Monthly Archives: October 2014

Moral Luck – Choice and Chance

Welcome to my first review from a lecture I picked up this course from the teaching company called “Questions of Value”. This lecture although rather deep, is quite a fairly good start to my blog since it involves ethics, something family, carers and the community can become involved in from daily situations.

The course is taught by Professor Patrick Grim from State University of New York.

Professor Patrick Grim

Within this particular course I look at lecture 19 out of 24 called “Choice and Chance”. Here this particular lecture looks at how the role of luck affects ethics and morality. We explore in this lecture Is life a mere matter of luck?

First the lecture explores why Immanuel Kant a famous philosopher thought that luck plays no role in mortality, Kant thinks that it is the good will that’s important and luck should not be a factor in moral decisions.

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Here is a passage where Kant explains why he feels Luck has no place in the idea of moral decisions.

“A good will is good not because of what it effects, or accomplishes, not because of its fitness to attain some intended end, but good just by its willing, i.e. in itself; and, considered by itself, it is to be esteemed beyond compare much higher than anything that could ever be brought about by it in favor of some inclinations, and indeed, if you will, the sum of all inclinations.”

However Prof Patrick feels moral value of an action CAN depend on mere luck, there are factors of luck that can affect the outcome of an action. Some outcomes can be favourable, while others can cause disaster.

 

This lecture explores how morality is open to chance and for most of the lecture, Prof Patrick concentrates on factors of the law. We have several examples where ethics and the law are open to dispute. A good example brought up in the lecture was for instance the idea of crime of murder and the idea of attempted crime. The law has varying levels of different punishment, hence the act of attempted and the act of murder carried out.

Prof Patrick poses several questions
– How can these cases be treated so differently?
– What the person was trying to do, if successful?

Patrick starts that attempted murder may be unsuccessful because something outside your control could have happened e.g. Luck or something deeper that changes the outcome.

so here we have the law which allows one person to be executed to death, and the other is in jail a few years. The lecture looks at what how much of a difference that the mere amount of luck plays. Plus it seems unfair because of the ethical differences, but mainly just down to chance.

The lecture looks at the idea of intent, for instance when two drunken men fight in a bar and one yells out “I ll Kill you” and pushes the other man far back, which leads to the man falling and cracking his skull. We are asked what was the intent?

Another view from a philosopher Thomas Nagel, feels something seems unfair about this. Thomas feels moral luck does play a part in ethics and how it affects us. Thomas explored the ideas of 4 types of moral luck.

Being : –

Circumstantial Moral Luck
Constitutive Moral Luck
Causal Moral Luck
Resultant Moral Luck

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The lecture examines the idea of “Resultant Moral luck” further by exploring the following example.

A speeding truck driver runs over a person, the driver will feel bad about this, however the truck driver can be negligence if he did not check his truck’s tires. While another truck driver also drives dangerously, but for him, even though he was speeding as well, the person was crossing on the road at the time.

Although negligence seems to be the case for both examples, the main difference is that outside forces e.g. the person being on the road must have played a part in how luck can affect the outcome.

Nagel shows our moral values can be self contradictory and he feels Kant conclusion of moral luck is unacceptable. However there are still some problems with this conclusion, the course feels Nagal is wrong, and there is a deeper level of ethics and intuition that plays its part in the human condition. Sometimes the legal system struggles take these factors into account because of the cost of social resources.

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The lecture also looks into the problem of how social machinery operates, where we all know that no social machinery operates flawlessly, we are all prone to error. The social machinery design to present harm, can actually cause harm as it sways from one factor to another in balancing social issues.

So the fine line between the truck drivers is that they have both done something wrong, whether or not the person dies…which leads kant to be roughly right, but the social machinery needs to fit in to this structure, which it sometimes does not do.

How can this relate to families and carers? How can moral principles affect how society views them. we all question ourselves about if we are negligent towards our loved ones. We wonder if they suffer more because we have made the wrong decision. I sometimes feel that as a carer it is not possible to cover all bases, sometimes carers are in a position where outside factors can affect the result of care.

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The lecture states that Morality has a social machinery as well, some moral principles are maybe too difficult to frame without expecting people to apply them without moral error.

The lecture finally looks at the problem of the transmission of ethical principles from generation to generation, such principles need to be generally effective and easily taught. Not all can be easily transferred, some are just not quite right where legal frameworks can also fail. for instance the idea of inherent wrongness cannot be easily identified.

There are problems where there are levels of social complexity in morality. The law also has is own problems because of social complexity. Prof Thomas feels that we have to take into account that some of our moral conditions or intuitions are far deeper than others, but the difficultly is identifying the ones that form some truth against the easy principles.

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Where the Caring “Mind” comes in

After spending some time thinking of what else I can add to my carers blog site, I wondered what could be of interest to others visiting the site. As you may have already known, I am bound to review things, such as the events I visit, but what about other subject criteria?

I mean this blog is not just about the world of caring, its also a reflection of what I have been through and what I have experienced in the realm of mental health. I actually have another blog, which reviews audio lectures. Some of the lectures are to do with history, but the problem is this particular blog site is on caring and mental health, so I took a long hard look at the subjects which I wish to include in the blog.

Continue reading

World Mental Health day 2014 – #mhday

The Future

On this blog post, I have decided to do a post about World Mental Health Day 2014. Last year on World Mental health day 2013, I visited an event to do with service user involvement in research, which was held over at the London School of Hygiene & Tropical Medicine.

This year I am going to visit around 3 or 4 events in South London and experience how different people celebrate world mental health day 2014.

 

Please check out the video I made of the events I visited that day.

Going back to my blog post, ever since I have been a carer for someone suffering from schizophrenia, I have always wondered how such a mysterious illness can take the personality away from our loved ones.

I sometimes struggle to work out why my loved one does not understand me as much as she used to. It seems as far as I can remember my loved one seems so different as if there is lack of interest in many things, sometimes she is irritable and other times very withdrawn.

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It feels like I could never understand mental health difficulties and I am sure my loved one struggles to explain how she feels.

I think that perhaps this is one of the reasons why there is a World Mental Health day 2014. The event is to allow others to reflect and think about mental health for the day. We cannot all experience what mental ill health fully means unless we are sufferers, but at least we can all help raise awareness and combat the stigma of mental ill health throughout society.

I feel it does not matter too much if you suffer from bipolar or severe depression, with world mental health day, it is so important to get our voices heard, it is so important to write down our thoughts and feelings so that others can learn from those affected by schizophrenia.

I only hope that as a carer and one that blogs fairly often, that others out there are inspired to blog about mental health. World Mental Health day need not be about depressing others about mental health, the day can also be a celebration of those who are clearly part of society.

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We all go through difficult days and we all hit different levels of mental health. The blur between carers, health professionals and those with lived experience can encompass us all as anyone can be hit by mental health problems.

Society can only gain in the long run when no one is isolated, where no one is stigmatized and where no one ends up developing mental ill health in the first place. With events like World Mental Health Day, we can take that extra step to be aware of our own mental health, we can take that extra step to be aware of others suffering mental health problems.

I feel World Mental Health Day is about coming together and recognising what makes us human, no matter how fragile or strong we all are, we can forget that we are people, we end up forgetting our minds until its too late. We need to use such events as a way to remember that our mental health and emotions play a far bigger role than we ever take notice of.

Let us all celebrate, help raise awareness and use World Mental Health Day to aid us in to becoming healthier people and not only look after ourselves but to stop, reflect and look after others.

Please take some time to check out everyone elses blog posts at http://blogs.psychcentral.com/mental-health-day/

Carers – Being the connection in communication

Welcome back to another blog post from a fellow carer. I would like you to check out the following scenario.

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Just imaging this. Here we have a patient who talks to the doctor, the doctor sometimes struggles to understand the patient, then the doctor contacts the mental health consultant, the mental health consultant then contacts the care coordinator, the care coordinator contacts the patient, the patient then contacts an advocate and the advocate contacts the doctor, the doctor contacts the social worker who in turn speaks to the care coordinator who then is too busy to contact the patient who in turn does not contact anyone for a long time sinking futher into relapse.

Whats missing from this scenario?

Who is not being contacted or doing the contacting?

Anyone guess?

Thats it!! It is the carer. Each and everyone in that scenario is important and they all have their roles and responsibilities. However When there is a communication break down, which can often happen, when is it time to contact…….the carer?

Chain in the link

Time and time again, us carers who are looking after someone suffering from mental ill health will look to contact those involved in providing a service for the patient or for our loved ones.

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There will be times that every so often carers feel shut out because we may not hear from anyone and yet us carers have to pluck up the courage and start raising issues, us carers have to start asking questions, because if we do not care then the ultimate question is who will care?

I am not stating that there is no reason for carers not to be contacted, there are plenty of good reasons and one being patient confidentiality. This goes to say that someone suffering mental ill health may not wish their family or carer to know what they are going through or suffering from. Some reasons are mental health stigma, other reasons are the fear of relationship break down and one of the most important is patient rights.

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We all know there must be a balance to protect the patient, but this also does not mean that confidentiality can be used as an excuse, which it can sometimes be used as an excuse. I am no expert in patient rights or confidentiality, I can only speak as a carer of 11 years. Yet I have seen excuse after excuse as to why I have not been contacted if whoever I am looked after is suffering physical or mental health health difficulties, although at times I can see why information was not devulged to myself.

Us carers walk the fine line between fear, guilt and being isolated or pushed aside. We do not want our loved ones to experience any more pain, but we sit there at times silently waiting and guessing when to act. Us carers wonder when to ask more questions or when to raise concerns. Carers are that vital chain in the link, especially if we are caring for those who struggle to look after themselves.

 

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Mental Health and the Mortality Gap

It is known that those suffering mental health problems unfortunately have short life expectancies. They lives are about 10 years shorter than those who do not have mental health difficulties. This has become an issue in which the government is trying to tackle, but there is no easy solution.

When you hear of such depressing statistics then many are asking the question why are people suffering mental health problems dying far earlier?

  • Is this because suffers are so unwell that they cannot raise physical health problems sooner to the health professional?
  • Maybe the fault is with the health profession who might dismiss the patient because the service user is not making sense?
  • Perhaps isolation is the biggest killer of those suffering mental health problems as no one is there to listen to them, because the mental ill health has driven others away.
  • Or it could be the old numbers game where there just is not enough resources to check up on someone.
  • Another problem could be that of medication, which can aid in recovery, but can also pacify a patient to the point where they just do not even care about their own health or at worst speed up physical problems due to side effects.
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I am not an expert in mental health and I am sure I am missing far more things off the reasons I have pointed out, I guess I can only speak from carer experience and to be honest I am sure this is also the experience of other carers out there wondering how many years are left for those they are caring for. It is an awful question to ponder, but this is usually on the forfront of many carers minds.

Back in 2013, I went to an interesting event held over at the Institute of Psychiatry. The event was called “Mental Health and the mortality gap: what is responsible and who is to act?”.

The event looked at the challenges and solutions surrounding the physical health of mental health service users.

The panel at the event were experts in their field and suited for such an event.

Where we had Professor Shitij Kapur, Deputy Vice-Principal (Health) and Dean of the IoP hosting the event.

On the panel was Dr Fiona Gaughran, Lead Consultant in the Psychosis Service at South London and Maudsley NHS Foundation Trust.
Simon Wylie, Clinical Lead for Southwark Acute.
Dr Ruth Ohslen, Lecturer in mental Health Studies at the Florence Nightingale School of Nursing and Midwifery.

You can listen to the recording of the event below.

http://alumni.kcl.ac.uk/mental-health-event-2013

In fact at around 33 minutes into the recording, you can hear me asking a question to the panel on my fears about the medication issue, which in fact I was absolutely terrified in asking, but ever since that event I am glad I did ask the question and I felt grateful to have been giving the oppertunity to do so.

However for any carer out there who is wrestling with such questions concerning mental health, I do urge them to attend events like the one I mentioned above. Even if as a carer you might not understand much of what is being discussed, at least you can feel that you making your presence felt, perhaps even form a network.

I can only hope that the Institute of Psychiatry or its new name being the Institute of Psychiatry Psychology and Neuroscience hold more events like these in future.

Whose responsible?

Going back to the issue of carers being part of the connection in communication. Us carers have to sometimes ask those difficult questions. I understand that pressure is placed upon the health professionals and there usually is a tug of war on who gets to know what about the patient.

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The issue is even more tricky if deep down in the back of your mind you feel your loved one is lacking capacity to understand their own health risks, particularly if the physical health problems become more chronic.

I understand us carers cannot live someone else’s life for them and we should not smother whoever we care for either, but there is a threshold on when to act before its too late, which can be difficult for those providing the care and agonizing for those who are too late in raising the alarm.

In the end we are all part of the chain in helping to provide care for those suffering mental ill health and yes even the service user has to be proactive. We all have to communicate at certain degrees, that being the doctor, the consultant, mental health advocates and us carers.

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The NHS is under pressure as resources become harder to reach, the outcome is that families and carers will play an even bigger part to fill what is left out of the gap of health service, to try close the mortality gap and finally to form the connection of communication.

In the end we are all responsible.