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Variable-Value axiologies avoid Parfit’s Repugnant Conclusion while satisfying some weak instances of the Mere Addition principle. We apply calibration methods to two leading members of the family of Variable-Value views conditional upon: first, a very weak instance of Mere Addition and, second, some plausible empirical assumptions about the size and welfare of the intertemporal world population. We find that such facts calibrate these two Variable-Value views to be nearly totalist, and therefore imply conclusions that should seem repugnant to anyone who opposes Total Utilitarianism only due to the Repugnant Conclusion.
I defend a weak version of the Pigou–Dalton principle for chances. The principle says that it is better to increase the survival chance of a person who is more likely to die rather than a person who is less likely to die, assuming that the two people do not differ in any other morally relevant respect. The principle justifies plausible moral judgements that standard ex post views, such as prioritarianism and rank-dependent egalitarianism, cannot accommodate. However, the principle can be justified by the same reasoning that has recently been used to defend the core axiom of ex post prioritarianism and egalitarianism, namely, Pigou–Dalton for well-being. The arguably biggest challenge for proponents of Pigou–Dalton for chances is that it violates state dominance for social prospects. However, I argue that we have independent reason for rejecting state dominance for social prospects, since it prevents a social planner from properly respecting people's preferences.
Laurie Paul argues that, when it comes to many of your most significant life-changing decisions, the principles of rational choice are silent. That is because, in these cases, you anticipate that one of your choice options would yield a transformative experience. We argue that such decisions are best seen as ones in which you anticipate awareness growth. You do not merely lack knowledge about which possible outcome will arise from a transformative option; you lack knowledge about what are the possible outcomes. We show how principles of rational choice can be extended to cases of anticipated awareness growth.
This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several ‘calibration dilemmas’, in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, we show that our results challenge common utilitarian accounts of the badness of inequalities in resources.
The main aim of this Element is to introduce the topic of limited awareness, and changes in awareness, to those interested in the philosophy of decision-making and uncertain reasoning. While it has long been of interest to economists and computer scientists, this topic has only recently been subject to philosophical investigation. Indeed, at first sight limited awareness seems to evade any systematic treatment: it is beyond the uncertainty that can be managed. On the one hand, an agent has no control over what contingencies she is and is not aware of at a given time, and any awareness growth takes her by surprise. On the other hand, agents apparently learn to identify the situations in which they are more and less likely to experience limited awareness and subsequent awareness growth. How can these two sides be reconciled? That is the puzzle we confront in this Element.
Suppose that a decision-maker’s aim, under certainty, is to maximize some continuous value, such as lifetime income or continuous social welfare. Can such a decision-maker rationally satisfy what has been called ‘continuity for easy cases’ while at the same time satisfying what seems to be a widespread intuition against the full-blown continuity axiom of expected utility theory? In this note I argue that the answer is ‘no’: given transitivity and a weak trade-off principle, continuity for easy cases violates the anti-continuity intuition. I end the note by exploring an even weaker continuity condition that is consistent with the aforementioned intuition.
The Repugnant Conclusion is an implication of some approaches to population ethics. It states, in Derek Parfit's original formulation,
For any possible population of at least ten billion people, all with a very high quality of life, there must be some much larger imaginable population whose existence, if other things are equal, would be better, even though its members have lives that are barely worth living. (Parfit 1984: 388)
Generalized Anxiety Disorder (GAD) is classified as an anxiety disorder. High co-morbidity with other anxiety and depressive disorders blurs boundaries between these disorders, clinically as in research. This is particularly relevant for genetic research into causes of these disorders.
We attempt to clarify where GAD belongs in the anxiety/depression spectrum disorders.
Methods:
The cohort is based on a population-wide screening for anxiety and depression in Iceland as part of a genetic research project. Following the screening participants underwent the Composite International Diagnostic Interview (CIDI) for possible ICD-10 diagnoses. Odds ratios (OR) were calculated by logistic regression analysis for GAD and the other disorders. The phobias (simple, social and agoraphobia) were pooled together in the analysis.
Results:
A total of 3.150 participants underwent the CIDI. The OR between GAD and dysthymia was 2.99 (2.37-3,78), Panic disorder, PD, 2.03 (1.59-2.59); any phobia 1.15 (0.92-1.42) and Major Depressive Disorder, MDD, 1.07 (0.84-1.37). The OR between dysthymia, MDD and GAD is very high, . The OR, with co-morbidity accounted for by logistic regression analysis, is slightly lowered for all except dysthymia.
Conclusions:
Our results show that GAD is significantly associated with dysthymia, followed by PD, but non-significant with the phobias and MDD. Dysthymia, on the other hand, has a robust relationship both to GAD and MDD, 2.97 and 2.91 respectively. Logistic regression confirms the strong link between GAD and dysthymia and gives these disorders the possible role of a genetic bridge between anxiety and depressive disorders.
The National Board of Health and Welfare (NBHW) has developed a multi-dimensional performance assessment framework for open comparisons and assessment of health care. The framework includes the dimensions effectiveness, safety, patient-centeredness, timeliness, equity and efficiency.
Objective
To apply the framework to the area of psychiatric care in Sweden.
Aim
To identify disparities in the treatment and health outcomes of psychiatric patients in order to stimulate improvements.
Methods
More than 30 process and outcome indicators were developed using nationwide health data registers and were compared among regions or between patient groups.
Results
Among other results the study shows large disparities in somatic care between patients with and without comorbid psychiatric disease (equity), low compliance to antidepressant treatment with small regional variations (effectiveness), decreasing suicidal rates (safety), regional variations concerning timeliness of care, lack of national data to asses patient-centeredness and no obvious relationship between costs of psychiatric care and outcome (efficiency).
Conclusions
The study indicates that the quality of psychiatric care in Sweden does not differ to any great extent between regions. However, there are large disparities in somatic care between patients with and without comorbid psychiatric disease. The framework is a useful starting point for assessing psychiatric care but improved reporting to existing registers and development of new data sources, particularly related to psychiatric health care outcomes, could lead to more adequate and comprehensive assessments including all the six dimensions of the framework.
To assess the predictive value of the Suicide Intent Scale in patients with a high suicide risk. The secondary aim was to assess if the use of the factors of the Suicide Intent Scale would offer a better predictive value in case detection. Finally a short version of the scale was created after an item analysis.
Method
Eighty-one suicide attempters were assessed with the Beck‘s Suicide Intent Scale (SIS). All patients were followed up for cause of death. Receiver-operating characteristic (ROC) curves and tables were created to establish the optimal cut-off values for SIS and SIS factors to predict suicide.
Results
Seven patients committed suicide during a mean follow up of 9.5 years. The major finding was that mean SIS distinguished between suicides and survivors. The positive predictive value was 16.7% and the AUC was 0.74. Only the planning subscale reached the statistical significance. Four items were used to test a short version of SIS in the suicide prediction. The positive predictive value was 19% and the AUC was 0.82.
Conclusions
The Suicide Intent Scale is a valuable tool in clinical suicide risk assessment, a short version of the scale may offer a better predictive value.
Treatment resistant schizophrenia (TRS) is one of the most disabling of psychiatric disorders, affecting about 1/3 of patients. First-line treatments include both atypical and typical antipsychotics. The original atypical, clozapine, is a final option, and although it has been shown to be the only effective treatment for TRS, many patients do not respond well to clozapine. Clozapine use is related to adverse events, most notably agranulocytosis, a potentially fatal blood disorder which affects about 1% of those prescribed clozapine and requires regular blood monitoring. This as a barrier to prescription and there is a long delay in access for TRS patients, of five or more years, from first antipsychotic prescription. Better tools to predict treatment resistance and to identify risk of adverse events would allow faster and safer access to clozapine for patients who are likely to benefit from it. The CRESTAR project (www.crestar-project.eu) is a European Framework 7 collaborative project that aims to develop tools to predict i) treatment response, particularly patients who are less likely to respond to usual antipsychotics, indicating treatment with clozapine as early as possible, ii) patients who are at high or low risk of adverse events and side effects, iii) extreme TRS patients so that they can be stratified in clinical trials for novel treatments. CRESTAR has addressed these questions by examining genome-wide association data, genome sequence, epigenetic biomarkers and epidemiological data in European patient cohorts characterized for treatment response, and adverse drug reaction using data from clozapine therapeutic drug monitoring and linked National population medical and pharmacy databases, to identify predictive factors. In parallel CRESTAR will perform health economic research on potential benefits, and ethics and patient-centred research with stakeholders.
When people must either save a greater number of people from a smaller harm or a smaller number from a greater harm, do their choices reflect a reasonable moral outlook? We pursue this question with the help of an experiment. In our experiment, two-fifths of subjects employ a similarity heuristic. When alternatives appear dissimilar in terms of the number saved but similar in terms of the magnitude of harm prevented, this heuristic mandates saving the greater number. In our experiment, this leads to choices that are inconsistent with all standard theories of justice. We argue that this demonstrates the untrustworthiness of distributive judgements in cases that elicit similarity-based choice.
The effects of CO2 on water-basaltic glass interaction have been simulated at 25ºC. The calculations indicate that addition of CO2 (2—30 bar) to water significantly changes the reaction path. Initially, the pH is buffered between 4 and 6 by CO2 ionization, with dissolution of basaltic glass and the formation of secondary minerals with SiO2, Mg-Fe carbonates and dolomite predominating. Upon the dissolution of additional basaltic glass and mineral fixation of CO2, the pH increases to >8 and (Ca)-Fe-Mg smectites, SiO2, Ca-Na zeolites and calcite become the dominant secondary minerals forming. The overall reaction path depends on the initial water composition, reactive surface area, and the composition of the phyllosilicates and carbonates forming. The key factors are the mobility of Mg2+, Fe2+ and Ca2+ and the competing reactions for these solutes among secondary minerals.
The interaction of CO2-rich water with olivine was studied using geochemical reaction modelling in order to gain insight into the effects of temperature, acid supply (CO2) and extent of reaction on the secondary mineralogy, water chemistry and mass transfer. Olivine (Fo93) was dissolved at 150 and 250ºC and pCO2 of 2 and 20 bar in a closed system and an open system with secondary minerals allowed to precipitate. The progressive water–rock interaction resulted in increased solution pH, with gradual carbonate formation starting at pH 5 and various Mg-OH and Mg-Si minerals becoming dominant at pH>8. The major factor determining olivine alteration is the pH of the water. In turn, the pH value is determined by acid supply, reaction progress and temperature.
Pore-volume changes in porous media during water–rock interaction can be studied using hydrological tracers. The tracers used here were amino G acid, napthionic acid and fluorescein at pH 3 and 6.5 in contact with basaltic glass, quartz and rhyolite. The experimental setup mimicked that of a hydrological tracer test where a fixed volume of tracer was injected into a flow-through column and the breakthrough curve monitored. The measured breakthrough tracer curves were compared to theoretical 1-D reactive transport simulations calculated using the PHREEQC program. In some cases the tracers were observed to behave ideally, whereas in others they clearly reacted with the solid surfaces. This implies that some common hydrological tracers used in groundwater hydrology may not be suitable under all conditions as they may react with the surrounding rocks in the groundwater system.
Most people at some point in their lives face transformative decisions that could result in experiences that are radically different from any that they have had, and that could radically change their personalities and preferences. For instance, most people make the conscious decision to either become or not become parents. In a recent but already influential book, L. A. Paul (2014) argues that transformative choices cannot be rational – or, more precisely, that they cannot be rational if one assumes what Paul sees as a cultural paradigm for rational decision-making. Paul arrives at this surprising conclusion due to her understanding of transformative experience as being both epistemically and personally transformative. An experience is epistemically transformative if it ‘teaches [a person] something she could not have learned without having that kind of experience’ (11), but it is personally transformative if it changes the person's point of view and her fundamental preferences (16).