This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that—even with (...) respect to their ‘autonomy enhancing’ potential—these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy and substantive-relational autonomy. While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation. (shrink)

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

Bioethics is a diverse field that accommodates a broad range of perspectives and disciplines. The recent explosion of literature on methods in interdisciplinary and empirical ethics might appear, however, to overshadow the fact that ‘bioethics’ has long been an interdisciplinary field. The Interdisciplinary and Empirical Ethics Network (IEEN) was established, with funding from the Wellcome Trust, to facilitate critical and constructive discussion around the nature of this disciplinary diversity and shift focus away from the ‘empirical turn’, towards the ongoing development (...) of bioethics as an evolving field of interdisciplinary study. In April 2012 the IEEN organized a workshop at the Centre for Public Policy Research, King's College London, dedicated to discussing the relationship between aims and methods in interdisciplinary and empirical bioethics. This paper reports on that first meeting. (shrink)

Does the act of creation show itself anywhere within the creation? A common contemporary ontology tends to see two possibilities for those who want to defend a notion of creation. The first is to argue that an original set of materials was brought into existence out of nothing by divine action a long time ago. The second, in the tradition of Paley, posits a specific divine action that oversees the development of some of the materials into entities with an end-directedness. (...) Much contemporary energy focuses on the second possibility. The argument of the paper is that the ontology behind both of these possibilities, which limits itself to the notions of a creation of materials and the building of some of the materials into end-directed entities, conceals rather than reveals the idea of creation. The paper tries to show how an Aristotelian sense of nature, with its recognition of internal teleology and original spontaneity, offers a better starting point for coming up against the mystery of divine creative activity. (shrink)

In this paper we argue that austerity creates working conditions that can undermine professionalism in healthcare. We characterise austerity in terms of overlapping economic, social and ethical dimensions and explain how these can pose significant challenges for healthcare professionals. Amongst other things, austerity is detrimental to healthcare practice because it creates shortages of material and staff resources, negatively affects relationships and institutional cultures, and creates increased burdens and pressures for staff, not least as a result of deteriorating public health conditions. (...) After discussing the multiple dimensions of austerity, we consider the challenges it creates for professional ethics in healthcare. We highlight three mechanisms—intensification of work, practitioner isolation, and organisational alienation—which pose acute problems for healthcare professionals working under conditions of austerity. These mechanisms can turn ‘routine moral stress’ into moral distress and, at the same time, make poor care much more likely. While professionalism clearly depends on individual capabilities and behaviours, it also depends upon a complex sets of social conditions being established and maintained. The problems caused by austerity reveal a need to broaden the scope of professional ethics so that it includes the responsibilities of ‘role constructors’ and not just ‘role occupiers’. Austerity therefore presents opportunities for health professionals and associated ‘role constructors’ to contribute to a reimagining of future models of healthcare professionalism. (shrink)

In this paper we contribute to “sociology in bioethics” and help clarify the range of ways sociological work can contribute to ethics scholarship. We do this using a case study of an innovative neurotechnology, functional magnetic resonance imaging, and its use to attempt to diagnose and communicate with severely brain-injured patients. We compare empirical data from interviews with relatives of patients who have a severe brain injury with perspectives from mainstream bioethics scholars. We use the notion of an “ethical landscape” (...) as an analogy for the different ethical positions subjects can take—whereby a person’s position relative to the landscape makes a difference to the way they experience and interact with it. We show that, in comparison to studying abstract ethics “from above” the ethical landscape, which involves universal generalizations and global judgements, studying ethics empirically “from the ground,” within the ethical landscape foregrounds a more plural and differentiated picture. We argue it is important not to treat empirical ethics as secondary to abstract ethics, to treat on-the-ground perspectives as useful only insofar as they can inform ethics from above. Rather, empirical perspectives can illuminate the plural vantage points in ethical judgments, highlight the “lived” nature of ethical reasoning, and point to all ethical vantage points as being significant. This is of epistemic importance to normative ethics, since researchers who pay attention to the various positions in and trajectories through the ethical landscape are unlikely to think about ethics in terms of abstract agency—as can happen with top-down ethics—or to elide agency with the agency of policymakers. Moreover, empirical perspectives may have transformative implications for people on the ground, especially where focus on the potential harms and benefits they face brings their experiences and interests to the forefront of ethical and policy discussion. (shrink)

We report key themes arising from a postgraduate workshop organized by the King's Interdisciplinary Discussion Society (KIDS) held in April 2011. KIDS believe that health is a phenomenon that transcends disciplinary boundaries, and therefore issues relating to health care and medical ethics are best addressed with an interdisciplinary approach. The workshop, entitled ‘Everyday Ethics and Primary Healthcare’, included poster presentations and oral presentations from participants from a range of disciplines and occupational backgrounds which highlighted the challenges faced by primary health-care (...) workers. Three common themes emerged: the impersonal and cumbersome work environment that can result from the encroachment of rationalizing tools; the tension between ‘ethical practice as an ongoing sensibility’ and ‘ethical practice as “box-ticking”’; and the contested nature of what constitutes ‘health’. Participants felt that the interdisciplinary perspective was helpful in elucidating the various ethical issues arising in primary health care. (shrink)

Bioethics is an interdisciplinary field that accommodates a broad range of perspectives and disciplines. This inherent diversity sets a number of challenges for both teachers and students of bioethics, notably in respect to the appropriate aims and methods of bioethics education, standards and criteria for evaluating performance and disciplinary identity. The Interdisciplinary and Empirical Ethics Network (IEEN) was established, with funding from the Wellcome Trust, to facilitate critical and constructive discussion about the ongoing development of bioethics as an evolving field (...) of interdisciplinary study. In November 2012 the IEEN organised a workshop at the University of Birmingham to discuss the issues relating to teaching and learning in interdisciplinary and empirical bioethics. This paper reports on that meeting. (shrink)

Owens, John F It is about sixty years since Frederick Copleston was required by the ecclesiastical censor to insert 'some unambiguous condemnation of Nietzsche' into a new edition of his 'Friedrich Nietzsche, Philosopher of Culture.' Copleston thought the work 'disfigured' as a result, sensing perhaps that the addition would reinforce crude misunderstandings of his subject. He was aware of something that probably passed the ecclesiastical censor by, that whatever is to be said of Nietzsche's relation to Christianity, it is not (...) straightforward. (shrink)

The Interdisciplinary and Empirical Ethics Network was established in 2012 with funding from the Wellcome Trust in order to facilitate critical and constructive discussion around the nature of the disciplinary diversity within bioethics and to consider the ongoing development of bioethics as an evolving field of interdisciplinary study. In April 2013, the Interdisciplinary and Empirical Ethics Network organized a workshop at the Centre for Public Policy Research, King’s College London, which discussed the nature and possibility of professionalism within interdisciplinary and (...) empirical bioethics. This paper provides a report of that workshop. (shrink)

This book examines Richard Rorty’s position that religious and metaphysical beliefs should simply be abandoned, and it proposes that Rorty’s position is contradicted by what is a fundamental part of every human life: the phenomenon of human recognition of other people.

D. Z. Phillips holds that we cannot ask a general philosophical question about the existence of God because we discover what it means for God to exist only from within particular linguistic contexts, especially those of prayer and worship. This raises the suspicion that God’s existence therefore depends on a particular language-use, as does the existence of cultural objects like prices or the equator. The article suggests that Phillips’s position overlooks the peculiar status of other persons in our discourse, and (...) the part they play in establishing a basic sense of “existence.” Closer consideration of this aspect of our language-use can take us beyond the limits of Phillips’s approach, and reopen the question of God’s existence in a strong sense. (shrink)

D. Z. Phillips holds that we cannot ask a general philosophical question about the existence of God because we discover what it means for God to exist only from within particular linguistic contexts, especially those of prayer and worship. This raises the suspicion that God’s existence therefore depends on a particular language-use, as does the existence of cultural objects like prices or the equator. The article suggests that Phillips’s position overlooks the peculiar status of other persons in our discourse, and (...) the part they play in establishing a basic sense of “existence.” Closer consideration of this aspect of our language-use can take us beyond the limits of Phillips’s approach, and reopen the question of God’s existence in a strong sense. (shrink)

RICHARD RORTY’S IDEAL CHARACTER, THE “IRONIST,” is simultaneously committed to two different projects. The first is the repudiation of metaphysics, implying the abandonment of all philosophical or theological efforts “to achieve universality by the transcendence of contingency.” This first project is not so remarkable anymore, the twentieth century having seen any number of attempts to bring metaphysics to a close. But the second project has been gathering speed only in the last few decades. It is described as the attempt to (...) make something “never... dreamed of before,” which is also the attempt to get free from “inherited contingencies.” Given that many of life’s contingencies are originally inherited, getting free of them is a far-reaching business, bringing a whole Nietzschean lifestyle in its train. Sometimes Rorty talks as if the two projects were simply two sides of the one project. He says for example that a person becomes an ironist “when one’s aim becomes an expanding repertoire of alternative descriptions rather than The One Right Description,” as if renouncing the latter meant embracing the former. However, surely a person can repudiate metaphysics, and yet live peacefully with his or her current contingencies? If I regard my everyday vocabulary as a useful way of talking which my society has developed as a way of coping, why should I automatically want to change it, or move beyond it? (shrink)

RICHARD RORTY’S IDEAL CHARACTER, THE “IRONIST,” is simultaneously committed to two different projects. The first is the repudiation of metaphysics, implying the abandonment of all philosophical or theological efforts “to achieve universality by the transcendence of contingency.” This first project is not so remarkable anymore, the twentieth century having seen any number of attempts to bring metaphysics to a close. But the second project has been gathering speed only in the last few decades. It is described as the attempt to (...) make something “never... dreamed of before,” which is also the attempt to get free from “inherited contingencies.” Given that many of life’s contingencies are originally inherited, getting free of them is a far-reaching business, bringing a whole Nietzschean lifestyle in its train. Sometimes Rorty talks as if the two projects were simply two sides of the one project. He says for example that a person becomes an ironist “when one’s aim becomes an expanding repertoire of alternative descriptions rather than The One Right Description,” as if renouncing the latter meant embracing the former. However, surely a person can repudiate metaphysics, and yet live peacefully with his or her current contingencies? If I regard my everyday vocabulary as a useful way of talking which my society has developed as a way of coping, why should I automatically want to change it, or move beyond it? (shrink)

This paper considers proposals for developing ‘co-productive’ medical partnerships, within the UK National Health Service (NHS), concentrating in particular on the potential problem involved in combining professional and lay conceptions of health. Much of the literature that advocates the introduction of co-productive healthcare partnerships assumes that medical professionals and patients share, or can easily come to share, a common set of beliefs about what is valuable with regard to health interventions and outcomes. However, a substantial literature documents the contestability of (...) the concept of health, particular across professional and lay divides. We suggest that this potential disagreement ought to be taken seriously, and suggest that the prospect of a co-productive NHS in which patients and professionals act in partnership is threatened by the existence of unresolved epistemic differences. We suggest that part of the solution may lie in re-framing this potential disagreement in the terms provided by Engel’s bio-psycho-social account of health, and demonstrate how support for this account can be grounded upon a critical realist foundation. What we call a ‘stratified conception of health’ reveals the potential complementarity between health beliefs which may have at first seemed to be essentially contradictory. We consider some of the practical implications this idea has for conceiving and creating co-productive medical partnerships. (shrink)