Introduction -- Historical perspectives of medical ethics -- The medical ethics Renaissance: a brief assessment -- Risk disclosure/'informed consent' -- Consent, control and minors: Gillick and beyond -- Sterilisation/best interests: legislation intervenes -- The end of life: total abrogation -- Medical ethics in government-commissioned reports -- Conclusion.

As the General Medical Council (GMC) is currently in the process of reviewing its ethical guidance on confidentiality, it is a prescient time to consider the legal and ethical issues inherent in it. This paper examines the question of anonymized data, and highlights the fact that the legal position regarding whether it should be classed as confidential is unclear, with the possibility of a change in the law being very real. Indeed, the article argues that the notion that anonymized data (...) is not confidential can be challenged on both legal and ethical grounds, and thus that the GMC should take this into account in its new guidance. Although identifying the fact that this might have implications for epidemiological research, the article highlights an alternative approach that would allow the conduct of such research while not infringing patients' legally protected human rights. (shrink)

Some time ago, Ian Kennedy asked whether consent wasthe great bulwark of “patient's rights”? Is it a necessary nuisance granted as a concession to modish thinking? Is it simply a figment of some lawyer's imagination which practitioners know is meaningless in practice? Is it just part of the rhetoric of “patient power”, sent to try doctors' patience and challenge their authority?

Background Dynamic consent has been proposed as a process through which participants and patients can gain more control over how their data and samples, donated for biomedical research, are used, resulting in greater trust in researchers. It is also a way to respond to evolving data protection frameworks and new legislation. Others argue that the broad consent currently used in biobank research is ethically robust. Little empirical research with cohort study participants has been published. This research investigated the participants’ opinions (...) of adding a dynamic consent interface to their existing study. Methods Adult participants in the Extended Cohort for E-health, Environment and DNA longitudinal cohort study who are members of the EXCEED Public and Participant Engagement Group were recruited. Four focus groups were conducted and analysed for thematic content. Discussion topics were derived from a review of the current literature on dynamic consent. Results Participants were in favour of many aspects of a dynamic consent interface, such as being able to update their information, add additional data to their records and choose withdrawal options. They were supportive provided it was simple to use and not intrusive. Participants expressed a markedly high level of trust in the study and its investigators and were unanimously happy with their current participation. No strong support was found for adding a dynamic consent interface to EXCEED. Conclusions Trust in the study researchers was the strongest theme found. Openness and good data security were needed to retain their trust. While happy to discuss dynamic consent, participants were satisfied with the current study arrangements. There were indications that changing the study might unnecessarily disturb their trust. This raised the question of whether there are contexts where dynamic consent is more appropriate than others. This study was limited by the small number of participants who were committed to the study and biased towards it. More research is needed to fully understand the potential impact of adding a dynamic consent interface to an existing cohort study. (shrink)

In 2014, Lord Saatchi launched his ultimately unsuccessful Medical Innovation Bill in the UK. Its laudable aim was to free doctors from the shackles that prevented them from providing responsible innovative treatment. Lord Saatchi’s principal contention was that current law was the unsurmountable barrier that prevented clinicians from delivering innovative treatments to cancer patients when conventional options had failed. This was because doctors feared that they might be sued or tried and convicted of gross negligence manslaughter if they deviated from (...) standard practice. Concerns about fear of the law and potential negative effects on medical practice are not new. Fear of litigation has been suggested as the reason for doctors practising “defensive medicine,” by opting for treatments regarded as “grievance-resistant,” rather than clinically indicated, for example, by ordering diagnostic tests or performing certain procedures, which are not strictly medically necessary. Whilst this claim is plausible and apparently accepted by the courts, there is limited empirical evidence in support of it so far as practitioners in the UK are concerned. In this paper, we report on our empirical research which provides a snapshot of medical opinion to begin to rectify this gap. We ran focus groups of different medical specialties, asking what these medical practitioners thought the barriers to medical innovation to be. We found that fear of the law was not the principal barrier to be lowered, and that the answer was far more multifaceted. (shrink)

In the United Kingdom, the question of how much information is required to be given to patients about the benefits and risks of proposed treatment remains extant. Issues about whether healthcare resources can accommodate extended shared decision-making processes are yet to be resolved. COVID-19 has now stepped into this arena of uncertainty, adding more complexity. U.K. public health responses to the pandemic raise important questions about professional standards regarding how the obtaining and recording of consent might change or be maintained (...) in such emergency conditions, particularly in settings where equipment, medicines, and appropriately trained or specialized staff are in short supply. Such conditions have important implications for the professional capacity and knowledge available to discuss the risks and benefits of and alternatives to proposed treatment with patients. The government’s drive to expedite the recruitment to wards of medical students nearing the end of their studies, as well as inviting retired practitioners back into practice, raises questions about the ability of such healthcare providers to engage fully in shared decision-making.This article explores whether the legal duty on healthcare practitioners to disclose the material risks of a proposed medical treatment to a patient should be upheld during pandemic conditions or whether the pre-eminence of patient autonomy should be partly sacrificed in such exceptional circumstances. We argue that measures to protect public health and to respect autonomous decision-making are not mutually exclusive and that there are good reasons to maintain professional standards in obtaining consent to treatment even during acute pressures on public health systems. (shrink)

Hard cases make bad law. In a matter of months, two such cases involving assisted reproduction have appeared before the U.K. High Court and legislation has been enacted. The common threads between them are consent and fatherhood. The first case concerns a ‘mistake’ resulting in sperm from the wrong man being used to create an embryo for a couple and the second the revocation of consent by a man to his former partner being allowed to use an embryo they created (...) together. Furthermore, Parliament has intervened, passing legislation which sets out when sperm from a dead man may be used by his former partner to generate an embryo. This note argues that the three developments cannot be reconciled with one another and that the cases in particular, decided on a narrow legal basis, convey contradictory messages, leading in at least one instance to a gross injustice. (shrink)

This article seeks to identify a 'problem' in the interaction between medical law and ethics, which is that neither fully appreciates how the other works. In particular, it argues that medical law has not only failed to formulate a consistent conception of the role that medical ethics performs, but it does not adequately differentiate between categories of medical ethics discourse. Consequently, the ethical content of a case, if identified at all, will not be dealt with in a consistent manner. The (...) article further argues that medical ethics does not recognize the power that law gives to it, and that the result is a regulatory vacuum. It then uses the findings of the Bristol Royal Infirmary Report to demonstrate, by analogy, how this may lead to problems. (shrink)

British Library MS Harley 7368 or The Book of Sir Thomas More presents a play by five hands in various states of revision. Scholars have identified Anthony Munday as the principal playwright and William Shakespeare as the author of three pages that portray Thomas More quelling a Mayday London riot against foreigners. Its manifold uncertainties notwithstanding, the playscript teaches us some things about Shakespeare and about Thomas More. It enables us to see the Bard in the act of creating and (...) revising, participating fully in the processes of collaboration typical in his time. Moreover, it presents More as a heroic wise man whom Protestants and Catholics can admire for his resolution, mirth and compassion, qualities that transcend confessional dispute. (shrink)

Background The Regional Committee for Africa of the World Health Organization (WHO) in 2001 expressed concern that some health-related studies undertaken in the Region were not subjected to any form of ethics review. In 2003, the study reported in this paper was conducted to determine which Member country did not have a national research ethics committee (REC) with a view to guiding the WHO Regional Office in developing practical strategies for supporting those countries. Methods This is a descriptive study. The (...) questionnaire was prepared and sent by diplomatic pouch to all the 46 Member States in the WHO African Region, through the WHO country representatives, for facilitation and follow up. The data were entered in Excel spreadsheet and subsequently exported to STATA for analysis. A Chi-Squared test (χ 2) for independence was undertaken to test the relationship between presence/absence of Research Ethics Committee (REC) and selected individual socioeconomic and health variables. Results The main findings were as follows: the response rate was 61% (28/46); 64% (18/28) confirmed the existence of RECs; 36% (10/28) of the respondent countries did not have a REC (although 80% of them reported that they had in place an ad hoc ethical review mechanism); 85% (22/26) of the countries that responded to this question indicated that ethical approval of research proposals was, in principle, required; and although 59% of the countries that had a REC expected it to meet every month, only 44% of them reported that the REC actually met on a monthly basis. In the Chi-Squared test, only the average population in the group of countries with a REC was statistically different (at 5% level of significance) from that of the group of countries without a REC. Conclusion In the current era of globalized biomedical research, good ethics stewardship demands that every country, irrespective of its level of economic development, should have in place a functional research ethics review system in order to protect the dignity, integrity and safety of its citizens who participate in research. (shrink)

Este artículo aborda el antiguo problema de la diferencia entre filosofía y poesía partiendo de una interpretación del arte narrativo personificado por Ulises en la Odisea. Una lectura del episodio de las Sirenas permite reconstruir la trama de voces diversas que compone el relato homérico y comprender la significación de esta estructura polifónica en el imaginario odiseico. Frente a la neta oposición entre autofonía y alofonía que propone la filosofía platónica, la poesía homérica implica una idea de heterofonía que apunta (...) más allá de una lógica binaria y sugiere la irreductibilidad de la voz poética a un juego entre extremos contrarios. La heterofonía consiste más bien en una voz figural que crea la «lógica difusa» del mundo ficcional mediante la neutralización de las diferencias entre sujetos enunciativos. (shrink)

In this paper I will argue that when Aristotle uses the word ‘ἀρχή’ he is often referring to what we call a condition, whether necessary, sufficient or necessary and sufficient. To this end I will discuss how conditions for being, change, and knowledge, as identified by Aristotle, can be equated to ontological, physical and noetic principles, respectively.

This article argues that bodily awareness is a basic form of self-consciousness through which perceiving agents are directly conscious of the bodily self. It clarifies the nature of bodily awareness, categorises the different types of body-relative information, and rejects the claim that we can have a sense of ownership of our own bodies. It explores how bodily awareness functions as a form of self-consciousness and highlights the importance of certain forms of bodily awareness that share an important epistemological property with (...) canonical forms of self-consciousness such as introspection. (shrink)

It is now 25 years since Gareth Evans introduced the distinction between conceptual and nonconceptual content in The Varieties of Reference. This is a fitting time to take stock of what has become a complex and extended debate both within philosophy and at the interface between philosophy and psychology. Unfortunately, the debate has become increasingly murky as it has become increasingly ramified. Much of the contemporary discussion does not do full justice to the powerful theoretical tool originally proposed by Evans (...) and subsequently refined by theorists in the late 1980’s and early 1990’s – most effectively, I think, by Christopher Peacocke (particularly in his 1992). Even worse, significant parts of the discussion are somewhat confused. This paper makes a start on clarifying what I think ought to be the central issues in debates about nonconceptual content. I begin in §1 by pointing out how narrowly focused contemporary discussion is relative to Evans’s original discussion. We are not making as much use as we should of nonconceptual content as a tool for understanding subpersonal information processing and the complexities of its status relative to perception and thought at the personal level. In §2 I turn to what is the central focus of contemporary discussion, namely, the content of perception and identify a “master argument” for nonconceptualism based on the relation between conceptual capacities and capacities for perceptual discrimination. The aim of §3 is to clarify the relation between the claim that perception has nonconceptual content and some superficially similar claims discussed by philosophers of perception. Finally, in §4 I explain why the attention recently focused on what is sometimes called the state version of the nonconceptualist thesis seems to me to be misdirected. (shrink)

Philosophical accounts of self-deception can be divided into two broad groups – the intentionalist and the anti-intentionalist. On intentionalist models what happens in the central cases of self-deception is parallel to what happens when one person intentionally deceives another, except that deceiver and deceived are the same person. This paper offers a positive argument for intentionalism about self-deception and defends the view against standard objections.

Frames and framing make one dimension of a decision problem particularly salient. In the simplest case, framesprimeresponses (as in, e.g., the Asian disease paradigm, where the gain frame primes risk-aversion and the loss frame primes risk-seeking). But in more complicated situations frames can function reflectively, by making salient particular reason-giving aspects of a thing, outcome, or action. For Shakespeare's Macbeth, for example, his feudal commitments are salient in one frame, while downplayed in another in favor of his personal ambition. The (...) role of frames in reasoning can give rise torational framing effects. Macbeth can prefer fulfilling his feudal duty to murdering the king, while also preferring bravely taking the throne to fulfilling his feudal duty, knowing full well that bravely taking the throne just is murdering the king. Such patterns ofquasi-cyclicalpreferences can be correct and appropriate from the normative perspective of how one ought to reason. The paper explores three less dramatic types of rational framing effects: (1) Consciously framing and reframing long-term goals and short-term temptations can be important tools for self-control. (2) In the prototypical social interactions modeled by game theory, allowing for rational framing effects solves longstanding problems, such as the equilibrium selection problem and explaining the appeal of non-equilibrium solutions (e.g., the cooperative solution in the Prisoner's Dilemma). (3) Processes for resolving interpersonal conflicts and breaking discursive deadlock, because they involve internalizing multiple and incompatible ways of framing actions and outcomes, in effect create rational framing effects. (shrink)

Based on published works and unpublished materials, this article analyses how cybernetics was received by two Spanish thinkers exiled in Mexico: José Gaos (1900–1969) and Eduardo Nicol (1907–1990). This reception is particularly intriguing especially when considering the substantial presence and social impact that Norbert Wiener had in Mexican society because of his friendship with Arturo Rosenblueth. Gaos and Nicol are the first philosophers to develop a complex and original diagnosis of cybernetics in Mexico. It will be shown how the (...) exiled thinkers take on the philosophical implications of this science in the light of their respective theoretical projects, and finally, it will be defended how the critical perspective they develop is particularly significant for Mexico’s political and academic context since it illuminates some negative aspects of cybernetics that Wiener did not foresee and that had not been reported there until then. (shrink)

Until 2008, if doctors followed the General Medical Council's (GMC's) guidance on providing information prior to obtaining a patient's consent to treatment, they would be going beyond what was technically required by the law. It was hoped that the common law would catch up with this guidance and encourage respect for patients' autonomy by facilitating informed decision-making. Regrettably, this has not occurred. For once, the law's inability to keep up with changing medical practice and standards is not the problem. The (...) authors argue that while the common law has moved forward and started to recognise the importance of patient autonomy and informed decision-making, the GMC has taken a step back in their 2008 guidance on consent. Indeed, doctors are now required to tell their patients less than they were in 1998 when the last guidance was produced. This is an unfortunate development and the authors urge the GMC to revisit their guidance. (shrink)

My topic in this paper is social understanding. By this I mean the cognitive skills underlying social behaviour and social coordination. Normal, encultured, non-autistic and non-brain-damaged human beings are capable of an impressive degree of social coordination. We navigate the social world with a level of skill and dexterity fully comparable to that which we manifest in navigating the physical world. In neither sphere, one might think, would it be a trivial matter to identify the various competences which underly this (...) impressive level of performance. Nonetheless, at least as far as interpersonal interactions are concerned, philosophers show a rare degree of unanimity. What grounds our success in these interactions is supposed to be our common mastery of folk psychology. (shrink)

In Thinking without Words I develop a philosophical framework for treating some animals and human infants as genuine thinkers. This paper outlines the aspects of this account that are most relevant to those working in animal ethics. There is a range of different levels of cognitive sophistication in different animal species, in addition to limits to the types of thought available to non-linguistic creatures, and it may be important for animal ethicists to take this into account in exploring issues of (...) moral significance and the obligations that we might or might not have to non-human animals. (shrink)

In their recent book The Inessential Indexical Herman Cappelen and Josh Dever take issue with what has become close to philosophical orthodoxy – the view, most often associated with John Perry and David Lewis, that psychological explanations are essentially indexical. Cappelen and Dever claim that claims of essential indexicality are typically driven by intuitions rather than supported by arguments. They issue a challenge to supporters of essential indexicality: Produce an argument to back up the intuitions. This paper answers their challenge.

Table of Contents Acknowledgments 1 Self-Consciousness and the Body: An Interdisciplinary Introduction by Naomi Eiland, Anthony Marcel and José Luis Bermúdez 2 The Body Image and Self-Consciousness by John Campbell 3 Infants’ Understanding of People and Things: From Body Imitation to Folk Psychology by Andrew N. Meltzoff and M. Keith Moore 4 Persons, Animals, and Bodies by Paul F. Snowdon 5 An Ecological Perspective on the Origins of Self by George Butterworth 6 Objectivity, Causality, and Agency by Thomas Baldwin (...) 7 At Two with Nature: Agency and the Development of Self-World Dualism by James Russell 8 Ecological Perception and the Notion of a Nonconceptual Point of View by José Luis Bermúdez 9 Proprioception and the Body Image by Brian O’Shaughnessy 10 Awareness of One’s Own Body: An Attentional Theory of Its Nature, Development, and Brain Basis by Marcel Kinsbourne 11 Body Schema and Intentionality by Shaun Gallagher 12 Living without Touch and Peripheral Information about Body Position and Movement: Studies with Deafferented Subjects by Jonathan Cole and Jacques Paillard 13 Bodily Awareness: A Sense of Ownership by M. G. F. Martin 14 Bodily Awareness and the Self by Bill Brewer 15 Introspection and Bodily Self-Ascription by Quassim Cassam 16 Consciousness and the Self by Naomi Eilan Contributors Index. (shrink)

My topic in this paper is social understanding. By this I mean the cognitive skills underlying social behaviour and social coordination. Normal, encultured, non-autistic and non-brain-damaged human beings are capable of an impressive degree of social coordination. We navigate the social world with a level of skill and dexterity fully comparable to that which we manifest in navigating the physical world. In neither sphere, one might think, would it be a trivial matter to identify the various competences which underly this (...) impressive level of performance. Nonetheless, at least as far as interpersonal interactions are concerned, philosophers show a rare degree of unanimity. What grounds our success in these interactions is supposed to be our common mastery of folk psychology. (shrink)

This paper argues that, while there is a difference between personal and sub-personal explanation, claims of autonomy should be treated with scepticism. It distinguishes between horizontal and vertical explanatory relations that might hold between facts at the personal and facts at the sub-personal level. Noting that many philosophers are prepared to accept vertical explanatory relations between the two levels, I argue for the stronger claim that, in the case of at least three central personal level phenomena, the demands of explanatory (...) adequacy require postulating horizontal explanatory relations. (shrink)

Debates about bodily ownership and psychological ownership have typically proceeded independently of each other. This paper explores the relation between them, with particular reference to how each is illuminated by psychopathology. I propose a general framework for studying ownership that is applicable both to bodily ownership and psychological ownership. The framework proposes studying ownership by starting with explicit judgments of ownership and then exploring the bases for those judgments. Section 3 discusses John Campbell’s account of ψ-ownership in the light of (...) that general framework, emphasizing in particular his fractionation of ψ-ownership into two dissociable components. Section 4 briefly presents an account of φ-ownership that I have developed in more detail elsewhere. Section 5 explores the suggestion, originating with Alexandre Billon, that there needs to be an integrated account of φ-ownership and ψ-ownership because depersonalization disorders typically involve breakdowns of both φ-ownership and ψ-ownership. The argument from depersonalization is not compelling, but Section 6 proposes a different way of reaching the same conclusion. Section 7 shows how reflecting on agency and practical reasoning offers a common thread between the models of φ-ownership and ψ-ownership discussed earlier in the paper. (shrink)

Psychiatric treatment and diagnosis rests upon a richer conception of normativity than, for example, cognitive neuropsychology. This paper explores the role that considerations of rationality can play in defining this richer conception of normativity. It distinguishes two types of rationality and considers how each type can break down in different ways in delusional psychiatric disorders.

José L. Zalabardo defends a pragmatist account of what grounds the meaning of central semantic discourses--ascriptions of truth, of propositional attitudes, and of meanings. He argues that it is the procedures that regulate acceptance and rejection that give the sentences of these discourses their meanings, and explores the application of the pragmatist template to ethical discourse. The pragmatist approach is presented as an alternative to representationalist accounts of the meaning grounds of declarative sentences, according to which a sentence has (...) the meaning it has as a result of links with the bits of the world that it purports to represent. Zalabardo develops a version of the open-question argument to support the claim that the meaning grounds of the discourses he focuses on cannot receive representationalist accounts. It is generally assumed that a declarative sentence cannot perform the function of representing the world unless it has a representationalist meaning ground. Zalabardo rejects this assumption, arguing that sentences with pragmatist meaning grounds can represent the world in exactly the same sense that sentences with representationalist meaning grounds do. This requires that there are states of affairs that the target sentences represent as obtaining, and Zalabardo develops an account of the nature of the states of affairs that can play this role for sentences with pragmatist meaning grounds. Pragmatist Semantics concludes by developing the suggestion that the meaning grounds of all our representational discourses might be ultimately pragmatist. (shrink)