The ability to feel pain is a property of human beings that seems to be based entirely in our biological natures and to place us squarely within the animal kingdom. Yet the experience of pain is often used as an example of a mental attribute with qualitative properties that defeat attempts to identify mental events with physiological mechanisms. I will argue that neurophysiology and psychology help to explain the interwoven biological and subjective features of pain and recommend a view of (...) pain which differs in important respects from the one most commonly accepted. (shrink)

In discussing Disembodied Persons we need to confront two problems:A. Under what conditions would we consider that a person was present in the absence of the normal bodily cues?B. Could such circumstances arise?The first question may be regarded as epistemic and the second as metaphysical.

Informed consent is required for any medical procedure although the situations in which it is given are beset by uncertainties and indeterminacies. These make medicolegal scrutiny of such situations very difficult. Although some people find the decision in the Sidaway case incomprehensible because of its continuing regard for a 'professional practice standard' in informed consent, I will argue that an important fact in many cases is the moral integrity of the doctor concerned and the pattern of his practice. This may (...) provide the only morally principled and legally accessible evidence enabling a correct decision to be made in a difficult case. Although the epistemological significance of a professional practice standard is thereby defended the 'prudent patient standard' for what counts as consent is left intact. (shrink)

Decompressive craniectomy is a technically straightforward procedure whereby a large section of the cranium is temporarily removed in cases where the intracranial pressure is dangerously high. While its use has been described for a number of conditions, it is increasingly used in the context of severe head injury. As the use of the procedure increases, a significant number of patients may survive a severe head injury who otherwise would have died. Unfortunately some of these patients will be left severely disabled; (...) a condition likened to the RUB, an acronym for the Risk of Unacceptable Badness. Until recently it has been difficult to predict this outcome, however an accurate prediction model has been developed and this has been applied to a large cohort of patients in Western Australia. It is possible to compare the predicted outcome with the observed outcome at 18 months within this cohort. By using predicted and observed outcome data this paper considers the ethical implications in three cases of differing severity of head injury in view of the fact that it is possible to calculate the RUB for each case. (shrink)

I had my accident on the rugby field on July 29, 2000 about 2.00 p.m. during a simple line - out, even before the ball was thrown in. I t just felt like another simple case of concussion , I staggered to the sideline, the coach asked me “what ’s wrong”? He said I told him I just felt sick and to put me back on the field in 10 minutes. Then I collapsed, eventually blacked out and then was rushed (...) to hospital unconscious in an ambulance with them struggling drastically to keep me alive. Af ter three days of being in there, they thought I was alright and were going to send me home. Then it star ted happening. First I nearly collapsed again tak ing a shower . For days the spe - cialists didn’t k now what was wrong with me. M y girlfriend at the time, who had rushed down from Wanak a when she had heard it had happened went mad at the specialists to do something. Af ter six days of going in and out of seizures, finally af ter what seemed like all the tests k nown to man, they said I had suffered several brain stem strokes then one massive major one, which altogether had lef t me diagnosed with the ex tremely rare and unk nown condition only k nown to a few as “ locked in syndrome”. (shrink)

The rule of rescue describes the powerful human proclivity to rescue identified endangered lives, regardless of cost or risk. Deciding whether or not to perform a decompressive craniectomy as a life-saving or ‘rescue’ procedure for a young person with a severe traumatic brain injury provides a good example of the ethical tensions that occur in these situations. Unfortunately, there comes a point when the primary brain injury is so severe that if the patient survives they are likely to remain severely (...) disabled and fully dependent. The health resource implications of this outcome are significant. By using a web-based outcome prediction model this study compares the long-term outcome and designation of two groups of patients. One group had a very severe injury as adjudged by the model and the other group a less severe injury. At 18 month follow-up there were significant differences in outcome and healthcare requirements. This raises important ethical issues when considering life-saving but non-restorative surgical intervention. The discussion about realistic outcome cannot be dichotomised into simply life or death so that the outcome for the patient must enter the equation. As in other ‘rescue situations’, the utility of the procedure cannot be rationalised on a mere cost–benefit analysis. A compromise has to be reached to determine at what point either the likely outcome would be unacceptable to the person on whom the procedure is being performed or the social utility gained from the rule of rescue intervention fails to justify the utilitarian value and justice of equitable resource allocation. (shrink)

This paper concerns those patients whose brain is irreversibly damaged to the point where they will never recover significant mental life. I examine the reasons which justify the decision to withhold or discontinue active medical intervention in these patients. They involve the identity, quality of life and agency of those beings whom we value as persons.

The aim of this paper was to explore the issue of consent when considering the use of a life saving but not necessarily restorative surgical intervention for severe traumatic brain injury. A previous study has investigated the issue amongst 500 healthcare workers by using a two-part structured interview to assess opinion regarding decompressive craniectomy for three patients with varying injury severity. A visual analogue scale was used to assess the strengths of their opinions both before and after being shown objective (...) outcome data. Opinions were assessed in a number of scenarios, one of which was that the participants themselves were the injured party. The implication, which was clearly stated, was whether they would provide consent for the procedure to be performed. The study demonstrated that participants were relatively risk aversive in regards to survival with severe disability especially when the injury was severe and there was high probability of that outcome occurring. This finding was not however universal and a minority of participants would provide consent even when the possibility of survival with severe disability was very high. The obvious difficulty comes when considering consent in patients who are unable to express their wishes. In order to address this issue we propose a model of consent based on a balance of the various factors that seem to be of material relevance. These include the severity of the injury, the willingness or otherwise to accept survival with severe disability and the willingness to “risk” the possibility of an unacceptable outcome in order to achieve an acceptable outcome. (shrink)

This Companion provides a fresh and comprehensive account of this outstanding work, which remains among the most frequently read works of Greek philosophy, indeed of Classical antiquity in general. The sixteen essays, by authors who represent various academic disciplines, bring a spectrum of interpretive approaches to bear in order to aid the understanding of a wide-ranging audience, from first-time readers of the Republic who require guidance, to more experienced readers who wish to explore contemporary currents in the work’s interpretation. The (...) three initial chapters address aspects of the work as a whole. They are followed by essays that match closely the sequence in which topics are presented in the ten books of the Republic. Since the Republic returns frequently to the same topics by different routes, so do the authors of this volume, who provide the readers with divergent yet complementary perspectives by which to appreciate the Republic’s principal concerns. (shrink)

This full-length study of Plato's dialogue Phaedrus, now in paperback, is written in the belief that such concerted scrutiny of a single dialogue is an important part of the project of understanding Plato so far as possible 'from the inside' - of gaining a feel for the man's philosophy. The focus of this account is on how the resources both of persuasive myth and of formal argument, for all that Plato sets them in strong contrast, nevertheless complement and reinforce each (...) other in his philosophy. Not only is the dialogue in its formal structure a dovetail of myth and argument, but the philosophic life that it praises is also shaped by an acknowledgement of the limitations of argument and the importance of mythical understanding. By means of this correlation of form and content Plato invites his readers, through the very act of reading, to take a first step along the path of the philosophical life. (shrink)

Tracing a central theme of Plato's Republic , G. R. F. Ferrari reconsiders in this study the nature and purpose of the comparison between the structure of society and that of the individual soul. In four chapters, Ferrari examines the personalities and social status of the brothers Glaucon and Adeimantus, Plato's notion of justice, coherence in Plato's description of the decline of states, and the tyrant and the philosopher king—a pair who, in their different ways, break with the terms of (...) the city-soul analogy. In addition to acknowledging familiar themes in the interpretation of the Republic —the sincerity of its utopianism, the justice of the philosopher's return to the Cave—Ferrari provocatively engages secondary literature by Leo Strauss, Bernard Williams, and Jonathan Lear. With admirable clarity and insight, Ferrari conveys the relation between the city and the soul and the choice between tyranny and philosophy. City and Soul in Plato's Republic will be of value to students of classics, philosophy, and political theory alike. (shrink)

First published in 2000, this translation of one of the great works of Western political thought is based on the assumption that when Plato chose the dialogue form for his writing, he intended these dialogues to sound like conversations - although conversations of a philosophical sort. In addition to a vivid, dignified and accurate rendition of Plato's text, the student and general reader will find many aids to comprehension in this volume: an introduction that assesses the cultural background to the (...) Republic, its place within political philosophy, and its general argument; succinct notes in the body of the text; an analytical summary of the work's content; a full glossary of proper names; a chronology of important events; and a guide to further reading. The result is an accomplished and accessible edition of this seminal work, suitable for philosophers and classicists as well as historians of political thought at all levels. (shrink)

The purpose of this study is to determine the relative frequency of course offerings on social issues and business ethics in American business schools. Specifically, a random sample of the curricula of 119 American business schools were analyzed in order to gauge the importance given to coursework on ethics and social issues. The findings indicated that the incidence of such courses was generally low in American business curricula, particularly at the graduate level. These findings are discussed in light of the (...) current concern for more responsible corporate behavior. (shrink)

Steve Biko died in detention in South Africa in 1977. Critical ethical issues are raised both by the conduct of the doctors responsible for Biko's care and by the subsequent response of the medical profession as a whole. Because those issues are relevant to all healthcare professionals everywhere, the Biko affair provides a useful case study in medical ethics. We discuss the case in this article, describing how we use it in our teaching.

Unlike some other reproductions of classic texts (1) We have not used OCR(Optical Character Recognition), as this leads to bad quality books with introduced typos. (2) In books where there are images such as portraits, maps, sketches etc We have endeavoured to keep the quality of these images, so they represent accurately the original artefact. Although occasionally there may be certain imperfections with these old texts, we feel they deserve to be made available for future generations to enjoy.