Demographics and Characteristics of Vice Chairs in Academic Orthopaedic Surgery Programs: A Descriptive Study.

INTRODUCTION: The Vice-chair (VC) position is gaining popularity in academic orthopaedic surgery departments; however, there is a paucity of information regarding qualifications and career advancements associated with this role. The purpose of this study was to define the characteristics of current orthopaedic surgery department VCs. DESIGN: Descriptive study following a retrospective web-based search utilizing the Fellowship and Residency Electronic Interactive Database (FREIDA) database and orthopaedic surgery residency program websites. SETTING: 200 ACGME-accredited orthopaedic surgery residency programs across the United States. PARTICIPANTS: Program name and hospital affiliations were collected from the FREIDA database to account for all ACGME-accredited programs. The following information was derived from publicly available program websites: title, role description, previously trained institutions, academic rank, and concurrent roles of VCs. Research productivity was measured using the H-index. The previous roles of current Department Chairs (DC) were also evaluated. RESULTS: Of the 178 VCs identified, VC of Research (n = 36; 20%), Education (n = 25; 14%), and Clinical Operations/Affairs (n = 21; 12%) were the most common titles. Women made up 17% (n = 30) of the VCs. Trauma (n = 36; 20%) was the most common fellowship subspecialty among VCs. The average H-index for VCs was 25. Among VCs, 94 (53%) were professors, 78 were also Chiefs/Heads/Directors (44%), 7 (4%) were Fellowship Directors, and 18 (10%) were Residency Directors. Twenty-six of 95 (27%) current DC had VC experience. CONCLUSION: The findings can facilitate effective leadership development, promotion of diversity and inclusion in these roles, and guidance for those who seek such leadership positions.

Mandevillian vices.

Bernard Mandeville argued that traits that have traditionally been seen as detrimental or reprehensible, such as greed, ambition, vanity, and the willingness to deceive, can produce significant social goods. He went so far as to suggest that a society composed of individuals who embody these vices would, under certain constraints, be better off than one composed only of those who embody the virtues of self-restraint. In the twentieth century, Mandeville's insights were taken up in economics by John Maynard Keynes, among others. More recently, philosophers have drawn analogies to Mandeville's ideas in the domains of epistemology and morality, arguing that traits that are typically understood as epistemic or moral vices (e.g. closed-mindedness, vindictiveness) can lead to beneficial outcomes for the groups in which individuals cooperate, deliberate, and decide, for instance by propitiously dividing the cognitive labor involved in critical inquiry and introducing transient diversity. We argue that mandevillian virtues have a negative counterpart, mandevillian vices, which are traits that are beneficial to or admirable in their individual possessor, but are or can be systematically detrimental to the group to which that individual belongs. Whilst virtue ethics and epistemology prescribe character traits that are good for every moral and epistemic agent, and ideally across all situations, mandevillian virtues show that group dynamics can complicate this picture. In this paper, we provide a unifying explanation of the main mechanism responsible for mandevillian traits in general and motivate the case for the opposite of mandevillian virtues, namely mandevillian vices.

La labor del Protomedicato en la salud pública en el virreinato del Perú / O trabalho do Protomedicato na saúde pública no vice-reinado do Peru / The work of the Protomedicato in public health in the viceroyalty of Peru

El objetivo de la presente investigación es conocer el papelque cumplió el Protomedicato en la salud publica en elvirreinato del Perú. La metodología utilizada fue la narraciónhistórica siguiendo el método heurístico y hermenéutico,utilizando fuentes primarias documentales de archivoshistóricos peruanos y españoles. El resultado obtenido fueconfirmar que el Protomedicato veló por la salud de losvecinos y que tenía carácter administrativo judicial y susfunciones principales fueron regularizar la labor de los queejercieran cualquier tipo de atención sanitaria, otorgandolicencias, fijando aranceles y vigilando el trabajo realizadoen las boticas y la calidad de los medicamentos, a través devisitas periódicas. La conclusión determina que hubo mejorassanitarias como consecuencia de la gestión del Protomedicatoen el virreinato del Perú, proponiendo medidas salubrese, incluso, disponía la movilización de personal médico através del virreinato y participaba ante cualquier consultade otras entidades coloniales, como el cabildo, referentes asalud pública, como eliminación de acequias, declaraciónde pestes, y otros.(AU)

The objective of this research is to know the role that theProtomedicato played in public health in the viceroyaltyof Peru. The methodology used was historical narrationfollowing the heuristic and hermeneutic method, usingprimary documentary sources from Peruvian and Spanishhistorical archives. The result obtained was to confirm thatthe Protomedicato looked after the health of the neighborsand that it had a judicial administrative nature and its main functions were to regularize the work of those whocarried out any type of health care, granting licenses, settingtariffs and monitoring the work carried out in pharmaciesand the quality of medicines, through periodic visits. Theconclusion determines that there were health improvementsas a consequence of the management of the Protomedicato inthe viceroyalty of Peru, proposing health measures and evenordered the mobilization of medical personnel throughoutthe viceroyalty and participated in any consultation fromother colonial entities, such as the council, referring to publichealth, such as elimination of ditches, declaration of pests,and others.(AU)

O objetivo desta pesquisa é conhecer o papel que o Protomedicatodesempenhou na saúde pública no vice-reinado do Peru. Ametodologia utilizada foi a narração histórica seguindo o métodoheurístico e hermenêutico, utilizando fontes documentaisprimárias de arquivos históricos peruanos e espanhóis. Oresultado obtido foi confirmar que o Protomedicato zelava pelasaúde dos vizinhos e que tinha caráter administrativo judiciale suas principais funções eram regularizar o trabalho de quemrealizava qualquer tipo de assistência à saúde, concedendolicenças, fixando tarifas e acompanhamento do trabalhorealizado nas farmácias e da qualidade dos medicamentos,através de visitas periódicas. A conclusão determina quehouve melhorias na saúde como consequência da gestão doProtomedicato no vice-reinado do Peru, propondo medidassanitárias e ainda ordenou a mobilização de pessoal médicoem todo o vice-reinado e participou de qualquer consultade outras entidades coloniais, como o conselho. , referentesà saúde pública, como eliminação de valas, declaração depragas, entre outros.(AU)

Tanesini on truth and epistemic vice.

Alessandra Taniesini's 'The Mismeasure of the Self' develops an internalist account of epistemic vice. On this view, epistemic vices are grounded in attitudes towards the self: fatalism, self-satisfaction, narcissistic infatuation, and self-abasement. The account is internalist insofar as it claims to ground both the nature and the normativity of vice within the subject's skull. In this paper, I argue against vice internalism: epistemic vices, I show, need a normative hook outside the skull to explain their vicious nature. In other words, the 'mis' in the 'mismeasure' of the self demands externalist unpacking.

Measuring the self and measuring the world.

I evaluate Tanesini's attempt to provide a social approach to intellectual vices. I do this in three steps. First, I explain what I mean by a 'social approach'. Tanesini offers three senses in which her account is social, and I explain each of these before honing in on the one in which I am most interested. Second, I address the extent to which her approach to the causes of intellectual vices can be said to be a social approach. My assessment here will be broadly positive, though I highlight some points where I think more explicit details could be given. Third, I discuss whether Tanesini's approach to responding to intellectual vices is a social one. Here I decide that her approach is not social, and that she doesn't intend it to be. Finally, in the last section, I offer some remarks about what these conclusions mean, and what further work I hope they could provoke.

Psychiatry Vice Chairs of Education: Expected and Actual Responsibilities, Satisfaction, and Work Barriers.

OBJECTIVES: The current study investigated the gap between actual and expected work responsibilities of psychiatry vice chairs of education (VCEs), their work satisfaction, and perceived work barriers. METHODS: Psychiatry VCEs were identified through professional memberships and school websites within the USA. In 2021, identified VCEs were emailed an anonymous survey that was based on past research on roles and responsibilities of VCEs. Through qualitative and quantitative questions, the survey assessed demographic characteristics, actual and expected work responsibilities, work satisfaction, and work barriers during time spent in the VCE role. RESULTS: Of 57 identified psychiatry VCEs, 32 (56.1%) completed the survey. Most respondents (59.4%) said their department/institution did not have a written VCE job description. There were gaps between actual and expected VCE responsibilities, especially with the performance review of education leaders (Δ - 11; actual n = 20 vs. expected n = 31). The greatest satisfaction came from mentoring trainees/faculty (respectively 4.88 ± 0.33 and 4.85 ± 0.37 on a 5-point scale) and overseeing/supporting educational programs (4.66 ± 0.48). Comments on work barriers included limited protected time (n = 11), education budget constraints (n = 6), and having multiple leadership roles (n = 5). The actual full-time equivalent in the VCE role was significantly lower than expected (p < .001). CONCLUSION: Considering the role of psychiatry VCEs remains relatively new and is evolving, adequate allocation of resources and improved job descriptions may help close the gap between expected and actual responsibilities. The current findings can assist in developing such job descriptions to attract and define the work of a VCE based on specific responsibilities and associated work satisfaction.

Practiceand exploration of building public hospital volunteer service brand based on humanistic hospi-tal construction thinking / 现代医院

With the development of society and the awakening of civic consciousness,hospital volunteer service has be-come an indispensable part of modern medical and health system,which plays an important role in improving service mode,im-proving patients'medical experience,and establishing the public welfare image of hospitals.Based on the humanistic hospital construction thinking and combined with the connotation and goal of humanistic hospital construction,this paper is committed to building the hospital volunteer service brand,and summarizes the volunteer management system,service content and process,in order to provide theoretical reference and guidance for the standardization and systematization of hospital volunteer service brand construction.

The Effect of Vice-Virtue Bundles on Consumers' Purchase Intentions for Vice Packaged Foods: Evidence from Randomized Experiments.

Packaged foods have significantly expanded their market presence, with the utilization of vice-virtue bundles gaining momentum, particularly in the realm of vice-packaged foods. Consequently, understanding how consumers respond to vice-packaged food with vice-virtue bundles (i.e., vice-packaged food combined with virtue ingredients) becomes crucial. This research investigates this issue through four experiments employing a one-way between-subjects design, incorporating distinct stimuli and measures, and involving samples from diverse sources. In Experiment 1 (n = 172), Experiment 2 (n = 169), and the follow-up experiment (n = 153), variance analysis, chi-square test, and mediating analysis demonstrate that consumers are more inclined to purchase vice-packaged food with vice-virtue bundles owing to the perception of it being healthier than vice packaged food with vice-virtue bundles. Furthermore, Experiment 3 (n = 249) employs moderated mediation analysis, uncovering that both the heightened purchase intention for vice-packaged food with vice-virtue bundles and the mediating effect of perceived healthiness are attenuated among consumers with prevention (vs. promotion) focus. Beyond contributing to theories on packaged food consumption, vice-virtue bundles, and regulatory focus theory, these findings hold practical implications for packaged food marketing, promoting rational food choices, and enhancing healthier diets.

The epistemic vices of corporations.

Vice epistemology studies the qualities of individuals and collectives that undermine the creation, sharing, and storing of knowledge. There is no settled understanding of which epistemic vices exist at the collective level. Yet understanding which collective epistemic vices exist is important, both to facilitate research on the antecedents and effects of collective epistemic vice, and to advance philosophical discussions such as whether some collective epistemic vices are genuinely collective. I propose an empirical approach to identifying epistemic vices in corporations, analyzing a large dataset of online employee reviews. The approach has parallels to the methodology for identifying the big-five personality traits. It surfaces epistemic vices that are attributed to corporations by its own members and reduces the number of vices to the minimum required to describe differences between corporations. This approach yields a new taxonomy of epistemic vices for corporations. While two vices identified have close correlates in the existing literature, four others have not been identified at all or only in aspects. Two of these vices are 'genuinely' collective in the sense that they can only be attributed to collectives. Supplementary Information: The online version contains supplementary material available at 10.1007/s11229-023-04133-2.

Predicting the successful application of high-flow nasal oxygen cannula in patients with COVID-19 respiratory failure: a retrospective analysis.

BACKGROUND: The right time of high-flow nasal cannulas (HFNCs) application in COVID-19 patients with acute respiratory failure remains uncertain. RESEARCH DESIGN AND METHODS: In this retrospective study, COVID-19-infected adult patients with hypoxemic respiratory failure were enrolled. Their baseline epidemiological data and respiratory failure related parameters, including the Ventilation in COVID-19 Estimation (VICE), and the ratio of oxygen saturation (ROX index), were recorded. The primary outcome measured was the 28-day mortality. RESULTS: A total of 69 patients were enrolled. Fifty-four (78%) patients who intubated and received invasive mechanical ventilatory (MV) support on day 1 were enrolled in the MV group. The remaining fifteen (22%) patients received HFNC initially (HFNC group), in which, ten (66%) patients were not intubated during hospitalization were belong to HFNC-success group and five (33%) of these patients were intubated later due to disease progression were attributed to HFNC-failure group. Compared with those in the MV group, those in the HFNC group had a lower mortality rate (6.7% vs. 40.7%, p = 0.0138). There were no differences in baseline characteristics among the two groups; however, the HFNC group had a lower VICE score (0.105 [0.049-0.269] vs. 0.260 [0.126-0.693], p = 0.0092) and higher ROX index (5.3 [5.1-10.7] vs. 4.3 [3.9-4.9], p = 0.0007) than the MV group. The ROX index was higher in the HFNC success group immediately before (p = 0.0136) and up to 12 hours of HFNC therapy than in the HFNC failure group. CONCLUSIONS: Early intubation may be considered in patients with a higher VICE score or a lower ROX index. The ROX score during HFNCs use can provide an early warning sign of treatment failure. Further investigations are warranted to confirm these results.

High flow nasal cannulas (HFNCs) were widely used in patients with COVID-19 infection related hypoxemic respiratory failure. However, there were concerns about its failure and related delayed intubation may be associated with a higher mortality rate. This retrospective study revealed patients with higher baseline disease severity and higher VICE scores may be treated with primary invasive mechanical ventilation. On the contrary, if their baseline VICE score is low and ROX index is high, HFNCs treatment might be safely applied initially. The trends of serial ROX index values during HFNC use could be a reliable periscope to predict the HFNC therapy outcome, therefore avoided delayed intubation.

Harming by Deceit: Epistemic Malevolence and Organizational Wrongdoing.

Research on organizational epistemic vice alleges that some organizations are epistemically malevolent, i.e. they habitually harm others by deceiving them. Yet, there is a lack of empirical research on epistemic malevolence. We connect the discussion of epistemic malevolence to the empirical literature on organizational deception. The existing empirical literature does not pay sufficient attention to the impact of an organization's ability to control compromising information on its deception strategy. We address this gap by studying eighty high-penalty corporate misconduct cases between 2000 and 2020 in the United States. We find that organizations use two different strategies to deceive: Organizations 'sow doubt' when they contest information about them or their impacts that others have access to. By contrast, organizations 'exploit trust' when they deceive others by obfuscating, concealing, or falsifying information that they themselves control. While previous research has focused on cases of 'sowing doubt', we find that organizations 'exploit trust' in the majority of cases that we studied. This has important policy implications because the strategy of 'exploiting trust' calls for a different response from regulators and organizations than the strategy of 'sowing doubt'.

Institutional Strategies to Maintain and Grow Imaging Research During the COVID-19 Pandemic.

Understanding imaging research experiences, challenges, and strategies for academic radiology departments during and after COVID-19 is critical to prepare for future disruptive events. We summarize key insights and programmatic initiatives at major academic hospitals across the world, based on literature review and meetings of the Radiological Society of North America Vice Chairs of Research (RSNA VCR) group. Through expert discussion and case studies, we provide suggested guidelines to maintain and grow radiology research in the postpandemic era.

Is There a Dose-Response Relationship between High-Intensity Interval Exercise (HIIE) Intensity and Affective Valence? Analysis of Three HIIE Sessions Performed with Different Amplitudes.

The inverse relationship between exercise intensity and affective valence is well established for continuous exercise but not for high-intensity interval exercise (HIIE). The objective was to verify the dose-response relationship between exercise intensity and affective valence in HIIE sessions. Eleven young men underwent a vigorous-intensity continuous exercise (VICE) and three HIIE sessions at the same average intensity (70% of peak power-WPeak) and duration (20 min) but with different amplitudes: 10 × [1 min at 90% WPeak/1 min at 50% WPeak]-HIIE-90/50; 10 × [1 min at 100% WPeak/1 min at 40% WPeak]-HIIE-100/40; 10 × [1 min at 110% WPeak/1 min at 30% WPeak]-HIIE-110/30. During the exercise sessions, psychophysiological variables were recorded (VO2, VCO2, heart rate, perceived exertion CR10, and Feeling Scale (FS)). Higher correlations were found between CR10 and FS for all conditions (VICE = -0.987; HIIE-90/50 = -0.873; HIIE-100/40 = -0.908; HIIE-110/30 = -0.948). Regarding the physiological variables, the %HRMax presented moderate inverse correlations with FS for all exercise conditions (VICE = -0.867; HIIE-90/50 = -0.818; HIIE-100/40 = -0.837; HIIE-110/30 = -0.828) while the respiratory variables (%VO2Peak and %VCO2Peak) presented low-to-moderate correlations only for VICE, HIIE-90/50, and HIIE-100/40 (ranging from -0.523 to -0.805). Poor correlations were observed between the %VO2Peak (r = -0.293) and %VCO2Peak (r = -0.020) with FS. The results indicated that perceived exertion is more sensible than physiological variables to explain the intensity-affective valence relationship in HIIE sessions. RPE should be used for HIIE prescription with a focus on affect.

Outcome prediction in hospitalized COVID-19 patients: Comparison of the performance of five severity scores.

Background: The aim of our study was to externally validate the predictive capability of five developed coronavirus disease 2019 (COVID-19)-specific prognostic tools, including the COVID-19 Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Shang COVID severity score, COVID-intubation risk score-neutrophil/lymphocyte ratio (IRS-NLR), inflammation-based score, and ventilation in COVID estimator (VICE) score. Methods: The medical records of all patients hospitalized for a laboratory-confirmed COVID-19 diagnosis between May 2021 and June 2021 were retrospectively analyzed. Data were extracted within the first 24 h of admission, and five different scores were calculated. The primary and secondary outcomes were 30-day mortality and mechanical ventilation, respectively. Results: A total of 285 patients were enrolled in our cohort. Sixty-five patients (22.8%) were intubated with ventilator support, and the 30-day mortality rate was 8.8%. The Shang COVID severity score had the highest numerical area under the receiver operator characteristic (AUC-ROC) (AUC 0.836) curve to predict 30-day mortality, followed by the SEIMC score (AUC 0.807) and VICE score (AUC 0.804). For intubation, both the VICE and COVID-IRS-NLR scores had the highest AUC (AUC 0.82) compared to the inflammation-based score (AUC 0.69). The 30-day mortality increased steadily according to higher Shang COVID severity scores and SEIMC scores. The intubation rate exceeded 50% in the patients stratified by higher VICE scores and COVID-IRS-NLR score quintiles. Conclusion: The discriminative performances of the SEIMC score and Shang COVID severity score are good for predicting the 30-day mortality of hospitalized COVID-19 patients. The COVID-IRS-NLR and VICE showed good performance for predicting invasive mechanical ventilation (IMV).

Trends in Medical Training and Leadership at Academic Orthopedic Programs.

INTRODUCTION: When deciding on which programs to rank or fellowships to enter, medical students and residents may assess the program's prestige and specialty training opportunities. This report aimed to analyze the demographics of orthopedic department chairs and program directors (PDs), focusing on the prestige of their orthopedic training and medical school. Secondary data included fellowship, higher-level education, sex, professorship, years of practice, and total published research. METHODS: We used U.S. News and Doximity to rank 192 medical schools and 200 orthopedic residency programs based on prestige rankings, respectively. We searched for the department chair, vice-chair, and PD via program websites, Council of Orthopaedic Residency Directors (CORD), Orthopedic Residency Information Network (ORIN), personal websites, LinkedIn, and Doximity. Subsequently, we searched for each individual's demographic information, education and research history, employment history, and medical school attended. RESULTS: We gathered data on 268 orthopedic surgeons with leadership positions at academic hospitals. Of the 268, 115 were department chairs, 15 were vice-chairs, 126 were PDs, 11 were both the chair and PD, and one was vice-chair and PD. Of the 268 physicians, 244 physicians were male (91.0%), while 22 were female (9.0%). The average residency reputation ranking overall was 59.7 ± 5.7. More specifically, for chairs, the average was 57.0 ± 8.3 (p < 0.005), and for PDs, the average was 63.6 ± 8.0 (p <0.005). There was no significant difference between chairs and PDs (p = 0.26). CONCLUSION: Orthopedic leaders were found to have trained at more prestigious programs. This trend could be explained by increased research opportunities at more prestigious programs or programs attempting to increase their own reputation. 9.0% of the leaders identify as female, which is comparable to the 6.5% of practicing female orthopedic surgeons. However, this further demonstrates a need for gender equity in orthopedic surgery. Assessing trends in the training of orthopedic surgeons with leadership positions will allow a better understanding of what programs look for in the hiring process.

A novel understanding of the nature of epistemic vice.

My aim in this paper is to present and discuss a novel understanding of the nature of epistemic vice. I highlight that epistemic vice such as excessive curiosity, gossip and excessive inquisitiveness do not obstruct the acquisition, transmission and retention of knowledge and are not characterized by a deficiency of epistemic desires or vicious epistemic motivations. However, I argue that such traits ought to be classified as epistemic vices because the agent who possesses them causes epistemic harm to other agents through those traits' characteristic activities. To remedy obstructivism's inability to account for vices that cause epistemic harm in other ways besides blocking effective epistemic inquiry, I propose an amended version of this theory. I argue that epistemic vices are character traits, attitudes, and ways of thinking that obstruct the acquisition, transmission, and retention of knowledge and/or cause other kinds of epistemic harm. In addition, I propose a modified version of motivationalism that cashes out non-obstructing, excess-motivation vices in terms of motivation simply by acknowledging, and incorporating into theory, excessive epistemic drives and the negative epistemic (and non-epistemic) consequences stemming from them.

Multisectoral actions of mental health during the COVID-19 pandemic in Mazandaran province of Iran.

AIM: A widespread outbreak of COVID-19 is followed by adverse effects on the mental health of the general population. Therefore, this study is an audit to investigate the activities of various organizations during the COVID-19 pandemic in Mazandaran Province, Iran. METHODS: The aim of the study was to collect the data, the relevant officials in various organizations and units were contacted to collect the statistics of actions taken in psychology and psychiatry wards. Moreover, databases such as Google Scholar and Iranian resources were searched. RESULTS: According to the results, different healthcare systems worked in parallel during the peak of the COVID-19 pandemic. For example, Mazandaran University of Medical Science [MAZUMS] Health Vice-Chancellor performed the following activities during this crisis: establishing a virtual crisis management working group, holding a provincial educational committee to train the crisis management teams, organizing virtual psychological intervention teams in the healthcare systems, and so forth. In addition, the mental health activities by Mazandaran Welfare Organization during the COVID-19 outbreak included providing hostelry free psychological counseling, quarantine boarding and rehabilitation centers, and providing harm prevention protocols of COVID-19, especially for marginalized regions. In the third level of medical centers, including hospitals, consultation-liaison psychiatry or psychiatrists and clinical psychologists, therapeutic interventions for comorbid psychiatric disorders with COVID-19 disease, and online workshops for mental health were conducted to reduce burnout of medical staff and nurses. CONCLUSION: This study can provide a good guideline for different service providers by using the experiences of other centers to achieve better results.

A national survey of Neurology Vice Chairs For Education.

OBJECTIVES: A growing number of Neurology Departments have appointed a Neurology Vice Chair for Education (NVCE), yet the roles and responsibilities of an NVCE have not been previously described in the literature. METHODS: A group of current NVCEs developed a survey that was sent to all NVCEs in the US via a secure, anonymous survey. Questions included roles and responsibilities, sources of support, metrics to determine success, faculty development, basic demographics and education scholarship engagement. RESULTS: Response rate was 27 of 45 NVCEs (60%). Among the respondents, 70% have been in the role 5 years or less and the NVCE role existed for 5 years or less in 60% of departments. Eighteen percent were provided with a written job description, and 63% never received any job description. Most common responsibilities included overseeing student (78%), resident (78%), and fellowship (74%) education, participation in education section of an annual report (67%) and oversight of education scholarship (59%). Fifty-two percent reported no specific funding for the NVCE role. Most were prior program directors (59%), male (61%) and White (85%). CONCLUSIONS: The NVCE role is new, and few have written job descriptions or specific funding for the role. They oversee education across the continuum of learners in their departments, communicate the education mission in an annual report and oversee educational scholarship. Most were not formally trained for the role and previously served in other education leadership roles. These data will be useful to programs in creating job descriptions and goals for the NVCE role.

Vices in autonomous paternalism: The case of advance directives and persons living with dementia1.

Advance directives are intended to extend patient autonomy by enabling patients to prospectively direct the care of their future incapacitated selves. There has been much discussion about issues such as whether the future incompetent self is identical to the agent who issues the advance directive or whether advance directives can legitimately secure patient autonomy. However, there is another important question to ask: to what extent and in what conditions is it ethically appropriate for one to limit the liberty or agency of one's future incompetent self by issuing an advance directive? In this paper, I use a virtue-ethical approach to explore this question, focusing on the case of an advance directive for the future self with moderate dementia. First, I examine virtuous attitudes with regard to autonomy and argue that one can manifest vices or ethically undesirable character traits in trying to intervene in the future self's life. In particular, I argue that this case can manifest vices such as disdainfulness, intellectual arrogance, and self-dictatorship, which is the vice of trying to control one's life to an excessive degree, and that a self-dictator fails to give due moral consideration to the future self's liberty or agency. I then introduce the Daoist idea of wu-wei, which recommends embracement of what happens in one's life, as one of the possible remedies for the overemphasis on the value of autonomy and control.

Consumption Threshold at Which Virtue Products Become Vice Products: The Case of Beer.

Relative vices and virtues have traditionally been defined according to time-inconsistent preferences. Vice products exchange small immediate rewards (e.g., pleasure) for larger delayed costs (e.g., health), while virtue products exchange small immediate costs for larger delayed rewards. This definition can be criticized because there is evidence that small amounts of beer (or chocolate) convey a long-term health benefit, whereas large quantities impose a delayed cost. Thus, we assume that virtue products can become vice products when consumption is above a certain threshold. Survey data identifies alcoholic beer as a product that gives immediate rewards and does not impose a delayed cost. Our analysis reveals a consumption threshold that supports our assumptions.