This paper aims to resolve an unremarked-upon tension between Anne Conway’s commitment to the moral responsibility of created beings, or creatures, and her commitment to emanative, constant creation. Emanation causation has an atemporal aspect according to which God’s act of will coexists with its effect. There is no before or after, or past or future in God’s causal contribution. Additionally, Conway’s constant creation picture has it that all times are determined via divine emanation. Creaturely agency, by contrast, is fundamentally temporal, (...) occurring successively over time. It is unclear how creatures can count as emanative causes, which coexists with its effect, given that their agency is limited by time, proceeding from before to after, or past to future. Conway’s account of divine justice in the progress of time, however, requires that creatures are causally responsible. That is, moral responsibility requires causal responsibility. I propose that Conway’s distinction between vital motion and local motion enables a resolution of the tension. Vital motion contributes an atemporal aspect to creaturely agency so that creatures can count as secondary emanative causes. (shrink)

Important advances in biomedical and behavioral research ethics have occurred over the past few decades, many of them centered on identifying and eliminating significant harms to human subjects of research. Comprehensive attention has not been paid to the totality of harms experienced by animal subjects, although scientific and moral progress require explicit appraisal of these harms. Science is a public good and the prioritizing within, conduct of, generation of, and application of research must soundly address questions about which research is (...) morally defensible and valuable enough to support through funding, publication, tenure, and promotion. Likewise, educational pathways of re-imagined science are critical. (shrink)

Abstract:Human and animal research both operate within established standards. In the United States, criticism of the human research environment and recorded abuses of human research subjects served as the impetus for the establishment of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, and the resulting Belmont Report. The Belmont Report established key ethical principles to which human research should adhere: respect for autonomy, obligations to beneficence and justice, and special protections for vulnerable individuals and (...) populations. While current guidelines appropriately aim to protect the individual interests of human participants in research, no similar, comprehensive, and principled effort has addressed the use of (nonhuman) animals in research. Although published policies regarding animal research provide relevant regulatory guidance, the lack of a fundamental effort to explore the ethical issues and principles that should guide decisions about the potential use of animals in research has led to unclear and disparate policies. Here, we explore how the ethical principles outlined in the Belmont Report could be applied consistently to animals. We describe how concepts such as respect for autonomy and obligations to beneficence and justice could be applied to animals, as well as how animals are entitled to special protections as a result of their vulnerability. (shrink)

This article centres around two somewhat contrasting case histories: one involving a person with dementia; the other a person with mild mania.

There is a long history of medical research that involves intentionally infecting healthy people in order to study diseases and their treatments. Such research—what might be called “human challenge studies”—are an important strand of much current research—for example, in the development of vaccinations. The many international and national guidelines about the proper conduct of medical research do not specifically address human challenge studies. In this paper we review the guidelines on the risk of harm that healthy volunteers may be exposed (...) to in the course of medical research. We examine the ethical arguments that are implicit or explicit in these guidelines. We then ask whether there is reason for limiting such studies on grounds independent of risk of harm. We conclude that the major ethical concern with challenge studies is that of risk of harm and that the fact that a study is a challenge study is not a wrong in itself. (shrink)

This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it from three different kinds of hope, or ‘hopes for’, and then relate (...) these distinctions back to differing accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make. (shrink)

Conway characterizes freedom in apparently contradictory ways. She describes God as the most free, yet he is necessitated to act perfectly due to his wisdom and goodness. Created beings, by contrast, sin. They are not necessitated to do so. This suggests that Conway has a binary account of freedom: divine freedom is a matter of being necessitated by wisdom and goodness, whereas creaturely freedom consists in indifference, understood as a power to act, or not act. Despite the apparently conflicting remarks, (...) I argue that Conway has a single account of freedom as spontaneity. Conway defines spontaneity in terms of causing one’s own action independent of external causes. I suggest that spontaneity is more precisely understood as an intrinsic power aimed at the good in Conway’s metaphysics, and that this account of freedom can combine necessity and contingency. Rather than a binary, Conway offers an account of freedom in creation that has it on a continuum with divine freedom. (shrink)

I attempt first to disentangle three aspects of Kant’s distinction between perfect and imperfect duty. There is the central distinction between principles of duty contrary to that which is contradictory in conception/consistent in conception but contradictory in will. There is also a distinction between essential and non-essential duties: those which cannot, or occasionally can, be passed over consistent with the requirements of morality. Finally, there is a distinction between duties that exhibit a scalar aspect – degrees of goodness or virtue (...) – and duties that do not. My aim is to show how these distinct considerations can be reconciled as aspects of a single distinction, and I conclude that the remarkable complexity of Kant’s perfect/imperfect distinction is actually a strength, rather than a weakness. (shrink)

When interpreters orient Kant in relation to contemporary philosophy of time, they claim that the B series is dependent on the A series. However, I claim that the opposite direction of dependence is also supported, due to Kant’s position that change is both intelligible and involves incompatibility. This paper extends the contemporary description of Kant’s philosophy of time to show that Kant endorses the interdependence of A series and B series views on time.

Kant’s ethics provides surprising resources for addressing duties with respect to climate change. First, I show how Kant’s moral metaphysics, according to which the self is a phenomenon, provides a distinctive ground to mitigate the harm of climate change for future generations. In short, the physical appearances of our actions are grounded in an atemporal existence from which our intrinsic moral value derives. As such, the a priori basis for addressing climate duties to the present is no different from that (...) of duties to address climate duties to the future, though we must consider present circumstances in order to act effectively. Second, I show that recent helpful contributions towards understanding the resources of Kantian ethics for addressing climate face the following prima facie dilemma: perfect duties to reduce emissions are overly demanding because it requires reduction below subsistence levels, while imperfect duties to reduce emissions are not demanding enough to address the climate crisis. Without ruling out the existence of perfect duties to address climate, I analyze the latter horn of the dilemma and show how imperfect duties can be more demanding than one might have thought, given that we are in a climate emergency. Recent work on the role of emergency in Kant’s ethics has shown that there are resources for making sense of the prioritization of some concerns as more pressing. Overall, the aim of this contribution is to highlight some of the prospects and problems that face Kantian approaches to climate ethics. (shrink)

It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...) concept of authenticity belatedly, one might say. We had been talking to people who had a diagnosis of anorexia nervosa about their experiences of living with their condition, and though we had not raised issues of authenticity or identity ourselves, they often did. They struggled with questions of .. (shrink)

Issues in medical ethics are rarely out of the media and it is an area of ethics that has particular interest for the general public as well as the medical practitioner. This short and accessible introduction provides an invaluable tool with which to think about the ethical values that lie at the heart of medicine. Tony Hope deals with thorny moral questions, such as euthanasia and the morality of killing, and also explores political questions such as: how should health (...) care resources be distributed fairly? (shrink)

Aristotle's Nicomachean Ethics is devoted to the topic of human happiness. Yet, although Aristotle's conception of happiness is central to his whole philosophical project, there is much controversy surrounding it. Hope May offers a new interpretation of Aristotle's account of happiness - one which incorporates Aristotle's views about the biological development of human beings. May argues that the relationship amongst the moral virtues, the intellectual virtues, and happiness, is best understood through the lens of developmentalism. On this view, happiness (...) emerges from the cultivation of a number of virtues that are developmentally related. May goes on to show how contemporary scholarship in psychology, ethical theory and legal philosophy signals a return to Aristotelian ethics. Specifically, May shows how a theory of motivation known as Self-Determination Theory and recent research on goal attainment have deep affinities to Aristotle's ethical theory. May argues that this recent work can ground a contemporary virtue theory that acknowledges the centrality of autonomy in a way that captures the fundamental tenets of Aristotle's ethics. (shrink)

I address the usefulness of thinking about a human right to subsistence within conceptions of human rights grounded in ordinary moral reasoning. I argue that that natural rights should be understood as rights in rem, with their dynamism constrained by the requirements of justification and their scope constrained by the distinction between perfect and imperfect duty. I then suggest that many of the most pressing demands which the moral significance of subsistence needs create are plausibly imperfect duties, and so cannot (...) correlate to a natural right to subsistence. This restricts the helpfulness of a human right to subsistence in our reasoning about what we owe to others. (shrink)

The non-identity problem arises when an intervention or behavior changes the identity of those affected. Delaying pregnancy is an example of such a behavior. The problem is whether and in what ways such changes in identity affect moral considerations. While a great deal has been written about the non-identity problem, relatively little has been written about the implications for physicians and how they should understand their duties. We argue that the non-identity problem can make a crucial moral difference in some (...) circumstances, and that it has some interesting implications for when it is or is not right for a physician to refuse to accede to a patient's request. If a physician is asked to provide an intervention (identity preserving) that makes a person worse off, then such harm provides a good reason for the physician to refuse to provide the intervention. However, in cases where different (identity-altering) interventions result in different people having a better or worse life, physicians should normally respect patient choice. (shrink)

Health care systems across the world are unable to afford the best treatment for all patients in all situations. Choices have to be made. One key ethical issue that arises for health authorities is whether the principle of the “rule of rescue” should be adopted or rejected. According to this principle more funding should be available in order to save lives of identifiable, compared with unidentifiable, individuals. Six reasons for giving such priority to identifiable individuals are considered. All are rejected. (...) It is concluded that the principle of the rule of rescue should not be used in determining the allocation of health resources. (shrink)

The risks of harm to nonhuman primates, and the absence of benefits for them, are critically important to decisions about nonhuman primate research. Current guidelines for review and practice tend to be permissive for nonhuman primate research as long as minimal welfare requirements are fulfilled and human medical advances are anticipated. This situation is substantially different from human research, in which risks of harms to the individual subject are typically reduced to the extent feasible. A risk threshold is needed for (...) the justification of research on nonhuman primates, comparable to the way risk thresholds are set for vulnerable human subjects who cannot provide informed consent. Much of the laboratory research conducted today has inadequate standards, leading to common physical, psychological, and social harms. (shrink)

The concept of need is often proposed as providing an additional or alternative criterion to cost-effectiveness in making allocation decisions in health care. If it is to be of practical value it must be sufficiently precisely characterized to be useful to decision makers. This will require both an account of how degree of need for an intervention is to be determined and a prioritization rule that clarifies how degree of need and the cost of the intervention interact in determining the (...) relative priority of the intervention. Three common features of health care interventions must be accommodated in a comprehensive theory of need: the probabilistic nature of prognosis (with and without the intervention); the time course of effects; and the fact that the most effective treatments often combine more than one intervention. These common features are problematic for the concept of need. We outline various approaches to prioritization on the basis of need and argue that some approaches are more promising than others. (shrink)

Hope and Gabbert review and distil the relevant research examining the mnemonic consequences associated with conversations within an eyewitness context. In particular, they focus on how co‐witnesses’ retellings of witnessed events impair the quantity and quality of information subsequently reported to law enforcement authorities. Notably, they also provide interventions (e.g., careful witness management and post incident procedures, use of warnings, early individual accounts, etc.) to mitigate these negative, well‐documented mnemonic effects.

David Hume famously states, in his A Treatise of Human Nature, “that ’tis only from the selfishness and confin’d generosity of men, along with the scanty provision nature has made for his wants, that justice derives its origin”.1 This is Hume’s summary of the conditions under which the very idea of rules of justice makes practical sense, and he effectively repeats it in the Enquiry Concerning the Principles of Morals.2 To put it briefly at the outset, Hume’s point is simply (...) this: if there was either a superabundance or drastic scarcity of resources, or if everyone were either completely and unfailingly virtuous or completely and unfailingly wicked, we would not need rules. (shrink)

Focusing on the barriers between social work intervention in education and government funded programs that impact African American students, this book approaches these issues from a child-centered perspective. Interviews with ten African American students were conducted to discuss their perspectives on education, family life, and social work intervention.

In this paper I argue that, for Nietzsche, the will to power is a kind of élan vital, i.e., vital impulse, force or drive. In living creatures, it is a drive to express their natures. In human beings, it is complex and must be developed in stages. The initial stages include becoming independent and striving for freedom of spirit and expression. Of the few that achieve the last stage, some will become the Übermensch or superior persons who will achieve great (...) creative acts and in so doing enhance the capabilities of all humans. Nietzsche spoke as if he were one of the free spirits, but implicit in his writings is the idea that he is an exemplar of the Übermensch. (shrink)

Journal of Political Philosophy, EarlyView.

It is sometimes held that modern institutionally-focussed conceptions of social justice are lacking in one essential respect: they ignore the importance of civic friendship or solidarity. It is also, typically simultaneously, held that Aristotle’s thought provides a fertile ground for elucidating an account of civic friendship. I argue, first, that Aristotle is no help on this score: he has no conception of distinctively civic friendship. I then go on to argue that the Kantian distinction between perfect and imperfect duties is (...) more useful than talk of civic friendship in capturing the non-institutional demands of social justice. (shrink)

In this paper I assess the possibility of advancing a modern conception of social justice under neo-Aristotelian lights, focussing primarily on conceptions that assert a fundamental connection between social justice and eudaimonia. After some preliminary remarks on the extent to which a neo-Aristotelian account must stay close to Aristotle’s own, I focus on Martha Nussbaum’s sophisticated neo-Aristotelian approach, which I argue implausibly overworks the aspects of Aristotle’s thought it appeals to. I then outline the shape of a deeper and more (...) general, and as yet unanswered, problem facing neo-Aristotelian accounts: how to justify the claim that the point of a just society is to assist or enable its members to flourish. (shrink)

Ethics, communication skills, and the law ('practice skills') are important in all aspects of modern health care. Doctors and nurses must be sensitive to the ethical aspects of their work and understand the legal framework within which clinical decisions are made. Well developed skills of communication, with patients, their relatives and other members of the clinical team, are a key feature of good clinical practice Until recently, the important of practice skills has been relatively neglected in health care education. This (...) situation is changing. The UK General Medical Council, for example, has recently identified three aspects as part of the core of the medical course, and the move to degree courses in nursing has led to an increasing focus of practice skills in nurse education. The Oxford Practice Skills Project (OPSP) team have developed a course, within the University of Oxford Clinical School, which covers the teaching of practice skills in an integrated manner. This course is widely recognized as one of the most systematic developments of education in these areas. This manual describes the OPSP course in detail and provides teaching materials. Although developed initially for medical students, it should be helpful to all those involved in teaching ethics, communication skills, and law in health care. Each Seminar is described in detail Tutors' guides are provided Student handouts are included Contains guidelines for introducing 'practice skills' into a busy clinical curriculum Includes over forty case histories for teaching and examination Gives details of many useful sources and resources Details a variety of teaching methods together with their advantages and disadvantages Provides an ethics teaching toolkit for clinical teachers new to this area Readers are welcome to photocopy any part of this manual for their own teaching. (shrink)

:Current debates about ideal theory and idealization in modern moral and political philosophy do not typically scrutinize the form of reflection itself. This is an unfortunate oversight: assumptions about the form of reflection shape the positions defended in those debates. I argue that the appropriate form of reflection on the nature and justification of standards of justice and morality is the form of practical reason. I further argue that the form of practical reason cannot support many of the idealizations typically (...) deployed in modern moral and political philosophy. (shrink)

We describe the teaching programme in ethics, law and communication skills for clinical medical students which is being developed as part of the Oxford Practice Skills Project. These three elements of practice are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centred health care in guiding the teaching is described. Although the final aim of the teaching is to improve actual practice, we have found three 'sub-aims' helpful in (...) the development of the programme. These sub-aims are: increasing students' awareness of ethical issues; enhancing their analytical thinking skills, and teaching specific knowledge. (shrink)

Anne Conway’s commitment to the moral responsibility of creatures, or created beings, is seemingly in tension with her unique metaphysics. Conway is committed to individual moral responsibility. Conway insists that an innocent person ought not be punished for someone else’s sin. Interesting recent work highlights a unique aspect of Conway’s position that creatures are multiplicities: not only are creatures integrated into the larger whole of creation, but also their parts are mutually integrated into one another. The latter, which I will (...) call ‘ontological overlap,’ renders the boundaries between creatures unclear. However, creatures must be distinct enough from each other to provide a proper subject for individual moral responsibility. This contribution suggests that Conway’s account of vital power can resolve an apparent tension between ontological overlap and individual moral responsibility and, more broadly, that Conway has a relational metaphysics of moral subjecthood. (shrink)

The “best interests” of the patient are widely seen as a cornerstone of medical practice. They are the explicit legal standard for medical care in the case of patients who lack capacity to consent to treatment.The best interests of the individual patient have, of course, long been compromised for the sake of other potential patients—in infectious disease control for example. The question of the ethics of such compromise became a hot issue, for UK doctors, about fifteen years ago in the (...) context of health care rationing. At that time the fact that there are insufficient resources to provide all patients, in all circumstances, with the best possible treatment became explicit. Faced with this uncomfortable truth, doctors tended to divide into two camps. Some wanted to play no role in decisions about resource allocation. They continued to be guided by the single ethic of each individual patient's best interests. However, “best interests” could be interpreted as “best” given the treatments that were made available by those who determined the allocation of resources. Others took the opposite approach: since choices had to be made as to the best use of available resources, doctors ought to be playing a significant role in making these choices.This polarisation has softened over time. Doctors have become more at ease with the idea that some treatments are not, given the overall resources, cost-effective, even if they are the best available. Clinical guidelines increasingly are influenced by cost-effectiveness. To provide the best health care overall, within the available resources, doctors aim to provide good care for each individual patient, but they do not always provide the best care. (shrink)

Some of the most important achievements in the field of empiricist ethics were made by the School of Moral Sentiment, comprising Francis Hutcheson, David Hume, and Adam Smith. This book throws new light on their consensus theory of virtue. Hope works some of their ideas into a merit theory of rights applicable to conventional rights, defends ethical cognitivism, and analyzes pleasure.

The Mental Capacity Act is an impressive piece of legislation that deserves serious ethical attention, but much of the commentary on the Act has focussed on its legal and practical implications rather than the underlying ethical concepts. This paper examines the approach that the Act takes to best interests. The Act does not provide an account of the underlying concept of best interests. Instead it lists factors that must be considered in determining best interests, and the Code of Practice to (...) the Act states that this list is incomplete. This paper argues that this general approach is correct, contrary to some accounts of best interests. The checklist includes items that are unhelpful. Furthermore, neither the Act nor its Code of Practice provides sufficient guidance to carers faced with difficult decisions concerning best interests. This paper suggests ways in which the checklist can be developed and discusses cases that could be used in an updated Code of Practice. (shrink)

Both human research and animal research operate within established standards and procedures. Although the human research environment has been criticized for its sometimes inefficient and imperfect process, reported abuses of human subjects in research served as the impetus for the establishment of the Nuremberg Code, Declaration of Helsinki, and the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and the resulting Belmont Report. No similar, comprehensive and principled effort has addressed the use of animals in (...) research. Although published policies regarding animal research provide relevant regulatory guidance, these policies have not emerged from the process of specifying consistent and reasoned ethical principles. The lack of a fundamental effort to explore the ethical issues and principles regarding the use of animals in research has led to unclear and disparate policies. Recent studies have increased our understanding of animal cognition and emotion, suggesting that animals' potential for experiencing a wide variety of harms, such as pain and fear, is greater than has been previously appreciated. Furthermore, relationships between methods of captivity and certain laboratory procedures and the resulting adverse physical, social and psychological effects have been established. In light of this information, current protections may need to be reconsidered and modified. This paper explores the historical convergence and divergence in the creation of human and animal research guidelines, as well as opportunities to align ethical frameworks with new scientific discoveries. (shrink)