Respect for Autonomy has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility (...) of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons. (shrink)

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery (...) resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT. (shrink)

This paper argues that healthcare aims at the good of health, that this pursuit of the good necessitates conscience, and that conscience is required in every practical judgement, including clinical...

In her paper ‘Cosmetic surgery and conscientious objection’, Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because it overlooks an important distinction regarding autonomy's meaning (...) and place in clinical practice, and it makes obsolete the important concepts of expert clinical judgment and beneficence. Finally, we discuss two ideas which emerge from consideration of cosmetic surgery in relation to conscientious objection. These are the possible analogy between clinical judgment and conscientious objection, and the possible role the goals of medicine can play in defining the scope of conscientious objection. (shrink)

Debate persists over the place of conscience in medicine. Some argue for the complete exclusion of conscientious objection, while others claim an absolute right of refusal. This paper proposes that claims of conscientious objection can and should be permitted if they concern kinds of actions which fall outside of the normative standard of medicine, which is the pursuit of health. Medical practice which meets this criterion we call medicine qua medicine. If conscientious refusal concerns something consonant with the health-restoring aims (...) of medicine, it entails a desertion of professional duty. If, however, it relates to something other than medicine qua medicine, it can rightly be refused. It thus becomes possible to test instances of conscientious objection to determine their validity, and thereby conserve both the principle of conscientious objection and define its scope. This test of conscience prevents arbitrary discrimination, and preserves doctors’ agency. It is a theoretical razor rooted in the pra... (shrink)

Hoping to bring some objectivity to the debate, Ben-Moshe has argued that conscientious objection in medicine should be accommodated based on its concordance with the ‘impartial spectator’, a metaphor for conscience drawn from the writings of Adam Smith. This response finds fault with this account on two fronts: first, that its claim to objectivity is unsubstantiated; second, that it implicitly relies on moral absolutes, despite claiming that conscience is a social construct, thereby calling its coherence and claims into question. Briefly, (...) a traditional account of conscience is then described, before ending with a related thesis for future discussion. (shrink)

Räsänen has attempted to make a moral case for permitting some people to change their legal age: if someone considers that their chronological age does not correspond to their emotional age or biological age, and they face age-based discrimination as a result, they may change the legal record of their age. This response considers some of the problems with Räsänen’s paper, including its reliance on equivocation. It concludes that what is billed as a moral argument turns out to be a (...) conflicted case for deception which relies on a nihilistic outlook on reality. (shrink)

Florence Ashley has responded to our response to ‘Gatekeeping hormone replacement therapy for transgender patients is dehumanising.’ Ashley criticises some of our objections to their view that patients seeking hormone replacement therapy (HRT) for gender dysphoria should not have to undergo a prior psychological assessment. Here we clarify our objections, most importantly that concerning the parity between cosmetic surgery and the sort of intervention Ashley has in mind. Firstly, we show Ashley’s criticism of our comparison is insubstantial. We then examine (...) their comments regarding the analogy between abortion and HRT, and the language of informed consent. We also scrutinize the data upon which Ashley relies to defend the claim that informed consent without assessment always yields positive outcomes, finding this conclusion to be overstated. Finally, even if Ashley’s arguments were vindicated, the claim that the gatekeeping of HRT is motivated by hostility towards transgender people remains unsupported. (shrink)

Cremation has substantial practical benefits. Not only is it much cheaper than traditional burial, but it also comes without its ecological burden. Despite this, we argue that cremation is an inadequate way of disposing of the dead because it entails the destruction of community memory, and, by extension, community and individual identity. It deprives the living of these benefits, while also treating the dead in way which goes against common intuitions about personhood, anthropology and respect for the will of the (...) deceased. Death is perhaps one of the most important subjects in philosophy, and by marginalising it through cremation and related practices, we deprive ourselves of its didactic and social uses. The case we make against cremation is not absolute, but we hope it succeeds in casting doubt on the presumed neutrality of cremation. Our essay is under three heads: we consider the practical benefits of cremation; we reconsider the value of cremation in light of what it deprives individuals and communities of and; we analyse the significance of the corpse in regard to cremation. (shrink)

In a recent article in this journal, Abram Brummett argues that new and future assisted reproductive technologies will provide challenging ethical questions relating to lesbian, gay, bisexual and transgender (LGBT) persons. Brummett notes that it is likely that some clinicians may wish to conscientiously object to offering assisted reproductive technologies to LGBT couples on moral or religious grounds, and argues that such appeals to conscience should be constrained. We argue that Brummett's case is unsuccessful because he: does not adequately interact (...) with his opponents’ views; equivocates on the meaning of ‘natural’; fails to show that the practice he opposes is eugenic in any non‐trivial sense; and fails to justify and explicate the relevance of the naturalism he proposes. We do not argue that conscience protections should exist for those objecting to providing LGBT people with artificial reproductive technologies, but only show that Brummett's arguments are insufficient to prove that they should not. (shrink)

Our thesis is that the story of Onan in Genesis chapter 38 offers scriptural and logical grounds for believing that contraceptive acts are sinful. We set out a five-part modus ponens argument which considers the meaning and significance the story of Onan and, by showing that contraceptive acts are substantially similar to the act for which Onan is infamous, conclude that Christians ought not to practise contraception. We then respond to objections to this conclusion before finally and briefly touching upon (...) some of the implications of our thesis for Christian ethics, namely with reference to the perverted faculty argument and natural law. (shrink)

Introduction The General Medical Council stipulates that doctors must be competent professionals, not merely scholars and practitioners. Medical school curricula should enable students to develop professional values and competencies. Additionally, medical schools are moving towards integrated undergraduate curricula, Cardiff's C21 being one such example. Methods We carried out an audit to determine the extent to which C21 delivers GMC professionalism competencies, and a student questionnaire to explore student perspective on ethics and professionalism. Results and discussion C21 delivers explicit or implicit (...) teaching for all major GMC competencies, though some missed opportunities remain. The questionnaire responses showed that most students value ethics and professionalism teaching, and that it is most well received when delivered in a variety of ways and contexts throughout the curriculum. We also note that some respondents confuse ethics and professionalism with the policing of student behaviour. Conclusions C21 and curricula like it offer many opportunities for nurturing ethically and professionally competent physicians. Students appear to value this, though there remains confusion between medical school discipline and ethics and professionalism which needs further explication. (shrink)

Natural law is probably the most misrepresented and, therefore, unfairly dismissed ethical theory. If current academic ethics were a battlefield, it would be littered with the felled strawmen alleg...

Volume 26, Issue 3, September 2020, Page 284-286.

Arianne Shahvisi has argued that a doctor’s conscientious objection to abortion is a misuse of their authority which unduly burdens patients and, moreover, does not succeed in its aim of exculpating objectors from participating in perceived evil. We examine these claims in this response. First, we ask what the ‘conscience clause’ really requires of doctors and whether Shahvisi has interpreted it correctly. Second, we explore the notions of vulnerability and power in the doctor–patient relationship and cast doubt on Shahvisi’s claims (...) about these. Third, we tackle Shahvisi’s claim that conscientious objection is self-defeating because it entails remaing causally implicated in a chain of events leading to abortion. We show that this claim entails absurdity, then revisit the classical framework for the ethics ethics of co-operation to show that conscientious objection can suceed in exculpating objectors from perceived wrongdoing. We briefly critically evaluate the General Medical Council’s guidance on conscie... (shrink)

Our thesis is that the story of Onan in Genesis chapter 38 offers scriptural and logical grounds for believing that contraceptive acts are sinful. We set out a five-part modus ponens argument which considers the meaning and significance the story of Onan and, by showing that contraceptive acts are substantially similar to the act for which Onan is infamous, conclude that Christians ought not to practise contraception. We then respond to objections to this conclusion before finally and briefly touching upon (...) some of the implications of our thesis for Christian ethics, namely with reference to the perverted faculty argument and natural law. (shrink)

Here we respond to Shaw et al., and show why the application of Conscientious Objection cannot be dismissed from cases of organ donation, where the donor is presumed to be dead.

This article considers the idea of medicine’s internal morality as it is understood by its various proponents. Although the use of the phrase ‘internal morality’ in relation to medicine predates Ed...

The latter part of the twentieth century saw the Chinese economy moving towards a socialist market economy rather than a planned system. Despite growing interest in Chinese business ethics, little work has examined ethical issues concerning the Chinese sales force. This study draws from existing work on Chinese and Western business and sales ethics to develop hypotheses regarding the perceptions of unethical selling behaviour of modern Chinese salespeople. A survey of Chinese sales executives is conducted and statistically analysed. Results are (...) compared with those reported in previous US-based research with regard to differences in perceptions of unethical selling behaviour. The results indicate that contemporary Chinese salespeople were more favourably disposed than expected towards unethical selling behaviour, and also more favourably disposed than previously studied US salespeople. Younger Chinese salespeople evaluated unethical behaviours more favourably than older ones. The results are discussed, along with implications for theory, practice and future work. (shrink)

The latter part of the twentieth century saw the Chinese economy moving towards a socialist market economy rather than a planned system. Despite growing interest in Chinese business ethics, little work has examined ethical issues concerning the Chinese sales force. This study draws from existing work on Chinese and Western business and sales ethics to develop hypotheses regarding the perceptions of unethical selling behaviour of modern Chinese salespeople. A survey of Chinese sales executives is conducted and statistically analysed. Results are (...) compared with those reported in previous US-based research with regard to differences in perceptions of unethical selling behaviour. The results indicate that contemporary Chinese salespeople were more favourably disposed than expected towards unethical selling behaviour, and also more favourably disposed than previously studied US salespeople. Younger Chinese salespeople evaluated unethical behaviours more favourably than older ones. The results are discussed, along with implications for theory, practice and future work. (shrink)

The conventional historical account of the concept of brain death credits developments and discoveries of the twentieth century with its inception, emphasizing the role of technological developments and professional conferences, notably the 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. This essay argues that the French physician Eugène Bouchut anticipated the concept of brain death as early as 1846. Correspondence with Bouchut’s understanding of brain death and one important contemporary concept of brain (...) death is established then contrasted with current trends of defining death as the death of the brain. The philosophical factors that influenced Bouchut and the later developments of concepts of brain death are considered, with special reference to mechanistic philosophy and vitalism. (shrink)

Conscientious Objection has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible (...) to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited. (shrink)

Drawing on his distinguished philosophy training and years of award-winning university teaching, Graham McLean, of Charles Sturt University, Australia, has produced a refreshing and far-reaching ac...

Volume 25, Issue 4, December 2019, Page 374-377.

This brief and remarkably inexpensive book by the distinguished Professor Maehle of Durham University is composed of five detailed studies of aspects of nineteenth and twentieth century British med...

Why conscience matters is a landmark in the literature on conscientious objection in healthcare. In it, Xavier Symons, bioethicist and postdoctoral research fellow at Harvard University, makes the...

Curing Mad Truths, a short collection of essays and lectures, is Rémi Brague's plea for ‘some sort of return to the Middle Ages’ (p. 5) in the teeth of the ideology of Modernity which, he posits, t...

Drawing on his distinguished philosophy training and years of award-winning university teaching, Graham McLean, of Charles Sturt University, Australia, has produced a refreshing and far-reaching ac...

This is a rich, challenging, densely-argued book of great learning and lasting value. While it is not for the uninitiated, those who with more than a passing interest in ethics are unlikely to find...

The phenomenological goal of grounding the content of conceptual thought in the background understanding of everyday, skillful coping was approached using evolutionary autonomous agent methodology. The behavior of an EAA evolved to perform a specified motor task was identified with skillful coping. Changes in the dynamics of the EAA controller occurred when the EAA encountered an unexpected obstacle with loss of longer time scale components in its hierarchical temporal organization. These temporal changes are consistent with the phenomenological changes which we (...) experience with breakdown during equipment use with our adoption of a more immediate, determinate stance. Since this latter experience is the basis of conceptual thought, the EAA paradigm goes some way in providing a naturalized explanation for the grounding of the content of conceptual thought in everyday, skillful coping in a manner that is physiologically plausible and phenomenologically accurate. (shrink)

During the height of the COVID-19 pandemic, teachers around the globe had been forced to move their teaching to full-time online, remote teaching. In this study, we aimed at understanding teacher burnout during COVID-19. We conducted a survey among 399 teachers at the peak of a prolonged physical school closure. Teachers reported experiencing more burnout during the COVID-19 pandemic. Contributing factors to this burnout were high family work conflict and low online teaching proficiency. Burnout was associated with lower work-related wellbeing: (...) Lower work commitment, and higher turnover intentions. It was also associated with lower psychological wellbeing: More depressive and anxiety symptoms, and lower subjective wellbeing. Approach coping strategies served as a protective factor against the burnout-turnover intentions association. We conclude with recommendations on how to mitigate teacher burnout, thereby contributing to teacher wellbeing. (shrink)

Cell adhesion complexes are critical for the physical coordination of cell–cell interactions and the morphogenesis of tissues and organs. Many adhesion receptors are anchored to the plasma membrane by a glycosylphosphatidylinositol (GPI) moiety and are thereby partitioned into membrane rafts. In this review, we focus on reciprocal interactions between rafts and adhesion molecules, leading to receptor clustering and raft expansion and stability. A model for a three‐stage adhesion complex assembly process is also proposed. First, GPI‐anchored adhesion molecules are recruited into (...) rafts, which in turn promote receptor cis‐oligomerization and thereby produce precursory complexes primed for avid trans‐interactions. Second, trans‐interactions of the receptors cross‐link and stabilize large amalgams of rafts at sites of adhesion complex assembly. Finally, the enlarged and stabilized rafts acquire enhanced abilities to recruit the cytoskeleton and induce signaling. This process exemplifies how the domain structure of the plasma membrane can impact the function of its receptors. BioEssays 24:996–1003, 2002. © 2002 Wiley‐Periodicals, Inc. (shrink)

To what extent should scientists, doctors and the community be constrained in their decision-making by a duty to posterity? How should we as a community balance our desire to benefit the present generation against the need not to irretrievably harm our successors? These questions are discussed with particular reference to genetic research and treatment that may have great potential for people suffering from genetic disease but may cause inherited changes in future generations, either deliberately or inadvertently. We conclude that the (...) community should take account of the interests of its successors but this should not immobilise us in the decisions we make for the present. (shrink)

This paper studies the relationship between Argumentation Logic, a recently defined logic based on the study of argumentation in AI, and classical Propositional Logic. In particular, it shows that AL and PL are logically equivalent in that they have the same entailment relation from any given classically consistent theory. This equivalence follows from a correspondence between the non-acceptability of sentences in AL and Natural Deduction proofs of the complement of these sentences. The proof of this equivalence uses a restricted form (...) of ND proofs, where hypotheses in the application of the Reductio of Absurdum inference rule are required to be “relevant” to the absurdity derived in the rule. The paper also discusses how the argumentative re-interpretation of PL could help control the application of ex-falso quodlibet in the presence of inconsistencies. (shrink)

There are unusual challenges in ethics for RAS. Perhaps the issue can best be summarised as needing to consider “technically informed ethics”. The technology of RAS raises issues that have an ethical dimension, and perhaps uniquely so due to the possibility of moving human decision-making which is implicitly ethically informed to computer systems. Further, if seeking solutions to these problems – ethically aligned design, to use the IEEE’s terminology – then the solutions must be technically meaningful, capable of realisation, capable (...) of assurance, and suitable as a basis for regulation. Thus, ethics for RAS is a rich, complex multi-disciplinary concern, and perhaps more complex than many other ethical issues facing society today. It is also fast-moving. This paper has endeavoured to give an accessible introduction to some of the key issues, noting that many of them are quite subtle, and it is not possible to do them full justice in such a short document. However, we have sought to counterbalance this by giving an extensive list of initiatives, standards, etc. that focus on ethics of RAS and AI, see Annex A. (shrink)

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia (...) nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals. (shrink)