As support for clinical ethics committees in the UK grows, care must be taken to define their function, membership and method of working and the status of their decisions.The modern practice of medicine raises a plethora of complex issues—medical, ethical and legal. Doctors and other healthcare professionals increasingly must try to resolve these and may sometimes have to do so in the face of contrary opinion expressed by patients and/or their surrogates. While clearly qualified in the medical arena, and although (...) there is now more ethics teaching in the medical curriculum, healthcare professionals are seldom qualified to adjudicate on ethical or legal matters, or even, perhaps, to recognise them when they arise. Yet, as Doyal says, “clinical life must go on and moral and legal indeterminacy within medicine cries out for practical resolution.”1 Meanwhile, the expectations of patients and their families—and, indeed, of wider society—are that decisions about patient care, resources and therapeutic regimes should be soundly based on appropriate ethicolegal, as well as scientific, principle.Recognition of these additional burdens on healthcare professionals has generated some interest in the provision of ethics consultation. In the USA this has been undertaken by a variety of tribunals and individuals. Hospital ethics committees and ethics consultants feature in many US hospitals and perform a variety of roles. In Europe, a number of countries have also established clinical ethics committees and they are becoming more common in the UK—primarily in England and Wales for the moment. Whereas, however, “[i]n North America, CECs have … become an integral part of the organisational infrastructure of hospitals ...”,1 in the United Kingdom they remain essentially ad hoc bodies, generated for a variety of reasons and with different goals, structures, membership, methods of working and functions. The initial impetus for the …. (shrink)

The new regulations on xenotransplantation pay insufficient attention to the broad ethical problems raised by this technique and that the abandonment of a national body with overall regulatory authority in this area is a mistake.Following reports from the Nuffield Council on Bioethics1 and, most importantly, the Advisory Group on the Ethics of Xenotransplantation2 , the UK Xenotransplantation Interim Regulatory Authority was established in 1997. The existence of a national body to govern xenotransplantation was deemed to be of critical importance by (...) the Kennedy report given the practical and ethical issues associated with xenotransplantation. Indeed, the Kennedy report recommended that ultimately UKXIRA should be placed on a statutory footing.2 The remit of UKXIRA was to advise the Secretary of State on particular applications, gather information on issues such as safety, and assess whether the preconditions identified by the Kennedy report had been met.3In December 2006, UKXIRA was quietly disbanded, and the Department of Health issued a statement of guidance, the terms of which now govern xenotransplantation in the UK. This document superseded procedures that had been in place since 1998, which had placed the overall regulation of applications to conduct xenotransplantation in the hands of UKXIRA and, ultimately, the Secretary of State.4 The revised guidance defines xenotransplantation as being: “… any procedure that involves the transplantation, implantation, or infusion into a human recipient of either live tissues or organs retrieved from animals, or, human body fluids, cells, tissue or organs that have undergone ex vivo contact with live non-human animal cells, tissues or organs.”5 . Given the range and nature of the procedures covered by the guidance, it is surprising, not to say a little worrying, that it is so …. (shrink)

The patient-doctor relationship has recently come under intense scrutiny, resulting in a re-evaluation of the basis of that relationship. The papers by Glannon and Ross, and McKay seek to identify the sources of authority in the patient-doctor relationship by evaluating it in terms of the concept of altruism. In this paper I argue that the analysis of Glannon and Ross, and of McKay is unnecessary and that the analysis offered by the latter is also flawed. I do acknowledge, however, that (...) Glannon and Ross's description of doctors' responsibilities and patients' roles has much to commend it. (shrink)

The controversies in Bristol, Alder Hey and elsewhere in the UK surrounding the removal and retention of human tissue and organs have led to extensive law reform in all three UK legal systems. This paper reports a short study of the reactions of a range of health professionals to these changes. Three main areas of ethical concern were noted: the balancing of individual rights and social benefit; the efficacy of the new procedures for consent; and the helpfulness for professional practice (...) of the new legislation and regulation. Recognition of these concerns may help in forging a new partnership between professionals and patients and their families. (shrink)

La relacion entre la etica y la medicina tiene una larga historia y tradicion que se puede remontar hasta la Grecia, China e India clasicas. La relacion entre ambas disciplinas es muy intensa porque la pregunta etica sobre el que debo hacer se aplica sobre la pregunta medica sobre que es mejor para la salud y el bienestar de una persona. Los textos que componen este libro tienen como hilo conductor el principio de autonomia. Este principio implica que las elecciones (...) individuales de planes de vida son valiosas y, por lo tanto, el Estado no debe interferir en ellas (dimension negativa) y debe disenar instituciones que faciliten la persecucion individual de estos planes de vida (dimension positiva). En los textos se observa que este enfoque eminentemente subjetivo se enfrenta a un enfoque colectivo (dimension relacional) que recuerda que las decisiones individuales se adoptan y repercuten positiva y negativamente en un entorno social. Este enfrentamiento permitiria observar que las elecciones individuales solo tienen un valor prima facie, pudiendose en algunos justificar limites mas amplios. (shrink)

Majority cycling and related social choice paradoxes are often thought to threaten the meaningfulness of democracy. But deliberation can prevent majority cycles – not by inducing unanimity, which is unrealistic, but by bringing preferences closer to single-peakedness. We present the first empirical test of this hypothesis, using data from Deliberative Polls. Comparing preferences before and after deliberation, we find increases in proximity to single-peakedness. The increases are greater for lower versus higher salience issues and for individuals who seem to have (...) deliberated more versus less effectively. They are not merely a byproduct of increased substantive agreement. Our results both refine and support the idea that deliberation, by increasing proximity to single-peakedness, provides an escape from the problem of majority cycling. (shrink)

There is a debate regarding the use of the white coat, a traditional symbol of the medical profession, by students. In a study evaluating final-year South African medical students' perceptions, the white coat was associated with traditional symbolic values (e.g., trust) and had practical uses (e.g., identification). The coat was generally perceived to evoke positive emotions in patients, but some recognized that it may cause anxiety or mistrust. Donning a white coat generally implied a responsibility to the profession. For a (...) few, without the coat, patients would not cooperate, resulting in some perceiving no need to be distinguished from qualified practitioners. There was thus some evidence of entitled (vs. earned) respect. In the light of the underresourced health care setting in which these students learn clinical medicine, we recommend that students be able to recognize the potential for unprofessional or unethical behavior. Students should also be able to identify role models. (shrink)

Common Truths brings together the best minds writing on one of today's most important and heated issues: natural law. This diverse group of thinkers addresses the theoretical, historical, and--in a section of particular importance--the legislative and juridical aspects of natural law. A revival of natural law concepts, the essayists argue, is crucial to the refurbishing of American civil society. Anyone wanting to understand what the natural law is and why it matters will find this engaging book indispensable.

The rapid rise of varieties of historicism in Germany, during the mid- to late-nineteenth century, and subsequently in England and America, resulted in a radical transformation of the principles of coherence and methods of analysis within biblical studies.1This paper will argue that the foundational ‘subject/object’ metaphysics of historicism has been subverted over the past century. For this reason, historical positivism should no longer be accorded the status of ‘normative paradigm’ and ‘gatekeeper’ over and against other interpretive approaches. This paper next (...) lays out five principles for a renewed practice of historical inquiry. It argues, first, that historical inquiry continues to serve a vital function within biblical studies in its ability to call attention to historical difference, and, thereby, to contribute to a strategy of resistance to ideology and to totalizing theories; second, that the traditional appeal to historical ‘context’ and ‘author’ in the interpretation of texts continues to be a useful practice – despite the provisional and constructed nature of both – as a way of taking into account extra-lingual reference and of avoiding presentism; third, that the substitution of new ‘grand narratives’ of Christian origins in place of the (quasi-theological) ‘historical’ narrative of traditional Christianity – under the claim of historical objectivity – should be abandoned because the very concept of ‘origins’ is the result of a literalizing of a metaphor. Such totalizing narratives always reduce history's inherent polycentricism. Fourth, I will argue that the continued use of historicism in the antiquarian attempt to reconstruct the past, disconnected from both a quest for social justice and a desire for personal self-creation, represents a form of thought that alienates scholars from themselves and from their real material contexts. Finally, and following on the previous point, this paper submits that the practice of historical analysis has an ethical dimension by virtue of the fact that the personhood of the biblical historian is indissolubly linked to other dimensions of life including the social and ethical aspects of life. These added dimensions complicate the making of choices, which is implicit within all practices of interpretation. These five principles are here suggested as points of departure for the reconceptualization of the scope and function of historical inquiry within the discipline of New Testament studies. (shrink)

In recent work, Peter Hanks and Scott Soames argue that propositions are types whose tokens are acts, states, or events. Let’s call this view the type view. Hanks and Soames think that one of the virtues of the type view is that it allows them to explain why propositions have semantic properties. But, in this paper, we argue that their explanations aren’t satisfactory. In Section 2, we present the type view. In Section 3, we present one explanation—due to Hanks (2007, (...) 2011) and Soames (2010)—of why propositions have semantic properties. We criticize this first explanation in Section 4. In Section 5, we present another explanation—due to Soames (2104)—of why propositions have semantic properties. We criticize this second explanation in Section 6. (shrink)

The paper surveys the lifetime achievements of Claude Sumner, S.J., a Canadian Jesuit who lived for 45 years in Ethiopia and devoted his life's work to collecting, documenting and evaluating Ethiopian philosophical texts and oral literature.

In the present paper we give a precise definition of a hidden-variable theory for quantum mechanics, whereby we adopt the weakest possible definition of a hidden-variable theory, which is compatible with the assumption that the bounded observables of a quantum mechanical system are represented by the elements of the real part Ar of a W*-algebra A (of the most general type) and the states are represented by the “normal states” (in the mathematical sense) of A. We then go on to (...) show that an example put forward by Bell in 1966 satisfies our definition (Sec. 2). Finally we make use of Bell's famous theorem to show that for a sufficiently non-commutative W*-algebra A no hidden-variable theory in our sense exists (Theorem 3.3 and its corollaries). (shrink)

This article highlights the long accomplishments of Claude Sumner, S.J. in the field of African philosophy. During his lifetime he published over 33 books and 184 articles. He lived and worked in Ethiopia for 44 years. He translated into English and analysed several key historical works in Ethiopian philosophy, written originally in Ge’ez. He argued that modern rationalist philosophy began in Africa with Zera Yacob at the same time that it began in France with Descartes. He then set to work (...) recording and analyzing oral philosophical sources found in proverbs and songs. He theorized on the definitions of philosophy and the methods to explore philosophy found in different sources. (shrink)

Drawing on interviews with 140 young British males, this article explores the ways in which men talk about their own bodies and bodily practices, and those of other men. The specific focus of interest is a variety of body modification practices. We argue, however, that the significance of this analysis extends beyond the topic of body modification. In discussing the appearance of their bodies, the men we interviewed talked less about muscle and skin than about their own selves located within (...) particular social, cultural and moral universes. This article shows that, in talking about seemingly trivial questions such as whether to have one’s nose pierced or join a gym, men are actively engaged in regulating normative masculinity. Our analysis lends support to the claim that the body has become a new (identity) project in high/late/post-modernity, but shows how fraught with difficulties this project is for young men who must simultaneously work on and discipline their bodies while disavowing any (inappropriate) interest in their own appearance. The analysis highlights the pervasive individualism of young men’s discourses, and the absence of alternative ways of making sense of embodied experiences. (shrink)

Drawing on interviews with 140 young British males, this article explores the ways in which men talk about their own bodies and bodily practices, and those of other men. The specific focus of interest is a variety of body modification practices. We argue, however, that the significance of this analysis extends beyond the topic of body modification. In discussing the appearance of their bodies, the men we interviewed talked less about muscle and skin than about their own selves located within (...) particular social, cultural and moral universes. This article shows that, in talking about seemingly trivial questions such as whether to have one’s nose pierced or join a gym, men are actively engaged in regulating normative masculinity. Our analysis lends support to the claim that the body has become a new (identity) project in high/late/post-modernity, but shows how fraught with difficulties this project is for young men who must simultaneously work on and discipline their bodies while disavowing any (inappropriate) interest in their own appearance. The analysis highlights the pervasive individualism of young men’s discourses, and the absence of alternative ways of making sense of embodied experiences. (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.

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

In 2005, Ethiopia changed its abortion law to curb its high maternal mortality. This has led to a considerable reduction in deaths from unsafe abortions. Abortion is now legal if the woman’s pregnancy is a result of rape or incest, if her health is endangered, if the fetus has a serious deformity, if she suffers from a physical or mental deficiency, or if she is under 18 years of age. The word of the woman, if in compliance with the law, (...) is sufficient to qualify for an abortion. In this context, where the law makes the door slightly open, health workers become important in deciding who gets access to safe services and who doesn’t, thus creating considerable ethical dilemmas. The objective of this study was to explore abortion service providers’ personal experiences and reflections, perceptions of the abortion law, and ethical and dilemmas that arise. Data collection took place from March to May 2016 in Addis Ababa, at different health clinics providing abortion services. Thirty in-depth interviews and three focus group discussions were conducted with 41 abortion service providers at governmental and non-governmental clinics. Content analysis was drawn upon in the interpretation of the findings. When working in a context where the law has slightly opened the door for abortion seeking women, the health workers describe conflicting concerns, burdensome responsibilities, and ambiguity concerning how to interpret and implement the law. They describe efforts to balance their religious faith and values against their professional obligations and concern for women’s health and well-being. This negotiation is particularly evident in the care of women who fall outside the law’s indications. They usually handle ethical dilemmas and decision-making alone without guidance. Moreover, many health workers face a stigma from fellow colleagues not performing abortions and therefore keep their job a secret from family and friends. Health workers in Ethiopia experience ethical dilemmas trying to maneuver between the abortion law, their personal values, and their genuine concern for the health of women. More research is needed to further explore this. (shrink)

ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the (...) experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. (shrink)