This paper argues that recent ethics research guidelines fit poorly onto the kinds of research undertaken in the humanities, where a research conversation often forms a distinctive method of investigation that has no scientific equivalent The NH&MRC ethics guidelines pay little attention to the issues raised in humanities and social science research. Also, ethics committees are constituted primarily to look at ethical issues that arise from medical and scientific research, causing extra problems for those in the humanities and social sciences.

What is health policy for? In Health and the Good Society, Alan Cribb addresses this question in a way that cuts across disciplinary boundaries. His core argument is that biomedical ethics should draw upon public health values and ethics; specifically, he argues that everybody has some share of responsibility for health, including a responsibility for promoting greater health equality. In the process, Cribb argues for a major rethink of the whole project of health education.

Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety (...) as a field of practice. We argue that dignitary harms in health care are—at least sometimes—preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality. (shrink)

Winner of the Los Angeles Times Book Prize With a new preface by the author In his most powerful and important book, renowned psychiatrist Robert Jay Lifton presents a brilliant analysis of the crucial role that German doctors played in the Nazi genocide. Now updated with a new preface, The Nazi Doctors remains the definitive work on the Nazi medical atrocities, a chilling exposé of the banality of evil at its epitome, and a sobering reminder of the darkest side (...) of human nature. (shrink)

This paper offers an overview of "the species problem", arguing for a view of species as homeostatic property cluster kinds, positioning the resulting form of realism about species as an alternative to the claim that species are individuals and pluralistic views of species. It draws on taxonomic practice in the neurosciences, especially of neural crest cells and retinal ganglion cells, to motivate both the rejection of the species-as-individuals thesis and species pluralism.

Drawing on a passage from Ramsey's Truth and Probability, we formulate a simple, plausible constraint on evaluating the accuracy of credences: the Calibration Test. We show that any additive, continuous accuracy measure that passes the Calibration Test will be strictly proper. Strictly proper accuracy measures are known to support the touchstone results of accuracy-first epistemology, for example vindications of probabilism and conditionalization. We show that our use of Calibration is an improvement on previous such appeals by showing how it answers (...) or sidesteps problems that have been raised for previous work in this area. (shrink)

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a (...) focus on respecting people’s autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition. (shrink)

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

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ’normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ’explanatory complexity’. In brief, normative complexity relates to (...) the inherent difficulty of deciding what kinds of changes are ’improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (’orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination. (shrink)

The thirty chapters work through various fundamental metaphysical issues, sometimes focusing more on scholastic thought, sometimes on the seventeenth century.

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, (...) be treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality. (shrink)

Are interpersonal comparisons of desire possible? Can we give an account of how facts about desires are grounded, that underpins such comparisons? This paper supposes the answer to the first question is yes, and provides an account of the nature of desire that explains how this is so. The account is a modification of the interpretationist metaphysics of representation that the author has recently been developing. The modification is to allow phenomenological affective valence into the “base facts” on which correct (...) interpretation is grounded. To use this extra resource within that theory to vindicate interpersonal comparisons, we will need to appeal rational connections between level of valence and level of desire, which this paper sets out and examines. (shrink)

Translational research is now a critically important current in academic medicine. Researchers in all health-related fields are being encouraged not only to demonstrate the potential benefits of their research but also to help identify the steps through which their research might be ‘made practical’. This paper considers the prospects of a corresponding movement of ‘translational ethics’. Some of the advantages and disadvantages of focusing upon the translation of ethical scholarship are reviewed. While emphasising the difficulties of crossing the gap between (...) scholarship and practice, the paper concludes that a debate about the business of translation would be useful for medical ethics. (shrink)

In this paper I consider the routine moral burden of occupying a professional role and having to negotiate tensions between the normative expectations attached to that role and one's own personal moral compass. Using an example to introduce this central issue I then seek to explore it through a discussion of the tensions between, and spaces between, ‘identifying’ with one's role and ‘separating’ oneself from one's role. I suggest that ethical integrity at work is revealed through the successful negotiation of (...) these tensions, but that such negotiation depends upon the power and other resources available to individual professionals. Finally I argue that this discussion of ‘the ethics of role occupation’ has important implication for ‘the ethics of role construction’ and adds weight to concerns about the potential moral costs of managerialism. (shrink)

Available from UMI in association with The British Library. Requires signed TDF. ;This thesis considers the place of values in comparative political inquiry. After a review of the debate in the philosophy of social science between the positivist and hermeneutic approaches , the argument is divided into two parts. The first part looks at the origins, and consequences, of the attempt to establish a positivistic value-free comparative political science. The second part considers the basis, and the potential nature, of a (...) self-consciously normative discipline of comparative politics. ;The idea of value-freedom is criticised; it is argued: that the failure to take into account the values of the comparative theorist results in the imposition of a non-neutral framework on the phenomena under investigation; and that the failure to take into account the values of the agents under investigation makes it impossible to properly describe or explain political phenomena. ;Examples are used to illustrate these points but also to show how, and why, the rhetoric of neutrality is sustained in practice. It is suggested that mainstream comparative political science conflates a positivist epistemology and a quantitative research methodology. This mixture results in a variety of confusions but is seen to protect comparative politics from "the problem of relativism", which is treated as the principal weakness of the hermeneutic approach. ;Two possible foundations for a normative comparative politics are considered. Firstly, the idea that it is possible to found comparative politics on a non-relative moral theory is reviewed and rejected. It is argued that the best candidates for such a theory, utilitarianism and "thin" theories of the good, cannot be established a priori. Secondly, the assumption that the existence of a plurality of cultures, moral beliefs, and theoretical perspectives leads to relativism is rejected. Instead it is argued that the existence of diversity and disagreement itself provides the basis for a coherent and self-critical discipline, and enhances the scope of comparative politics. (shrink)

This text attempts to show why the academic split between ethics and social sciences has been disastrous and argues that advances in vigour and sensitivity are made possible by closing this artificial divide.

In this editorial essay I explore the possibilities of ‘improvement scholarship’ in order to set the scene for the theme of, and the other papers in, this issue. I contrast a narrow conception of quality improvement research with a much broader and more inclusive conception, arguing that we should greatly extend the existing dialogue between ‘problem-solving’ and ‘critical’ currents in improvement research. I have in mind the potential for building a much larger conversation between those people in ‘improvement science’ who (...) are expressly concerned with tackling the problems facing healthcare and the wider group of colleagues who are engaged in health-related scholarship but who do not see themselves as particularly interested in quality improvement, indeed who may be critical of the language or concerns of QI. As one contribution to that conversation I suggest that that the increasing emphasis on theory and rigour in improvement research should include more focus on normative theory and rigour. The remaining papers in the issue are introduced including the various ways in which they handle the ‘implicit normativity’ of QI research and practice, and the linked theme of combining relatively ‘tidy’ and potentially ‘unruly’ forms of knowledge. (shrink)

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

The paper offers an analysis of Protagoras’ fr. DK 80 B 1 and rejects the traditional reading of Protagoras as relativist. By considering the ipsissima verba that Protagoras makes use of in his passage, it is argued that alternative interpretations are possible, of which epistemological reism and psychological individualism are proposed. On a more general level, it is discussed to what extent Protagoras’ fragment contains descriptive rather than normative claim.

In the good old days, when general philosophy of science ruled the Earth, a simple division was often invoked to talk about philosophical issues specific to particular kinds of science: that between the natural sciences and the social sciences. Over the last 20 years, philosophical studies shaped around this dichotomy have given way to those organized by more fine-grained categories, corresponding to specific disciplines, as the literatures on the philosophy of physics, biology, economics and psychology--to take the most prominent four (...) examples--have blossomed. In general terms, work in each of these areas has become increasingly enmeshed with that in the corresponding science itself, increasingly naturalistic (in at least one sense of that term), and in my view, increasingly interesting. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

Nursing Law and Ethics explores a variety of key legal and ethical issues in nursing practice using a thought-provoking and holistic approach. It addresses both what the law requires and what is right, and explores whether these two are always the same. The book provides an overview of the legal, ethical and professional dimensions of nursing, followed by exploration of key issues in greater depth. This edition features updated legislation and new material on patient safety. Key topics are accompanied by (...) both a legal and an ethical perspective, covering both law and ethics Case examples throughout place concepts in a real-life context Written by experts in the field and includes contributions from leading nurses, lawyers and ethicists Accessible, relevant, and comprehensive, this title is ideal for pre- and post-registration nurses. (shrink)

In this paper I explore Michael Loux’s important distinction between “tropes” and “tropers”. First, I argue that the distinction throws into relief an ambiguity and discrepancy in the literature, revealing two fundamentally different versions of trope theory. Second, I argue that the distinction brings into focus unique challenges facing each of the resulting trope theories, thus calling into question an alleged advantage of trope theory—that by uniquely occupying the middle ground between its rivals, trope theory is able to recover and (...) preserve the insights of these views. Ultimately, the distinction suggests that trope theory is a divided house. (shrink)

The general concept of a trope – that of a non-shareable character-grounder – admits of a distinction between modifier tropes and module tropes. Roughly, a module trope is self-exemplifying whereas a modifier trope is not. This distinction has wide-ranging implications. Modifier tropes are uniquely eligible to be powers and fundamental determinables, whereas module tropes are uniquely eligible to play a direct role in perception and causation. Moreover, each type of trope theory faces unique challenges concerning character- grounding. Modifier trope theory (...) faces challenges concerning the inscrutability of predication and the incompatibility with bundle theory, whereas module trope theory faces challenges concerning character overdetermination and a collapse into austere nominalism. These differences indicate that the modifier/module distinction divides the advantages of general trope theory and thus presents the trope theorist with a pivotal choice. (shrink)

My aim is to propose affectivity as a criterion for personal identity. My proposal is to be taken in its weak version: affectivity as _only one_ of the criteria for personal identity. I start by arguing for affectivity being a better candidate as a criterion for personal identity than thinking. Next, I focus on synchronic vs. diachronic and on ontic vs. epistemic distinctions (my proposal will concern diachronic ontic personal identity) and consider the realm of affectivity in its temporal dimension. (...) In my argument, I rely on the genuineness of affectivity and I exploit chiefly long- or everlasting feelings (or emotions) and those which involve the feeling subject more rather than less. I conclude by stating that genuine long-lasting feelings (or emotions) are constitutive of diachronic ontic personal identity. (shrink)

Se resume en esta obra el vasto y complejo sistema teórico-jurídico de Hans Kelsen, el jurista más grande de nuestro siglo. La doctrina de Kelsen y en particular su Teoría Pura del Derecho han conocido muchas vicisitudes y ataques debidos más a prejuicios políticos y racistas que a una verdadera confrontación con sus tesis. El autor enfatiza en el hecho de que la doctrina jurídica de Kelsen no es una teoría terminada y archivada sino en permanente desarrollo, una teoría a (...) cuya ulterior construcción están convocados todos los juristas. (shrink)

A common compatibilist view says that we are free and morally responsible in virtue of the ability to respond aptly to reasons. Many hold a version of this view despite disagreement about whether free will requires the ability to do otherwise. The canonical version of this view is reductive. It reduces the pertinent ability to a set of modal properties that are more obviously compatible with determinism, like dispositions. I argue that this and any reductive view of abilities faces a (...) significant challenge: it cannot adequately explain the freedom-grounding element of this ability. The problem has the form of a dilemma. This leaves reasons-responsive compatibilists with two options: abandon theories of free will grounded in abilities or abandon reductive theories of abilities. (shrink)

El profesor Robert Walter, el más eminente representante de la Teoría Pura del Derecho en nuestro tiempo, estudia en "Hans Kelsen, la Teoría Pura del Derecho y el problema de la justicia" y "Normas y enunciados sobre normas", los dos textos que componen esta obra, los puntos centrales del pensamiento filosófico y jurídico de Hans Kelsen.

Initiated by Robert Wesson, _Evolution and Human Values_ is a collection of newly written essays designed to bring interdisciplinary insight to that area of thought where human evolution intersects with human values. The disciplines brought to bear on the subject are diverse - philosophy, psychiatry, behavioral science, biology, anthropology, psychology, biochemistry, and sociology. Yet, as organized by co-editor Patricia A. Williams, the volume falls coherently into three related sections. Entitled Evolutionary Ethics, the first section brings contemporary research to an (...) area first explored by Herbert Spencer. Evolutionary ethics looks to the theory of evolution by natural selection to find values for human living. The second section, Evolved Ethics, discusses the evolution of language and religion and their impact on moral thought and feeling. Evolved ethics was partly Charles Darwin's subject in _The Descent of Man._ The last section bears the title Scientific Ethics. A nascent field, scientific ethics asks about the evolution of human nature and the implications of that nature for ethical theory and social policy. Together, the essays collected here provide important contemporary insights into what it is - and what it may be - to be human. (shrink)

"Among the foremost Catholic philosophers of his generation. He has utilized the fullness of the Catholic intellectual tradition to brilliantly take the measure of modern philosophical thought... This volume is an expression of Robert Wood's singular philosophical outlook." -Jude Dougherty, dean emeritus, school of philosophy, The Catholic University of America.

'Quality' is a widely invoked concept in healthcare, and 'quality improvement' is now a central part of healthcare service delivery. However, these concepts and their associated practices represent relatively uncharted territory for applied philosophy and bioethics. In this paper, we explore some of the conceptual complexity of quality in healthcare and argue that quality is best understood to be conceptually plural. Quality is widely agreed to be multidimensional and as such constitutively plural. However, we argue that quality is plural in (...) two further senses. First, quality is competitively plural : that is, different high-level conceptions of quality can be appropriately invoked in different contexts and serve... (shrink)

This paper uses the recent history of marketization and privatization in the UK National Health Service as a case study through which to explore the relationship between health-care organization and health-care goods. Phases and processes of marketization are briefly reviewed in order to show that, although the scope of both marketization and privatization reforms have, until recently, been very heavily circumscribed (and can only be understood in the context of the rise of managerialism), they have nonetheless had a major impact (...) on the “value field” of UK health services. The second half of the paper draws upon the concerns of the critics of market-style reforms to set out and explore the ways in which organizational reform and the shifts in institutional norms consequent upon it construct health-care goods and argues that the investigation of this organization-goods axis ought to have a central place in health-care ethics. (shrink)

Doing Greek Philosophy conveys a vivid sense of dynamism and continuity of the Greek philosophical tradition and illustrates how interaction between Greek philosophers creates and sustains that tradition. It concentrates on a set of inter-related challenges and problems that emerged early in the tradition and moves on to the subsequent reactions to them.

Der Wandel der kulturellen Verhältnisse führt zu einer Zuspitzung des Verhältnisses von Gesellschaft und Rechtssystem. In diesem Prozess gestaltet New Political Ecology (NPE) Umwelt und Rechtssystem und ist zugleich evolutiv ausgerichtet. NPE erfährt Evolution in der Zeit als Überfluss und in eigenartiger Vernetzung als knappes Gut. Diese Verbindung basiert auf Zusammenhängen, die bisher noch nicht systematisch bearbeitet worden sind. Dabei geht es ganz wesentlich auch um das Verhältnis von Staat und moderner Risikogesellschaft. Wissenschaftlicher Fortschritt erweist sich vor diesem Hintergrund selbst (...) als ein evolutiver Prozess. (shrink)