for patients and for health care providers. In this paper, we will first define Luck Egalitarianism. Then, we will discuss arguments for and against the theory in the literature. Our final task is to suggest additional criticisms of the theory and justify them.

Commercialism, holism, and individual responsibility comment on "buying health: the costs of commercialism and an alternative philosophy".

Churchill and Churchill's editorial discusses negative (health) effects of commercialism in the provision of health care and nutrition. Three parts of their argument are commented: the claim that the fundamental problem of markets is the decomposition of the whole into parts ("reductionism"); the call for individual responsibility; and the notion of holism. On the three aspects the commentary concludes thus: Because provision of health and food must be controlled and managed in some form, an alternative to some kind of decomposition is hard to see. The call for individual responsibility is controversial due to its lack of attention to socioeconomic inequalities. The concept of "holism" is problematic due to its epistemological and normative status.

Liberalismo, justiça social e responsabilidade individual / Liberalism, social justice, and individual responsibility / Libéralisme, justice sociale et responsabilité individuelle

The study examines the contemporary normative debate on social justice from the perspective of the normative political theory of “egalitarian liberalism”. Contrary to an anti-egalitarian liberal political theory, or “libertarianism”, the argument is that a notion of “effective freedom”, and not negative freedom, is central to egalitarian liberalism. Additionally, in contrast to a theoretical current of egalitarianism known as “luck egalitarianism”, the article further argues that although egalitarian liberalism assigns special importance to individual responsibility, it does so (unlike “luck egalitarianism”) without implying any concession to the conservative critique of egalitarianism and the state’s redistributive action.

Dans cet article, on examine le débat normatif contemporain sur la justice sociale dans l’optique de la théorie politique normative du “libéralisme égalitaire”. En opposition avec une théorie politique libérale anti-égalitaire, le libertarianisme, on propose que la notion de “liberté effective” et non pas de liberté négative, est centrale pour le libéralisme égalitaire. Et, en opposition avec un versant théorique de l’égalitarisme nommé luck egalitarianism, on soutient que, bien que le libéralisme égalitaire donne une importance particulière à la responsabilité individuelle, il le fait de façon que, à l’inverse de ce qui se passe avec l’”égalitarisme de la fortune”, cela n’implique aucun renoncement à la critique conservatrice à propos de l’égalitarisme et de l’action redistributive de l’État.

El modelo de salud colombiano y la calidad del cuidado de enfermería *

Mantener los principios morales, en medio de la adversidad y el conflicto, suele ser todo un desafío. Sin embargo, nuestro compromiso como seres humanos íntegros es superar las contrariedades del medio y los dilemas éticos que plantea el día a día. También nos corresponde, como personal de salud, apropiarnos de la responsabilidad individual y social de brindar cuidados de calidad en enfermería. Estos deberes no son fáciles de cumplir, más cuando somos conscientes de que el modelo de salud tiene unos condicionantes económicos, políticos y sociales que influyen categóricamente en el ejercicio de la profesión. Indudablemente, el cuestionamiento sobre el quehacer de enfermería y sus repercusiones es una constante para la reflexión ética. Por ello, como sujetos morales, debemos generar y aprovechar espacios de deliberación con el propósito de asumir verdaderos compromisos para el cambio, la toma de conciencia moral y el fortalecimiento de la profesión. En ese orden de ideas, la propuesta y argumentación general del texto consiste en que, como benefactores de la calidad de vida, llevemos a cabo acciones y decisiones que, en medio de la dificultad, salvaguarden el bien interno de nuestra profesión: el cuidado de la salud de los seres humanos.

Enduring morals through adversity and conflict use to be a challenge. Notwithstanding, our compromise as integral human beings is to overcome milieu obstacles and daily ethical dilemmas. As health staff, it is our duty to take possession of the individual and social responsibility of rendering a quality nursing care. These duties are not easy to cope with, even more if we are aware of the economical, political and social elements of the health model that are definitively influencing the nursing practice. Undoubtedly, enquiring about nursing duty and its consequences is a constant for ethical pondering. Therefore, as moral subjects we must give raise and take advantage of debating spaces in order to assume real changing compromises, moral awareness and strengthening of the profession. As a result and as life quality guards, the general proposal and argument of the present document is to conduct actions and make decisions that, even in difficult times, safeguard the inner good of our profession: humane beings health care.