During the COVID-19 pandemic, the media have repeatedly praised healthcare workers for their ‘heroic’ work. Although this gratitude is undoubtedly appreciated by many, we must be cautious about overuse of the term ‘hero’ in such discussions. The challenges currently faced by healthcare workers are substantially greater than those encountered in their normal work, and it is understandable that the language of heroism has been evoked to praise them for their actions. Yet such language can have potentially negative consequences. Here, I (...) examine what heroism is and why it is being applied to the healthcare workers currently, before outlining some of the problems associated with the heroism narrative currently being employed by the media. Healthcare workers have a clear and limited duty to treat during the COVID-19 pandemic, which can be grounded in a broad social contract and is strongly associated with certain reciprocal duties that society has towards healthcare workers. I argue that the heroism narrative can be damaging, as it stifles meaningful discussion about what the limits of this duty to treat are. It fails to acknowledge the importance of reciprocity, and through its implication that all healthcare workers have to be heroic, it can have negative psychological effects on workers themselves. I conclude that rather than invoking the language of heroism to praise healthcare workers, we should examine, as a society, what duties healthcare workers have to work in this pandemic, and how we can support them in fulfilling these. (shrink)

To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should act (...) when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders, we ensure that conflicting needs are considered robustly.We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just. (shrink)

In a recent response to our paper on developing a philosophical framework to guide the design and delivery of a just health service, Sarela raises several objections. We feel that although Sarela makes points which are worthy of discussion, his critique does not undermine either the need for, or the worth of, our proposed model. First, the law does not negate the need for ethics in determining just healthcare policy. Reliance on legal processes can drive inappropriate focus on ensuring policies (...) avoid judicial review, as opposed to ensuring they are truly just; the law affords protection against unjust policies but does not put a commitment to avoiding them at the heart of policy-making. We defend the need for Scanlonian supplementation by emphasising the practical value of adding a step based on reasonable rejection, particularly in ensuring that the views of vulnerable stakeholders are robustly considered. We discuss the similarities and differences between the work of Daniels and Sen in considering the relationship between health and opportunity, concluding that Sen’s capability approach is both valuable and compatible with our proposed model. Finally, the practical use of our model requires consideration of what constitutes a reasonable person. Our model is explicitly intended to help develop a healthcare system which is just to all its users. With this in mind, we suggest that those involved in decision-making should meet Scanlon’s definition of reasonable: they should be motivated to justify their actions to, and seek agreement with, others. (shrink)

Bioethics, Volume 36, Issue 4, Page 434-444, May 2022.

Asymptomatic COVID‐19 testing programmes are being introduced in higher education institutions, but stakeholder views regarding the acceptability of mandating or incentivizing participation remain little understood. A mixed‐method study (semi‐structured interviews and a survey including open and closed questions) was undertaken in a case study university with a student testing programme. Survey data were analysed descriptively; analysis for interviews was based on the framework method. Two hundred and thirty‐nine people participated in the study: 213 in the survey (189 students, 24 staff), (...) and 26 in interviews (19 students, 7 staff). There was majority (62%) but not universal support for voluntary participation, with a range of concerns expressed about the potentially negative effects of mandating testing. Those who supported mandatory testing tended to do so on the grounds that it would protect others. There was also majority (64%) opposition to penalties for refusing to test. Views on restricting access to face‐to‐face teaching for non‐participants were polarized. Three‐quarters (75%) supported incentives, though there were some concerns about effectiveness and unintended consequences. Participants emphasized the importance of communication about the potential benefits of testing. Preserving the voluntariness of participation in student asymptomatic testing programmes is likely to be the most ethically sound policy unless circumstances change. (shrink)

This book provides the first complete, literal English translation of Alexis de Tocqueville’s and Gustave de Beaumont’s first edition of On the Penitentiary System in the United States and Its Application to France. The work contains a critical comparison of two competing American penitentiary disciplines known as the Auburn and Philadelphia systems, an evaluation of whether American penitentiaries can successfully work in France, a detailed description of Houses of Refuge as the first juvenile detention centers, and an argument against (...) penal colonization. The work provides valuable insights into understanding Tocqueville as a statesman, as well as a comparative look at civic engagement in early American and French penal reform movements. The Translator’s Introduction provides historical context for understanding Tocqueville’s work in French penal reform and the major themes of the report. The book thus fills a void in Tocquevillian studies and extrapolates the roots of American and French criminal justice systems in the nineteenth century. (shrink)

We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls’ principles – using his ‘veil of ignorance’ and both the ‘difference’ and ‘just savings’ principles which it generates – provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making (...) them did not know if one was patient, doctor, nurse or manager – in this generation or the next. We first offer a brief summary of Rawls’ approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls’ approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls’ thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil. (shrink)

This article deals with the concepts, processes, and antagonisms that are associated with the notion of postsecularity. In light of this article’s expanded interpretation of José Casanova on the secular and secularization, as well as thoughts on James A. Beckford’s take on public religions, five rubrics on the postsecular derived from critical theory and an understanding of ‘reflexive secularization’ are presented. This term focuses on secularization processes and how these practices unleash complementary as well as antagonistic tendencies, a confrontation of (...) normativities and specific social-empirical challenges. From this basis it is argued that social-empirical analysis should focus on non-naturalistic relations between individuals occupying structurally equivalent positions in narrative networks. A plurality of normativities are seriously considered as ideas circulating through social relations where the critical competence of the participants of such communication processes are provoked to subvert anything – including any normative positionality – as taken for granted. Moves towards the decolonization of the secular/postsecular dyad are emphasized, with ramifications for thinking about the urban, which point to the universal and authentic foundations of the human condition that are brought into play. (shrink)

This historical study aims to explain how the transition from student nurse service to fully qualified “graduate nurse” service in the United States in the 20th century affected assumptions about fundamental patient care in hospital wards and provide historical context for current apprenticeship programs. Through analysis of documents from 1920 when student nurse service, a nurse apprentice model, was the norm to 1960 when the nurse apprentice model was waning in favor of registered nurse service, this study found that the (...) replacement of student nurses with registered nurses led to weakened standardization of fundamental bedside care and the introduction of large numbers of unlicensed nursing assistants. While student nurses could perform all the functions of fully qualified graduate nurses, nursing assistants could not, resulting in a separation of fundamental nursing care from the professional nurse role and changes in assumptions and attitudes toward fundamental care. These changes had a negative effect on fundamental nursing care. New apprenticeship programs provide opportunities for improvement. (shrink)

This book examines contemporary relations between religion, politics and urban societies from a theoretical perspective. Special attention is paid to those authors (e.g. Habermas, Taylor) who analyze new global constellations in terms of a shift from the secular to the postsecular.

Many contemporary scholars defend the position that J. S. Mill was a ‘eudaimonist’, in a sense implying that he was not an ‘experiential’ hedonist. One ‘activist’ argument for this interpretation rests on the claim that Mill’s core axiological uses of ‘pleasure’ in Utilitarianism should be understood to refer to worthy or pleasurable activities rather than mental states. This paper offers a three-stage rebuttal of the activist interpretation. Firstly, in the Analysis, the Examination and the Logic, Mill explicitly identifies pleasures and (...) pains as mental states. Secondly, if we read Mill’s core axiological uses of ‘pleasure’ in Utilitarianism along activist lines, the text’s overall coherence and intelligibility becomes even more questionable than on the traditional experientialist reading. Finally, in his discussions of Plato, Mill seems to distance himself from the axiological view that non-hedonic features of mind or character have intrinsic value in their own right. In consequence, in the small number of cases in Utilitarianism in which Mill clearly speaks of ‘pleasures’ as activities, this is best construed as a derivative usage. (shrink)

Pettit endorses a ‘republican’ conception of social freedom of the person as consisting of a state of non-domination, and takes this to refute Mill’s ‘liberal’ claim that non-domineering but coercive interference can compromise social freedom of choice. This paper argues that Pettit’s interpretation is true to the extent that Mill believes that the legitimate, non-arbitrary and just coercion of would-be dominators, for the sake of preventing them from dominating others, can render them unfree to choose to do so without rendering (...) them socially unfree (qua dominated) persons in their own right. However, contra Pettit, Mill is correct to reject the ‘republican’ view for at least two reasons. Firstly, it enables him to avoid commitment to the implausible implication that would-be dominators who sincerely deny any interest in a shared system of basic liberties are automatically rendered unfree persons by the coercion necessary to uphold such a system. Secondly, it enables him to avoid begging the question against ‘immoralists’ like Nietzsche, whose opposition to systems of reciprocal non-domination is at least partly motivated by the losses of social freedom of choice they entail for those they deem to be worthy of dominating others. (shrink)

Maximizing Hedonism maintains that the most pleasurable pleasures are the best. Francis Bradley argues that this is either incompatible with Mill’s Qualitative Hedonism, or renders the latter redundant. Some ‘sympathetic’ interpreters respond that Mill was either a Non-Maximizing Hedonist or a Non-Hedonist. However, Bradley’s argument is fallacious, and these ‘sympathetic’ interpretations cannot provide adequate accounts of: Mill’s identification with the Protagorean Socrates; his criticisms of the Gorgian Socrates; or his apparent belief that Callicles is misguided to attempt to show that (...) the pleasures of the intelligent can be more valuable than the pleasures of fools without also being more pleasurable. -/- L’hédonisme maximisateur maintient que les plaisirs les plus plaisants sont les meilleurs. Francis Bradley soutient que soit cela est incompatible avec l’hédonisme qualitatif de Mill, soit cela rend ce dernier redondant. Certains interprètes bien intentionnés répondent que Mill était soit un hédoniste non-maximisateur, soit un non-hédoniste. L’argument de Bradley est toutefois fallacieux et ces interprétations bien intentionnées ne peuvent rendre compte de manière adéquate de l’identification de Mill avec le Socrate protagorien, de ses critiques du Socrate gorgien, ni de sa conviction apparente que Calliclès a tort de tenter de montrer que les plaisirs de la personne intelligente peuvent être plus précieux que les plaisirs de l’idiot sans pour autant être plus plaisants. (shrink)

Mill's System of Logic (1843) indicates that the definition of ‘nationality’ he offered in Considerations on Representative Government (1861) is not a throwaway comment but a carefully considered causal hypothesis tailored to his politico-ethological research programme. This matters because Lord Acton's critique of Mill's claim that free institutions are almost impossible in multinational states ignored the definition, thereby obscuring subsequent scholars' vision of the conceptual dimension of this famous dispute. Although Mill struggled in his politico-ethological endeavour, he was sufficiently confident (...) to judge that, if nationalities seek self-determination through exclusive control of the state, liberal democratic institutions would be unlikely to emerge in multinational states, let alone survive and prosper. Since Acton's critique presupposed an undemocratic conception of free institutions and a far weaker notion of national self-determination, it failed to contradict that judgement. Indeed, once their conceptual disagreements are clarified, Acton's empirical analysis can be seen to support it. (shrink)

The passage of Mill’s Utilitarianism that sets out the condition in which one pleasure has a superior quality than another stokes interpretive controversy. According to the Lexical Interpretation, Mill takes one pleasure, P1, to be of a superior quality than another, P2, if, and only if, the smallest quantity of P1 is more valuable than any finite quantity of P2. This paper argues that, while the Lexical Interpretation may be supported with supplementary evidence, the passage itself does not rule out (...) qualitative superiority without lexical dominance, as it only requires P1 to be more valuable than any quantity of P2 that it is possible for someone to experience. Some will object that this concession to opponents of the Lexical Interpretation still renders Mill’s condition for qualitative superiority too demanding to be plausible. However, if Mill’s qualitative rankings apply to higher-order pleasures taken in modes of existence as such rather than to the pleasures of different activities chosen from within these modes, the objection loses much of its force. One upshot is that Mill may have more to contribute to debates in contemporary population axiology than is usually acknowledged. (shrink)

How does so much gender inequality endure in an era when many laws and policies endorse principles of gender equality? This essay examines this dilemma by considering Susan Moller Okin's criticism of “false gender neutrality,” research on implicit bias, and the shifting relation of gender bias to American law. I argue that these are crucial elements of the modern cycle of gender inequality, enabling it to operate through a perverse “invisible-hand” mechanism. This framework helps convey how underlying gender bias influences (...) individual behaviors that generate, legitimate, and mask broad patterns of inequality. Contemporary legal conflicts reflect many of these dynamics, which appear in controversies over gender-based violence, gender discrimination in pay and promotion, and women's reproductive health care benefits. This analysis advances our understanding of how the contemporary cycle of gender inequality operates, the complex links between individual behavior and structural bias, and the difficulty of pursuing gender justice through prevailing frameworks of law and liberalism. It also underscores the continued importance of feminists' collective work to address “invisible” as well as visible biases. (shrink)

It is possible to distinguish between empire, as a form of political order, and imperialism, as a process of aggressive expansion. Mill's liberalism allows for a legitimate empire, in which a civilized state rules a less civilized foreign people paternalistically to prepare them for liberal democratic self-rule. However, it rejects paternalistic imperialism, in the sense of aggression designed to establish such an empire. Apparent textual evidence to the contrary really demonstrates Mill's commitment to three distinct theses: that imperialism may benefit (...) those subject to it, and this can mitigate its evil; that it is easier to justify non-aggressive, empire-creating wars of conquest in response to aggression by barbarian powers; and finally, that civilized states are justified in engaging distant uncivilized peoples non-aggressively, even though the latter's aggressive tendencies mean that such engagement renders empire-justifying wars more likely. (shrink)

High on energy and imagination, this ode to self-esteem encourages kids to appreciate everything about themselves--inside and out. Messy hair? Beaver breath? So what! Here's a little girl who knows what really matters. At once silly and serious, Karen Beaumont's joyous rhyming text and David Catrow's wild illustrations unite in a book that is sassy, soulful--and straight from the heart.

The arrival of Muslim rulers who were insistent on the unity of God among Christians who testified to the unity of God in His triune nature introduced a considerable challenge to those Christians who were in the ascendency throughout the Middle East. Now they were on the defensive, needing to stem the movement of members of their own community to Islam which would eventually lead to Muslims becoming the majority. In the period of gradual transfer from majority to minority status (...) Christian theologians attempted both to make their faith in the Trinity intelligible to Muslim intellectuals with whom they debated, and to give reasons to Christians for holding firm to their faith. These theologians are hardly known to the global church of the 21st century and it is the purpose of this paper to make them come alive for Christians who are witnessing to their faith before Muslims in our time in the hope that a contemporary testimony to the Triune God can be encouraged. (shrink)

Contemporary philosophers often purport to ‘borrow’ or ‘refute’ claims made by past philosophers. In doing so they contravene a contextualist methodological prohibition once defended by Quentin Skinner in his seminal paper “Meaning and Understanding in the History of Ideas”. Skinner's methodology has been much debated by theorists of textual meaning and interpretation, and yet the precise nature of the logical path from his premises to his prohibitory conclusion remains elusive. This paper seeks to refute two of the most promising variants (...) of an argument for his methodological prohibition on ‘refutation’, one of which draws on his appeal to Wittgenstein's conception of ‘meaning as use’, and the other of which draws on his appeal to speech act theory. (shrink)

Two Christian theologians writing in Arabic in the early ninth century argued that God had created humanity to freely choose good or evil actions, a belief shared universally by previous Christian writers in Greek and Syriac no matter the denomination they came from. They were debating with Muslim intellectuals who held that God created all human actions before they were acquired by humans, so that God had already decided which actions a particular human being would choose, whether good or evil. (...) Theodore Abū Qurra and ʿAmmār al-Baṣrī developed dialogues with determinist Muslims in the hope that they might influence these determinist Muslims to adopt earlier Muslim beliefs that the Qurʾan taught that God would judge humans for the choices that they freely made for good or evil. However, the trend towards determinism was so strong that by the end of the ninth century the mainstream Sunni view would be that God decreed all human actions before they were acquired by humans. (shrink)

Christian views of the Prophet Muhammad have in the past 30 years covered a wide spectrum from rejection of Muhammad’s prophetic status as a bringer of revelation from God to a warm embrace of the Qur’an as a third testament to revelation after the Old and New Testaments. The significance of the late Anglican Bishop Kenneth Cragg’s assessment of Muhammad, published in 1984, is addressed in this article by surveying the range of responses to the founder of Islam which followed. (...) Twenty-first century Christian–Muslim relations are likely to be deeply concerned with dialogue about Christian attitudes to the Prophet Muhammad. (shrink)