This chapter contains sections titled: References.

Replacing logical coherence by effectiveness as criteria of rationality, Gigerenzer et al. show that simple heuristics can outperform comprehensive procedures (e.g., regression analysis) that overload human limited information processing capacity. Although their work casts long overdue doubt on the normative status of the Rational Choice Paradigm, their methodology leaves open its relevance as to how decisions are actually made.

The present study tested the existence of a cognitive schema that guides people's evaluations of the likelihood that observed problem-solving processes will succeed. The hypothesised schema consisted of attributes that were found to distinguish between retrospective case reports of successful and unsuccessful real world problem solving (Lipshitz & Bar Ilan, 1996). Participants were asked to evaluate the likelihood of success of identical cases of problem solving that differed in the presence or absence of diagnosis, the selection of appropriate or inappropriate (...) solutions, and the pairing of diagnosis with appropriate or non-appropriate solutions. Consistent with the proposition, diagnosis affected perceived likelihood of success, albeit only when solution quality was held constant, and appropriate diagnosis with a compatible solution produced higher perceived likelihood of success than appropriate diagnosis with incompatible solutions. In addition, results showed that solution quality played a significant role, and that compatibility with a six-phase rational model of problem solving played no role in judging likelihood of success. (shrink)

This paper presents an integrative framework for analyzing decisions. Three generic modes of decision making are identified: consequential choice , matching and reassessment . The three generic modes are compared on a common set of attributes, and the conditions for their proper use are outlined. Two case analyses illustrate how the framework can be used to analyze specific decisions from multiple perspectives.

In lieu of an abstract, here is a brief excerpt of the content:Philosophies versus Philosophy:In Defense of a Flexible DefinitionRein RaudIt is strange that no one has taken up Carine Defoort's clearly formulated and timely argument about the intercultural tensions in interpreting what philosophy is, although the issue deserves at least a roundtable, if not an international conference.1 I doubt that this is because there is a general consensus that the matter is now settled, and I would therefore like to (...) develop the argument a bit further and offer a few additional factors to consider. It is also obvious that the problem is not limited to the subject of Chinese philosophy alone: all traditions of thought from all over the world, but most notably the Indian, Islamic, and Japanese heritages, are affected by the positions we adopt. As in most debates about the commensurability of cultural traditions, we can find differences when we look for them, and similarities if these are what we would like to see, so the "conflict of sensitivities"2 is also a matter of attitudes. My own position is that regardless of what we prefer to call the practice of deeper thought (and 'philosophy' is a very good name), it would be extremely useful for all of its participants, whatever their origin and upbringing, to find a common denominator for them to be able to exchange ideas and mutually enrich each other on its basis. In what follows I shall try to sketch a perspective from which this could, in my opinion, be theoretically grounded.Four PositionsDefoort has identified four possible points of view on the problem of whether classical Chinese thought could or should be called 'philosophy,' which could be summarized as follows.1. Chinese classical thought is not philosophy, because it does not satisfy the conditions of philosophy as it is generally and traditionally understood in the West.2. Chinese classical thought is philosophy, because it reveals the necessary characteristics if analyzed with the help of an appropriate (Western-type) observation language.3. Chinese classical thought can be called philosophy, but only if we redefine philosophy in order to accommodate some of its nontypical or clearly deviant features.4. Chinese classical thought should not be called philosophy, because philosophy is a culturally closed Western phenomenon with a limited scope and incapable of understanding fundamentally different modes of thought. [End Page 618]If we dismiss the birthright variety of the first position, we could label it essentialist, and its weakest point is certainly that Western philosophy has not remained unchanged during the course of history. It is highly doubtful that Socrates, Diogenes, scholastics, Nietzsche, and Gareth Evans could all be members of the same set if the same strict criteria were applied to all periods and all cultural settings in the same way, and, as Defoort herself stresses,3 the fact that seventeenth-century Jesuits (the basis of whose original worldview, we should think, was much farther from the Chinese than ours) had no problem in calling Chinese thought philosophy should show us that the paradigm shift of the thing called 'philosophy' has occurred in the West and is, so to speak, our problem and not theirs.Now, it is also possible that in some circles even some prominent names in the Western tradition do not qualify as real philosophers, in the sense in which Hegel was treated by Bertrand Russell4 and Heidegger was dismissed by Alfred Ayer5 in their respective histories of philosophy (while they nevertheless felt compelled to include chapters or passages on them). A definition of philosophy that puts forward such criteria that a considerable number of thinkers would have to remain outside its borders should be labeled sectarian-and it can still be met, even if ever less often, in some analytical schools of philosophy. It is my conviction, however, that in our globalizing world any definition that would leave non-European philosophy outside the borders of 'philosophy proper' should be considered sectarian in nature. The main problem that I have with Defoort's family model6 is precisely that in it the head of the family, who makes the decisions as to who can be adopted and who cannot, is always Western, and the... (shrink)

Analyzes the moral problems confronting health care practitioners from a wide variety of perspectives, especially those connected by four major ethical principles--respect for autonomy, beneficence, non-maleficence and justice.

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren (...) Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

The difficulty in the apostrophe of the has been noticed by commentators. So Barrett : ‘/ this cannot mean that the Amazon from Hipp, now that he is exiled: in all the forms of her legend … she meets a violent death at a time which cannot be long after Hipp.'s birth, and it is inconceivable that Eur. should mean his audience to think of her as still alive in Trozen or Athens.’ What seems to have passed unnoticed is that (...) there are, in this choral ode , two other passages which also suffer from at least prima facie incongruities with details of the story well known to the audience. (shrink)

Justice, one of the four Beauchamp and Childress prima facie basic principles of biomedical ethics, is explored in two excellent papers in the current issue of the journal. The papers stem from a British Medical Association essay competition on justice and fairness in medical practice and policy. Although the competition was open to all comers, of the 235 entries both the winning paper by Alistair Wardrope1 and the highly commended runner-up by Zoe Fritz and Caitríona Cox2 were written by practising (...) doctors—a welcome indication of the growing importance being accorded to philosophical reflection about medical practice and practices within medicine itself. Both papers are thoroughly thought provoking and represent two very different approaches to the topic. Each deserves a careful read. The competition was a component of a BMA 2019/2020 ‘Presidential project’ on fairness and justice and asked candidates to ‘use ethical reasoning and theory to tackle challenging, practical, contemporary, problems in health care and help provide a solution based on an explained and defended sense of fairness/justice’. In this guest editorial I’d like to explain why, in 2018 on becoming president-elect of the BMA, I chose the theme of justice and fairness in medical ethics for my 2019–2020 Presidential project—and why in a world of massive and ever-increasing and remediable health inequalities biomedical ethics requires greater international and interdisciplinary efforts to try to reach agreement on the need to achieve greater ‘health justice’ and to reach agreement on what that commitment actually means and on what in practice it requires. First, some background. As president I was offered the wonderful opportunity to pursue, with the organisation’s formidable assistance, a ‘project’ consistent with the BMA’s interests and values. As a hybrid of general medical practitioner and philosopher/medical ethicist, and as a firm defender of the Beauchamp …. (shrink)

Late last year the English Court of Appeal confirmed a lower court's ruling that doctors could impose an operation to separate recently born conjoined twins, overriding the refusal of consent of their parents. The doctors believed the operation would probably save one of the babies at the cost of killing the other, while not operating would highly probably be followed by the death of both twins within months of their birth. The parents, said to be devout Roman Catholics, believed that (...) it was absolutely wrong to kill one of their babies, even to save the life of the other.Undoubtedly many people, the writer included, would agree with the English courts that the “least worst” option was to separate the twins and save one at the cost of killing the other. But surely many fewer people would have imposed their own resolution of this acute moral dilemma upon parents who conscientiously chose the other limb of the dilemma, refusing to kill one baby even in order to save the other. Were the English judges right, then, to take away the parents' normal right and duty to make health care decisions on behalf of their children and instead impose their own answer to what they admitted to be a terrible dilemma? Describing the two alternatives in terms of choosing between the lesser of two evils on the one hand, and the obligation not to kill on the other, Lord Justice Ward declared, according to The Times law report,1 that: “Parents who were placed on the horns of such a terrible dilemma simply had to choose the lesser of their inevitable loss [sic]”. But that surely is to beg the moral question in favour of the judges' preferred answer to this moral dilemma. The fact is that there are—as …. (shrink)

This paper argues that Charlie Gard’s parents should have been the decision-makers about their son’s best interests and that determination of Charlie’s best interests depended on a moral decision about which horn of a profound moral dilemma to choose. Charlie’s parents chose one horn of that moral dilemma and the courts, like Charlie Gard’s doctors, chose the other horn. Contrary to the first UK court’s assertion, supported by all the higher courts that considered it, that its judgement was ‘objective’, this (...) paper argues that the judgement was not and could not be ‘objective’ in the sense of objectively correct but was instead a value judgement based on the judge’s choice of one horn of the moral dilemma. While that horn was morally justified so too was the horn chosen by the parents. The court could and should have avoided depriving the parents of their normal moral and legal right and responsibility to decide on their child’s best interests. Instead, this paper argues that the court should have acknowledged the lawfulness of both horns of the moral dilemma and added to its judgement that Charlie Gard’s doctors were not legally obliged to provide treatment that they believed to be against their patient’s best interests the additional judgement that Charlie’s parents could lawfully transfer his care to other doctors prepared to offer the infant a trial of the experimental treatment requested by his parents. (shrink)

This paper argues that the central issue in the abortion debate has not changed since 1967 when the English parliament enacted the Abortion Act. That central issue concerns the moral status of the human fetus. The debate here is not, it is argued, primarily a moral debate, but rather a metaphysical debate and/or a theological debate—though one with massive moral implications. It concerns the nature and attributes that an entity requires to have “full moral standing” or “moral inviolability” including a (...) “right to life”. It concerns the question when, in its development from newly fertilised ovum to unequivocally mature, autonomous morally inviolable person does a human being acquire that nature and those attributes, and thus a “right to life”. The paper briefly reviews standard answers to these questions, outlining some problems associated with each. Finally there is a brief discussion of one way in which the abortion debate has changed since 1967—notably in the increasingly vociferous claim, especially from disability rights sectors, that abortion on grounds of fetal abnormality implies contempt for and rejection of disabled people—a claim that is rebutted. (shrink)

Gripped by an odd blend of excited liberation at forthcoming retirement and the sadness of impending loss, I've been skimming past issues of the JME looking for themes, for developments, for ideas, for this valedictory editorial after twenty years as its editor. A few may be worth offering. First some general impressions. The enthusiasm that medical ethics still seems to inspire in those who write about it leaps out of the JME's pages. So does the enormous breadth of the subject, (...) along with the multi-, interand trans-disciplinarity from which it is approached. Doctors, philosophers, theologians and lawyers; bishops and rabbis, social scientists and government officials; patients and patient representatives; professors and students, and many many more are in our pages, advocating and arguing vigorously: and they have been doing so from an ever increasing number of countries. One of the most agreeable benefits for me has been the friendships, intellectual with many and personal with quite a few, with people from these various disciplines, occupations and perspectives, cultures and countries, that medical ethics has facilitated and it was good to find so many of these friends communicating with me as I browsed through the journal's pages. Let me also take the opportunity of thanking all my friends and colleagues who have helped me edit this journal—authors, book reviewers, letter writers, referees (so exceedingly important and unsung and unrewarded a group), editorial and advisory board members, especially our wise chairman, Tom Oppe, members of the BMJ special journals division, and all those who actually make the journal appear once the editor has chosen its contents. While I don't have space to name all whom I thank, particular tribute is due to the small team who have been with me for eighteen or more of my editorial years, Ann Lloyd, our excellent …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophies versus Philosophy:In Defense of a Flexible DefinitionRein RaudIt is strange that no one has taken up Carine Defoort's clearly formulated and timely argument about the intercultural tensions in interpreting what philosophy is, although the issue deserves at least a roundtable, if not an international conference.1 I doubt that this is because there is a general consensus that the matter is now settled, and I would therefore like to (...) develop the argument a bit further and offer a few additional factors to consider. It is also obvious that the problem is not limited to the subject of Chinese philosophy alone: all traditions of thought from all over the world, but most notably the Indian, Islamic, and Japanese heritages, are affected by the positions we adopt. As in most debates about the commensurability of cultural traditions, we can find differences when we look for them, and similarities if these are what we would like to see, so the "conflict of sensitivities"2 is also a matter of attitudes. My own position is that regardless of what we prefer to call the practice of deeper thought (and 'philosophy' is a very good name), it would be extremely useful for all of its participants, whatever their origin and upbringing, to find a common denominator for them to be able to exchange ideas and mutually enrich each other on its basis. In what follows I shall try to sketch a perspective from which this could, in my opinion, be theoretically grounded.Four PositionsDefoort has identified four possible points of view on the problem of whether classical Chinese thought could or should be called 'philosophy,' which could be summarized as follows.1. Chinese classical thought is not philosophy, because it does not satisfy the conditions of philosophy as it is generally and traditionally understood in the West.2. Chinese classical thought is philosophy, because it reveals the necessary characteristics if analyzed with the help of an appropriate (Western-type) observation language.3. Chinese classical thought can be called philosophy, but only if we redefine philosophy in order to accommodate some of its nontypical or clearly deviant features.4. Chinese classical thought should not be called philosophy, because philosophy is a culturally closed Western phenomenon with a limited scope and incapable of understanding fundamentally different modes of thought. [End Page 618]If we dismiss the birthright variety of the first position, we could label it essentialist, and its weakest point is certainly that Western philosophy has not remained unchanged during the course of history. It is highly doubtful that Socrates, Diogenes, scholastics, Nietzsche, and Gareth Evans could all be members of the same set if the same strict criteria were applied to all periods and all cultural settings in the same way, and, as Defoort herself stresses,3 the fact that seventeenth-century Jesuits (the basis of whose original worldview, we should think, was much farther from the Chinese than ours) had no problem in calling Chinese thought philosophy should show us that the paradigm shift of the thing called 'philosophy' has occurred in the West and is, so to speak, our problem and not theirs.Now, it is also possible that in some circles even some prominent names in the Western tradition do not qualify as real philosophers, in the sense in which Hegel was treated by Bertrand Russell4 and Heidegger was dismissed by Alfred Ayer5 in their respective histories of philosophy (while they nevertheless felt compelled to include chapters or passages on them). A definition of philosophy that puts forward such criteria that a considerable number of thinkers would have to remain outside its borders should be labeled sectarian-and it can still be met, even if ever less often, in some analytical schools of philosophy. It is my conviction, however, that in our globalizing world any definition that would leave non-European philosophy outside the borders of 'philosophy proper' should be considered sectarian in nature. The main problem that I have with Defoort's family model6 is precisely that in it the head of the family, who makes the decisions as to who can be adopted and who cannot, is always Western, and the... (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

This paper, based on a talk given at a conference on compassion in health care held at the Royal Society of Medicine in November 2012, argues that the ethical requirement for humanity in health care is obvious and needs little ethical analysis – the problem is to get the results of ethical reflection, ordinary humanity and everyday common sense, into everyday behaviour. The author offers some suggestions that might help to achieve this aim and bring back the human face of (...) health and social care. These suggestions concern organisational structural changes (including `humanity objectives' in appraisal and reward schemes); individual attitudes (including self assessment of their own humanity in their work by all health and social care workers – `does my own practice manifest a human face?'); and a possible research agenda (and a concomitant effort to remind all health care research funders that `humanity is an integral component of medical, health and care research'. And the author proposes a standing high level `humanity task force' to implement and oversee Health Education England's recent `humanity mandate'. (shrink)

Considerable attention in bioethics has been devoted to moral expertise and its implications for handling applied moral problems. The existence and nature of moral expertise has been a contested topic, and particularly, whether philosophers are moral experts. In this study, we put the question of philosophers’ moral expertise in a wider context, utilizing a novel and global study among 4,087 philosophers from 96 countries. We find that despite the skepticism in recent literature, the vast majority of philosophers do believe in (...) moral expertise and in the contribution of philosophical training and experience to its acquisition. Yet, they still differ on what philosophers’ moral expertise consists of. While they widely accept that philosophers possess superior analytic abilities regarding moral matters, they diverge on whether they also possess improved ability to judge moral problems. Nonetheless, most philosophers in our sample believe that philosophers possess an improved ability to both analyze and judge moral problems and that they commonly see these two capacities as going hand in hand. We also point at significant associations between personal and professional attributes and philosophers’ beliefs, such as age, working in the field of moral philosophy, public involvement, and association with the analytic tradition. We discuss the implications of these findings for the debate about moral expertise. -/- . (shrink)

Lying is an important moral phenomenon that most people are affected by on a daily basis—be it in personal relationships, in political debates, or in the form of fake news. Nevertheless, surprisingly little is known about what actually constitutes a lie. According to the traditional definition of lying, a person lies if they explicitly express something they believe to be false. Consequently, it is often assumed that people cannot lie by more indirectly communicating believed‐false claims, for instance by merely conversationally (...) implicating them. In this paper, we subject this claim to an empirical test. In a preregistered study of 300 participants, we investigate how people judge cases of implicit deceptions that would usually be excluded by the traditional definition of lying (i.e., conversational implicatures, presuppositions, and nonverbal actions). Our results show that people do in fact consider it possible to lie by indirect means, suggesting that people have a broader concept of lying than is usually assumed. Moreover, our findings indicate that lie judgments are closely tied to the extent to which agents are perceived as having committed themselves to the believed‐false claims they have communicated. We discuss the implications of our results for the traditional definition of lying and propose a new commitment‐based definition of lying that can account for the findings of our experiment. (shrink)

Co-éditions avec la Maison descartes d'Amsterdam Les 29 et 30 novembre 1979 s'est tenu à la Maison Descartes (Institut Français d'Amsterdam) un colloque franco-néerlandais sur le thème de "L'Enfermement", sous la présidence de Charles Grivel du côté néerlandais et de Michel Deguy du côté français.Les intervenants venaient d'horizons divers. Poètes, comme Maurice Roche pour la France et Rein Bloem pour les Pyas-Bas. Psychanalyste: Anton Mooij. Sociologues: le néerlandais Pieter Nijhoff et le français Jean Duvignaud. Historiens: Robert Muchembled. Professeurs de littérature (...) française (Roger Kempf) et de linguistique (Teun van Dijk).Cette diversité dans la formation, cette convergence des points de vue, voilà peut-être ce qui a permis de cerner le difficile concept d'enfermement. S'agit-il bien d'ailleurs d'un concept? N'est-ce pas là un mythe à la mode? Toutes les civilisations, toutes les sociétés définissent et suscitent, chaque fois d'une manière différente et pour elles-même, une certaine expérience de l'enfermememnt. Pour la mort ou la sexualité sans doute, mais aussi pour l'art et le savoir: les idéologies ou les doctrines ne sont-elles pas aussi des formes de l'enfermement? Il s'agit alors de se demander pourquoi notre époque, et plus particulièrement une certaine situation de la société intellectuelle, valorise, non sans complaisance, cet "enfermement". (shrink)

It is a commonplace that Frege thought ordinary language to be seriously defective. Yet his remarks about ordinary language are not always unflattering. Comparing the relation between his formal language and ordinary language to the relation between the microscope and the eye, Frege remarked: ‘[the eye], because of the range of its applicability and because of the ease with which it can adapt itself to the most varied circumstances, has a great superiority over the microscope’. The point, of course, is (...) that, for Frege, the deficiencies of ordinary language arise in connection with the scientific endeavour: ordinary language is not an acceptable medium in which to pursue truth. As he goes on to observe: ‘… viewed as an optical instrument [the eye] reveals many imperfections … as soon as scientific purposes place strong requirements upon sharpness of resolution, the eye proves to be inadequate. On the other hand, the microscope is perfectly suited for just such purposes’. (shrink)

This paper describes the medical ethics scene in Britain. After giving a brief account of the structure of British medical ethics and of the roles of the different groups involved it mentions some of the important medico-moral events and issues of the fairly recent past, and describes in greater detail four important examples of professional, legal, governmental and media concerns with medical ethics, themselves illustrating the wide variety of interests wishing to influence the British medical profession's ethics. The examples offered (...) are the development of research ethics committees, the Sidaway case concerning informed consent, the Warnock Committee's Report on in vitro fertilisation and associated issues, and the 1980 Reith Lectures on Unmasking Medicine. In the final section a fairly new methodological development in British medical ethics is described in which the medical profession is increasingly recognising the need to add to traditional medical ethics education, with its longstanding history of the inculation and enforcement of ethical norms, an element of philosophical or critical medical ethics, at the heart of which is justification of substantive medico-moral claims in the light of counterarguments. (shrink)

Medical Ethics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medical ethics and bioethics in the UK more centrally within its historical and human contex.

This commentary briefly argues that the four prima facie principles of beneficence, non-maleficence, respect for autonomy and justice enable a clinician (and anybody else) to make ethical sense of the author's proposed reliance on professional guidance and rules, on law, on professional integrity and on best interests, and to subject them all to ethical analysis and criticism based on widely acceptable basic prima facie moral obligations; and also to confront new situations in the light of those acceptable principles.

IN DEFENCE OF MEDICAL COMMITMENT CEREMONIESI confess to an overwhelming astonishment on first reading my friend Bob Veatch's attack on white coat ceremonies. Surely, I had thought, everyone who considered the issue would want doctors to commit themselves to the basic moral goals of medicine and especially that ancient Hippocratic goal of working to benefit the health of their/our patients, and only risking or doing harm with the intention and likely outcome of producing their net health benefit? Surely, too, it's (...) a good idea for the new medical student—or at least the new clinical student about to encounter and interact with real patients—to commit himself or herself to those goals? But as usual Professor Veatch is an incisive and thought-provoking critic and his three criticisms require careful reflection. Those criticisms were: that the oaths or affirmations were not legitimate, especially because the students were unlikely to understand them or their implications; that it is not clear which of the competing candidate oaths or commitments should be chosen and why, and that the “bonding” aspect of the ceremony in which the new student is welcomed as a student member of the medical profession is undesirable in so far as it tends to remove medical students from their own cultures and place them instead in a medical culture “increasingly isolated from the people and cultures from which they have come”.Too ill informed, too young, too coerced to commit?As for the first criticism, I suppose a sensible development of the white coat ceremony would be to send each medical school applicant a copy of the commitment that he or she would be expected to make on joining the medical school so that he or she can study, reflect on, and discuss it with family and friends. On the other hand if the white coat commitment I saw is typical of others, such …. (shrink)

In this journal, Dr Daniel Daly, an American bioethicist, uses a principlist approach (respect for autonomy, non-maleficence, beneficence and justice) to argue that intravenous opiate users should not be denied repeat heart valve replacements if these are medically indicated, ‘unless the valve replacement significantly violates another’s autonomy or one or more of the three remaining principles’.1 In brief outline, the paper seeks to use a widely accepted ethical theory—‘principlism’ as developed by Beauchamp and Childress over the last 40 plus years (...) and eight editions of their ground-breaking book Principles of Biomedical Ethics2—to resolve clinical disagreement about the ethics of denying medically indicated life-prolonging treatment to patients who continue or resume intravenous opiate use. The argument Dr Daly's argument in very brief summary is that in the context of contemporary American medical practice, such treatment is ethically justified—perhaps even ethically required—if requested or accepted by an adequately autonomous patient and thus respects the patient’s autonomy, if it is not harmful to the patient, if it is beneficial to the patient, and if it is fair and just in terms of Aristotle’s formal theory of justice according to which equals should be treated equally while unequals should be treated unequally in proportion to the morally relevant inequality or inequalities. Dr Daly focuses his argument around a typical case description where these conditions are met and therefore where, he concludes, repeat heart valve replacements ought to be provided. As Dr Daly notes, principlism ‘is not without its problems; nonetheless it does provide a viable set of principles that are widely held by medical ethicists and inform the work of ethics committees at many secular medical facilities’. DOI (declaration of interest): The writer of this editorial is a career-long supporter and defender of the use of ‘principlism’ or ‘the four principles …. (shrink)

We wish to describe and acknowledge the exceptional contributions to medical ethics, both in the UK and internationally, made by Edward Shotter1 who died at home on 3 July 2019. He was founder of the London Medical Group2 3 and instigator of similar student-led medical ethics groups throughout the UK; founder of the Institute of Medical Ethics4 and founder of the Journal of Medical Ethics. Ted Shotter transformed the study of medical ethics in the UK in the interests of patients (...) and professionals alike. In 1963, he established the pioneering ‘Medical Group’ model, an innovative bottom-up method whereby students in the health professions could gain a grounding in ethics that had previously been denied to the profession.5 It was with these Medical Groups that many of the leading figures in contemporary UK medical ethics and law began their careers in the subject including Sir Kenneth Calman, Sir Ian Kennedy, Professor Margaret Brazier OBE, Professor John Harris and Professor Sir Jonathan Montgomery to name but …. (shrink)