The book offers an introduction to the moral concepts and value of health care. It is written by a moral philosopher, a doctor and a nurse and contains questions, cases and exercises which are suitable for medical, nursing and all students and commentators on health care. Moral dilemmas include consent, confidentiality, the giving or withholding of information, and the economics of health care. The issues of artificial reproduction, terminal care and the research and testing of drugs are addressed.

Nietzsche's influence upon European philosophy has been, and continues to be, profound. Indeed, recent years have seen Nietzsche scholarship become the battleground for debates over philosophical method between the analytic and continental traditions. This fresh introduction to Nietzsche's philosophical work provides students new to Nietzsche with an excellent framework for understanding the central concerns of his philosophical and cultural writings and why Nietzsche's ideas continue to spark controversy in philosophy and in allied disciplines. The book is divided into three parts. (...) In the first section "Nietzsche Against the Tradition", the author shows why Nietzsche rejects wholesale certain components of the Western philosophical and religious traditions and examines the implications of rejecting them. Those components are considered under the headings of morality, religion and nihilism. In the second part "Nietzsche and the Tradition", the author explores Nietzsche's ambivalent and sophisticated reflections on some of the central topics in the Western philosophical tradition. These include Nietzsche's criticisms of metaphysics, his analysis of truth and knowledge, and his reflections on the self and consciousness. In the final section "Nietzsche Beyond the Tradition", Welshon discusses some of the ways in which Nietzsche does, or is thought to, transcend the Western philosophical tradition with chapters on the will to power, politics and education, artistry and the flourishing life. The book provides readers with balanced, clear analysis and is ideally suited as a companion resource for students tackling Nietzsche's challenging prose style. (shrink)

Judgement is traditionally seen as applicable in two spheres of human endeavour: the theoretical (or the sphere in which we consider both what must be the case and what is likely to be the case) and the practical (or the sphere in which we consider what we ought to do, either because it is in our interests or because morality requires it). Now insofar as we are speaking of ‘judgement’ two conceptual assumptions are being made. Firstly, we are assuming that (...) there are imponderables and complexity, and secondly, despite the imponderables and complexity, that there is still room for the exercise of reason. Granted this view of judgement we can state our two main theses. Firstly, we shall argue that, despite the pressures of market forces, employee needs, and shareholder interests, there is still room in business practice for judgements so understood. Secondly, we shall argue that these judgements need not inevitably be directed down the single track of the financial interests of the company and its shareholders. The second thesis can be understood as a moral thesis in either of two ways. Either it can be seen as the thesis that companies have broad social responsibilities extending well beyond the immediate interests of the company, or as the thesis that companies share the social interests of the communities to which they belong; they are citizens writ large, to gloss Plato. (shrink)

Neuroimaging has provided insight into numerous neurological disorders in children, such as epilepsy and cerebral palsy. Many clinicians and investigators believe that neuroimaging holds great promise, especially in the areas of behavioral and cognitive disorders. However, concerns about the risks of various neuroimaging modalities and the potential for misinterpretation of imaging results are mounting. Imaging evaluations also raise questions about stigmatization, allocation of resources, and confidentiality. Children are particularly vulnerable in this milieu and require special attention with regards to safety (...) guidelines and modality adaptations. This article examines pediatric neuroimaging practice through an ethics lens. Most authors in the field of neuroethics focus on the future concerns of neuroimaging. In contrast, our paper examines ethical matters surrounding current clinical applications in the pediatric population. We first provide a brief overview of the neuroimaging technologies most commonly used in a pediatric clinical context and then discuss a variety of ethical issues arising from the use of these technologies. (shrink)

Here we review 37 modern neuroimaging studies in an attempt to address this question posed by Halstead (1947) as he and other icons of the last century endeavored to understand how brain and behavior are linked through the expression of intelligence and reason. Reviewing studies from functional (i.e., functional magnetic resonance imaging, positron emission tomography) and structural (i.e., magnetic resonance spectroscopy, diffusion tensor imaging, voxel-based morphometry) neuroimaging paradigms, we report a striking consensus suggesting that variations in a distributed network predict (...) individual differences found on intelligence and reasoning tasks. We describe this network as the Parieto-Frontal Integration Theory (P-FIT). The P-FIT model includes, by Brodmann areas (BAs): the dorsolateral prefrontal cortex (BAs 6, 9, 10, 45, 46, 47), the inferior (BAs 39, 40) and superior (BA 7) parietal lobule, the anterior cingulate (BA 32), and regions within the temporal (BAs 21, 37) and occipital (BAs 18, 19) lobes. White matter regions (i.e., arcuate fasciculus) are also implicated. The P-FIT is examined in light of findings from human lesion studies, including missile wounds, frontal lobotomy/leukotomy, temporal lobectomy, and lesions resulting in damage to the language network (e.g., aphasia), as well as findings from imaging research identifying brain regions under significant genetic control. Overall, we conclude that modern neuroimaging techniques are beginning to articulate a biology of intelligence. We propose that the P-FIT provides a parsimonious account for many of the empirical observations, to date, which relate individual differences in intelligence test scores to variations in brain structure and function. Moreover, the model provides a framework for testing new hypotheses in future experimental designs. (shrink)

An Essay on Metaphysics is one of the finest works of the great Oxford philosopher R. G. Collingwood : in it he considers the nature of philosophy, especially of metaphysics, and puts forward his original and influential theories of absolute presuppositions, causation, and the logic of question and answer. Three fascinating unpublished pieces by Collingwood have been added for this revised edition: they illuminate and amplify the ideas of the Essay, to which they are closely related. The editor Rex Martin (...) contributes a substantial introduction telling the story of the composition of all these works, discussing their major themes, and setting them in the context of Collingwood's philosophy as a whole. (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Wind turbine noise is annoying and has been linked to increased levels of psychological distress, stress, difficulty falling asleep, and sleep interruption. For these reasons, there is a need for competently designed noise standards to safeguard community health and well-being. The authors identify key considerations for the development of wind turbine noise standards, which emphasize a more social and humanistic approach to the assessment of new energy technologies in society.

To what extent should states accommodate religious liberty claims? Can the pluralist state be neutral between religions and secularism? This book explores contemporary legal controversies regarding the protection of religious liberty from a theoretical and comparative perspective, looking at issues such as family and parenting, medical treatment, education, employment, religious group autonomy, and freedom of expression.

In his paper ‘Collective Responsibility’ Mr. D. E. Cooper argues for the thesis that collectives can be held responsible in a sense not reducible to the individual responsibility of the members of the collective. And he uses this conclusion to support views of individual responsibility and of blame and punishment which he wishes to assert independently. Is hall argue that although there is a sense in which the actions and responsibility of a collective cannot be analysed in terms of the (...) actions and responsibilities of the individual persons who compose the collective, it is not moral responsibility which is involved. I shall then maintain that Cooper's account of collective responsibility does not support his account of individual responsibility; and that his account of individual responsibility is in any case false, if he means moral responsiblity. (shrink)

In Canada, as in many developed countries, healthcare conscientious objection is growing in visibility, if not in incidence. Yet the country's health professional policies on conscientious objection are in disarray. The article reports the results of a comprehensive review of policies relevant to conscientious objection for four Canadian health professions: medicine, nursing, pharmacy and dentistry. Where relevant policies exist in many Canadian provinces, there is much controversy and potential for confusion, due to policy inconsistencies and terminological vagueness. Meanwhile, in Canada's (...) three most northerly territories with significant Aboriginal populations, whose already precarious health is influenced by funding and practitioner shortages, there are major policy gaps applicable to conscientious objection. In many parts of the country, as a result of health professionals' conscientious refusals, access to some legal health services – including but not limited to reproductive health services such as abortion – has been seriously impeded. Although policy reform on conscientious conflicts may be difficult, and may generate strenuous opposition from some professional groups, for the sake of both patients and providers, such policy change must become an urgent priority. (shrink)

Supererogation can be distinguished from altruism, in that the former is located in the category of duty but exceeds the strict requirements of duty, whereas altruism belongs to a different moral category from duty. It follows that doctors do not act altruistically in their professional roles. Individual doctors may sometimes show supererogation, but supererogation is not a necessary feature of the medical profession. The aim of medicine is to act in the best interests of patients. This aim involves neither supererogation (...) nor even the moral quality of beneficence. It is simply a job description. Morality enters medicine through the quality of the individual doctor's work, not by the definition of that work. (shrink)

This article argues that secularism is not neutral. Secularization is a process, the secular state is a structure, whereas secularism is a political philosophy. Secularism takes two main forms: first, a “benevolent” secularism that endeavours to treat all religious and nonreligious belief systems even-handedly, and, second, a “hostile” kind that privileges unbelief and excludes religion from the public sphere. I analyze the European Court of Human Rights decision in Lautsi v Italy, which illustrates these types. The article concludes that secularism (...) as a political philosophy cannot be neutral, and the secular state is not neutral in its effects, standpoint, governing assumptions or treatment of religious truth claims. (shrink)

It is often said that human beings have the ability to plan and choose what to do, can think for themselves and have the freedom and the right to form their own opinions on moral questions. Such claims are sometimes expressed by saying that the human agent is autonomous. In this paper we shall try to disentangle various theses about the autonomy of the agent which the common claims do not always distinguish.

The concept of moral responsibility has many applications. We speak, for example, of a person's responsibilities, and mean his professional or domestic commitments. In this sense a person can be said to have too many responsibilities, or none at all, and he can be said to be responsible to or for another person. Again, we can speak of the person himself as being responsible or irresponsible, and mean that he is conscientious and trustworthy in the performance of his duties or (...) that he has a sense of responsibility. Finally, we can speak of a person as accepting responsibility for an action or another person. A thorough analysis of these complexities of usage would require the investigation of a number of background concepts, but in this paper I have the more limited object of classifying some of the usages. I propose to do this by constructing three analytical models based on the concept of a social role. (shrink)

In this chapter, we explore the issue of assisted dying for individuals with dementia at the nexus of ethics and law. We set out the basic medical realities of dementia and the available data about the desire for the option of assisted dying in the face of dementia. We then describe law and practice with respect to voluntary euthanasia and assisted suicide in jurisdictions that permit at least some assisted dying. We conclude that, because of the peculiar ways in which (...) some of the features of dementia interact with specific legislative provisions, less access to assisted dying for persons with dementia can be realized through the legislation than might have been intended or expected. We then describe draft assisted dying legislation that is before the federal Parliament of Canada. We conclude that, because of the peculiar ways in which some of the features of dementia interact with specific legislative provisions, more access to assisted dying for persons with dementia would be realized, if the legislation was passed as drafted, than might be intended or expected. This exercise reveals that very careful attention needs to be paid to the features of dementia if drafting assisted dying legislation in order to actually achieve the desired law reform effect (whatever that might be). The interplay of common ethical rationales for permitting assisted dying (e.g., autonomy and alleviation of suffering) with common features of dementia (e.g., loss of competence before the terminal phase of the illness, loss of the capacity to communicate before the loss of the capacity to suffer) raises challenges for translating one’s ethical position on assisted dying for individuals with dementia into law. NB: This chapter is current up to 2015. (shrink)

BackgroundHealthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity.MethodsWe conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including (...) support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death.ResultsSupport for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics.ConclusionsFindings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered. (shrink)

This important new introduction to Nietzsche's philosophical work provides readers with an excellent framework for understanding the central concerns of his philosophical and cultural writings. It shows how Nietzsche's ideas have had a profound influence on European philosophy and why, in recent years, Nietzsche scholarship has become the battleground for debates between the analytic and continental traditions over philosophical method. The book is divided into three parts. In the first part, the author discusses morality, religion and nihilism to show why (...) Nietzsche rejects certain components of the Western philosophical and religious traditions as well as the implications of this rejection. In the second part, the author explores Nietzsche's ambivalent and sophisticated reflections on some of philosophy's biggest questions. These include his criticisms of metaphysics, his analysis of truth and knowledge, and his reflections on the self and consciousness. In the final section, Welshon discusses some of the ways in which Nietzsche transcends, or is thought to transcend, the Western philosophical tradition, with chapters on the will to power, politics, and the flourishing life. (shrink)

Ultraviolet radiation activates the expression of a wide variety of genes, by pathways which differ between the short non‐solar ultraviolet C (UVC) wavelengths, which are strongly absorbed by nucleic acids, and the long solar ultraviolet A (UVA, 320–380 nm) wavelengths, which generate active oxygen intermediates. Intermediate solar ultraviolet (UV) wavelengths in the UVB (290–320 nm) range also contain an oxidative component, but more closely resemble UVC in their gene activating properties. Short wavelength UV, in common with other extracellular stimuli including (...) growth factors, activates signal transduction events that involve both stress‐ and mitogen‐activated protein kinase cascades. The extrapolation of the complex modulation of gene expression that ensues to the consequences of natural UV exposure requires careful attention to the details of doses and wavelength employed in the model experiments. Nevertheless, there is evidence that UVB irrradiation of skin can activate the expression of proteins including immunomodulating cytokines, ornithine decarboxylase and, to a limited extent, nuclear oncogene products, as well as lead to stabilisation of p53. Non‐cytotoxic doses of UVA radiation also lead to the strong activation of several genes which would be expected to have functional relevance in vivo. (shrink)

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may (...) be as important as that of the students. (shrink)

`The first and only book to explore, at once, the field of my work and its limits, with both the intimacy and distance required: doubling and shadowing. It gives me great pleasure to find something that, beyond commentary, sees what I see and at the same time what I am unable to see' - Jean Baudrillard Baudrillard is a controversial figure. His work tends to fascinate and infuriate readers in equal numbers. Yet there is no doubting his importance to the (...) key debates in culture and theory of the last ten years. A prolific author, readers sometimes find it difficult to tease out the consistencies in Baudrillard's arguments. This book seeks to redress the balance. It aims to go beyond his writings on consumer objects, the Gulf War and America, to identify the fundamental logic that underpins his writings. It does this through a series of close readings of his main texts, paying particular attention to the form and internal coherence of his arguments. The book contends that, just as Baudrillard himself grapples with the problems of how to criticize self-defining systems, so we cannot simply hold Baudrillard up against external standards but must seek to judge him on his own terms. Jean Baudrillard: A Defence of the Real will be an indispensable text for all those interested in social theory who want a general introduction to Baudrillard's work. (shrink)

In the first section of this paper, I articulate Jaegwon Kim's argument against emergent down ward causation. In the second section, I canvas four responses to Kim's argument and argue that each fails. In the third section, I show that emergent downward causation does not, contra Kim, entail overdetermination. I argue that supervenience of emergent upon base properties is not sufficient for nomological causal relationsbetween emergent and base properties. What sustains Kim's argument is rather the claim that emergent properties realized (...) by base properties can have no causal powers distinct from those base properties. I argue that this is false. (shrink)

Proust reminds us many times in the pages of In Search of Lost Time that there is no such thing as a singular or unchanging self.1 When viewing the novel as a whole, this point is most evident in the journey of Marcel, the narrator, who has to become a myriad of Marcels before he reaches the library of the Guermantes and the discovery of what he must write about. But the theme is also prevalent in a more intimate reading (...) of the novel's many vignettes. Swann, for instance, cannot understand the torment he has gone through for a woman who wasn't his type precisely because he has ceased to be the Swann who desired Odette. Rather, the newfound subjectivity he inhabits at the end of Swann in Love takes him back to an... (shrink)