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Sick Role Theory



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Health \u0026 Medicine: Crash Course Sociology #42

Welfarism is the view that goodness should be assessed only in terms of subjective utility. Second, because it is concerned only with feelings it neglects information about physical health, though this would seem obviously relevant to assessing well-being. People can become so normalized to their conditions of material deprivation and social injustice that they may claim to be entirely satisfied. As Sen puts it,. Our mental reactions to what we actually get and what we can sensibly expect to get may frequently involve compromises with a harsh reality. The destitute thrown into beggary, the vulnerable landless labourer precariously surviving at the edge of subsistence, the overworked domestic servant working round the clock, the subdued and subjugated housewife reconciled to her role and her fate, all tend to come to terms with their respective predicaments.

The deprivations are suppressed and muffled in the scale of utilities reflected by desire-fulfilment and happiness by the necessity of endurance in uneventful survival. Sen , Sum-ranking focuses on maximizing the total amount of welfare in a society without regard for how it is distributed, although this is generally felt to be important by the individuals concerned.

Sen argues, together with liberal philosophers such as Bernard Williams and John Rawls, that sum-ranking does not take seriously the distinction between persons. Sen also points out that individuals differ in their ability to convert resources such as income into welfare. For example, a disabled person may need expensive medical and transport equipment to achieve the same level of welfare. A society that tried to maximize the total amount of welfare would distribute resources so that the marginal increase in welfare from giving an extra dollar to any person would be the same. Resources would therefore be distributed away from the sick and disabled to people who are more efficient convertors of resources into utility.

Resourcism is defined by its neutrality about what constitutes the good life. It therefore assesses how well people are doing in terms of their possession of the general purpose resources necessary for the construction of any particular good life. Sen believes such cases are far from abnormal and excluding them at the beginning risks building a structure that excludes them permanently. Nevertheless Sen acknowledges that although the distribution of resources should not be the direct concern in evaluating how well people are doing, it is very relevant to considerations of procedural fairness. When evaluating well-being, Sen argues, the most important thing is to consider what people are actually able to be and do.

The commodities or wealth people have or their mental reactions utility are an inappropriate focus because they provide only limited or indirect information about how well a life is going. Sen illustrates his point with the example of a standard bicycle. It might be considered a generally useful tool for most people to extend their mobility, but it obviously will not do that for a person without legs. Even if that person, by some quirk, finds the bicycle delightful, we should nevertheless be able to note within our evaluative system that she still lacks transportation. Nor does this mental reaction show that the same person would not appreciate transportation if it were really available to her. The Capability Approach focuses directly on the quality of life that individuals are actually able to achieve.

Figure 1. Outline of the core relationships in the Capability Approach. Figure 1 outlines the core relationships of the Capability Approach and how they relate to the main alternative approaches focused on resources and utility. Achieved functionings are those they actually select. The functioning they actually select to get to work may be the public bus.

Utility is considered both an output and a functioning. Utility is an output because what people choose to do and to be naturally has an effect on their sense of subjective well-being for example, the pleasure of bicycling to work on a sunny day. However the Capability Approach also considers subjective well-being — feeling happy — as a valuable functioning in its own right and incorporates it into the capability framework. Sen argues that the correct focus for evaluating how well off people are is their capability to live a life we have reason to value, not their resource wealth or subjective well-being.

But in order to begin to evaluate how people are performing in terms of capability, we first need to determine which functionings matter for the good life and how much, or at least we need to specify a valuation procedure for determining this. One way of addressing the problem is to specify a list of the constituents of the flourishing life, and do this on philosophical grounds Martha Nussbaum does this for her Capability Theory of Justice.

Sen rejects this approach because he argues that it denies the relevance of the values people may come to have and the role of democracy Sen b. Philosophers and social scientists may provide helpful ideas and arguments, but the legitimate source of decisions about the nature of the life we have reason to value must be the people concerned. Sen therefore proposes a social choice exercise requiring both public reasoning and democratic procedures of decision-making. One reason that social scientists and philosophers are so keen to specify a list is that it can be used as an index: by ranking all the different constituents of the flourishing life with respect to each other it would allow easier evaluation of how well people are doing. But Sen argues that substantial action-guiding agreement is possible.

Sen does suggest that in many cases a sub-set of crucially important capabilities associated with basic needs may be relatively easily identified and agreed upon as urgent moral and political priorities. They may be particularly helpful in assessing the extent and nature of poverty in developing countries. Evaluating capability is a second order exercise concerned with mapping the set of valuable functionings people have real access to. Since it takes the value of functionings as given, its conclusions will reflect any ambiguity in the valuation stage.

Assessing capability is more informationally demanding than other accounts of advantage since it not only takes a much broader view of what well-being achievement consists in but also tries to assess the freedom people actually have to choose high quality options. This is not a purely procedural matter of adding up the number of options available, since the option to purchase a tenth brand of washing powder has a rather different significance than the option to vote in democratic elections. The informational focus can be tightened depending on the purpose of the evaluation exercise and relevant valuational and informational constraints.

In order to achieve the same functionings, people may have particular needs for non-standard commodities — such as prosthetics for a disability — or they may need more of the standard commodities — such as additional food in the case of intestinal parasites. These can impose particular costs such as more or less expensive heating or clothing requirements. Conventions and customs determine the commodity requirements of expected standards of behaviour and consumption, so that relative income poverty in a rich community may translate into absolute poverty in the space of capability.

The diagnosis of capability failures, or significant interpersonal variations in capability, directs attention to the relevant causal pathways responsible. For example, the physically handicapped often have more expensive requirements to achieve the same capabilities, such as mobility, while at the same time they also have greater difficulty earning income in the first place. The concept of a capability has a global-local character in that its definition abstracts from particular circumstances, but its realization depends on specific local requirements.

This makes the Capability Approach applicable across political, economic, and cultural borders. For example, Sen points out that being relatively income poor in a wealthy society can entail absolute poverty in some important capabilities, because they may require more resources to achieve. For example, the capability for employment may require more years of education in a richer society.

Many capabilities will have underlying requirements that vary strongly with social circumstances although others, such as adequate nourishment, may vary less. Presently in Saudi Arabia, for example, women must have the company of a close male relative to appear in public, and require a chauffeur and private car to move between private spaces since they are not permitted to use public transport or drive a car themselves. The Capability Approach only identifies such capability failures and diagnoses their causes. However, if there is general agreement in the first place that such capabilities should be equally guaranteed for all, there is a clear basis for criticizing clearly unjust social norms as the source of relative deprivation and thus as inconsistent with the spirit of such a guarantee.

The capability approach takes a multi-dimensional approach to evaluation. Capability analysis rejects the presumption that unusual achievement in some dimensions compensates for shortfalls in others. Capability evaluation is informationally demanding and its precision is limited by the level of agreement about which functionings are valuable. However, Sen has shown that even where only elementary evaluation of quite basic capabilities is possible for example, life-expectancy or literacy outcomes , this can still provide much more, and more relevant, action-guiding information than the standard alternatives. In particular, by making perspicuous contrasts between successes and failures the capability approach can direct political and public attention to neglected dimensions of human well-being.

For example, countries with similar levels of wealth can have dramatically different levels of aggregate achievement — and inequality — on such non-controversially important dimensions as longevity and literacy. And, vice versa , countries with very small economies can sometimes score as highly on these dimensions as the richest. This demonstrates both the limitations of relying exclusively on economic metrics for evaluating development, and the fact that national wealth does not pose a rigid constraint on such achievements that GNP is not destiny.

Figure 2. Perspicuous contrasts: The Philippines does more with less. Rawls suggests that this constitutes the privileging of a particular non-political comprehensive conception of rational advantage or the good. Theories of justice that focus on the distribution of means implicitly assume that they will provide the same effective freedom to live the life one has reason to value to all, but this excludes relevant information about the relationship between particular people and resources. That means that even if it happened that everyone had the same conception of the good, and the same bundle of resources, the fact of heterogeneity would mean that people would have differential real capability to pursue the life they had reason to value.

Therefore, Sen argues, a theory of justice based on fairness should be directly and deeply concerned with the effective freedom — capability — of actual people to achieve the lives they have reason to value. Sen does not say which capabilities are important or how they are to be distributed: he argues that those are political decisions for the society itself to decide. Different capability theorists have taken different approaches to the valuation of capabilities, from procedural accounts to ones based on substantive understandings of human nature.

There are related concerns about the institutional structure of the Capability Approach, for example, brought by the Rawlsian social justice theorist, Thomas Pogge Pogge How should capabilities be weighted against each other and non-capability concerns? For example, should some basic capabilities be prioritized as more urgent? What does the Capability Approach imply for interpersonal equality? How should capability enhancement be paid for? How much responsibility should individuals take for the results of their own choices? What should be done about non-remediable deprivations, such as blindness?

There are several components to this family of criticisms. Martha Nussbaum, for example, points out that a just society requires balancing and even limiting certain freedoms, such as regarding the expression of racist views, and in order to do so must make commitments about which freedoms are good or bad, important or trivial Nussbaum Nevertheless Sen is clear in his view that the value of social goods is only derivative upon the reflective choices of those concerned see, for example, Sen a. With regard to freedom, Sen distinguishes the ability to choose between different options from the value of those options. These two together make up effective freedom or capability.

This relates to its concern with tracing the causal pathways of specific deprivations, with how exactly different people are able or unable to convert resources into valuable functionings. However it has been criticized for its crudeness. It contains only three dimensions — longevity, literacy mean years of schooling , and Gross National Income per capita — which are weighted equally. It also requires detailed information on the real inter-personal variations in translating commodities into functionings.

It is not clear however that such informational ambitions could ever be realized. Nevertheless it has succeeded in demonstrating that capability related information can be used systematically as a credible supplement to economic metrics. Sen accepts that some information about capabilities is easier to obtain than others. Firstly, he argues that we already have quite extensive information about some basic capabilities even for many quite poor countries, such as about health, that can and should be systematically assessed. There is therefore no need to limit our assessment to economic metrics which firstly count the wrong things means and secondly also come with significant measurement error despite their apparent numerical precision.

Secondly, he argues that if researchers accept the capability space as the new priority for evaluation that will motivate the development of new data collection priorities and methods. Nevertheless, the Capability Approach is not concerned with information collection for its own sake, but rather with the appropriate use of information for assessment. It is therefore not committed to, nor does its effective use require, building a perfect information collection and assessment bureaucracy. Some theoretical accounts are primarily concerned with operationalising the evaluative dimension of the Capability Approach: the assessment of quality of life, well-being and human development. This section provides a brief outline of some of these. Instead she proposes a procedural approach to the selection of capabilities for particular purposes, such as the evaluation of gender inequality in terms of capabilities Robeyns She claims that valuational procedures that meet her criteria provide epistemic, academic, and political legitimacy for empirically evaluating capability.

Her five criteria are:. All proposed list elements should be explicit, so they can be discussed and debated. The method of generating the list should be made explicit so it can be scrutinized. The level of abstraction of the list should be appropriate to its purposes, whether for philosophical, legal, political, or social discussion. If the list is intended for empirical application or public policy then it should be drawn up in two distinct stages, first an ideal stage and then a pragmatic one that reflects perhaps temporary feasibility constraints on information and resources.

The list should include all important elements and those elements should not be reducible to others though they may overlap. Sabina Alkire has developed a philosophically grounded framework for the participatory valuation and evaluation of development projects in terms of capability enhancement Alkire This allows her to go beyond standard cost-benefit analyses of development projects in financial terms to investigate which capabilities that the people concerned have reason to value are enhanced and by how much. The intrinsically important dimensions identified by this method are: Life; Knowledge; Play; Aesthetic experience; Sociability; Practical reasonableness; Religion. One of the advantages Alkire claims for her approach is its ability to elicit what the people whose lives are the subject of development projects really consider valuable, which may sometimes surprise external planners and observers.

Her use of the participatory approach for assessing NGO fieldwork in Pakistan showed, for example, that even the very poor can and do reasonably value other things than material well-being, such as religion and social participation. Elizabeth Anderson has proposed a partial theory of justice based on equal capability of democratic citizenship Anderson Anderson takes equality in social relationships as the focus for her egalitarian theory of justice and argues that one should analyze the requirements of such equality in terms of the social conditions supporting it as a capability. Positively, they are entitled to whatever capabilities are necessary for functioning as an equal citizen in a democratic state Anderson , John Alexander has proposed a capability theory based on a Republican understanding of the importance of freedom as non-domination Alexander The reason why these passengers were oblivious?

Because a majority of the cruise ship's cases were asymptomatic. Researchers are now pointing to this cruise ship outbreak, in which all passengers were provided surgical masks, as evidence that universal masking may result in a higher proportion of asymptomatic COVID cases. Other outbreaks of mostly asymptomatic cases where widespread masking was implemented, in places like jails and meatpacking plants, provide epidemiological data that masks could reduce viral inoculum -- and as a result, decrease the severity of illness.

Writing in the New England Journal of Medicine , Monica Gandhi, MD, and George Rutherford, MD, of the University of California in San Francisco, hypothesized that widespread population masking may act as a sort of "variolation," exposing individuals to a smaller amount of viral particles and producing an immune response. Gandhi told MedPage Today that the viral inoculum, or the initial dose of virus that a patient takes in, is one likely determinant of ultimate illness severity. That's separate from patients' subsequent viral load, the level of replicating virus as measured by copies per mL. The "variolation" hypothesis holds that, at some level, the inoculum overwhelms the immune system, leading to serious illness. With less than that and the threshold may vary from one person to the next , the individual successfully fights off the infection, with mild or no clinical illness.

Severe COVID may be caused by a reaction known as the cytokine storm, an immune response in which the body attacks its own cells and tissues as opposed to the virus itself. Although this theory has yet to be proven and other theories, such as the bradykinin storm , have been suggested , a large initial dose of SARS-CoV-2 may be the trigger. Trials that give humans different doses of viral RNA are not ethical, of course. But animal studies provide preliminary evidence that viral inoculum could impact disease severity, Gandhi noted. In a study of Syrian hamsters , for example, those infected with a higher dose of SARS-CoV-2 had worse outcomes compared to those infected with smaller amounts of virus.

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