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1.
Trab. Educ. Saúde (Online) ; 22: e02827248, 2024.
Article in Portuguese | LILACS | ID: biblio-1560602

ABSTRACT

RESUMO: Neste texto celebram-se as ideias e o legado do educador Carlos Rodrigues Brandão, falecido, infelizmente, no dia 12 de julho de 2023. Para homenagear Brandão, optou-se por tomar como base a obra intitulada O educador: vida e morte, que completou 42 anos e serviu como inspiração ao título deste texto. Por certo, a distância do tempo não apaga o espírito do educador de vocação amorosa e libertária. Brandão era implacável ao tecer críticas às injustiças sociais, ao mesmo tempo que indicava saídas cotidianas para o trabalho educativo de cariz emancipatório. O pensamento de Brandão não feneceu; poético e divertido, permanece vivo e a florescer entre nós. Como na reflexão de Rubem Alves (1983, p. 17): "E o educador, morreu? Educadores são como as velhas árvores. Possuem uma face, um nome, uma estória a ser contada".


ABSTRACT: This text celebrates the ideas and legacy of educator Carlos Rodrigues Brandão, who unfortunately died on July 12, 2023. To honor Brandão, we chose to take as a basis the work entitled O educador: vida e morte (The Educator: Life and Death), which completed 42 years and served as inspiration for the title of this text. Indeed, the distance of time does not erase the educator's spirit of a loving and libertarian vocation. Brandão ruthlessly criticized social injustices while indicating daily outlets for emancipatory educational work. Brandão's thought has not withered; poetic and amusing, it remains alive and flourishing among us. As in the reflection of Rubem Alves (1983, p. 17): "And the educator, did he die? Educators are like old trees. They have a face, a name, a story to be told."


RESUMEN: Este texto celebra las ideas y el legado del educador Carlos Rodrigues Brandão, fallecido lamentablemente el 12 de julio de 2023. Para homenajear a Brandão, optamos por basarnos en la obra titulada O educador: vida e morte (El educador: vida y muerte), que cumple 42 años y sirvió de inspiración para el título de este texto. Por supuesto, la distancia del tiempo no borra el espíritu del educador con vocación amorosa y humanitaria. Brandão fue implacable en su crítica a las injusticias sociales, al tiempo que apuntaba soluciones cotidianas para un trabajo educativo emancipador. El pensamiento de Brandão no ha muerto; poético y divertido, permanece vivo y floreciente entre nosotros. Como reflexiona Rubem Alves (1983, p. 17): "Y el educador, ¿está muerto? Los educadores son como árboles ancianos. Tienen un rostro, un nombre, una historia que contar".


Subject(s)
Education , Teaching
2.
Neuropsychologia ; 188: 108632, 2023 09 09.
Article in English | MEDLINE | ID: mdl-37385373

ABSTRACT

Free will has been at the heart of philosophical and scientific discussions for many years. However, recent advances in neuroscience have been perceived as a threat to the commonsense notion of free will as they challenge two core requirements for actions to be free. The first is the notion of determinism and free will, i.e., decisions and actions must not be entirely determined by antecedent causes. The second is the notion of mental causation, i.e., our mental state must have causal effects in the physical world, in other words, actions are caused by conscious intention. We present the classical philosophical positions related to determinism and mental causation, and discuss how neuroscience could shed a new light on the philosophical debate based on recent experimental findings. Overall, we conclude that the current evidence is insufficient to undermine free will.


Subject(s)
Neurosciences , Personal Autonomy , Humans , Consciousness , Intention
3.
Society ; : 1-14, 2023 May 12.
Article in English | MEDLINE | ID: mdl-37362038

ABSTRACT

Nudging, according to its inventors and defenders, is supposed to provide a non-coercive way of changing human behavior for the better-a freedom-respecting form of "libertarian paternalism." Its original point was to complement coercive modes of influence without any need of justification in liberal frameworks. This article shows, using the example of food-product placement in grocery stores, how this image is deceptive. Although nudging practices may not restrict the freedom of consumers, nudging arrangements by public health authorities do restrict the freedom of shopkeepers in standard liberal senses. Libertarianism cannot justify this coercion, and the creed is best left out of the equation as the ideological ruse that it, in this discussion, is. Other liberal theories can justify the coercion, but on grounds that can also be applied to other methods of public health promotion by subsidies and regulation. This result reaffirms that nudging should be seen to complement, not to replace, those other methods.

4.
J Law Med Ethics ; 51(1): 153-171, 2023.
Article in English | MEDLINE | ID: mdl-37226742

ABSTRACT

"Comprehensive Healthcare for America" is a largely single-payer reform proposal that, by applying the insights of behavioral economics, may be able to rally patients and clinicians sufficiently to overcome the opposition of politicians and vested interests to providing all Americans with less complicated and less costly access to needed healthcare.


Subject(s)
Comprehensive Health Care , Economics, Behavioral , Humans , Dissent and Disputes , Health Facilities , Delivery of Health Care
5.
Acta bioeth ; 28(1): 95-104, jun. 2022.
Article in Spanish | LILACS | ID: biblio-1383293

ABSTRACT

Resumen: Sabemos que el mundo enfrenta una terrible pandemia. La ciencia, con esfuerzo y prontitud, ha podido desarrollar diversas vacunas contra el covid-19, generando ello grandes expectativas. Sin embargo, por diversos factores, los procesos masivos de vacunación no han avanzado a la velocidad requerida; uno de los principales es la resistencia de muchas personas a vacunarse, aduciendo diferentes razones. Frente a esta situación se ha oscilado entre la realización de campañas de publicidad hasta propuestas de imposición forzada. Una alternativa para ir más allá de lo meramente lírico y lo coercitivo es generar formas de motivación para que aquellas personas decidan voluntariamente vacunarse a través de diversas medidas, directas e indirectas, apelando a "Nudge" -o "teoría del pequeño empujón"-, con el fin de propiciar la mejor protección de la salud individual y colectiva, tema del que trata el presente artículo, a partir de la revisión bibliográfica sobre la materia y diversas experiencias en la lucha contra el coronavirus.


Abstract: We all know that the world is facing a terrible pandemic. Science, with effort and promptness, has been able to develop various vaccines against Covid-19, generating great expectations. However, mass vaccination processes have not advanced at the required speed due to various factors; one of the main ones is the resistance of many people to get vaccinated, for different reasons. Faced with this situation, it has oscillated between carrying out advertising campaigns to proposals for forced imposition. An alternative to go beyond the merely lyrical and coercive is to generate forms of motivation for those people to voluntarily decide to be vaccinated through various measures, direct and indirect, appealing to "Nudge" -or the "little push theory" - in order to promote the best protection of individual and collective health, the subject of this article, based on the bibliographic review on the matter and various experiences in the fight against coronavirus.


Resumo: Sabemos que o mundo enfrenta uma terrível pandemia. A ciência, com esforço e prontidão, pode desenvolver diversas vacinas contra a Covid-19, gerando grandes expectativas. Sem dúvida, os processos massivos de vacinação não avançaram à velocidade requerida por diversos fatores; um dos principais é a resistência de muitas pessoas a vacinar-se, alegando diferentes razões. Frente a esta situação, observou-se uma oscilação entre a realização de campanhas de publicidade a propostas de imposição forçada. Uma alternativa para ir além do meramente lírico e do coercitivo é gerar formas de motivação para que as pessoas decidam voluntariamente vacinar-se através de diversas medidas, diretas e indiretas, apelando a "Nudge" -ou a "teoria do pequeno empurrão"- a fim de propiciar a melhor proteção da saúde individual e coletiva, tema do que trata o presente artigo, a partir da revisão bibliográfica sobre a matéria e diversas experiências na luta contra o coronavírus.


Subject(s)
Humans , Vaccination/ethics , COVID-19 Vaccines , COVID-19/prevention & control , Motivation/ethics , Social Responsibility , Coercion , Paternalism , Personal Autonomy , Pandemics
6.
Rev Esp Salud Publica ; 952021 Mar 10.
Article in Spanish | MEDLINE | ID: mdl-33750758

ABSTRACT

This paper intends to raise the potential interest that the principles and experiences of the so-called behavioral economy have in the field of public health and, more specifically, in behavioral changes, thus substituting harmful behaviors to health for salutogenic behaviors while respecting the final freedom of choice of the person. In this article, we review the foundations of behavioral economics, emphasizing the work of Tversky and Kahneman and their approach to prospective theory and the role of brain activity levels 1 (automatic) and 2 (reflective) in decision making process. On the basis of these approaches, Thaler and Sustein identify a series of biases that will be used as tools to facilitate behavioral changes through a set of actions "that modify people's behavior in a predictable way without prohibiting any option or significantly changing their economic incentives" based on the so-called libertarian paternalism. We review its interest in public health, citing some empirical studies that demonstrate its high level of effectiveness and efficiency, reflected in the creation of Nudge Units in various countries, and concluding that this can be an interesting tool to add (not to replace) the classical techniques of health promotion and disease prevention.


Se pretende plantear el potencial interés que los principios y experiencias de la denominada economía conductual tienen en el terreno de la salud pública y, más concretamente, en los cambios conductuales, substituyendo conductas nocivas para la salud por conductas salutogénicas, respetando la libertad final de elección de la persona. En el artículo revisamos las bases de la economía conductual, haciendo hincapié en los trabajos de Tversky y Kahneman, con su planteamiento de la teoría prospectiva y el rol de los niveles de actividad cerebral 1 (automático) y 2 (reflexivo) en la toma de decisiones. A partir de estos planteamientos Thaler y Sustein identifican una serie de sesgos que serán utilizados como herramientas para facilitar los cambios conductuales mediante un conjunto de actuaciones "que modifican la conducta de las personas de una manera predecible sin prohibir ninguna opción ni cambiar de forma significativa sus incentivos económicos" basándose en el denominado paternalismo libertario. Revisamos su interés en salud pública, citando algunos estudios empíricos que demuestran su alto nivel de efectividad y eficiencia, plasmado en la creación de Unidades de Nudges en diversos países, y llegando a la conclusión de que esta puede ser una herramienta interesante para añadir, no para substituir, a las técnicas clásicas de la promoción de la salud y la prevención de la enfermedad.


Subject(s)
Decision Making , Health Behavior , Health Promotion/methods , Public Health , Economics, Behavioral , Humans , Spain
7.
J Med Philos ; 44(4): 403-422, 2019 Jul 29.
Article in English | MEDLINE | ID: mdl-31356661

ABSTRACT

Nudging is a tool of libertarian paternalism. It involves making use of certain psychological tendencies in order to help people make better decisions without restricting their freedom. However, some have argued that nudging is objectionable because it interferes with, or undermines, the rational decision-making of the nudged agents. Opinions differ on why this is objectionable, but the underlying concerns appear to begin with nudging's threat to rational decision-making. Those who discuss this issue do not make it clear to what this threat to rationality amounts. In this paper I evaluate what effect nudging has on our decision-making and I argue that it does not typically interfere with our rationality in a problematic way. Perhaps nudging is objectionable for other reasons, but we should not argue that nudging is objectionable based on concerns about rational decision-making.


Subject(s)
Choice Behavior , Decision Making , Paternalism , Humans , Personal Autonomy , Philosophy, Medical
8.
Bioethics ; 33(1): 169-184, 2019 01.
Article in English | MEDLINE | ID: mdl-29920703

ABSTRACT

In order to avoid patient abuse, under normal situations before performing a medical intervention on a patient, a physician must obtain informed consent from that patient, where to give genuine informed consent a patient must be competent, understand her condition, her options and their expected risks and benefits, and must expressly consent to one of those options. However, many patients refrain from the option that their physician believes to be best, and many physicians worry that their patients make irrational healthcare decisions, hindering their ability to provide efficient healthcare for their patients. Some philosophers have proposed a solution to this problem: they advocate that physicians nudge their patients to steer them towards their physician's preferred option. A nudge is any influence designed to predictably alter a person's behavior without limiting their options or giving them reasons to act. Proponents of nudging contend that nudges are consistent with obtaining informed consent. Here I argue that nudging is incompatible with genuine informed consent, as it violates a physician's obligation to tell their patients the truth, the whole truth, and nothing but the truth during adequate disclosure.


Subject(s)
Decision Making , Informed Consent/ethics , Paternalism/ethics , Patient Participation , Persuasive Communication , Physician-Patient Relations/ethics , Physicians/ethics , Dissent and Disputes , Ethics, Medical , Female , Humans , Informed Consent/psychology , Male , Personal Autonomy , Truth Disclosure/ethics
9.
Camb Q Healthc Ethics ; 27(2): 188-216, 2018 04.
Article in English | MEDLINE | ID: mdl-29509119

ABSTRACT

Justice can be approached from many angles in ethical and political debates, including those involving healthcare, biomedical research, and well-being. The main doctrines of justice are liberal egalitarianism, libertarianism, luck egalitarianism, socialism, utilitarianism, capability approach, communitarianism, and care ethics. These can be further elaborated in the light of traditional moral and social theories, values, ideals, and interests, and there are distinct dimensions of justice that are captured better by some tactics than by others. In this article, questions surrounding these matters are approached with the hermeneutic idea of a distinction between "American" and "European" ways of thinking.


Subject(s)
Delivery of Health Care/ethics , Social Justice , Bioethical Issues/history , Ethical Theory/history , Europe , Female , History, 20th Century , Humans , Male , Philosophy/history , Social Justice/ethics , Social Justice/history , United States
10.
Int J Health Plann Manage ; 33(1): 272-275, 2018 Jan.
Article in English | MEDLINE | ID: mdl-28523778

ABSTRACT

Behavioural economics-the study of human decision making and how it sometimes deviates systematically from the assumptions of standard economic theory-has attracted a lot of attention in the health policy discourse over recent years. Many appear to believe that behavioural economic findings can be used only to help inform policies that manipulate the choices made by citizens, ie, the so-called nudge policy. However, these findings can be used to inform several different policy frameworks, from seemingly innocuous liberty-preserving changes to the contexts people operate in, to the outlawing of certain corporate behaviours. This article depicts diagrammatically, with the aid of a "behavioural policy cube" and in relation to smoking cessation interventions, the conceptual parameters of several behavioural economic-informed policy frameworks, which could be easily extended to other areas of health, and indeed broader public, policy.


Subject(s)
Economics, Behavioral , Health Policy , Choice Behavior , Humans , Models, Theoretical , Smoking Cessation/methods , Smoking Cessation/psychology
11.
Hum Mutat ; 37(12): 1257-1262, 2016 12.
Article in English | MEDLINE | ID: mdl-27647774

ABSTRACT

Ever since genetic testing is possible for specific mutations, ethical debate has sparked on the question of whether professionals have a duty to warn not only patients but also their relatives that might be at risk for hereditary diseases. As next-generation sequencing (NGS) swiftly finds its way into clinical practice, the question who is responsible for conveying unsolicited findings to family members becomes increasingly urgent. Traditionally, there is a strong emphasis on the duties of the professional in this debate. But what is the role of the patient and her family? In this article, we discuss the question of whose duty it is to convey relevant genetic risk information concerning hereditary diseases that can be cured or prevented to the relatives of patients undergoing NGS. We argue in favor of a shared responsibility for professionals and patients and present a strategy that reconciles these roles: a moral accountability nudge. Incorporated into informed consent and counseling services such as letters and online tools, this nudge aims to create awareness on specific patient responsibilities. Commitment of all parties is needed to ensure adequate dissemination of results in the NGS era.


Subject(s)
Disclosure/ethics , High-Throughput Nucleotide Sequencing/ethics , Family , Humans , Incidental Findings , Moral Obligations , Professional Role
12.
Annu Rev Public Health ; 37: 237-51, 2016.
Article in English | MEDLINE | ID: mdl-26735430

ABSTRACT

In recent years, the nudge approach to behavior change has emerged from the behavioral sciences to challenge the traditional use of regulation in public health strategies to address modifiable individual-level behaviors related to the rise of noncommunicable diseases and their treatment. However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier are being threatened by inadequate understandings of its scientific character, its relationship with regulation, and its ethical implications. This article reviews this character and its ethical implication with a special emphasis on the compatibility of nudging with traditional regulation, special domains of experience, and the need for a more nuanced approach to the ethical debate. The aim is to advance readers' understanding and give guidance to those who have considered working with or incorporating the nudge approach into programs or policies aimed at making healthful choices easier.


Subject(s)
Health Behavior , Health Promotion/legislation & jurisprudence , Health Promotion/methods , Models, Psychological , Motivation , Choice Behavior , Decision Making , Diet/psychology , Exercise/psychology , Government Regulation , Health Promotion/ethics , Humans , Public Health , Tissue and Organ Procurement
13.
Ecancermedicalscience ; 9: 588, 2015.
Article in English | MEDLINE | ID: mdl-26557886

ABSTRACT

We know that around 30% of all cancers are preventable. We also know that there is clear evidence of the causal relations between obesity and cancer. This means that there could be lifestyles that could prevent obesity and, thus, cancer. Yet, who legitimises these lifestyles and on which ground? Should citizens be free to accept or not to accept policies concerning them? This is a problem faced within what has been named libertarian paternalism. We discuss it, also proposing a version that we call deliberative libertarian paternalism, showing how important this problem is for a proper framing of the lifestyle policies concerning obesity and, thus, cancer prevention.

14.
Am J Bioeth ; 15(10): 28-38, 2015.
Article in English | MEDLINE | ID: mdl-26479099

ABSTRACT

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.


Subject(s)
Choice Behavior , Informed Consent/ethics , Paternalism , Personal Autonomy , Persuasive Communication , Physician-Patient Relations/ethics , Beneficence , Coercion , Comprehension , Freedom , Humans , Paternalism/ethics , Physicians/ethics
15.
Soc Sci Med ; 143: 62-70, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26344124

ABSTRACT

Controlling population weight gain is a major concern for industrialized nations because of associated health risks. Although Japan is experiencing rising prevalence of obesity and overweight, historically they have had and continue to maintain a low prevalence relative to other developed countries. Therefore, Japan provides an interesting case study of strategies to curb population weight gain. In this paper we explore Japanese approaches to obesity and diet through observational and ethnographic interviews conducted between June 2009 and September 2013. Nineteen interviews were conducted at four companies and three schools in Tokyo, as well as at a central Tokyo community health care center and school lunch distribution center. Interviewees included physicians, a Ministry of Health bureaucrat, human resources managers, welfare nurses employed by health insurance organizations, school nurses (also government employees), school nutritionists, and a school counselor. We highlight the role of culture and social norms in encouraging healthful behavior in Japan, focusing on the Ministry of Health, Labor, and Welfare's metabolic syndrome screening program (implemented in 2005) and the Japanese national school lunch program. The Japanese government prescribes optimal body metrics for all Japanese citizens and relies on institutions such as schools and health insurance organizations that are in some instances closely affiliated with the workplace to carry out education. Japan's socio-cultural approach leads us reflect on the cultural and social conditions that make different policy prescriptions more politically feasible and potentially effective. It also provokes us to question whether limited behavioral modifications and "nudging" can lead to broader change in an environment like the United States where there are fewer broadly shared socio-cultural norms regarding acceptable health behavior.


Subject(s)
Health Education/methods , Obesity/prevention & control , Paternalism , Public Health/methods , Anthropology, Cultural , Community Health Services , Government , Humans , Japan , Prevalence , United States , Workplace/organization & administration
16.
Soc Sci Med ; 133: 374-82, 2015 May.
Article in English | MEDLINE | ID: mdl-25605430

ABSTRACT

This paper evaluates the ideological and political origins of a place-based and commercial health promotion effort, the Blue Zones Project (BZP), launched in Iowa in 2011. Through critical discourse analysis, I argue that the BZP does reflect a neoliberalization of public health, but as an "actually existing neoliberalism" it emerges from a specific policy context, including dramatic health sector policy changes due to the national Affordable Care Act, also known as Obamacare; a media discourse of health crisis for an aging Midwestern population; and an effort to refashion Iowa cities as sites of healthy and active living, to retain and attract a creative class of young entrepreneurs. The BZP employs many well-known mechanisms of neoliberal governance: the public-private partnership; competition among communities for "public" funds; promotion of an apolitical discourse on individual responsibility and ownership of health; decentralizing governance to the "community" level; and marketing, branding, and corporate sponsorship of public projects. The BZP exemplifies the process of "neoliberal governmentality," by which individuals learn to govern themselves and their "life projects" in line with a market-based rationality. However, with its emphasis on "nudging" individuals towards healthy behaviors through small changes in the local environment, the BZP reflects the rise of "libertarian paternalism," a variant of neoliberalism, as a dominant ideology underlying contemporary health promotion efforts.


Subject(s)
Health Policy , Health Promotion/methods , Politics , Public Health , Health Behavior , Humans , Iowa
17.
Br J Sociol ; 64(4): 691-716, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24320072

ABSTRACT

Studies of the relationship between class position and political outlooks still only have a limited understanding of the class-related mechanisms that matter for ideological orientations. This article presents a comprehensive analysis of the mechanisms that link class position and left/right and authoritarian/libertarian orientations. Besides main factors such as income, career prospects, job security, education, class origin and class identification, the significance of work-related factors such as work autonomy, working in a team, a physically demanding job and a mentally demanding job is studied. The findings are based on a survey specifically designed for this purpose and collected in Sweden in 2008/2009. A great deal of the association between class position and left/right orientations is explained by socio-economic conditions; different classes sympathize with policies that will benefit them economically. Another important factor is class identification. Work-related factors also have relevance, but the effect of class position on left/right orientations works mainly through the remuneration system. Class position is also related to authoritarian/libertarian orientations. However, this relationship is less explained by socio-economic position per se, but is rather an effect of the educational system and its allocation of the workforce into different class positions. It also turns out that work-related factors do not explain the class effects; however, a physically demanding job shows a unique effect. Overall, our findings suggest that besides factors such as class position, income, education and class identification, we need to consider work-related aspects to derive a more complete understanding of the distribution of ideological orientations in Western societies.


Subject(s)
Politics , Social Class , Adolescent , Adult , Aged , Aged, 80 and over , Data Collection , Employment/statistics & numerical data , Female , Humans , Male , Middle Aged , Socioeconomic Factors , Sweden , Young Adult
18.
Front Psychol ; 4: 972, 2013.
Article in English | MEDLINE | ID: mdl-24391622
19.
Rev. Polis Psique ; 3(3): 189-202, 2013.
Article in Portuguese | Index Psychology - journals | ID: psi-60909

ABSTRACT

O artigo propõe uma investigação acerca das proveniências dos mecanismos de monitoramento eletrônico de presos nos Estados Unidos e a sua posterior implementação no Brasil. O enfoque volta-se para uso de tornozeleiras eletrônicas para controle dos chamados delinquentes no Brasil, por meio do Sistema de Acompanhamento de Custódia 24 horas (SAC24). Pretende-se apontar os atuais deslocamentos nas técnicas punitivas, que estendem o controle penal para fora dos edifícios carcerários. Para isso, busca-se acompanhar algumas considerações analíticas de Michel Foucault a respeito dos dispositivos de segurança e as recentes transformações no exercício do poder de punir.(AU)


The article proposes an investigation about the precedence of the mechanisms of electronic monitoring of people under justice control in the United States, and its further implementation in Brazil. The focus is the use of electronic anklets for the control of the so-called criminals in Brazil, by means of the 24 hours Custody Tracking System (SAC24). The current displacements of the punitive techniques are pointed showing how they extend the penal control to outside prisons wall. For this aim, some of Michel Foucault’s analytic considerations about the security dispositive are exposed, as well as the recent transformations of exercise of the power of punish.(AU)


El artículo propone una investigación acera de las proveniencias de los mecanismos de monitorización electrónica de prisioneros en Estado Unidos e su posterior implementación en Brasil. El enfoque vuelve a la utilización de tobilleras electrónicas para el control de los designados delincuentes en Brasil, por medio del Sistema de Acompañamiento de Custodia 24 horas (SAC24). Pretende-se apuntar las actuales transformaciones en las técnicas punitivas, que alargan el control penal para fuera de los edificios carcelarios. Para esto, se buscó acompañar algunas consideraciones analíticas de Michel Foucault a respecto de los dispositivos de seguridad e los recente cambios en el ejercicio del poder punir.(AU)

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