ABSTRACT This article surveys recent work on oracular prophecies and their role in Greek perceptions of Russia in the early modern period. Drawing on this survey, the article provides a critical assessment of the historiographical paradigm of the ‘Russian Expectation’ offered by Paschalis Kitromilides for the analysis of Greek-Russian relations. Finally, the article proposes that scholars should focus on the concept of protection as an aspect of political language, this providing an explanation for particular Greek and also Russian interpretations of (...) the Treaty of Kuçuk-Kaynardja of 1774. (shrink)

Este artigo tem como intenção investigar as maneiras segundo as quais as inter- relações didático-pedagógicas nas "comunidades de investigação filosófica", possam ser lidas a partir de uma ótica que enfatize os processos de (auto)construção subjetiva constantemente realizados por seus/suas participantes. Utilizando a noção de ―relação de vontade a vontade‖ articulada por Jacques Rancière, procurarei desenvolver algumas possíveis interpretações das interações entre pensamento e afetos, em especial, sua condição latente de ocupar posição privilegiada nas dinâmicas de auto-percepção e hetero-reconhecimento intelectuais. A (...) intenção é tentar mostrar como as dinâmicas são realizadas verbal e/ou corporalmente, segundo enunciações avaliativas da participação e contribuição em classe, feitas tanto por colegas como por mediadores/as. (shrink)

Pendragon Press is proud to offer this new, revised, and expanded edition of Formalized Music, Iannis Xenakis's landmark book of 1971. In addition to three totally new chapters examining recent breakthroughs in music theory, two original computer programs illustrating the actual realization of newly proposed methods of composition, and an appendix of the very latest developments of stochastic synthesis as an invitation to future exploration, Xenakis offers a very critical self-examination of his theoretical propositions and artistic output of the past (...) thirty-five years. This edition of Formalized Music is an essential tool for understanding the man and the thought processes of one of this century's most important and revolutionary musical figures. (shrink)

PRELIMINAR Y STA TEMENT BY IA NNIS XENA KIS Subtended Philosophy* The worlds of classical, contemporary, pop, folk, traditional, avant-garde, etc., ...

Antonio Ianni Segatto Dans cet article, je veux montrer quel est le malentendu commun aux lectures opposées des remarques wittgensteiniennes sur « suivre une règle », notamment la lecture sceptique de Kripke et la lecture de Baker et Hacker. Je crois que caractériser correctement le malentendu de ces dernières nous permet de voir la bonne façon de lire ces remarques, dans la mesure où ces lectures sont toujours soumises à une confusion philosophique que Wittgenstein veut dissoudre. Ensuite, je présente (...) un commentaire des §§239-242 des Recherches philosophiques inspiré de la lecture dite résolue, en attirant l’attention sur un des aspects souvent négligés par les commentateurs, en particulier la dimension temporelle du langage. L’examen de la relation entre celle-ci et l’activité de suivre des règles entend présenter de nouveaux arguments en faveur d’une lecture résolue. (shrink)

Pretende-se é elucidar alguns aspectos da teoria pragmática da linguagem de Habermas tal como apresentada no primeiro capítulo de Facticidade e validade relacionando as teses apresentadas nessa parte do livro a teses apresentadas sobretudo na segunda parte de Pensamento pós-metafísico a fim de elucidar com como a teoria discursiva do direito e da democracia apresentada em 1992 tem seu ponto de apoio em uma concepção específica da linguagem. Essa estratégia permite examinar os pressupostos normalmente deixados à sombra nas discussões da (...) teoria do direito e da democracia de Habermas, assim como permite responder a algumas objeções dirigidas a essa teoria. (shrink)

The main object of this project is how it can become possible to sense an invisible element such as the air. An installation will be created that will aim to provide a sensorial way of dealing with the air and the wind – that is air in motion – with the help of a computer-assisted environment. The objective is to engage the spectator in the navigation of semantic and sensual space that has its own quasi-mythical structure. The attention is focused (...) on the cognition dimension of the human body and senses and the enlargement of perception through the application of new technologies. The wind is a highly abstract phenomenon, with many physical and metaphysical aspects and is one of the basic elements of the physical universe. At the same time, the wind has an enormous impact on our lives, which we perceive, visually and acoustically only through its effects. That is why it has provided material for mythology and art throughout the centuries. In this project, the intention is to create a place where the visitor will be immersed into the landscapes of the winds of the world in order to increase his awareness and knowledge about them by merging technology, myth and body. The research is going to deal with both physical and metaphysical/mythological dimensions of the phenomenon. This starts with an investigation of references to winds and wind phenomena in mythologies world-wide, and extends over the scientific or causal explanations of the wind, as well as the investigation of its auditory and visual manifestations. Data from the Internet will be converted to audio and visual forms in a physical space, in real time. The online data that will be fed into the system are the intensity and direction of the winds at specific default locations on the planet. The visitor’s movements and his/her path in this given area will affect these audio-visual forms. The deliverables of the project (still in its definition phase) are:A study including the research methodology and the outcomes from the researchAn audio-visual interactive installation based on web data. (shrink)

Wilhelm von Humboldt, na esteira de autores como Johann Georg Hamann e Johann Gottfied Herder, inaugura uma das versões daquela tradição de pensamento conhecida sob a rubrica de “virada lingüística”. Mais de um século antes da consolidação dessa tradição, esses autores já realizavam uma crítica decisiva da concepção de linguagem vigente em quase toda a história da filosofia e propunham uma nova maneira de conceber as relações entre pensamento, razão e linguagem. Basta para atestá-lo, a recordação seja dos famosos bordões (...) de Hamann segundo os quais “razão é linguagem, logos” ou “sem a palavra, não há razão – nem mundo”, seja da frase de Herder segundo o qual “a linguagem é o critério da razão”. (shrink)

Based on the distinction drawn by James Conant between Cartesian skepticism and Kantian skepticism, I intend to show that Wittgenstein’s remarks on dreaming should not be understood as a direct attack on the former, as commonly held, but as an indirect attack on it, for Wittgenstein approaches Descartes’ dreaming hypothesis by changing the very problematic at stake. Wittgenstein’s attack on skepticism takes one step back from a question about how to distinguish between dreaming that one is experiencing something and actually (...) experiencing it, for this attack focuses on the linguistic conditions of the possibility of something that the Cartesian problematic takes for granted, that is, the very possibility of saying “I am dreaming.” I also intend to show that Wittgenstein’s remarks on dreaming should be read in light of his claim that skepticism is nonsensical put forward in the Tractatus logico-philosophicus as well in his last writings. More specifically, I intend to show that the words “I am dreaming” are nonsensical in the same sense as the alleged proposition “There are physical objects” and the expression of doubt about the existence of physical objects or the external world. (shrink)

In this paper I aim to elucidate Wittgenstein’s claim that the so-called dream argument is senseless. Unlike other interpreters, who understand the sentence “I am dreaming” as contradictory or self-defeating, I intend to elucidate in what sense one should understand it as senseless or, more precisely, as nonsensical. In this sense, I propose to understand the above-mentioned claim in light of Wittgenstein’s criticism of skepticism from the _Tractatus logico-philosophicus_ to his last writings. I intend to show that the words “I (...) am dreaming” are nonsensical in the same sense as the alleged proposition “There are physical objects” or the expression of doubt about the existence of external objects. (shrink)

Neste artigo pretende-se discutir a dimensão política presente na origem da teoria do reconhecimento de Axel Honneth, partindo da constatação de que durante a reelaboração de sua tese de habilitação, publicada em 1992 com o título de Luta por reconhecimento, o autor se posiciona pela primeira vez diante do debate entre liberais e comunitaristas e elabora seu conceito formal de eticidade como uma resposta às limitações de cada uma dessas correntes da teoria política contemporânea.

Harmonia, m etodo e filosofia -- Intencionalidade -- Regras e acordos.

It is argued that the current policy of the British Medical Association (BMA) on conscientious objection is not aligned with recent human rights developments. These grant a right to conscientious objection to doctors in many more circumstances than the very few recognised by the BMA. However, this wide-ranging right may be overridden if the refusal to accommodate the conscientious objection is proportionate. It is shown that it is very likely that it is lawful to refuse to accommodate conscientious objections that (...) would result in discrimination of protected groups. It is still uncertain, however, in what particular circumstances the objection may be lawfully refused, if it poses risks to the health and safety of patients. The BMA's policy has not caught up with these human rights developments and ought to be changed. (shrink)

The paper considers the recently published British Medical Association Guidance on ethical issues arising in relation to rationing of treatment during the COVID-19 Pandemic. It considers whether it...

The doctor-patient relationship -- Consent, choice, and refusal : adults with capacity -- Treating adults who lack capacity -- Children and young people -- Confidentiality -- Health records -- Contraception, abortion, and birth -- Assisted reproduction -- Genetics -- Caring for patients at the end of life -- Euthanasia and physician assisted suicide -- Responsibilities after a patient's death -- Prescribing and administering medication -- Research and innovative treatment -- Emergency situations -- Doctors with dual obligations -- Providing treatment and (...) care in detention settings -- Education and training -- Teamwork, referral, delegation, and shared care -- Public health dimensions of medical practice -- Reducing risk, clinical error, and poor performance. (shrink)

This personal view draws attention to the lack of regard, given by the BMA in its new guidance, to the symptomatic benefit of clinically assisted nutrition and hydration in patients who are not imminently dying. This article aims to identify how ignoring symptomatic benefit is a serious oversight and cause for concern given that this document, endorsed by the General Medical Council and courts, is created with the purpose of providing a framework for best interests decision-making. The new BMA guidance (...) on CANH, which is endorsed by the GMC,1 follows up on the Supreme Court case of An NHS Trust v Y,2 that any removal of CANH from a patient in prolonged disorder of consciousness no longer requires the approval of the court unless there is disagreement or the decision is finely balanced. The decision in …. (shrink)

Iannis Xenakis (1922–2001), composer, architect, engineer and media artist, designed together with Le Corbusier the Philips-pavilion for the 1958 Brussels World Fair. This pavilion is an early example of (“hybrid”) combined media and architectural space as it contained a Poème Électronique, an electronic synthesis of visual projections (conceived by Le Corbusier ) and acoustic events (composed by Varèse). The pavilion's architecture with its hyperbolic-paraboloid shells had a dynamic expression. Xenakis continued this research into complex material architectural forms. He also worked (...) on the complex ephemeral architectures of light and sound events. What is specific to Xenakis is the way he used forms in different fields and transferred them from one field to another, from engineering to music, from music to architecture and visual events. This experience of working simultaneously and applying the same (mental) structures in different fields opened him the way (partly supported by the universal computer instrument) for the practice of transferring mathematical-scientific structures into artistic production. In this context Xenakis pleads for the development of a “General Morphology”, a research concerned with the understanding of form and its generation. Xenakis's ‘material’ architectural work is to be seen in continuity with his architectures of music and light. (shrink)

This article offers a critique of the recently revised BMA guidance on routine neonatal male circumcision and seeks to challenge the assumptions underpinning the guidance which construe this procedure as a matter of parental choice. Our aim is to problematise continued professional willingness to tolerate the non-therapeutic, non-consensual excision of healthy tissue, arguing that in this context both professional guidance and law are uncharacteristically tolerant of risks inflicted on young children, given the absence of clear medical benefits. By interrogating historical (...) medical explanations for this practice, which continue to surface in contemporary justifications of non-consensual male circumcision, we demonstrate how circumcision has long existed as a procedure in need of a justification. We conclude that it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful. (shrink)

The working party on euthanasia set up by the British Medical Association produced its report in 1988 (1). The first of its terms of reference was 'to examine the ethical problems relating to euthanasia, terminal illness, and suicide' and as far as active voluntary euthanasia (AVE) is concerned it failed conspicuously to do its job. The purpose of this article is not to restate the case for AVE but to examine the reason for the failure. (Figures in square brackets refer (...) to sections in the report.). (shrink)

Making decisions when caring for children and young people involves a delicate balancing of the child’s rights and needs as well as the rights of the parents. Those who look to the law for guidance will find that it is often unclear. The courts have asserted the parents’ rights to make decisions concerning the child’s treatment, in so far as these accord with the child’s welfare. Children have the right to be consulted about decisions concerning their welfare. Some people see (...) an anomaly in relation to treatment in that, while a court has overruled in the case of a competent child’s right to refuse treatment, a child considered competent may initiate consultation and consent to treatment without their parents’ knowledge or consent. The child’s right to confidentiality appears to override the parent’s right to the information parents need if they are to be aware of, let …. (shrink)

The BMA’s recent discussion paper A rational way forward for the NHS in England, while wishing to free the English NHS from day-to-day politics, merely shifts the locus of the political conflict.In May this year, the British Medical Association published a discussion paper entitled “A rational way forward for the NHS in England”, outlining the association’s suggestions for reform of the English NHS.1The paper is worth reading for its insightful dissection and analysis of the current problems of the English NHS, (...) as well as for its interesting but not totally unexpected conflation of professional and clinical with medical in most of the report. Many of the recommendations are eminently sensible, but some of the suggestions for reconfiguration of the highest-level structures of the English NHS are problematic and unrealistic. What the BMA wants is to free the English NHS from the influence of day-to-day politics by the establishment of a constitution and an independent board of governors, while keeping it free at the point of delivery and paid by general taxation. This is expressed in the first five of the total of 24 recommendations that outline the BMA proposals …. (shrink)

The British Medical Association (BMA) has called upon the General Medical Council (GMC) to instruct all medical schools to provide identifiable and substantial courses on medical ethics in their undergraduate curricula. The author reviews a postgraduate scheme of study in the ethics of health-care and suggests that it could provide some useful guidelines for teaching the subject at the undergraduate level.

The recently published BMA Guidelines on Withholding and Withdrawing Medical Treatment encourage a balance between deriving maximal benefit from medical treatment, and achieving as natural a death as possible in the circumstances. I argue that the concepts of burdensomeness, natural death and medicalised death are of greater fundamental importance than that of intention, and do not help constitute a moral distinction between withdrawal of treatment and active assistance to die. Nor should they continue to ground the corresponding legal distinction. In (...) the situations of both treatment withdrawal and active assistance to die, disease causation, human agency and moral responsibility are related in the same way. In both situations, we can intend that a person die for the right reasons, based on a concern for natural death.However, the law is reluctant to impose positive obligations on people, in contrast to the protection of negative rights. For example, the Northern Territory’s Rights of the Terminally Ill Act (1996) provided for assisted death as a lawful exception to an otherwise unlawful act, rather than as an enforceable right like the right to refuse unwanted medical treatment. Nevertheless, that the enforceability of a positive right to assisted death is difficult to conceive, is itself the product of a particular historical/moral/religious frame of reference currently under deconstruction. Genuine natural death statutes would consolidate the important principles supported here, and could apply uniform safeguards to all death-hastening decisions. (shrink)

In June 2021, the BMA published its report on moral distress and moral injury in UK doctors.1 The report includes definitions of the terms ‘moral distress’ and ‘moral injury’ as well as a summary of how the concepts have developed over time. There is also an analysis of the BMA’s pan-profession survey of moral distress and moral injury of doctors in the UK, the first of its kind. The impact of COVID-19 and recommendations for tackling moral distress also feature. Many (...) may be unfamiliar with the concepts of ‘moral distress’ and ‘moral injury’. These terms are relatively new, and debate is ongoing in academic circles on the best way to understand them.2 Some use the terms interchangeably. The BMA defines moral distress as the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action. Even without an understanding of the morally correct action, moral distress can arise from the sense of a moral transgression. More simply, it is the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. This can be as a result of a lack of power or agency, or structural limitations, such as insufficient staff, resources, training or time. The individual suffering from moral distress need not be the one who has acted or failed to act; moral distress can be caused by witnessing moral transgressions by others. Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger and profound ‘moral disorientation’. It has also been linked to severe mental health issues. There is increasing recognition across the UK of the problem …. (shrink)

We explored the relationship between 24 character strengths measured by the Global Assessment of Character Strengths (GACS), which was revised from the original VIA instrument, and moral functioning comprising postconventional moral reasoning, empathic traits and moral identity. Bayesian Model Averaging (BMA) was employed to explore the best models, which were more parsimonious than full regression models estimated through frequentist regression, predicting moral functioning indicators with the 24 candidate character strength predictors. Our exploration was conducted with a dataset collected from 666 (...) college students at a public university in the Southern United States. Results showed that character strengths as measured by GACS partially predicted relevant moral functioning indicators. Performance evaluation results demonstrated that the best models identified by BMA performed significantly better than the full models estimated by frequentist regression in terms of AIC, BIC, and cross-validation accuracy. We discuss theoretical and methodological implications of the findings for future studies addressing character strengths and moral functioning. (shrink)

Although some previous studies have investigated the relationship between moral foundations and moral judgment development, the methods used have not been able to fully explore the relationship. In the present study, we used Bayesian Model Averaging (BMA) in order to address the limitations in traditional regression methods that have been used previously. Results showed consistency with previous findings that binding foundations are negatively correlated with post-conventional moral reasoning and positively correlated with maintaining norms and personal interest schemas. In addition to (...) previous studies, our results showed a positive correlation for individualizing foundations and post-conventional moral reasoning. Implications are discussed as well as a detailed explanation of the novel BMA method in order to allow others in the field of moral education to be able to use it in their own studies. (shrink)

Justice, one of the four Beauchamp and Childress prima facie basic principles of biomedical ethics, is explored in two excellent papers in the current issue of the journal. The papers stem from a British Medical Association essay competition on justice and fairness in medical practice and policy. Although the competition was open to all comers, of the 235 entries both the winning paper by Alistair Wardrope1 and the highly commended runner-up by Zoe Fritz and Caitríona Cox2 were written by practising (...) doctors—a welcome indication of the growing importance being accorded to philosophical reflection about medical practice and practices within medicine itself. Both papers are thoroughly thought provoking and represent two very different approaches to the topic. Each deserves a careful read. The competition was a component of a BMA 2019/2020 ‘Presidential project’ on fairness and justice and asked candidates to ‘use ethical reasoning and theory to tackle challenging, practical, contemporary, problems in health care and help provide a solution based on an explained and defended sense of fairness/justice’. In this guest editorial I’d like to explain why, in 2018 on becoming president-elect of the BMA, I chose the theme of justice and fairness in medical ethics for my 2019–2020 Presidential project—and why in a world of massive and ever-increasing and remediable health inequalities biomedical ethics requires greater international and interdisciplinary efforts to try to reach agreement on the need to achieve greater ‘health justice’ and to reach agreement on what that commitment actually means and on what in practice it requires. First, some background. As president I was offered the wonderful opportunity to pursue, with the organisation’s formidable assistance, a ‘project’ consistent with the BMA’s interests and values. As a hybrid of general medical practitioner and philosopher/medical ethicist, and as a firm defender of the Beauchamp …. (shrink)

Force-feeding of detainees at Guantánamo BayIn April, the US Department of Defense reportedly sent 40 additional military medical personnel, including doctors and nurses, to the Guantánamo Bay Naval Base to carry out the force-feeding of detainees on hunger strike.1 By the end of June, up to 104 of the remaining 166 individuals held in US military detention at Guantánamo were refusing food. The protest against conditions at the base, and the fate of those being held there—including those already cleared for (...) transfer or release—began in February 2013. In June, it was reported that as many as 44 of the hunger strikers were being force-fed by military medical teams.2The response by the US authorities to the hunger strike prompted expressions of outrage from the international medical community.3,4 In April, the American Medical Association wrote to the US secretary of defense, insisting that ‘forced feeding of [competent] detainees violates core ethical values of the medical profession.’5 Adding the voice of the profession in the UK to these calls, at its annual conference in June, the British Medical Association condemned the participation of doctors and nurses in the force-feeding, calling on governments worldwide to ensure that all prisoners have access to confidential, independent medical treatment, and supporting any clinician who challenged cruel, inhuman or degrading treatment. Also in June, the BMA Chairman wrote to President Obama and US secretary of defense, Hagel, urging them to immediately suspend medical involvement in force-feeding at Guantánamo, and to institute an urgent inquiry into how the current situation was allowed to develop.Force-feeding mentally competent adults who are refusing food is a clear violation of medical ethics and is unjustifiable, as articulated by the World Medical Association's Declaration of Malta.6 Doctors with dual loyalties, including military doctors, are bound by the same …. (shrink)

Understanding compositional practices is a major goal of musicology and music theory. Compositional practices have been traditionally viewed as disembodied and idiosyncratic. This view makes it hard to integrate musical creativity into our understanding of the general cognitive processes underlying meaning construction. To overcome this unnecessary isolation of musical composition from cognitive science, in this conceptual analysis, we approach compositional processes with the analytic tools of blending theory, material anchoring, and enaction. Our case study is Iannis Xenakis’ use of sieves (...) for distributing rhythmic patterns in Psappha. Though disregarded in previous accounts, the timeline and the gearwheel provide crucial conceptual templates for anchoring Xenakis’ idea of time for this score. This case study of conceptual integration templates for temporal representation seeks to gain insight into musical creativity, embodiment, and blending, especially into how virtual interactions with material structures facilitate the construction of complex meanings. (shrink)

In February 2020, the British Medical Association will be surveying members for their views on what the BMA’s position on physician-assisted dying should be. The BMA is currently opposed to physician-assisted dying in all its forms, a position that was agreed in 2006 at the annual representative meeting, the Association’s policy-making conference.1 As previously reported in Ethics briefing,2 the decision to survey members follows a motion passed at last year’s ARM which called on the BMA to “carry out a poll (...) of members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying”. The results from the survey will not determine BMA policy. Rather, the results be published ahead of this year’s ARM and provided to those attending to inform a debate and discussion on the BMA’s policy position. More information about the survey, including a briefing pack of useful information, and information for BMA members on how to participate can be found online at www.bma.org.uk/PAD. ### High Court rejects Judicial reviews on assisted suicide The High Court has refused permission for two separate challenges to the law on assisted suicide in the UK to proceed to a full hearing. In the first case, Phil Newby, who has motor neuron disease, applied for judicial review of the law on assisted suicide and asked for the court to carry out a detailed examination of what he termed “legislative facts” – that is, an examination of the existing evidence on the “costs, risks and benefits” of regulating assisted suicide – including a cross-examination of relevant expert witnesses.1 Handing down the judgement, Lord Justice Irwin and Mrs Justice May, held that assisted dying …. (shrink)

Legal battles continue in the UK over the Government’s plans to transport asylum seekers arriving on British shores to Rwanda in East Africa. Originally announced as a system for ‘processing’ asylum seekers, the Government has subsequently made it clear that there would not be an option for asylum seekers to return to the UK. The arrangement forms part of a deal between the UK and Rwanda, with the UK promising to invest £120 m in economic growth and development in Rwanda, (...) along with financing the cost of the ‘offshored’ asylum operation.1 The Government states that the policy is designed to break the business model of people traffickers involved in facilitating hazardous trips across the Channel in small, overcrowded and unseaworthy craft, leading to multiple drownings. Critics argue that the policy will do nothing to stop desperate people from seeking refuge in the UK, that transferring already traumatised people to Rwanda – which has been criticised for its human rights record – is inhumane and potentially outwith international law. Medical bodies, including the BMA, along with refugee organisations have expressed serious concerns about the health impact of such a system of ‘offshoring’. An equivalent system in Australia has been notorious for the devastating health impacts on those ‘offshored’ to the Pacific islands of Manus and Naura. Unusually in the UK the offshoring proposals have been greeted by unanimous condemnation by the Church of England. The lawfulness of the process is also subject to question. On the 14 July, a plane carrying a small number of asylum seekers to Rwanda was halted shortly before take-off following an intervention by the European Court of Human Rights. The ECtHR, part of the Council of Europe, of which the UK is still a member, said an Iraqi man known as KN faced ‘a real …. (shrink)

Prolonging neonatal lifeThe paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics. Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will not (...) survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine.1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.TOO FAR?One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …. (shrink)

This fully revised new edition re-establishes Paul Griffiths's survey as the definitive study of music since the Second World War. The disruptions of the war, and the struggles of the ensuing peace, were reflected in the music of the time: in Pierre Boulez's radical reforming of compositional technique and in John Cage's move into zen music, in Milton Babbitt's settling of the serial system and in Dmitry Shostakovich's unsettling symphonies, in Karlheinz Stockhausen's development of electronic music and in Luigi Nono's (...) pursuit of the universally human, in Iannis Xenakis's view of music as sounding mathematics and in Luciano Berio's consideration of it as language. The initiatives of these composers and their contemporaries opened prospects that have continued to unfold. This constant expansion of musical thinking since 1945 has left us with no single history of music. Paul Griffiths's study accordingly follows several different paths, showing how and why they converge and diverge. In addition to the composers mentioned above, others whose music is discussed include Steve Reich, Jean Barraque, Elliott Carter, Olivier Messiaen, Gyorgy Kurtag, Harrison Birtwistle, and Gyorgy Ligeti. Publication and recording details are given for the works of all these composers and many others. (shrink)

Ethical guidance from the British Medical Association about treating doctor–patients is compared and contrasted with evidence from a qualitative study of general practitioners who have been patients. Semistructured interviews were conducted with 17 GPs who had experienced a significant illness. Their experiences were discussed and issues about both being and treating doctor–patients were revealed. Interpretative phenomenological analysis was used to evaluate the data. In this article data extracts are used to illustrate and discuss three key points that summarise the BMA (...) ethical guidance, in order to develop a picture of how far experiences map onto guidance. The data illustrate and extend the complexities of the issues outlined by the BMA document. In particular, differences between experienced GPs and those who have recently completed their training are identified. This analysis will be useful for medical professionals both when they themselves are unwell and when they treat doctor–patients. It will also inform recommendations for professionals who educate medical students or trainees. (shrink)

With recent guidance from the BMA and RCP on the withdrawal of nutrition from patients, and how the cause of death is being recorded (1), and the case of Vincent Lambert (2), the debate surrounding withdrawal of care and treatment has been rekindled in Catholic circles. In this article, I wish to highlight some of traditional principles that form the basis of such decision-making. I discuss these within the context of the withdrawal of nutrition and hydration (NaH), as well as (...) ventilation, to elucidate the key points. (shrink)

Background There is broad international agreement from clinicians and academics that healthcare rationing should be undertaken as explicitly as possible, and the BMA have publicly supported the call for more accountable priority setting for some time. However, studies in the UK and elsewhere suggest that clinicians experience a number of barriers to rationing openly, and the information needs of patients at the point of provision are largely unknown. Methodology In-depth interviews were undertaken with NHS professionals working at the community level (...) of provision, and with patients and professionals receiving or providing treatment for morbid obesity and breast cancer (n=52). Results Nearly all patients wanted to know about healthcare rationing and had high expectations of their clinical professionals to provide all relevant information about treatment options. However, professionals did not always understand these information requirements, and cases of implicit rationing were common. The existence of relevant national guidance was not always known about, meaning that patients were often reliant on other sources of information about treatment options, which included the popular media, the internet, patient advocacy groups and informal networks of support. Discussion Clinical professionals need to understand patients' need for detailed information when it comes to rationing, and to understand that they are the main gateway for this to be provided. However, disclosure could be distressing for both patients and professionals, and thus the most sensitive and acceptable ways to make this information available requires further investigation. (shrink)

The eclectic problem solving methodology used by the British Medical Association is described in this paper. It has grown from the daily need to respond to doctors’ practical queries and incorporates reference to law, traditional professional codes, and established BMA policies—all of which must be regularly assessed against the benchmark of contemporary societal expectations. The two Jehovah’s Witness scenarios are analysed, using this methodology and in both cases the four principles solution is found to concur with that of the BMA’s (...) approach. The author’s overall conclusion is that although the BMA resorts to a lengthier list of thins to consider, the solutions that emerge are often likely to coincide with the four principles approach. (shrink)

The british Medical Association wants to criminalise all boxing. This article examines the logic of the arguments it uses and finds them wanting. The move from medical evidence about the risk of brain damage to the conclusion that boxing should be banned is not warranted. The BMA's arguments are a combination of inconsistent paternalism and legal moralism. Consistent application of the principles implicit in the BMA's arguments would lead to absurd consequences and to severe limitations being put on individual freedom.