Child sexual exploitation and abuse has grave implications for the mental health and wellbeing of children and young people. It has been linked to a wide range of difficulties which may extend into adulthood. School-based prevention programs that aim to raise awareness are popular, however, have historically lacked robust and consistent evaluation. The purpose of the present study was therefore to explore young people’s experiences of attending a school-based theater-in-education program, and the impact this had on their awareness and understanding (...) of CSEA. Four focus groups of between four to six participants each were conducted with young people from two co-educational State schools in the United Kingdom. The approach of Template Analysis was used to analyze the data, and revealed a number of themes related to the superordinate themes of “Information and Detail Delivered” and “Format and Timing.” The results suggest that participants gained new awareness and understanding of aspects related to CSEA, including other forms of exploitation, as well as how to avoid harm and what to do “if bad things happen.” Participants further reported that the theater performance/live element of the program was particularly impactful, feeling that this was delivered to them at the right time, but suggesting that younger people would also benefit from the important messages. In addition, areas for improvement were identified in terms of the delivery of the program, and the issue of victim blaming. Findings are discussed with a view to practical implications and directions for future research. (shrink)

This book is an accessible text that explores what it means to be human. It is designed for an introductory course in Philosophy of the Human Being. This book contains an abundance of current examples, with embedded quotations from philosophers and selections from contemporary writers following the chapters.

Doctors and medical students in the UK have voted in support of the decriminalisation of abortion for women who self-administer abortions and healthcare professionals who provide abortions within the context of their clinical practice. Abortion should be treated as a medical issue rather than a criminal one. ### Background to the vote The vote took place at the end of June during the British Medical Association’s Annual Representative Meeting, where representatives of doctors and medical students from across the British Isles (...) gathered to set BMA policy through democratic procedures. Representatives considered the issue of decriminalisation during a 2-hour debate, where diverse and opposing viewpoints were heard. The debate was informed by a neutral discussion paper that was published by the BMA in February, which provided a guide to some of the key legal and ethical issues raised by the debate around decriminalisation.1 The BMA’s new policy only relates to whether abortion should or should not be a criminal offence; the policy does not address the broader issue of when and how abortion should be available. The BMA has established policy on these issues which remains unchanged.2 ### The law on abortion Induced abortion is currently a crime throughout the British Isles. There are, however, a range of exceptions to the crime laid out in statute and/or common law, for example, in England, Scotland and Wales, under the Abortion Act 1967. Any healthcare professionals operating within those defined exceptions, which include grounds for authorising an abortion and procedural requirements, can lawfully carry out an abortion as a clinical procedure. Outside these defined exceptions, the criminal offences potentially apply both to those who participate in carrying out abortions for others, including doctors, nurses and midwives, and to women who carry out abortions on themselves. For example, healthcare professionals who do not follow procedural requirements can attract criminal sanctions …. (shrink)

A volume with 14 chapters on various aspects of the relationship between responsibility and healthcare, plus a substantial introduction that offers a comprehensive overview of the relevant debates and how they relate to one another. -/- Questions of responsibility arise at all levels of health care. Most prominent has been the issue of patient responsibility. Some health conditions that risk death or serious harm are partly the result of lifestyle behaviours such as smoking, lack of exercise, or extreme sports. Are (...) patients with such conditions responsible for them? If so, might healthcare providers, be they state-run systems or private entities, be justified in treating such patients differently? And if they are, which forms of differential treatment are justified? Responsibility isn’t just relevant for patients. Even when individuals affect their health through voluntary behaviour, other influences are also at work before, during, and after the patient’s interaction with the health care system. What are the responsibilities of individual clinicians and other medical professionals, when thinking about individual and public health? What about institutions such as governments or national health care services, or society as a whole? This collection brings together work by world-renowned experts in population ethics, distributive justice, philosophy of action, cognitive science, and medical ethics in order to push the debate forward by elucidating our understanding of these questions, their possible answers, and how they are related. (shrink)

This introductory chapter offers an overview of the various ways that responsibility may be relevant to health care, in order to situate the chapters in this volume in their broader context. The chapter begins by outlining relevant concepts, and explaining why it is worth considering the role of responsibility in health care. The chapter then turns to various ways in which patients might be held responsible in a health care system, before considering objections to these practices. Finally, the chapter considers (...) the role of responsibility in health care beyond holding patients responsible, by considering the responsibility of medical professionals, and of institutions. (shrink)

On 26 January 2021, while announcing that the country had reached the mark of 100,000 deaths within 28 days of COVID-19, UK Prime Minister Boris Johnson said that he took “full responsibility for everything that the Government has done” as part of British efforts to tackle the pandemic. The force of this statement was undermined, however, by what followed: -/- What I can tell you is that we truly did everything we could, and continue to do everything that we can, (...) to minimise loss of life and to minimise suffering... -/- Taking these sentiments together, it was hard to avoid the conclusion that the government took responsibility only for doing everything right. Such an admission of responsibility, accommodating no admission of error or wrongdoing, is not really about responsibility at all. Indeed, the UK’s pandemic response has been marked from its earliest days by a shifting of focus from institutional responsibility to personal responsibility for individual UK residents. -/- This paper explores the relationship between these two sites of responsibility—the institutional and the personal—in the context of the sort of pandemic that is ongoing as we write. Section 2 offers some initial definitions and discussions of key terms. Section 3 outlines how these two ideas interact in principle during such emergencies. Section 4 turns to the ‘non-ideal’ implications for personal responsibility of failures of institutional responsibility. While our focus is on the specific context with which we are most familiar, the UK governmental approach, where appropriate we also include examples from other states. (shrink)

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...) and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health. (shrink)

The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...) even for those who will be left with very poor health. It then draws several further distinctions that may affect the application of responsibility at this level. We conclude that a more plausible version of the sufficientarian view is to allow a role for responsibility where failure to do so will leave someone else who is not responsible below the sufficiency threshold. However, we suggest that individuals must exhibit “sufficient responsibility” in order for this to apply, involving both a sufficient level of control and an avoidable failure to respond adequately to reasons for action. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

In February 2014, the Belgian Parliament passed legislation allowing euthanasia for terminally ill children of all ages by 86 votes to 44, with 12 abstentions. The Bill became law in early March after being signed by the King, making Belgium the first country in the world to abolish age restrictions for euthanasia. Previously, the youngest age at which euthanasia was permitted was 12 years old in The Netherlands.1Euthanasia was legalised in Belgium in 2002, and the new legislation introduces amendments to (...) the law extending euthanasia to minors in certain circumstances. Euthanasia is now permissible for children of all ages where the child has a “terminal and incurable illness”, experiences “constant and unbearable physical suffering”, and death is expected to occur within a “brief period”. The child must be deemed capable of making the decision, and have the agreement of their parents.Belgian law sets no timetable for euthanasia from the point at which the patient first expresses a wish to die. As with adults seeking euthanasia, any request must be made in writing. A physician and “outsider” brought in to give a second opinion must agree upon the diagnosis and prognosis, and a paediatric psychiatrist or psychologist must certify in writing that the child possesses “the capacity of discernment”. Following this, the child's physician must meet with the parents to inform them of the outcome of the consultation and ensure they are in agreement with the child's request. The child and the family must receive psychological care and support if so desired.The move provoked heated debate and divided the medical, legal and political professions in Belgium. A group of 160 of the country's paediatricians opposed a change in the law, citing concerns about the largely subjective assessment of the “capacity of discernment”, and drawing attention to advances in …. (shrink)

The British Medical Association has published a new report on health and human rights in immigration detention in the UK. Locked up, locked out outlines how aspects of current detention policies and practices are detrimental to the health of those detained and the challenges doctors face in providing healthcare in the immigration detention setting. It makes a number of recommendations aimed at addressing policy and practice which impact on health and well-being, including calling for an end to the routine use (...) of detention as a means of monitoring those facing removal from the UK and for the introduction of a time limit on the length of time individuals can be detained. It also provides guidance for doctors working in these settings on some of the common ethical and professional dilemmas they may face. The report can be accessed and downloaded at www.bma.org.uk/immigrationdetention. The Government has announced its intention to review mental health legislation for England and, in relation to non-devolved issues, for Wales.1 The Government states that it is ‘committed to delivering parity of esteem between mental and physical health’, although it does not clarify the meaning of ‘parity of esteem’. Similarly, the Government states that it wants to ensure that people with mental health problems ‘are treated with dignity, and that their liberty and autonomy is respected as far as possible’. Again, the Government has not indicated the meaning of ‘as far as possible’. Although not directly mentioned in the review’s terms of reference, it must be set against the background of changing legal and ethical expectations in relation to the rights of those with mental or cognitive disorders and disabilities. The UK is a signatory to the United Nations Convention on the Rights of People with …. (shrink)

Erdoğan intensifies assault on Turkish civil society Deeply worrying reports from the Turkish Medical Association suggest that the Turkish President Recep Erdoğan is hardening his attack on civil society in Turkey, using the legitimate activities of the TTB as the flimsiest of pretexts. In January 2018, the TTB issued a short statement raising concerns about the impact on public health of Turkey’s military operation in the Kurdish-controlled region of northern Syria. It denounced the operation saying ‘No to war, peace immediately’. (...) In response to the Association’s press release, the Turkish president publicly accused the 83 000 strong TTB of being terrorist sympathisers. ‘This institution has nothing to do with Turkishness and nothing about them is worthy of the notion of Turkishness’, he said. 1 Eleven of its senior doctors, including the Association’s chairman, were later detained following an order from a Turkish prosecutor. President Erdoğan made it... (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority . Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and (...) information about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18 . This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

The Supreme Court has ruled in the case of Y that there is no requirement to seek the approval of the Court of Protection in decisions to withdraw clinically assisted nutrition and hydration from patients in a prolonged disorder of consciousness.1 Mr Y was 52-year-old man who suffered a cardiac arrest after a myocardial infarction as a result of coronary artery disease. It was not possible to resuscitate him for well over 10 min, resulting in severe cerebral hypoxia which caused (...) extensive brain damage. Mr Y’s family and the NHS Trust treating him agreed that Mr Y would not want to be kept alive through the provision of CANH given his poor prognosis. They sought a declaration that it was not mandatory for applications of withdrawal of CANH to come before the court, which was granted by Mrs Justice O’Farrell in the first instance.2 Permission was granted for the appeal to ‘leapfrog’ the Court of Appeal and to proceed to the Supreme Court for consideration. In the interim, Mr Y died after contracting acute respiratory sepsis, but the Supreme Court determined that the appeal should go ahead in light of the general importance of the issues raised. In delivering the opinion of the Supreme Court on 30 July 2018, Lady Justice Black rejected the historical distinction that had been drawn between patients in PDOC and non-PDOC patients, in a way that had justified judicial involvement for patients in PDOC but not for others.3 She was clear that the correct approach to all cases involving CANH was to make a decision based on what was in the best interests of the patient. She further outlined that: > The documentation supplied to us shows that the difficulty that there is in assessing the patient and in …. (shrink)

There is an ongoing debate in medicine about whether patients have a ‘right not to know’ pertinent medical information, such as diagnoses of life-altering diseases. While this debate has employed various ethical concepts, probably the most widely-used by both defenders and detractors of the right is autonomy. Whereas defenders of the right not to know typically employ a ‘liberty’ conception of autonomy, according to which to be autonomous involves doing what one wants to do, opponents of the right not to (...) know often employ a ‘duty’ understanding, viewing autonomy as involving an obligation to be self-governing. The central contribution of this paper is in showing that neither view of autonomy can reasonably be said to support the extreme stances on the right not to know that they are sometimes taken to. That is, neither can a liberty view properly defend a right not to know without limits, nor can a duty view form the basis of an absolute rejection of the right not to know. While there is still theoretical distance between these two approaches, we conclude that the views are considerably closer on this issue than they first appear, opening the way for a possible compromise. (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)

Essex University, in association with Johns Hopkins Center for Public Health and Human Rights, has brought out a timely report highlighting the increasing global criminalisation of the provision of healthcare.1 The report, with a foreword by Professor Dainius Puras, United Nations Special Rapporteur on the right to health, explores the pressures on medical impartiality arising in large part from both global and national responses to the threat of terrorism. Both international humanitarian law, human rights law and long-established principles of medical (...) ethics—as set out in various declarations of the World Medical Association—establish an absolute principle that all people, regardless of their beliefs, affiliation or status, have rights of access to appropriate healthcare. And this right extends to wounded and sick combatants, as well as civilians, during times of armed conflict. One of the challenges in this area is that in recent years, many conflicts have become ‘asymmetric’. Contemporary conflicts seldom involve opposing state armies. Instead, they increasingly involve irregular combatants, often labelled ‘terrorists’ or ‘insurgents’ by the states they are opposing. In response to these threats, many states have developed sometimes draconian legislation outlawing terrorist groups and those offering support. The danger, outlined in some detail in the report, is that the vital distinction between the impartial provision of medical care and the criminal offence of materially aiding terrorism is lost. In 2016, largely in response to the deliberate targeting of healthcare personnel and facilities in the conflicts disfiguring the greater Middle …. (shrink)

In April, the UK House of Commons Science and Technology committee published a report evaluating the readiness of the National Health Service to incorporate genomic testing into mainstream service provision.1 The committee also examined some of the research and regulatory considerations in relation to the ongoing development of genome editing. ### Genomics in the NHS The main focus of the report is the 100,000 Genomes Project and the various practical and ethical challenges associated with the planned roll-out of the Genomics (...) Medicine Service in the NHS. The 1 00 000 Genomes Project was launched in 2012 and is the first large-scale whole genome sequencing research study of its kind in the world. The overall objective is to sequence genomes from NHS patients with a rare disease and their families, and from patients with specific cancers. The study seeks to benefit patients by potentially providing a diagnosis, gain new scientific insights, increase public knowledge of genomic medicine, encourage investment, and accelerate the uptake of genomic medicine in the NHS. At the time of writing the project had sequenced over 55 000 genomes and it is expected that the full 1 00 000 will be completed by the end of 2018. Building on the success of the project NHS England announced the establishment of a national NHS Genomic Medicine Service to provide ‘comprehensive and equitable access to the latest in genomic testing and management for the whole country, regardless of condition and where people live.’2 The service is set to be operational this year. The committee acknowledged the range of potential benefits that whole genome sequencing could have for patient care, however it also highlighted that there was a currently a lack of ‘sufficiently unambiguous evidence’ for its …. (shrink)

On 7 April 2022 – coinciding with World Health Day – the British Medical Association launched its new report, Health and human rights in the new world order.1 Written during the global upheaval triggered by the COVID-19 pandemic, and published just weeks after the Russian invasion of Ukraine, the report responds to a range of emerging and intensifying threats to health-related human rights globally. As the report establishes, human rights in health and healthcare matter because human suffering, and its relief, (...) are fundamental moral issues. As relief of human suffering is the primary purpose of medicine, it follows that doctors and other health professionals are often active in times of human challenge and extremity. During conflict, humanitarian crises, and, as we have so recently seen, global public health emergencies, health professionals are essential to the response. But these crises – and the response to them – can put fundamental human rights and interests under pressure. The Russian invasion of Ukraine has seen sustained indiscriminate shelling of civilian infrastructure. Whether health facilities were directly targeted is moot – the indiscriminate nature of the assault means they will inevitably be hit. Not only is this a violation of the Geneva Conventions, it undermines fundamental human rights, not least of which the right to health. Destroying health infrastructure drives further suffering and delays post-conflict recovery. Public heath emergencies can rightly require draconian measures – social distancing, enforced isolation, location tracking, economic shutdown. Although we saw their necessity during the COVID-19 outbreak, concerns were raised about disproportionate restrictions on basic rights, including rights to privacy and liberty. Human Rights Watch drew attention to the way governments unlawfully exploited COVID-19 to crack down on fundamental rights.2 Although conflicts and public health emergencies are not new, the report also tracks a number of …. (shrink)

Court of appeal ruling on assisted dyingIn July 2013, the Court of Appeal ruled on an assisted dying case brought by Paul Lamb, a 58-year-old man who has been quadriplegic and without function in any of his limbs, apart from a little movement in his right hand, since a car accident in 1990.1 Mr Lamb was permitted by the Court to take over the legal case of Tony Nicklinson, who died in August 2012, less than a week after his request (...) for judicial review was rejected by the High Court.2 Like Mr Nicklinson, the severity of Mr Lamb's injuries means that he is unable to take his own life, other than by starvation. He would like his life to be ended, preferably by lethal injection administered at home, and does not want to travel to Switzerland for an assisted suicide.Mr Lamb's case was heard, along with that of Mr Nicklinson's wife and that of another man, ‘Martin’, in the Court of Appeal in May.The Court identified three issues from the parties’ submissions: The common law should provide a defence to murder where that takes the form of euthanasia in circumstances where another party is giving effect to the settled wish of a competent person. The legal prohibitions on those providing assistance constitute a disproportionate interference with Article 8 rights to a private and family life. The Director of Public Prosecution's policy statement on factors which he will take into account when considering whether or not to exercise his discretion in favour of prosecuting does not satisfy the …. (shrink)

This year marks the 10th anniversary of the Female Genital Mutilation Act 2003.1 i The Act makes it an offence for any person to excise, infibulate or otherwise mutilate the whole or any part of a female's labia majora, labia minora or clitoris, or to aid, abet, counsel or procure the mutilation by another person. The exception is where a surgical or obstetric procedure is clinically indicated. There has long been UK legalisation against female genital mutilation but the 2003 Act (...) extended the criminal offence to UK nationals and permanent residents who are overseas, including in countries where the practice is legal. A person found guilty of an offence under the Act can be imprisoned for up to 14 years.Precise figures for the number of girls and women who have undergone, or who are at risk of FGM, in the UK, are hard to establish because of the secrecy surrounding the practice. It is estimated, however, that over 21 000 girls under the age of 15, in England and Wales, are at high risk of FGM.2 Despite this prevalence, recent clinical and policy guidelines3,4 and the legislative framework to prosecute, there have been no prosecutions for FGM in the UK. Worryingly, there is a suggestion that some girls are being brought to the UK for FGM, as the UK is seen as having ‘fewer controls’ and ‘less awareness about FGM’. A recent quote in the BMJ noted ‘People from many countries in Europe go to the UK for this purpose’.5In response to the lack of prosecutions, in November 2012, the Crown Prosecution Service launched an action plan for improving prosecutions. Action points include: gathering more robust data on allegations of FGM; raising with Ministers what the existing reporting …. (shrink)

### High Court rejects assisted dying challenge The High Court has rejected the latest challenge to the law on assisted dying in the UK, brought by Noel Conway. Mr Conway, a retired college lecturer, was diagnosed with motor neuron disease in 2012. Since his diagnosis, his health has deteriorated and he is dependent on ever-increasing levels of assistance with daily life, including the use of non-invasive ventilation to help him breathe. He sought a declaration from the court that section 2 (...) of the Suicide Act 1961 was incompatible with his right to a private and family life under Article 8 of the European Convention on Human Rights. As part of his case, Mr Conway submitted the outline of an alternative statutory scheme, which he argued, if implemented, would provide sufficient safeguards. He submitted that the prohibition on assisted suicide should not apply where an individual is aged 18 and over; has been diagnosed with a terminal illness and has a clinically assessed prognosis of 6 months or less to live; has the mental capacity to make the decision; makes that decision in a voluntary, clear and settled manner; and retains the ability to undertake the final act. Additionally, two doctors must confirm that the individual meets the criteria, and permission for the provision of assistance must be authorised by a High Court judge. Previous challenges to the UK law on assisted dying, including Pretty and Nicklinson, had established that section 2 of the Suicide Act does engage individual’s Article 18 rights, but that such an interference could be justified under Article 8 of the ECHR, which permits interference ‘such as is in accordance with the law and necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country’. The question …. (shrink)

In August 2012, the drug manufacturer, Fresenius Kabi, barred the sale of the anaesthetic, propofol, for use in lethal injections. The company announced that it would not accept orders for the drug from US departments of correction, and put in place similar requirements on all its wholesalers and distributors.1Propofol is one of the world's most widely used anaesthetics. Earlier in 2012, US states began to use propofol in executions following shortages of other drugs which had previously been used in lethal (...) injections. In May 2012, the state of Missouri decided to move to a one-drug protocol, using propofol alone for lethal injections, in place of the three-drug protocol that had been used by most states carrying out the death penalty. Missouri took this decision when supplies of thiopental sodium and pentobarbital, drugs used in the three-drug protocol, became unavailable.2Fresenius Kabi said that it had imposed the restrictions in order to ‘prevent Propofol from being used for purposes other than its approved medical indications’ and to ensure that ‘the immediate access to Propofol needed by medical professionals’ was not hindered. The company said that it objected to the use of its products in any manner that was not in full accordance with the medical indications for which they have been approved by health authorities.3 All forms of Fresenius Kabi propofol are manufactured in Europe. A European Union Council regulation prevents products that may reasonably be expected to be used in executions from being exported from the EU. The company said that, should propofol begin to be used in executions in the USA, inadequate access to the drug in the country was a likely consequence. At the time of writing, the US Food and Drug Administration was reporting shortages of the drug in the USA for …. (shrink)

The pituitary hormone prolactin (PRL) is best known for its role in the regulation of lactation. Recent evidence furthermore indicates PRL is required for normal reproduction in rodents. Here, we report on the insertion of two transposon-like DNA sequences in the human prolactin gene, which together function as an alternative promoter directing extrapituitary PRL expression. Indeed, the transposable elements contain transcription factor binding sites that have been shown to mediate PRL transcription in human uterine decidualised endometrial cells and lymphocytes. We (...) hypothesize that the transposon insertion event has resulted in divergent (pituitary versus extrapituitary) expression of prolactin in primates, and in differential actions of pituitary versus extrapituitary prolactin in lactation versus pregnancy respectively. Importantly, the TE insertion might provide a context for some of the conflicting results obtained in studies of PRL function in mice and man. (shrink)

Previous Ethics briefings have charted the unprecedented developments in relation to the law on abortion in Northern Ireland this year,1 resulting in legislation being passed by the UK government that ‘decriminalised’ abortion in Northern Ireland, up to the point at which a fetus ‘is capable of being born alive’, from 22 October 2019. A new legal framework and supporting guidelines on abortion are now set to be introduced by 31 March 2020—which should reflect the recommendations in the 2018 United Nations’ (...) Committee on the Elimination of Discrimination against Women report on abortion in Northern Ireland.2 ### Interim guidance In anticipation of this period between decriminalisation and the introduction of a new legal framework, on 7 October 2019 the UK government’s Northern Ireland Office published interim factual guidance for healthcare professionals on their responsibilities to patients in light of these changes.3 Among other things, the guidance notes that there are no plans for additional services to be routinely available in Northern Ireland before 31 March 2020. There will, however, be fewer restrictions on which women in Northern Ireland can access funded abortion services in England via the Central Booking Service—doctors should direct women to this service.4 If healthcare professionals do offer additional abortion services in Northern Ireland itself ‘they should do so in line with their professional competence and guidance from their professional body’. The guidance recognises that some women may still purchase drugs that cause abortions online during this interim period. The difference now is that should a woman require medical assistance as a result, there is no obligation on healthcare professionals to report the woman to the police as abortion, in these circumstances, is not a crime. Previously, under section 5 of the Criminal Law Act 1967 a legal duty, unique to Northern Ireland, was placed …. (shrink)

Population-level biomedical research has become crucial to the health system’s ability to improve the health of the population. This form of research raises a number of well-documented ethical concerns, perhaps the most significant of which is the inability of the researcher to obtain fully informed specific consent from participants. Two proposed technical solutions to this problem of consent in large-scale biomedical research that have become increasingly popular are meta-consent and dynamic consent. We critically examine the ethical and practical credentials of (...) these proposals and find them lacking. We suggest that the consent problem is not solved by adopting a technology driven approach grounded in a notion of ‘specific’ consent but by taking seriously the role of research governance in combination with broader conceptions of consent. In our view, these approaches misconstrue the rightful location of authority in the way in which population-level biomedical research activities are structured and organized. We conclude by showing how and why the authority for determining the nature and shape of choice making about participation ought not to lie with individual participants, but rather with the researchers and the research governance process, and that this necessarily leads to the endorsement of a fully articulated broad consent approach. (shrink)

On 8 October 2020, the British Medical Association published the results of its survey of BMA members on physician-assisted dying. With 28 986 respondents, this was one of the largest surveys of medical opinion on this topic ever carried out. This represents 19.35% of those who received an invitation to participate and the respondents were broadly representative of the BMA’s overall membership. The BMA was clear throughout this process that the results of the survey would not determine its policy. Its (...) current policy of opposition to all forms of physician-assisted dying would remain unless and until the Representative Body, which makes BMA policy, decided otherwise. The survey results would, however, inform a future debate on policy, currently scheduled to take place in June 2021. When asked what the BMA’s position should be on whether there should be a change in the law to allow doctors to prescribe drugs for an eligible patient to self-administer to end their own life, 40% said the BMA should be supportive, 33% opposed, 21% thought the BMA should be neutral and 6% were undecided. In relation to their own personal views, 50% were supportive, 39% opposed and 11% undecided. When asked whether they would be willing to participate in some way in the process, if it were to be legalised, 36% said yes, 45% said no and 19% were undecided. The same three questions were asked about a change in the law to allow doctors to administer drugs to end the life of an eligible patient. In response, 40% thought the BMA should oppose such a change, 30% thought the BMA should be supportive and 23% thought the BMA should be neutral; 7% of members responding were undecided on this question. In …. (shrink)

During the first UK wave of the pandemic, there were two areas of immediate ethical concern for the medical profession. The first was the possibility that life-saving resources could be overwhelmed. Early reports from hospitals in the Italian city of Bergamo suggested that ventilatory support might need rationing and emergency ‘battlefield’ triage was a real possibility.1 In the UK, several professional bodies, including the British Medical Association and the Royal College of Physicians rapidly developed guidance for doctors should triage become (...) a reality.2 The second issue was the acute shortage of personal protective equipment. Where doctors were unable to protect their patients – and themselves – from the risk of COVID-19, ethical challenges emerged. Ordinarily, doctors and patients do not present risks of significant harm to each other. To shift to a position where every patient – and every health professional – could potentially be a threat presented serious clinical and ethical challenges. To treat with inadequate PPE, so options for mitigating harms are radically reduced, deepens the challenges. Among the questions the BMA wrestled with was the extent of doctors’ duties to treat infected or potentially infected patients in the absence of effective PPE. The BMA was clear that despite obligations to treat, medicine is not a self-sacrificing profession: there were limits to the risk doctors could be required to expose themselves to.3 These issues no longer seem so pressing. In the UK at least, there is adequate PPE and with the second steep wave behind us, and significant numbers vaccinated, it is less likely that triage will be required in the UK. But as those concerns have receded so other ethical questions have arisen. Among them is a cluster of issues associated with what might be called COVID-19’s indirect harms. Understandably, in response to …. (shrink)

The empirical study of grace, a relational virtue, is in its beginning stages. The purpose of this study was to provide rich, context-based, qualitative data to describe Mainline Protestants’ (a) experiences of, and (b) beliefs about, divine grace. Interviews were conducted with 28 community adults who were affiliated with Mainline Protestant Churches. Results indicated that Mainline Protestant Christians have varying beliefs about divine grace and how it is related to both the present moment and the afterlife. Divine grace was often (...) defined as, or associated with, other relational virtues (e.g., forgiveness and love), and participants occasionally defined grace as a gift. In addition, divine grace was also reported to be difficult to accept at times for a variety of reasons, but the effects of divine grace have direct associations with participants’ overall well-being. Divine grace was also associated with beliefs about heaven or the afterlife, yet participants had varying beliefs about how grace is applied to non-Christians. Limitations and future directions for research are discussed in light of the present empirical literature on divine grace. (shrink)

Much has been written about recidivist punishments, particularly within the area of criminology. However there is a notorious lack of penal philosophical reflection on this issue. This book attempts to fill that gap by presenting the philosopher’s view on this matter as a way of furthering the debate on recidivist punishments.

Introduction -- The type/token theory introduced -- Motivating the type/token theory : repeatability -- Nominalist approaches to the ontology of music -- Musical anti-realism -- The type/token theory elaborated -- Types I : abstract, unstructured, unchanging -- Types introduced and nominalism repelled -- Types as abstracta -- Types as unstructured entities -- Types as fixed and unchanging -- Types II : platonism -- Introduction : eternal existence and timelessness -- Types and properties -- The eternal existence of properties reconsidered -- (...) Types and patterns -- Defending the type/token theory I -- Unstructuredness and analogical predication -- Musical works as fixed and unchanging -- Abstractness and audibility (again) -- Works and interpretations -- Conclusion and resumé -- Defending the type/token theory II : musical platonism -- Platonism it is : replies to Anderson and Levinson -- The existence conditions of works of music -- Composition as creative discovery -- The nature of the compositional process : replies to objections -- Composition and aesthetic appraisal : a reply to Levinson -- Composition and aesthetic appraisal : understanding, interpretation, and correctness -- Musical works as continuants : a theory rejected -- A theory introduced -- Explicating and motivating the continuant view -- The continuant view and repeatability -- Further objections to the continuant view -- Musical works as compositional actions : a critique -- Currie's action-type hypothesis -- Davies's performance theory -- Sonicism I : against instrumentalism -- Sonicism introduced -- Sonicism motivated : moderate empiricism -- Instrumentation : timbral sonicism introduced -- Scores -- Instrumentation, artistic properties, and aesthetic content -- Levinson's rejoinder -- Sonicism II : against contextualism -- Introduction : formulating contextualism -- Contextualist ontological proposals -- Levinson's doppelgänger thought-experiments -- Artistic, representational, and object-directed expressive properties -- Aesthetic and non-object-directed expressive properties -- Conclusion : the place of context. (shrink)

In a recent judgment1 the Court of Protection was highly critical of health professionals for continuing to provide clinically-assisted nutrition and hydration in the face of disagreement about the patient’s best interests, without seeking to resolve the issue. This hearing had been set up specifically to consider whether GU’s dignity had been properly protected, and if not why not, given concerns raised by the Official Solicitor about what she considered to be “a complete abrogation of responsibility to consider properly or (...) at all, and to determine whether it was in GU’s best interests and therefore lawful to continue to give him an invasive medical treatment, CANH.” In April 2014, at 63 years old and living in Thailand, GU sustained severe injuries after suffering from an electrocution accident. He sustained a cardiorespiratory arrest with a significant delay before cardiopulmonary resuscitation was started and was unconscious and unresponsive. In September 2014 he was transferred to the UK. In August 2018, GU’s brother made a request for a best interests decision concerning the continuation of CANH. The family met to discuss this and all except GU’s son, agreed that continuing CANH was not in GU’s best interests. In view of the fact that there was not unanimity among the family, a decision was made that CANH should continue. Commenting on this decision, Mr Justice Hayden said ‘the apparent assumption that in the face of family disagreement ‘ therefore will continue to be cared for by nursing staff ” is a troubling non sequitur’ and stressed that ‘family dissent to a medical consensus should never stand in the way of an incapacitated patients’ best interests being properly identified’. He also made clear that the responsibility for ensuring that a best interests assessment is undertaken rests with the …. (shrink)

In parts of the world, discussion regarding COVID-19 has shifted towards endemicity, and questions of living with, rather than directly battling, the virus. As a result, ethical questions are being refocussed. The imperative is beginning to shift towards what we can learn from the pandemic, and how we can better prepare for future global outbreaks. Among the questions that need to be addressed is what Covid-29 has taught us about how research can be conducted ethically during major global public health (...) emergencies. It is widely accepted that research has an essential role to play in improving the effectiveness of health interventions in major public health crises.1 Even before COVID-19, a special series published in The Lancet highlighted the critical role of research in humanitarian crises, and lamented the paucity of good data on the effectiveness of health interventions in these particularly demanding contexts.2 The impact of expedited vaccine research on the mortality, morbidity and global disruption of the COVID-19 pandemic would be difficult to exaggerate. But it is clear that one important driver of vaccine hesitancy was public concern about the speed with which research into the vaccines was undertaken and hence the reliability of the data concerning their safety.3 Although for understandable reasons, the focus of attention on ethical research during the COVID-19 pandemic has been on vaccines and anti-virals, research in public health emergencies involves a wide range of activities designed to generate evidence, including social science research – which can be particularly critical in understanding barriers to vaccine uptake for example – along with epidemiological studies and health systems research. One widely acknowledged area of ethical tension concerning research in public health emergencies is between the need for rapid ethical review, and the strong moral requirement …. (shrink)

At the time of writing the COVID-19 pandemic was entering its ninth month, with nearly 800 000 recorded fatalities and 22 million infections in 188 countries and territories.1 In previous ethics briefings2 we raised concerns about the possibility that demand for life-sustaining treatment would overwhelm supply, with a consequent requirement for health professionals to make challenging triage decisions. Fortunately, to date, these have largely not been realised, although there is a possibility that countries in which containment measures have been less-successful, (...) such as South Africa, may still be required to triage.3 Despite the successful ‘flattening of the curve’ in many countries, there is a wide consensus that we remain firmly within the pandemic. Enormous practical challenges remain. It is unclear whether the pandemic will ultimately take the form of two or more successive waves, or whether the patchwork of global responses will lead to a sustained slow ‘burn’ with sporadic flare-ups.4 Areas of uncertainty include whether infection confers some immunity, how long any such immunity might last, whether effective vaccines can be developed and if seasonal temperature fluctuations alter the spread of the virus. The pandemic will also be fundamentally shaped by the decisions that governments make and the extent to which their diktats are complied with by citizens. With the – possibly temporary – retreat of urgent clinical ethics issues, such as triage, opportunities have arisen to reflect on some of the ethical questions that underlie and structure the demanding policy decisions that governments are wrestling with. One of the early questions was how to balance the complex constellation of costs and benefits associated with lockdown. Countries that …. (shrink)

In December, the National Data Guardian 1 for health and care in England, Dame Fiona Caldicott, published the outcomes of a public consultation about the Caldicott Principles and the role of Caldicott Guardians.1 The Caldicott Principles are good practice guidelines which have been used by health and social care organisations in the UK since 1997 to ensure that people’s data are kept safe and used in an ethical way.2 The role of the Caldicott Guardian is well-established in the UK. Caldicott (...) Guardians are senior people which support the upholding of the Caldicott Principles within organisations. In response to views expressed during the consultation the NDG has added an eighth Caldicott Principle to the existing seven and will use her statutory powers to issue guidance about the appointment of Caldicott Guardians for health and adult social care organisations. The new eighth Caldicott Principle is: ‘Inform patients and service users about how their confidential information is used’. It provides that: > A range of steps should be taken to ensure no surprises for patients and service users, so they can have clear expectations about how and why their confidential information is used, and what choices they have about this. These steps will vary depending on the use: as a minimum, this should include providing accessible, relevant and appropriate information - in some cases, greater engagement will be required. The NDG explains that the introduction of the new principle was prompted by consideration of the role that the legal concept of ‘reasonable expectations’ should play in shaping the circumstances under which health and care data may be legitimately shared. The NDG does not envisage that this principle will establish reasonable expectations as a legal basis in its own right …. (shrink)

As the COVID-19 vaccine roll out continues apace, in the higher-income countries at least, concerns remain about the level of vaccine coverage in some health and social care settings. Although most countries have seen a relatively high uptake of vaccination against COVID-19 among staff, there continue to be some pockets of hesitancy. The risk of outbreaks in settings with potentially very vulnerable patients has led some governments across Europe to consider, or to introduce, measures compelling healthcare staff to be vaccinated. (...) The justifiability of mandating the vaccination of healthcare professionals is a longstanding question but it has come to the fore in recent months following a resurgence of cases of COVID-19 and the prevalence of the more transmissible Delta variant. In deciding whether the introduction of a mandate is appropriate, states have to balance a range of ethical and practical considerations. A voluntary approach, backed up with education, respects healthcare workers’ autonomy to make private healthcare decisions, which is valued highly in liberal democracies. However, healthcare professionals also have an obligation to ensure that they do not present a risk of harm to their patients. Similarly, healthcare providers have a responsibility to take appropriate steps to minimise the risk of infection. Alongside balancing these rights and responsibilities, governments must also consider the potential consequences and risks of enforcing vaccine uptake. For example, there are concerns that a coercive approach could deepen mistrust and resentment among people who are genuinely fearful or hesitant. Moreover, a large number of refusals and the subsequent imposition of sanctions, such as suspension or redeployment, could affect the ability of providers to staff necessary services. In the UK, Wales, Northern Ireland and Scotland have all ruled out the introduction of compulsory vaccination. However, in July, the English Parliament voted through …. (shrink)

### Challenge to the abortion act 1967 dismissed In September, the High Court dismissed a judicial review of the Abortion Act 1967 that sought a judgement of incompatibility with the European Convention on Human Rights.1 The case focused on a clause in the Act which permits abortion in England, Scotland and Wales after 24 weeks if there is a substantial risk that, if the child were born, it would suffer from ‘such physical or mental abnormalities as to be seriously handicapped’. (...) The case was brought by three parties: Heidi Crowter, a 24 year old woman living independently with Downs Syndrome and a campaigner for disability rights; a 2 year old boy with DS; and his mother who, when pregnant with him, felt pressure to terminate the pregnancy. The claimants sought a declaration that the clause was incompatible with the right to life; freedom from torture, inhuman or degrading treatment; right to private and family life; and protection from discrimination. Further to this it was also argued that the Act does not permit abortion on the basis that an unborn child has been diagnosed with a non-fatal fetal disability such as DS and that such abortions should not be funded by the state. In dismissing the claim, the judges focused on the ‘margin of appreciation’ that the European law allows domestic states on this issue and the fact that a foetus has never been deemed to have personhood status under the ECHR. The judges noted the ability to provide for a disabled child would vary significantly and that some conditions would only be found late in a pregnancy, after 24 weeks. Stating that the case by its nature did not permit the Court to hear from other perspectives, including women who may be affected by any change to the law and further criminalisation of abortion, the judges emphasised …. (shrink)

Descriptivism in the ontology of art is the thesis that the correct ontological proposal for a kind of artwork cannot show the nascent ontological conception of such things embedded in our critical and appreciative practices to be substantially mistaken. Descriptivists believe that the kinds of revisionary art ontological proposals propounded by Nelson Goodman, Gregory Currie, Mark Sagoff, and me are methodologically misconceived. In this paper I examine the case that has been made for a local form of descriptivism in the (...) ontology of art: a form that does not quarrel with the possibility of revisionism in matters of ‘fundamental metaphysics’, but which argues that special features of the arts make descriptivism in this particular sphere obligatory. David Davies, Andrew Kania and Stephen Davies are local descriptivists in this sense. I argue that the burden of proof lies with the local descriptivist, but that this burden is too heavy for him to carry. Specifically, it emerges that the only way in which the local descriptivist can motivate his position is by arguing that our artistic practices determine the art ontological facts: a thesis that local descriptivists typically appeal to, but have not been able to argue for successfully. My conclusion is that the methodological debate in the ontology of art should now proceed by focussing on the case for global descriptivism: i.e. that form of descriptivism that opposes the possibility of revisionism in ontological matters across the board. (shrink)

Simplifying somewhat, sonicists believe that works of music are individuated purely in terms of how they sound. For them, exact sound-alikes are identical. Stephen Davies, in his ‘Musical Works and Orchestral Colour’ ( BJA 48 (2008), pp. 363–375) took me to task for defending a version of sonicism. In this paper I seek to explain why Davies's objections miss their mark. In the course of the discussion, I make some methodological remarks about the ontology of music.

A work of music is repeatable in the following sense: it can be multiply performed or played in different places at the same time, and each such datable, locatable performance or playing is an occurrence of it: an item in which the work itself is somehow present, and which thereby makes the work manifest to an audience. As I see it, the central challenge in the ontology of musical works is to come up with an ontological proposal (i.e. an account (...) of what sort of thing a work of music is) which enables us to explain what such repeatability consists in, whilst doing maximal justice to the way in which we conceive of musical works in our reflective critical and appreciative practice. To this end, many have found it tempting to defend some version or other of the type-token theory : the thesis that a work is a type and its occurrences are its tokens. Much of the early debate prompted by the publication of Jerrold Levinson's seminal 'What a Musical Work Is' in 1980 has taken the type-token theory for granted, choosing to focus on how musical works, qua types, are individuated. (A key question here has been whether we should hold, with the sonicist , that works are identical just in case they sound exactly alike; or whether we should agree with Levinson's contextualist thesis that exact sound-alikes are distinct, if composed in distinct musico-historical contexts.) More recently, however, the type-token theory itself has been put under pressure, and alternatives have been suggested. So, e.g. Gregory Currie and David Davies have held versions of the thesis that musical works (and artworks generally) are acts of composition, whilst Guy Rohrbaugh has recommended that we think more innovatively about our metaphysical categories, and treat musical works (along with all repeatable artworks) as historical individuals . Historical individuals, like particular substances, come into and go out of existence, could have been somewhat different than they are, and can change through time; but such items, unlike particular substances, are nonetheless capable of having occurrences. In the last few years, ontologists of music have also stepped back to consider the very nature of their enterprise. In particular, a debate has ensued concerning the cogency of ontological proposals (such as those of Nelson Goodman, Nicholas Wolterstorff and Julian Dodd) that are substantially revisionary of our folk concept of a work of music. Amie Thomasson, David Davies and Andrew Kania occupy, to a greater or lesser degree, the descriptivist standpoint, according to which such revisionary ontologies are misconceived. The debate between revisionists and descriptivists in the ontology of music – if prosecuted against the backdrop of an awareness of developments in meta-ontology more generally – is a particularly fertile area in the philosophy of music at present. Author Recommends Wollheim, Richard. Art and its Objects . 2nd ed. Cambridge: Cambridge University Press, 1980. This seminal study nicely introduces and motivates the type-token theory, and in the course of doing so, helpfully, although perhaps contentiously, distinguishes types from both sets and properties. Wollheim's treatment was to a large part responsible for stimulating the subsequent debate as to the ontological nature of musical works. Levinson, Jerrold. 'What a Musical Work Is.' Journal of Philosophy 77 (1980); reprinted in his Music, Art and Metaphysics , 63–88. This paper has, perhaps, been the most influential account of the nature of musical works, post-Wollheim. Presuming the type-token theory to be correct, Levinson elaborates it by claiming musical works to be, not sound structures (i.e. structured patterns of sound-types), but a species of types he calls indicated structures . According to Levinson, a work of music is not to be identified with its sound structure, S ; it is, in fact, a compound of S and a performance-means structure, PM , as indicated (typically, via a score) by its composer on a certain occasion : something that we can represent as S/PM -as-indicated-by- X -at- t . Such indicated structures, Levinson argues, fit the bill for being what works of music are, because they come into being with their indication (i.e. their composition), are individuated in terms of the musico-historical context in which they were composed, and have their specified performance-means (i.e. their instrumentation) essentially. Wolterstorff, Nicholas. Works and Worlds of Art . Oxford: Clarendon Press, 1980. Part I of this book sees Wolterstorff defend a Platonistic version of the type-token theory (although Wolterstorff calls them 'kinds' rather than 'types'). According to Wolterstorff, considerations about the existence conditions of types commit us to the thesis that works of music, qua types, are entities that cannot come into or go out of existence. Kivy, Peter. 'Platonism in Music: A Kind of Defence.' Grazer Philosophische Studien 19 (1983): 109–29. In this article, Kivy ingeniously (and wittily) defends a variety of Platonism about works of music against the animadversions of Levinson. Currie, Gregory. An Ontology of Art . New York: St, Martin's Press, 1989. Here Currie introduces and defends the thesis that works of music (and, indeed, all artworks) are compositional action-types. The book also contains some well-aimed criticisms of Levinson's account. Dodd, Julian. Works of Music: An Essay in Ontology . Oxford: Oxford University Press, 2007. In this book, Dodd defends the type-token theory, but argues that no version of it can escape the Platonisic consequence that musical works exist at all times (and hence, are discovered, rather than created, by their composers). Dodd also defends another controversial thesis, this time concerning musical works' individuation. According to Dodd, and pace Levinson and others, sonicism is correct: works that sound exactly alike are identical. Rohrbaugh, Guy. 'Artworks as Historical Individuals.' European Journal of Philosophy 11 (2003): 177–205. In this essay, Rohrbaugh makes some pointed criticisms of the type-token theory of repeatable artworks in the course of arguing that such works should be viewed, not as types, but as historical individuals (see above). Rohrbaugh suggests that treating musical works as historical individuals best captures our intuitions about such works' temporal and modal characteristics, and, in the course of elaborating his position, he makes some meta-ontological claims that see him endorsing a non-revisionary, descriptivist approach to the ontology of art. As Rohrbaugh sees it, ontologies of art are 'beholden to our artistic practices' (179), and 'aesthetics should not be beholden to the metaphysics on offer, but rather should drive new work in metaphysics' (197). Ridley, Aaron. 'Against Musical Ontology,' Journal of Philosophy 100 (2003): 203–220. This paper sees Ridley outlining a sceptical attitude towards the project of formulating ontological proposals. In his view, a 'serious philosophical engagement with music is orthogonal to, and may well in fact be impeded by, the pursuit of ontological issues' (203). Thomasson, Amie. 'The Ontology of Art and Knowledge in Aesthetics.' JAAC 63 (2005:221–9). Thomasson defends descriptivism in the ontology of art by arguing that such a position is a consequence of the only defensible solution to a problem in the theory of reference: the so-called 'qua' problem concerning how the reference of a term can be fixed. Davies, David. Art as Performance . Oxford: Blackwell, 2004. Davies' position is characterised by two theses: one methodological, the other ontological. The methodological claim is that the ontology of art faces a pragmatic constraint : roughly speaking, the ontology of art is answerable to the epistemology of art. The ontological claim is that the rigorous enforcement of the pragmatic constraint commits us to the thesis that all artworks are compositional action-tokens. Online Materials http://www.blackwell-compass.com/subject/philosophy/article_view?article_id=phco_articles_bpL173 Dodd, Julian. 'Musical Works: Ontology and Meta-Ontology.' Philosophy Compass 3/6 (2008): 1113–34. doi: [DOI link] http://www3.interscience.wiley.com/journal/118557784/abstract Thomasson, Amie. 'Debates about the Ontology of Art: What are We Doing Here?' Philosophy Compass 1/3 (2006): 245–55. doi: [DOI link] http://www3.interscience.wiley.com/journal/122517227/abstract Davies, David. 'Works and Performances in the Performing Arts.' forthcoming in Philosophy Compass . doi: [DOI link] http://plato.stanford.edu/entries/music/ Kania, Andrew. 'The Philosophy of Music.' Stanford Encyclopedia of Philosophy . Sample Mini-Syllabus Week 1: The Type/Token Theory Introduced Wollheim, Richard. Art and its Objects , §§4–8, 21–3, 35–7. Kivy, Peter. Introduction to a Philosophy of Music , chapter 11. Oxford: Clarendon Press, 2002. Dodd, Julian. Works of Music: An Essay in Ontology , chapter 1. Wolterstorff, Nicholas. Works and Worlds of Art , chapter 2. Week 2: The Type/Token Theory and Platonism in Music Wolterstorff, Nicholas. Works and Worlds of Art , chapter 2. Levinson, Jerrold. 'What a Musical Work Is'. Dodd, Julian. Works of Music: An Essay in Ontology , chapters 2–5. Kivy, Peter. 'Platonism in Music: A Kind of Defence.' Grazer Philosophische Studien 19 (1983): 109–29. Kivy, Peter. 'Platonism in Music: Another Kind of Defence.' American Philosophical Quarterly 24 (1987): 245–52. Predelli, Stefano. 'Against Musical Platonism.' British Journal of Aesthetics 35 (1995): 338–50. Caplan, Ben and Carl Matheson. 'Can a Musical Work be Created?' British Journal of Aesthetics 44 (2004): 113–34. Week 3: Musical Works as Indicated Structures Levinson, Jerrold. 'What a Musical Work Is'. Levinson, Jerrold. 'What a Musical Work Is, Again', in his Music, Art and Metaphysics . Ithaca, NY: Cornell UP, 1990. 215–63. Dodd, Julian. 'Musical Works as Eternal Types.' British Journal of Aesthetics 40 (2000). Davies, Stephen. Musical Works and Performances: A Philosophical Account , chapter 2. Oxford: Oxford University Press, 2000. Howell, Robert. 'Types, Indicated and Initiated.' British Journal of Aesthetics 42 (2002): 105–27. Caplan, Ben and Carl Matheson. 'Fine Individuation.' British Journal of Aesthetics 47 (2007): 113–37. Week 4: Musical Work as Historical Individuals Rohrbaugh, Guy. 'Artworks as Historical Individuals'. Dodd, Julian. Works of Music: An Essay in Ontology , chapter 6. Caplan, Ben and Carl Matheson. 'Defending Musical Perdurantism.' British Journal of Aesthetics 46 (2006): 59–69. Caplan, Ben and Carl Matheson. 'Defending "Defending Musical Perdurantism".' British Journal of Aesthetics 48 (2008): 331–37. Week 5: Musical Works as Compositional Actions Currie, Gregory. An Ontology of Art . New York: St, Martin's Press, 1989. Davies, David. Art as Performance . Oxford: Blackwell, 2004. Dodd, Julian. Works of Music: An Essay in Ontology , chapter 7. Week 6: Meta-ontology of Music: What are we Doing When we do the Ontology of Music? Ridley, Aaron. 'Against Musical Ontology'. Thomasson, Amie. 'The Ontology of Art and Knowledge in Aesthetics'. Thomasson, Amie. Ordinary Objects , chapter 11. OUP, 2007. Davies, David. 'The Primacy of Practice in the Ontology of Art.' Journal of Aesthetics and Art Criticism 67 (2009): 159–72. Kania, Andrew. 'Piece for the End of Time: In Defence of Musical Ontology,' British Journal of Aesthetics 48 (2008): 65–79. Kania, Andrew. 'The Methodology of Musical Ontology: Descriptivism and its Implications.' British Journal of Aesthetics 48 (2008): 426–44. Cameron, Ross. 'There are No Things That are Musical Works.' British Journal of Aesthetics 48 (2008): 295–314. Dodd, Julian. 'Musical Works: Ontology and Meta-Ontology.' Philosophy Compass 3/6 (2008): 1113–1134. doi: [DOI link] Focus Questions 1. Are musical works literally created by their composers? 2. Critically examine Levinson's thesis that musical works are 'indicated structures'. 3. What, if anything, is wrong with the thesis that musical works are identical just in case they sound exactly alike? 4. Should we immediately be sceptical of ontological proposals for works of music that are substantially revisionary of the way in which we ordinarily think of them? (shrink)

Through a collection of contributions from an international team of empirical researchers and philosophers, _New Philosophies of Learning_ signals the need for a sharper critical awareness of the possibilities and problems that the recent spate of innovative learning techniques presents. Explores some of the many contemporary innovations in approaches to learning, including neuroscience and the focus on learners’ well-being and happiness Debates the controversial approaches to categorising learners such as dyslexia Raises doubts about the preoccupation with quasi-mathematical scrutiny and the (...) neglect of ethical reflection about education Discusses the possible grounds for concern, without exaggerating their similarities or offering sweeping judgements Includes contributions from empirical researchers and philosophers, including Usha Goswami, Howard Gardner, Julian Elliott, David Bakhurst, John White and Christopher Winch. (shrink)

A kind of musical authenticity Julian Dodd thinks has been neglected, interpretive authenticity, as he calls it, is intended to provide both an insightful and faithful understanding of the work. This kind of authenticity is distinguished from score compliance authenticity (a view I have defended) on grounds that an authentic musical interpretation can sometimes deliberately depart from the score. I argue that none of the four examples Dodd offers in favour of this hypothesis is uncontroversial. I have less faith (...) than Dodd in the ability of wholesale departures from the composer’s work specification to demonstrate performance insight or to be seen as unproblematically instancing all aspects of the work. (shrink)

Is ontologizing about art rightly held accountable to artistic practice, and, if so, how? Julian Dodd argues against such accountability. His target is “local descriptivism,” a meta-ontological principle that he contrasts with meta-ontological realism. The local descriptivist thinks that folk-theoretic beliefs implicit in our practices somehow determine the ontological characters of artworks. I argue, however, that according a grounding role to artistic practice in the ontology of art does not conflict with meta-ontological realism. Practice must ground our ontological inquiries (...) because our task is to make sense of the practices into which artworks enter. Terms like ‘musical work,’ as employed by the ontologist, play an essentially explanatory role in this endeavor, and it is only in terms of this role that we can specify the object of our ontological inquiries. But neither our practices nor our folk beliefs are sacrosanct. In taking ontology of art to be reflectively accountable to artistic practice, I also reject Amie Thomasson's claim that it involves conceptual analysis and therefore cannot rightly claim to be directly revisionary of folk understandings. Ontology of art involves not conceptual analysis but the codification of a practice in a way that clarifies that practice. (shrink)

Julian Dodd has argued that the type–token theory in musical ontology has a ‘default’ status because it can explain the repeatability and audibility of musical works without the need for philosophical reinterpretation. I present two challenges to Dodd's claims about audibility. First, I argue (a) that a type–token theorist who, like Dodd, adheres to Wolterstorff's doctrine of analogical predication must grant that musical works themselves are hearable only in an ‘analogical’ sense; and (b) that alternative musical ontologies are able (...) to explain the latter just as well as the type–token theory. Second, I argue that Dodd cannot evade this objection by claiming that what matters in musical ontology is accounting for audibility ‘in a derivative sense’, since the latter also allows of explanation by a range of musical ontologies. (shrink)

known as timbral sonicism, accepts that a musical work's orchestral colour is a factor in its identity, but denies that the use of the specified instruments is required for an authentic rendition of the work provided that sounds as of those instruments are achieved. This position has been defended by Julian Dodd. In arguing against his view, I appeal to empirical work showing that composers, musicians, and listeners typically hear through music to the actions that go into its production. (...) In this respect, musical listening reflects the standard account of ‘ecological hearing’; we appreciate sounds as providing information about their sources rather than for their intrinsic qualities. On this basis, I suggest that musical instruments are not merely means to the production of the sounds of performances. Their use is mandated if such performances are to be properly formed. More specifically, when composers are able to make the instrumentation of their compositions central to the identity of those compositions, accurate performances must involve the appropriate use of the specified instruments. CiteULike Connotea Del.icio.us What's this? (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force here. (...) As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

The death of Socrates is often taken as the starting point for reflection on the relationship between the philosopher and established power. In the Apology, Plato gives an account of Socrates’s own...

Las distinciones conceptuales propuestas por Thomas Hobbes reflejan el problema político de considerar lo múltiple en la unidad o la convergencia de innumerables cuerpos, deseos y pasiones en la consolidación de una voluntad soberana unitaria. Ejemplo de ello son las nociones de potentiae (potencias) y potestas (poder), junto a otras como multitud y pueblo o súbditos y soberano. Todas ellas reflejan el problema de la estabilidad del Estado y su legitimidad institucional: la necesidad de generar, de manera continua, un poder (...) común. Con la intención de formular una lectura democrática, el propósito de este artículo es relacionar una lectura iconográfica del frontispicio del Leviatán con la presencia/ausencia de un cuerpo indómito. El trabajo concluye que un rasgo esencial de la teoría política hobbesiana es el sentido de lo democrático fundamentado en la presencia ineludible de cuerpos colectivos que deben ser representados. (shrink)