What's Wrong with Tombstoning and What Does This Tell Us About Responsibility for Health?

Snelling, Paul

doi:10.1093/phe/phu008

Cited by 5 publications

(7 citation statements)

References 26 publications

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“…I imagine that my (adult) son has jumped 30 feet from a pier into the sea after enjoying a lunchtime drink. The activity of tombstoning has been subject to disapproval and regulation but also has been defended as an enjoyable outdoor activity whose risks can be minimized (Snelling, ). It can be regarded as analogous to the whole range of health‐threatening behaviours that are the standard targets of health promotion and regulation.…”

Section: Methodological and Reflective Interludementioning

confidence: 99%

“…If I found out that my son had jumped just because everyone else had or just to impress a girl or a gang of lads, my reaction would be more severe than had he made a cool calculation about the benefits and risks involved. The obligation that I hold him to and blame him for not meeting is one of process rather than outcome (Snelling, ). In arguing that the moral status of tombstoning is not linked to an absolute view that it is wrong I hope to escape the charge that I am regarding the sometimes permissible as always forbidden, that I place too much emphasis on impersonal and universalizable moral precepts, seeing them away from their lived experience.…”

Section: Methodological and Reflective Interludementioning

confidence: 99%

“…The continuing position of respecting autonomy as the predominant principle of bioethics may need increasingly robust defence in light of the challenges from behavioural, cognitive, and neurosciences (Sie & Wouters, ) and the view that, particularly when future and current desires are concerned, different versions of autonomy can coexist (Coggon, ). That the simplistic image of individuals as free and autonomous choosers is increasingly being accepted as questionable is demonstrated by the use of choice architecture based on behavioural insight (Cabinet Office, , Thaler & Sunstein, ) as well as the presentation of health promotion information in a way that does little to facilitate personal autonomy and much to manipulate choice (Snelling, ).…”

Section: Moral Agencymentioning

confidence: 99%

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Who can blame who for what and how in responsibility for health?

Snelling

2014

Nursing Philosophy

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This paper starts by introducing a tripartite conception of responsibility for health consisting of a moral agent having moral responsibilities and being held responsible, that is blamed, for failing to meet them and proceeds to a brief discussion of the nature of blame, noting difficulties in agency and obligation when the concept is applied to health threatening behaviours. Insights about the obligations that we hold people to and the extent of their moral agency are revealed by interrogating our blaming behaviour, and to facilitate this my own blaming attitudes and actions are analysed in respect of an imagined adult son who seeks thrills by jumping from a pier into the sea, an activity common around coastlines and intended to be analogous in varying degrees to a range of health-threatening behaviours. I consider my responses to this imagined act in relation to some features of moralism, the excess of morality, concluding that blame can be justified when it is proportionate and within interpersonal relationships. There is evidence that some nurses hold negative blaming attitudes towards groups of patients considered to have caused or contributed to their illness, but this is not justified, not only because of impaired agency, but because if there is responsibility for health, associated obligations are owed to those who share our lives, and it is those people who are entitled to hold individuals responsible. Nurses who hold negative blaming attitudes towards groups of patients are invited to identify the status of moral agency, the precise natures of their (failed) obligations and of the patient / nurse relationship. It is concluded that reflection on these matters, and the difference between justified blame and moralism demonstrates that blaming behaviour in the context of professional health care is built on nothing stronger than prejudice.

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Section: Methodological and Reflective Interludementioning

confidence: 99%

Section: Methodological and Reflective Interludementioning

confidence: 99%

Section: Moral Agencymentioning

confidence: 99%

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Who can blame who for what and how in responsibility for health?

Snelling

2014

Nursing Philosophy

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“…His point is an interesting one because the precise nature of our obligations to individuals is not clear. My own view is that a decision to continue to smoke or drink is a moral choice, which requires consideration of the effect our potentially diminished physical health has on those who have a legitimate interest in it (Snelling, ), and I am with Mill in saying that financial obligations also require consideration. This obligation has to be undertaken in the context of our own life and own version of the good life and need not be demanding.…”

Section: What Would Mill Say About Smoking Policies?mentioning

confidence: 99%

The subversion of Mill and the ultimate aim of nursing

Snelling

2017

Nursing Philosophy

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This is lightly edited and referenced version of a presentation given at the 20thInternational Philosophy of Nursing conference in Quebec on 23rd August 2016.Philosophical texts are not given the same prominence in nurse education as their more valued younger sibling, primary research evidence, but they can influence practice through guidelines, codes and espoused values. John Stuart Mill's harm principle, found in On Liberty, is not a universal law, and only a thoroughgoing libertarian would defend it as such, though it, or its remnants, can be seen can be seen in policy documents. But its influence is weakening. Smoking bans in enclosed spaces were initially justified with other-regarding considerations, but judgements from unsuccessful legal challenges from patients in UK psychiatric hospitals rely on preventing harm to the smoker, even when smoking outside, which does not harm others. In the wake of legislation, no-smoking policies enacted by hospitals are becoming more aggressive, banning smoking both inside and outside, and extending the use of power gained through employment to prevent nurses assisting patients enjoy a lawful habit. Mill's dictum has been subverted, and this speaks to the fundamental purpose of nursing.Should nurses collude and willingly exert their power for their version of the good of the patient? Or should they instead reaffirm values that support and facilitate life choices made by autonomous people? The paper supports the latter option, and this has wider application for nursing which can be illuminated, if not settled, by revisiting Mill and his famous dictum. K E Y W O R D SJohn Stuart Mill, no smoking policy, On Liberty, Rampton, Smoking | INTRODUCTIONWhen thinking about how I could make best use of this kind invitation to speak, I recalled a conference (I won't say which) some years ago. Two plenary speakers stick in the memory. The first was a wellknown nurse academic, who gave every impression that he was speaking completely off the cuff. He was to the extent that there were no notes and plenty of animation, but it soon became apparent that this was because it was little more than an introductory lecture, probably delivered in the same way to lecture halls full of bemused first semester undergraduates every September for many years. I went to coffee wondering whether he was worth the airfare.The second was a distinguished philosopher, and her paper was so dense and detailed that it passed straight over my head into the ether.Unlike the first speaker, she was reading her paper aloud. But it was a paper written to be read, not listened to. The complex ideas needed pause, a re-read and thoughtful application, and because as the education literature tells us, we have limited concentration spans, not least in a crowded and warm conference hall, her ideas were quickly lost. In my presentation, I aimed to steer the middle ground between these positions. I don't think that I said much that you haven't already heard but it's good to pause and revisit Mill and ask if we can lear...

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“…Serious questions can be raised in regard to the liberal criteria for the distribution of healthcare services, mainly the version presented by Sen's capabilities approach, 15 which privileges the liberty of the population to seek these services or favor some other functioning over those related to a good health. 16 The values that are central to leading a good life may be divergent in different cultures; for example, some cultures do not even consider a long life as a valuable end. 17 Liberalism accommodates these cases, allowing everyone the liberty to choose their own functioning, to pursue what they consider to be a good life.…”

Section: Liberalism Health and Life Plansmentioning

confidence: 99%

Issues on Luck Egalitarianism, Responsibility, and Intercultural Healthcare Policies

Bermea¹

2016

Camb Q Healthc Ethics

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This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services.

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What's Wrong with Tombstoning and What Does This Tell Us About Responsibility for Health?

Cited by 5 publications

References 26 publications

Who can blame who for what and how in responsibility for health?

Who can blame who for what and how in responsibility for health?

The subversion of Mill and the ultimate aim of nursing

Issues on Luck Egalitarianism, Responsibility, and Intercultural Healthcare Policies

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