Recently, in increasing numbers, citizens of wealthy nations are heading to poorer countries for medical care. They are traveling to the global South as medical tourists because in their home nations either they cannot get timely medical care or they cannot afford needed treatments. This essay offers a robust, particularist ethical assessment of the practice of citizens of richer nations traveling to poorer countries for healthcare.

In the context of medical ethics, how can the concept of informed consent be effectively implemented in a traditional society such as Japan? If the need for more openness and transparency is not felt in the practice of medicine and welfare, the clients must remain under the spell of paternalistic data. Patients and health-care professionals other than doctors are taken to be "responsible for what they do but not to be accountable for their conduct" because they do not participate (...) in a decision-making process. I explore the possibility of the concept's full implementation against the particularists' and communitarian ethicists' effort to reject the universal nature of the concept. (shrink)

The history of medical and professional ethics has largely been a history of attempts to identify, articulate, and defend principles that explain when and why certain actions, institutions, health care professionals, and particular decisions count as right or wrong, just or unjust, virtuous or vicious. Medical ethics has been dominated by principlism. However, so-called moral particularists have forcefully attacked the dominance of principle-based normative theories. The particularist critique of traditional moral theory derives from the rejection of the claim (...) that the normative content of ethics and medical... (shrink)

Phronesis has become a buzzword in contemporary medical ethics. Yet, the use of this single term conceals a number of significant conceptual controversies based on divergent philosophical assumptions. This paper explores three of them: on phronesis as universalist or relativist, generalist or particularist, and natural/painless or painful/ambivalent. It also reveals tensions between Alasdair MacIntyre’s take on phronesis, typically drawn upon in professional ethics discourses, and Aristotle’s original concept. The paper offers these four binaries as a possible analytical framework for (...) classifying and evaluating accounts of phronesis in the medical ethics literature. It argues that to make sense of phronesis as a putative ideal in professional medical ethics—for example, with the further aim of crafting interventions to cultivate phronesis in medical ethics education—the preliminary question of which conception of phronesis is most serviceable for the aim in question needs to be answered. The paper identifies considerable lack of clarity in the current discursive field on phronesis and suggests how that shortcoming can be ameliorated. (shrink)

On 27 September 2013, the Centre for the Humanities and Health (CHH) at King's College London hosted a 1-day workshop on ‘Medical knowledge, Medical Duties’. This workshop was the fifth in a series of five workshops whose aim is to provide a new model for high-quality, open interdisciplinary engagement between medical professionals and philosophers. This report identifies the key points of discussion raised throughout the day and the methodology employed.

Despite its authors’ intentions, the four principles approach to medical ethics can become crudely algorithmic in practice. The first section sets out the bare bones of the four principles approach drawing out those aspects of Beauchamp and Childress’s Principles of biomedical ethics that encourage this misreading. The second section argues that if the emphasis on the guidance of moral judgement is augmented by a particularist account of what disciplines it, then the danger can be reduced. In the third section, (...) I consider how much the resultant picture diverges from Beauchamp and Childress’s actual position. (shrink)

We write in response to the original article by Rennie and Rudland published in the April 2003 edition of this journal.1 Current and former Dundee Medical School students are concerned at the media misinterpretation of the study and the consequences that this branding of “dishonesty” will have on Dundee Medical School’s reputation and also on individuals embarking on their ….

This article presents an analysis of contractual relations in sport from the standpoint of the Croatian legislative system. Due to the complexity of the subject matter, the author considers only a small fragment of it - the significance and the role of sport in Croatian society and the law of contracts „as a cornerstone on which „sports law“ has been built and which is of primary importance in most areas where there is an interface between sport and the law, irrespective (...) of whether the sport is being played at an elite level or at a more humble one“. Bearing in mind the limited extent of this article, the autor tries to provide some clarifications and some guidance on how to deal with the designation and the determination of the applicable law for contracts in the sporting context. Considering that there are different legal regimes which may come into play with regard to the designation of the law applicable to contracts in the sporting context, the author first presents the determination of the applicable law according to the Rome I Regulation and then according to the Croatian Arbitration Act, Swiss Private International Law Act and the CAS Code of Sports-related Arbitration, as the most common in sports practice. Then, the author deals with contracts concluded with minor athletes and the determination of the law applicable to some preliminary questions. Finally, the author presents her perception of the problems encountered and some suggestions for the improvement of the existing legal framework. (shrink)

This code of practice for health professionals was prepared by a multi-professional group and reflects good clinical practice in encouraging dialogue about individuals' wishes concerning their future treatment. It has a broad practical approach, considers a range of advance statements, advises of dangers and benefits of making treatment decisions in advance and combines annotated code of practice with a quick pull out guide for easy reference.

1. Aim of the guidelines2. Principles of good practice3. Circumcision for medical purposes4. Non-therapeutic circumcision 4.1. The law 4.1.1. Summary: the law 4.2. Consent and refusal 4.2.1. Children’s own consent 4.2.2. Parents’ consent 4.2.3. Summary: consent and refusal 4.3. Best interests 4.3.1. Summary: best interests 4.4. Health issues 4.5. Standards 4.6. Facilities 4.7. Charging patients 4.8. Conscientious objection5. Useful addresses.

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

*The views expressed are the author's own. This article should not be construed as representing policies of the American Medical Association.

*Disclaimer: The views expressed are the author's and should not be ascribed to the American Medical Association.

Now I know why so many stories have been written with the theme: “everything changed in one moment.” More than 1,000 days have come and gone, and I still remember one Sunday morning and still follow and feel the effects of one decision.

The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

Bowman-Smart et al. (2023) argue for a framework to examine the ethical issues associated with genetic screening for non-medical traits in the context of noninvasive prenatal testing (NIPT). Such s...

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to (...) examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a (...) generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels. (shrink)

This textbook introduces the reader to basic problems in the philosophy of science and ethics, mainly by means of examples from medicine. It is based on the conviction that philosophy, medical science, medical informatics, and medical ethics are overlapping disciplines. It claims that the philosophical lessons to learn from the twentieth century are not that nature is a 'social construction' and that 'anything goes' with respect to methodological and moral rules. Instead, it claims that there is scientific (...) knowledge, but that it is never completely secure; that there are norms, but that they are situation-bound; and that, therefore, it makes good sense to search for scientific truths and try to act in a morally decent way. Using philosophical catchwords, the authors advocate 'fallibilism' and 'particularism'; a combination that might be called 'pragmatic realism'. (shrink)

This paper argues that substantive ethical rules serve a critical ethical function, even in those cases where we should deviate from those rules. Assuming that the rules are valid provides decision-makers with the context essential to reaching a well-justified decision. Recognizing this helps to reconcile two attractive but incompatible positions regarding the evaluation of healthcare ethics consultants. The first position is that ethical rules can validly be used to evaluate the quality of consultants’ advice, ensuring conformity to standards promoted by (...) a significant portion of medical ethicists. The second position—the message of ethical particularism—is that we should not evaluate consultants according to strict rules, since good ethical advice may deviate from even the most carefully wrought moral rules. Steering a path between these extremes, I argue that we should evaluate the quality of consultations by examining whether consultants have communicated the relevant ethical rules to participants as ethical presumptions. In communicating presumptions, a consultant provides an indispensable ingredient to ethical decision-making, while leaving open the possibility that the ethical course of action involves violating the very ethical rules that one should presume. (shrink)

This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466–8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel understanding of why analogy is an essential component in the attempt to justify moral beliefs. I seek to show how analogical argument both encapsulates and exercises (...) the notions of rationality and imagination and that the construction, development, and comparison of analogies fundamentally underpins ethical argument. In so doing, it enables us to adopt imaginative and ethically illuminating perspectives but in a manner that does not relinquish any claims to intellectual rigour. I present a critique of a brand of “moral particularism” by showing how it cannot, if construed in a certain way, adequately conceive of how we use analogies and imaginary cases in ethics. Although such a particularism is thus impotent with regard to ethical debate, I show that the wider motivation behind particularism that can be extracted is of clear relevance and importance to medical practitioners. (shrink)

The debate about the direction, coherence and possible imperialism of universal norms in global bioethics has been going on for years. Proponents of universal norms have fiercely stated their cases focusing on human rights, autonomy and/or further principles in bioethics. Equally forceful has been the opposition to such universal principles arguing mainly on grounds of cultural diversity. The alternative is commonly presented as one between moral relativism and moral imperialism; solutions that are equally unattractive. This paper suggests a way forward (...) for global bioethics by focusing on techniques of moral deliberation as well as on the specific social context from which moral dilemma arises. Such focus will show that the alternative between moral relativism and imperialism only arises when an unreflected notion of medical ethics is applied. The way forward for global bioethics is to acknowledge the way medical ethics is connected to a specific medical practice and to examine its cultural and conceptual foundation rather than insisting on context independent principles.If it is already doubtful whether bioethics exists, it is even more dubious for global bioethics. For almost two decades, discussion over such issue has been going on with hardly any progress. Some uphold the famous four principles as the universal standard; others would like to modify them while still hoping for universality; still others challenge the very notion of universality in the field of medical ethics. The discussion is trapped in a variety of antagonisms: between universalism and particularism, between liberalism and communitarism, between principalism and case-based-bioethics. This paper suggests a way forward beyond these antagonisms by asking about the very nature of medical ethics. First, however, we need to take a closer look on the issue at stake: the quest for a global bioethics and the debate over the identity of medical ethics. (shrink)

This article explores the theological foundations of both classical and contemporary Jewish ethics, with special reference to biomedical issues. Traditional views concerning God's revelation to Israel are shown to underlie the methodological orientation of classical Jewish ethics, which is both legalistic and particularistic. Contemporary Jewish ethicists, by contrast, have tended to embrace more liberal views of revelation which have mitigated both the legalism and the particularism of their approach. Apart from methodological considerations, much of the content of Jewish (...) class='Hi'>medical ethics has also been shaped by theological concerns. Specifically, a Jewish theology of creation provides basic norms and values which inform Jewish responses to a range of contemporary biomedical issues. Finally, it is suggested that the theological roots of this ethical tradition do not disqualify it from making a significant contribution to the wider discussion of biomedical issues in our secular, pluralistic society. Keywords: covenant, creation, halakha, Jewish ethics, relevation, Torah CiteULike Connotea Del.icio.us What's this? (shrink)

Weak particularism about reasons is the view that the normative valency of some descriptive considerations varies, while others have an invariant normative valency. A defence of this view needs to respond to arguments that a consideration cannot count in favour of any action unless it counts in favour of every action. But it cannot resort to a global holism about reasons, if it claims that there are some examples of invariant valency. This paper argues for weak particularism, and (...) presents a framework for understanding the relationships between practical reasons. A central part of this framework is the idea that there is an important kind of reason-a 'presumptive reason'-which need not be conclusive, but which is neither pro tanto nor prima facie. /// [Richard Holton] Should particularists about ethics claim that moral principles are never true? Or should they rather claim that any finite set of principles will not be sufficient to capture ethics? This paper explores and defends the possibility of embracing the second of these claims whilst rejecting the first, a position termed 'principled particularism'. The main argument that particularists present for their position-the argument that holds that any moral conclusion can be superseded by further considerations-is quite compatible with principled particularism; indeed, it is compatible with the idea that every true moral conclusion can be shown to follow deductively from a finite set of premises. Whilst it is true that these premises must contain implicit ceteris paribus clauses, this does not render the arguments trivial. On the contrary, they can do important work in justifying moral conclusions. Finally the approach is briefly applied to the related field of jurisprudence. (shrink)

Analytic particularism claims that judgments of moral wrongness are about particular acts rather than general principles. Metaphysical particularism claims that what makes true moral judgments true is not general principles but nonmoral properties of particular acts. Epistemological particularism claims that studying particular acts apart from general principles can justify beliefs in moral judgments. Methodological particularism claims that we will do better morally in everyday life if we look carefully at each particular decision as it arises and (...) give up the search for a complete moral theory. This paper raises problems for each of these versions of particularism. (shrink)

For the Intentionalist, utterance content is wholly determined by a speaker’s meaning-intentions; the sentence uttered serves merely to facilitate the audience’s recovering these intentions. We argue that Intentionalists ought to be Particularists, holding that the only “principles” of meaning recovery needed are those governing inferences to the best explanation; “principles” that are both defeasible and, in a sense to be elaborated, variable. We discuss some ways in which some theorists have erred in trying to tame the “wild west” of pragmatics (...) and context-sensitivity -- including recent work that makes essential appeal to the information structure of a discourse -- and in so doing, offer a general recipe for defending the Particularist picture of utterance content and its recovery that we favor. (shrink)

In What particularism about conspiracy theories entails Dentith responds to their critics and examines the case for a refined and revised thesis of Particularism, the argument that we should appraise individual and particular conspiracy theories rather than appraise them in light of our views of the class of conspiracy theories generally. Recent work in the Philosophy of Conspiracy Theories has presented challenges to Particularism simpliciter (or Naive Particularism). Dentith argues that by facing these challenges Particularism (...) presents an even stronger case for rejecting a generalist conception of what belief in conspiracy theories entails. (shrink)

Moral particularism is a contentious position at present and seems likely to be so for the foreseeable future. In this Introduction, I outline and detail its essential claim, which I take to be, roughly, that what can be a reason that helps to make one action right need not be a reason that always helps to make actions right. This claim challenges a central assumption on which most, if not all, normative ethical theories are supposedly based. We owe this (...) way of characterizing moral particularism to Jonathan Dancy, around whose writings much of the present debate revolves. Key Words: ethics • generalism • particularism • reasons • valency. (shrink)

Particularism renders the options for a sound moral epistemology few and the prospects dim. One leading approach treats basic knowledge of particular cases as derivable from an a priori moral principle and a posteriori knowledge of the contingent non-moral facts to which the principle applies. Particularists must forgo this approach because it requires principles. Yet a purely a posteriori moral epistemology is also implausible, especially when combined with particularism. Particularists such as Jonathan Dancy are thus led to the (...) view that our basic moral knowledge is a priori knowledge of contingent moral facts. We argue that this epistemology is unsound. While some cases of a priori knowledge of (even deeply) contingent facts may be defensible, they are not sufficient for particularist purposes. Moreover, neither Dancy’s appeal to the distinction between positive and negative dependence nor his discussion of intuitive examples provides sufficient support for this epistemology. (shrink)

The aim of this paper is to strengthen the point made by Horty about the relationship between reason holism and moral particularism. In the literature prima facie obligations have been considered as the only source of reason holism. I strengthen Horty’s point in two ways. First, I show that contrary-to-duties provide another independent support for reason holism. Next I outline a formal theory that is able to capture these two sources of holism. While in simple settings the proposed account (...) coincides with Horty’s one, this is not true in more complicated or “realistic” settings in which more than two norms collide. My chosen formalism is so-called input/output logic. A bottom-line example is introduced. It raises the issue of whether the conventional wisdom is right in assuming that normative reasons run parallel to epistemic ones. (shrink)

Logics—that is to say logical systems—are generally conceived of as describing the logical forms of arguments as well as endorsing cer- tain principles or rules of inference specified in terms of these forms. From this perspective, a correct logic is a system which captures only (and perhaps all) of the correct principles, and good—i.e. logical— reasoning is reasoning which at the level of logical form conforms to the principles of a correct logic. In contrast, as logical particularists we reject the (...) idea that logical validity is a property of logical forms or schema, and instead take validity to be a property of particular in- ferences. In this paper we describe and defend this radically different approach to validity, and explore the particularist understanding of the relationship between logical systems and logical reasoning. (shrink)

In this essay I offer a new particularist reading of Aristotle’s Nicomachean Ethics. I argue that the interpretation I present not only helps us to resolve some puzzles about Aristotle’s goals and methods, but it also gives rise to a novel account of morality—an account that is both interesting and plausible in its own right. The goal of this paper is, in part, exegetical—that is, to figure out how to best understand the text of the Nicomachean Ethics. But this paper (...) also aims to contribute to the current exciting and controversial debate over particularism. By taking the first steps towards a comprehensive particularist reading of Aristotle’s Ethics I hope to demonstrate that some of the mistrust of particularism is misplaces and that what is, perhaps, the most influential moral theory in the history of philosophy is, arguably, a particularist moral theory. (shrink)

A timely and penetrating investigation, this book seeks to transform moral philosophy. In the face of continuing disagreement about which general moral principles are correct, there has been a resurgence of interest in the idea that correct moral judgements can be only about particular cases. This view--moral particularism --forecasts a revolution in ordinary moral practice that has until now consisted largely of appeals to general moral principles. Moral particularism also opposes the primary aim of most contemporary normative moral (...) theory that attempts to show that either one general principle, or a set of general principles, is superior to all its rivals. (shrink)