Rationale, aims and objectives: Bioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real-world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners. Method: (...) Curriculum analysis: Thirty-two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In-depth, semi-structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted. Results: While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real-world’ clinical practice that are largely ignored. These fell into two broad domains: ‘sociological’ concerns about enculturation, bureaucracy, intra-professional relationships, and public perceptions of medicine; and epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols. Conclusions: Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice. (shrink)

While doctors generally enjoy considerable status, some believe that this is increasingly threatened by consumerism, managerialism, and competition from other health professions. Research into doctors’ perceptions of the changes occurring in medicine has provided some insights into how they perceive and respond to these changes but has generally failed to distinguish clearly between concerns about “status,” related to the entitlements associated with one’s position in a social hierarchy, and concerns about “respect,” related to being held in high regard for one’s (...) moral qualities. In this article we explore doctors’ perceptions of the degree to which they are respected and their explanations for, and responses to, instances of perceived lack of respect. We conclude that doctors’ concerns about loss of respect need to be clearly distinguished from concerns about loss of status and that medical students need to be prepared for a changing social field in which others’ respect cannot be taken for granted. (shrink)

This book develops a theory of existential security. It demonstrates that the publics of virtually all advanced industrial societies have been moving toward more secular orientations during the past half century, but also that the world as a whole now has more people with traditional religious views than ever before. This second edition expands the theory and provides new and updated evidence from a broad perspective and in a wide range of countries. This confirms that religiosity persists most strongly among (...) vulnerable populations, especially in poorer nations and in failed states. Conversely, a systematic erosion of religious practices, values and beliefs has occurred among the more prosperous strata in rich nations. (shrink)

The metaphor of inscription on the body and the constitution of the body through those inscriptions have been widely used in recent attempts to theorize the body. Michel Foucault calls the body the ‘inscribed surface of events’ (Foucault, 1984: 83) and Elizabeth Grosz argues that the ‘female (or male) body can no longer be regarded as a fixed, concrete substance, a pre-cultural given. It has a determinate form only by being socially inscribed’ (Grosz, 1987: 2). The body becomes plastic, inscribed (...) with gender and cultural standards. While Foucault assumes the existence of a pre-inscriptive body, many theorists reject that idea and argue that ‘there is no recourse to a body that has not always already been interpreted by cultural meanings’ (Butler, 1990: 8). The constitution of the body rests in its inscription; the body becomes the text which is written upon it and from which it is indistinguishable. Starting from Catherine Belsey's suggestion that to ‘give the metaphor literal significance … is to … isolate it for contemplation’ (Belsey, 1988: 100), I discuss this metaphor of inscription, using cosmetic surgery as one literal example. While some theorists reject the pre-inscriptive body, the popular discourses advocating changing one's body assume unproblematically the existence of a body prior to these ‘elective’ procedures and reinforce the mind/body dualism which recent theory has sought so insistently to reject. I examine how popular discourses of body modification enforce a disciplinary regime (in Foucault's sense) and impose degrees of both literal and figurative inscription. Juxtaposing these two perspectives, I explore how both discourses efface the materiality of the body and the social contexts within which bodies are experienced and constructed. While the rhetoric surrounding cosmetic surgery denies the physical process and the economic constraints, so theories of the body which stress the body's plasticity also deny the materiality of that process and the cultural and social contexts within which the body is always placed. (shrink)

This thesis argues that the concept of contingency plays a central role in Althusser's recasting of Marxist philosophy and in his attempt to free the Marxist conception of history from concepts such as teleology, necessity and origin. It is critically placed both against those readings that see the emergence of the problematic of contingency only in the late Althusserm and to the most recent attempts to establish a straightforward continuity in Althusser's work. Drawing on published and unplublished material and covering (...) the entirety of Althusser's philosophical itinerary, the thesis seeks both to unearth the latent presence of this problematic, and its various implications, at each stage in the development of his work. It seeks to clarify, in a systematic way, the conceptual consequences of Althusser's commitment to contingency to the received understanding of his conceptions of structural change, ideology and political action. In particular, it argues that the standpoint of contingency allows us to locate in Althusser's 'Structural Marxism' the emergence of a 'logic of irruption' and structurally under-determined development of becoming. By emphasising this logic of contingency, it then seeks to produce a more nuanced assessment of his theory of ideology through the introduction of the concept of 'overinterpellation'. It finally attempts to distinguish two moments in the emergence of a materialism of contingency, first political and then philosophical; the problematic coexistence of these two aspects helps to account for the unstable charactoer of Althusser's late philosophical project. (shrink)

Background In April 2019, our hospital transitioned to an electronic patient record system and patient portal. MyGOSH enables young people aged 12 years or older and their parents to access results, documentation, appointments, and to communicate with their care team. Aims A focus group was conducted to explore the ethical and legal considerations of young people and their parents using a patient portal from the perspective of hospital Ethics Committee members. Participants and research context Members of the hospital Paediatric Bioethics (...) Centre were recruited. Written informed consent was provided by all participants. Research design The focus group discussion was recorded, transcribed verbatim and analysed using thematic analysis. Ethical considerations Health Research Authority Research Ethics Committee Approval was granted by London Southeast REC. Results Four themes, and sub-themes, were identified: granting access – complexities of assessing competence/capacity, exclusion from MyGOSH due to non-disclosure of diagnosis, and truth-telling; inequalities resulting in inequities – complexities of inequity in access; responding to change – providing support and managing expectations; engagement, empowerment and understanding – data safety, empowering young people to take ownership of their health data, a one-size fits all system may not meet the needs of all families, and early engagement with young people/parents. Discussion Giving families portal access can increase engagement, empowering them to be more involved in care, yet poses challenges for all. Complexities exist in the assessment for portal access, and supporting and managing user expectations whilst providing an equitable service. Conclusions Ongoing support is required for all stakeholders following patient portal implementation to navigate the ethical and legal complexities, and to promote equity and portal utility for patient benefit. (shrink)

There is widespread concern that the nature of mass politics changed during the late twentieth century, and indeed changed largely for the worse, in most post-industrial societies. The standard arguments are familiar and widely rehearsed. You can hear them echoed everyday, whether in simple or sophisticated versions, in the press, scattered in political speeches, and published in academe. Some arguments are cast in strictly empirical terms, but many popular accounts have strongly normative overtones.The intellectual roots lie in the classics of (...) political sociology from the late 1950s and mid-1960s, captured perhaps just as the era of traditional party campaigns was passing, notably the work of Maurice Duverger on mass-branch political parties and Stein Rokkan and Seymour Martin Lipset on social cleavages and electoral behaviour.The standard view emphasizes the consequences of the significant shift from direct party-oriented linkages between citizens and the state towards indirect media-oriented linkages in representative democracies. In the traditional model of election campaigns that characterized the ‘golden age’ of West European party politics, running from the expansion of the mass franchise in the late nineteenth century until at least the mid-twentieth century, party loyalists characteristically selected parliamentary representatives based on long-standing social cleavages and stable ideological cues.The core cleavages of class, religion, region, and language gave a collective meaning to party support and united people with shared identities and social roots who strived for broadly similar political ideals. As illustrated in Figure 1, in traditional campaigns political leaders communicated with grass-roots party loyalists via elected representatives and core party activists, using direct face-to-face channels of persuasion, organization and mobilization, such as local meetings, party newsletters, candidate pamphlets, doorstep canvassing, and town-hall speeches, supplemented by partisan newspapers.Collective organizations and traditional interest groups such as unions and churches, local cooperatives, community groups, and workers’ clubs, mobilized many citizens at the margins of political power and linked their interests to political parties. Support by party loyalists was regarded as a sign of trust in the ability of elected leaders to translate their programmatic principles into concrete policy actions. (shrink)

Can parties such as the Swedish Democrats, the Jobbik Movement for a Better Hungary, the UK Independence Party and the Italian Lega Nord all be classified consistently as part of the same family? Part I of this study summarizes the conceptual framework arguing that the traditional post-war Left-Right cleavage in the electorate and party competition has faded, overlaid by divisions over authoritarian-libertarianism and populism-pluralism. Building on this, part II discusses the pros and cons of alternative methods for gathering evidence useful (...) to classify party positions. Part III describes how these are measured in this study, using Chapel Hill Expert Survey data in 2014 and 2017, and how they are mapped on a multidimensional issue space. Part IV compares European political parties on these scales – including Authoritarian-Populist parties – across a wide range of European countries. The conclusion in part V draws together the main findings and considers their implications. (shrink)

Objectives During the COVID-19 pandemic, healthcare resources including staff were diverted from paediatric services to support COVID-positive adult patients. Hospital visiting restrictions and reductions in face-to-face paediatric care were also enforced. We investigated the impact of service changes during the first wave of the pandemic on children and young people (CYP), to inform recommendations for maintaining their care during future pandemics. Design A multi-centre service evaluation was performed through a survey of consultant paediatricians working within the North Thames Paediatric Network, (...) a group of paediatric services in London. We investigated six areas: redeployment, visiting restrictions, patient safety, vulnerable children, virtual care and ethical issues. Results Survey responses were received from 47 paediatricians across six National Health Service Trusts. Children's right to health was largely believed to be compromised by the prioritisation of adults during the pandemic (81%; n = 33). Sub-optimal paediatric care due to redeployment (61%; n = 28) and the impact of visiting restrictions on CYP's mental health (79%; n = 37) were reported. Decreased hospital attendances of CYP were associated with parental fear of COVID-19 infection-risks (96%; n = 45) and government ‘stay at home’ advice (89%; n = 42). Reductions in face-to-face care were noted to have disadvantaged those with complex needs, disabilities and safeguarding concerns. Conclusion Consultant paediatricians perceived that paediatric care was compromised during the first wave of the pandemic, resulting in harm to children. This harm must be minimised in subsequent pandemics. Recommendations for future practice which were developed from our findings are provided, including maintaining face-to-face care for vulnerable children. (shrink)

We take a fresh look at emotion recognition in autistic children, by testing their recognition of three different emotions (happy, sad, and surprise). The interest in selecting these is that whereas the first two are typical “simple” emotions (caused by situations), the third is typically a “cognitive” emotion (caused by beliefs). Because subjects with autism have clear difficulties in understanding beliefs, we predicted they would show more difficulty in recognising surprise. In contrast, as they have no difficulty in understanding situations (...) as causes of emotion, we predicted they would not show deficits in recognising happy and sad. These predictions were borne out, in a comparison with a group of normal children and in a group of subjects with mental handicap. This result shows the importance of fine-grain analysis in emotion-recognition tasks, and is discussed in relation to affective and theory of mind models of autism. (shrink)

In this interview, Daniel Little provides an overview of his life and work in academia. Among other things, he discusses an actor-centred approach to theory of social ontology. For Little, this approach complements the assumptions of critical realism, in that it accords full ontological importance to social structures, causal mechanisms, and enduring and influential normative systems. The approach casts doubt, however, on the idea of ‘strong emergence' of social structures, the idea that social structures have properties and causal (...) powers that cannot, in principle be explained by their constituents (social actors) and their relationships. Little’s approach to social ontology endorses instead the idea of relative explanatory autonomy. During the interview, many points of convergence become evident between this actor-centred approach to social ontology and the fundamental insights of critical realism. According to Little, analysis of social ontology also turns out to be especially relevant to philosophy of history. (shrink)

Professor Little presents an introduction to the philosophy of social science with an emphasis on the central forms of explanation in social science: rational-intentional, causal, functional, structural, materialist, statistical and interpretive. The book is very strong on recent developments, particularly in its treatment of rational choice theory, microfoundations for social explanation, the idea of supervenience, functionalism, and current discussions of relativism.Of special interest is Professor Little’s insight that, like the philosophy of natural science, the philosophy of social science (...) can profit from examining actual scientific examples. Throughout the book, philosophical theory is integrated with recent empirical work on both agrarian and industrial society drawn from political science, sociology, geography, anthropology, and economics.Clearly written and well structured, this text provides the logical and conceptual tools necessary for dealing with the debates at the cutting edge of contemporary philosophy of social science. It will prove indispensible for philosophers, social scientists and their students. (shrink)

ABSTRACT This narrative synthesis based on a literature review undertaken for the project ?Creating Citizenship Communities? (funded by the Esmée Fairbairn Foundation) includes discussion, principally, about what research evidence tells us about young people?s definitions of community, of types of engagement by different groups of young people, actions by schools and what they might do in the future to promote engagement. Community is seen as a highly significant and contested area. Young people are viewed negatively by adults but are in (...) some contexts already positively engaged in communities. There seem to be gaps in the literature about what young people understand about community. There is, broadly, some consensus about how to promote engagement. (shrink)

In this article, we present an analysis of defeasible generalizations -- generalizations which are essentially exception-laden, yet genuinely explanatory -- in terms of various notions of privileged conditions. We argue that any plausible epistemology must make essential use of defeasible generalizations so understood. We also consider the epistemic significance of the sort of understanding of context that is required for understanding of explanatory defeasible generalizations on any topic.

This essay responds to some of the criticisms leveled against Little and Twiss, Comparative Religious Ethics. The general approach and some of the detailed conclusions are defended against those who charge, on the one hand, that the book lacks sufficient theoretical sweep, and, on the other, that its central concepts and categories impede sensitive understanding of particular religious traditions. An effort is made to clarify and support a basic assumption of the book (and, the authors believe, of all comparative (...) work): the importance of the investigator's cultural location in shaping the comparative enterprise. (shrink)

Māori (Indigenous people of New Zealand (NZ)) suffer food insecurity disproportionately in New Zealand. Some research suggests that Māori value mātauranga Māori (traditional Māori knowledge) when it comes to the collection, preparation and eating of kai (food). This study explores the connections between mātauranga Māori and kai in regional NZ schools for potential pathways to impact food security for children. Semi-structured interviews were undertaken with five primary school principals in the Hawke’s Bay region. Principals were purposively selected on commitments to (...) proactively incorporating mātauranga Māori into their school environment. Reflective thematic analysis was used to analyse the data. Three main themes were identified: teaching and learning around mātauranga Māori and kai; environmental sustainability and the sustainability of kai initiatives; and school values. A strong emphasis was placed on the learning of traditional Māori values around kai and the whenua (land) and the sustainability of teaching programs. School values were invariably bound in Te Ao Māori (a Māori worldview) however, schools felt challenged in aligning their values and their mātauranga Māori-bound teaching practices with the current food provision programme in their schools (Ka Ora, Ka Ako). The programme’s strict nutritional guidelines appeared to challenge traditional Māori approaches to kai. Schools remain an ideal environment for the incorporation of mātauranga Māori to support food security and food education, and future work should explore a demonstration project that incorporates the knowledge gained in this study and ways to integrate mātauranga Māori into Ka Ora, Ka Ako. (shrink)

This essay provides an exposition and critical assessment of Weber's typology of modes of practical reasoning and substitutes for practical reasoning, as well as of his definitions of the terms "ethics" and "religion." It then examines the application of these elements of "the sociology of rationalism" to religious systems of ethics. The author points out a number of difficulties in Weber's account, but concludes by insisting that it contains insights that are indispensable for the comparative study of religious ethics.

An accessible introduction to the latest developments and debates in the philosophy of social science.

Narrative analysis is well established as a means of examining the subjective experience of those who suffer chronic illness and cancer. In a study of perceptions of the outcomes of treatment of cancer of the colon, we have been struck by the consistency with which patients record three particular observations of their subjective experience: the immediate impact of the cancer diagnosis and a persisting identification as a cancer patient, regardless of the time since treatment and of the presence or absence (...) of persistent or recurrent disease; a state of variable alienation from social familiars, expressed as an inability to communicate the nature of the experience of the illness, its diagnosis and treatment; and a persistent sense of boundedness, an awareness of limits to space, empowerment and available time. These subjectivities were experienced in varying degree by all patients in our study. Individual responses to these experiences were complex and variable. The experiences are best understood under the rubric of a category we call “liminality”. We believe that all cancer patients enter and experience liminality as a process which begins with the first manifestations of their malignancy. An initial acute phase of liminality is marked by disorientation, a sense of loss and of loss of control, and a sense of uncertainty. An adaptive, enduring phase of suspended liminality supervenes, in which each patient constructs and reconstructs meaning for their experience by means of narrative. This phase persists, probably for the rest of the cancer patient’s life. The experience of liminality is firmly grounded in the changing and experiencing body that houses both the disease and the self. Insights into the nature of the experience can be gained from the Existentialist philosophers and from the history of attitudes to death. Understanding liminality helps us to understand what it is that patients with cancer seek from the system to which they turn for help. Its explication should therefore be important for those who provide health care, those who educate health care workers and those concerned to study and use outcomes as administrative and policy making instruments. (shrink)

In this article, I urge that mainstream discussions of abortion are dissatisfying in large part because they proceed in polite abstraction from the distinctive circumstances and meanings of gestation. Such discussions, in fact, apply to abortion conceptual tools that were designed on the premiss that people are physically demarcated, even as gestation is marked by a thorough-going intertwinement. We cannot fully appreciate what is normatively at stake with legally forcing continued gestation, or again how to discuss moral responsibilities to continue (...) gestating, until we appreciate in their own terms the goods and evils distinctive of gestational connection. To underscore the need to explore further the meanings of gestation, I provide two examples of the difference it might make to legal and moral discussions of abortion if we appreciate more fully that gestation is an intimacy. (shrink)

I develop two different epistemic roles for emotion and desire. Caring for moral ends and people plays a pivotal though contingent role in ensuring reliable awareness of morally salient details; possession of various emotions and motives is a necessary condition for autonomous understanding of moral concepts themselves. Those who believe such connections compromise the "objective" status of morality tend to assume rather than argue for the bifurcated conception of reason and affect this essay challenges.

This text focuses on the theory of popular politics constructed within the context of analytical Marxism, and asks if rational choice theory provides an adequate basis for explaining patterns of social, political and economic behaviour in traditional China.

High-dose chemotherapy and autologous stem cell transplantation is used to treat some advanced malignancies. It is a traumatic procedure, with a high complication rate and significant mortality. ASCT patients and their carers draw on many sources of information as they seek to understand the procedure and its consequences. Some seek information from beyond orthodox medicine. Alternative beliefs and practices may conflict with conventional understanding of the theory and practice of ASCT, and ‘contested understandings’ might interfere with patient adherence to the (...) strict and demanding protocols required for successful ASCT.The present study, conducted in Sydney, Australia, examines narrative-style interviews with 10 sequentially recruited ASCT patients and nine of their carers conducted at the time of transplant and three months later. Transcripts were read for instances of mention of alternative advice, and for instances of contested understanding of information relevant to the transplant.Patients and carer pairs expressed closely concordant views about alternative advice. Five pairs were consulting alternative practitioners. Contested understanding was expressed in four domains—understandings of the transplant itself and its underlying theory, of the relationship between the components of the ‘transplant’, of the nature and role of stem cells, and of beliefs about bodily function and life-style. Contested understandings of the transplant treatment were expressed as predominantly personal interpretations of orthodox informationPatients and carers seemed to recognise that alternative and conventional systems were discordant, yet they were able to separate the two, and adhere to each practice without prejudicing their medical treatment. A single case of late, post-transplant repudiation of Western medicine is discussed to emphasise some of the possible determinants of dissonance when it does occur. (shrink)

If particularism is right, the broad moral claims we make are usually riddled with exceptions. But such generalizations can still be a useful, even necessary part of moral life. They help us show what we should do, and they are essential for understanding why we should do it.

The article responds to Richard Lauer’s (2019) “Is Social Ontology Prior to Social Scientific Methodology?” The article concurs that “social ontology matters” for the conduct of research and theory in social science. It argues, however, that neither of the interpretations of the status of social ontology offered by Lauer is satisfactory (either apriori philosophical realism or pragmatist anti-realism). The article argues for a naturalized, fallibilist, and realist interpretation of the claims of social ontology and presents the field of social ontology (...) as the most abstract edge of social-science theorizing, subject to broad empirical constraints. The approach taken is anti-foundationalist in both epistemology and metaphysics. Ontological theorizing is part of the extended scientific enterprise of understanding the social world. Claims about the nature of the social world are not different in kind from more specific sociological claims about social class or individual rationality, to be justified ultimately by the coherence and explanatory success of the theories they help to create. At the same time, it is justified to treat the claims of social ontology as provisionally true, which supports a realist interpretation of the findings of social ontology. (shrink)

This chapter takes the form of a discussion between the editors of this volume and Daniel Little regarding the relationship between methodological individualism and methodological localism. The focus is on Little’s view that methodological individualism is incompatible with the assumption that actors are socially constituted and socially situated as well as on other topics such as micro-foundations, the micro–macro link, ontological individualism, causal explanation, rationality, Bourdieu’s theory of habitus, and Durkheim.

In this paper, I urge that the very real lessons Carol Gilligan's work in moral psychology offer to moral philosophy can best be appreciated if we take seriously the gap between the two disciplines. The care and justice perspectives Gilligan explores are psychological orientations, and orientations are defined as much by matters of emphasis, selectivity of interpretation, and gestalt as they are by propositional commitment. As such, I argue, their contribution to moral theory is best seen as stances from which (...) to do theory, rather than as constituting ready-made theories themselves. In pursuing this train of thought, I examine how Gilligan's work has developed over time and how, in the end, we should understand the juxtaposition between the two orientations. (shrink)

When a woman is pregnant, how should we understand the moral status of the life within her? How should we understand its status as conceptus, as embryo, when an early or again matured fetus? According to some, human life in all of these forms is inviolable: early human life has a moral status equivalent to a person from the moment of conception. According to others, such life has no intrinsic status, even late in pregnancy. According to still others, moral status (...) emerges when sentience does. Until the fetus is conscious - a point somewhere at the end of the second trimester, it has no moral status at all; after it is conscious, it does. (shrink)

Corruption is a word used loosely to describe many kinds of action that people find distasteful. We prefer to reserve it for the intentional misuse of the good offices of an established social entity for private benefit, posing as fair trading. The currency of corruption is not always material or financial. Moral corruption is all too familiar within churches and other ostensibly beneficent institutions, and it happens within medicine and the pharmaceutical industries. Corrupt behavior reduces trust, costs money, causes injustice, (...) and arouses anger. Yet it persists, despite all efforts since the beginnings of societies. People who act corruptly may lack conscience and empathy in the same way as those with some personality disorders. Finding ways to prevent corruption from contaminating beneficent organizations is therefore likely to be frustratingly difficult. Transparency and accountability may go some way, but the determined corruptor is unlikely to feel constrained by moral and reporting requirements of this kind. Punishment and redress are complicated issues, unlikely to satisfy victims and society at large. Both perhaps should deal in the same currency—material or social—in which the corrupt dealing took place. (shrink)

Discourse communities are groups of people who share common ideologies, and common ways of speaking about things. They can be sharply or loosely defined. We are each members of multiple discourse communities. Discourse can colonize the members of discourse communities, taking over domains of thought by means of ideology. The development of new discourse communities can serve positive ends, but discourse communities create risks as well. In our own work on the narratives of people with interests in health care, for (...) example, we find that patients speak of their illness experiences as victims of circumstance; policy makers construct adverse experiences and challenges as opportunities to be taken; health care workers speak from a mixed perspective, seeing themselves as both victims and opportunists depending on context. To be trapped within the discourse of a particular community is to put at risk the ability to communicate across discourses. Membership of a discourse community can impair the habit of critique, and deny opportunities for heteroglossic discourse. Privileging critique as a mode of discourse perhaps might define the ethical community, suggesting that ethical community may be an antidote to the constraining effects of conventional discourse community. (shrink)