The need to evaluate the performance of clinical ethics services is widely acknowledged although work in this area is more developed in the United States. In the USA many studies that assess clinical ethics services have utilized empirical methods and assessment criteria. The value of these approaches is thought to rest on their ability to measure the value of services in a demonstrable fashion. However, empirical measures tend to lack ethical content, making their contribution to developments in ethical governance unclear. (...) The steady increase of clinical ethics committees in the UK must be accompanied by efforts to evaluate their performance. As part of this evaluative work it is important to examine how the practice of clinical ethics committees can be informed by empirical measures. (shrink)

Patient and citizen participation is now regarded as central to the promotion of sustainable health and health care. Involvement efforts create and encounter many diverse ethical challenges that have the potential to enhance or undermine their success. This article examines different expressions of patient and citizen participation and the support health ethics offers. It is contended that despite its prominence and the link between patient empowerment and autonomy, traditional bioethics is insufficient to guide participation efforts. In addition, the turn to (...) a “social paradigm” of ethics in examinations of biotechnologies and public health does not provide an account of values that is commensurable with the pervasive autonomy paradigm. This exacerbates rather than eases tensions for patients and citizens endeavoring to engage with health. Citizen and patient participation must have a significant influence on the way we do health ethics if its potential is to be fulfilled. (shrink)

Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and (...) presumptive vaccination. It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics. (shrink)

Bioethics is a field in which innovation is required to help prevent and respond to zoonotic diseases with the potential to cause epidemics and pandemics. Some of the developments necessary to fight pandemics, such as COVID-19 vaccines, require public debate on the benefits and risks of individual choice versus responsibility to society. While these debates are necessary, a more fundamental ethical innovation to rebalance human, animal, and environmental interests is also needed. One Health (OH) can be characterized as a strategy (...) that recognizes and promotes the synergy between human, animal, and environmental health. Yet, despite the recognition that these entities are interdependent, there is a pronounced inequality in the power relations between human, non-human animal, and the environmental interests which threatens the well-being of all. Until OH can ensure the moral status of animals and the environment and thereby the equal consideration of these interests, it will struggle to protect non-human interests and, as a result, human health. To create a sustainable health system requires a renewed concept of justice that is ecocentric in nature and an application of OH that is flexible and responsive to different ethical interests (e.g., person-centred care and physician responsibilities). Ultimately, to save themselves, humans must now think beyond themselves. Bioethics must assume a key role in supporting the developments required to create and maintain relationships able to sustain environmental and human health. (shrink)

Public policy on alcohol in the UK relies on health promotion campaigns that encourage individuals who misuse alcohol to make healthier choices about their drinking. Individuals with alcohol-dependence syndrome have an impaired capacity to choose health. As a result, individuals with the worst alcohol misuse problems lie largely outside the reach of choice-based policy. However, such policy has been widely criticized and efforts to reform it are underway. This paper argues that the British Medical Association's recent attempt to improve policy (...) on alcohol in the UK by introducing strategies which have been shown to control drinking within populations still gives insufficient attention to alcohol dependence. This is because it fails accurately and consistently to characterize alcohol dependence and gives insufficient attention to the social challenges it presents. (shrink)

There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people’s recovery efforts. Issues which impede the development of prorecovery environments are complex, but include the far-reaching effects of the social stigma that surrounds SUDs; and the failure to harness relational and social support that allows debates to transcend blaming individual substance users. As part of efforts to create prorecovery environments, it is important to acknowledge that bioethics debate on SUDs (...) is narrow in scope, prioritising topics related to its traditional interests in individual autonomy and novel technologies. As a result, it has not played a significant role in helping to transform the ethical cultures in which substance use recovery takes place. For example, it largely neglects the ethical challenges of developing an empathic, person-centred approach to substance use problems that listens and responds to the voices of clients. It has also participated little in efforts to develop a positive response to reducing the toxic effects of stigma. Indeed, some contributions from the field fan stigma, rather than alleviate it. The aim of this paper is to seed broader ethical debate, in academic literature and lay/professional communities, on how societies should respond to SUDs: steering a course between the critical, but narrow approach of bioethics and the empowerment discourse of evidence-based treatments. (shrink)

Health ethics can justify the use of vaccination mandates. However, policies that pressurize parents to vaccinate their children can undermine traditional clinical ethics standards. The aim of this paper is to argue that the ethical impact of vaccination mandates can only be determined in the context of the clinical encounter. Public debate on the topic tends to be general in nature and, as a result, issues that require clarification to help sustain the trust of service users are underexamined. In addition, (...) ethical debates are hampered by a toxic dichotomy in the public sphere between those who claim a move away from parental choice is necessarily a serious ethical violation; and others who neglect serious consideration of ethical issues. This predicament permits flawed ethical claims to be made, and to remain unchallenged. Despite this, ethical concerns – including those relating to trust and individual freedom – are fundamental to sustaining confidence in vaccination. This has recently been highlighted by the Covid-19 pandemic which made accessing childhood vaccinations harder, leading to a further decline in uptake. The pandemic has also revealed the strength of public feeling towards infection control measures that restrict peoples’ freedoms. In this paper I argue that to minimize the ethical disruption associated with the use of vaccination mandates, it is essential to focus more attention on their impact in the clinic and to accurately identify the drivers of such tensions. (shrink)

Xenotransplantation - the transfer of living tissue between species - has long been heralded as a potential solution to the severe organ shortage crisis experienced by the United Kingdom and other 'developed' nations. However, the significant risks which accompany this biotechnology led the United Kingdom to adopt a cautious approach to its regulation, with the establishment of a non-departmental public body - UKXIRA - to oversee the development of this technology on a national basis. In December 2006 UKXIRA was quietly (...) disbanded and replaced with revised guidance, which entrusts the regulation of xenotransplantation largely to research ethics committees. In this article we seek to problematize this new regulatory framework, arguing that specialist expertise and national oversight are necessary components of an adequate regulatory framework for a biotechnology which poses new orders of risk, challenges the adequacy of traditional understandings of autonomy and consent, and raises significant animal welfare concerns. We argue for a more considered and holistic approach, based on adequate consultation, to regulating biotechnological developments in the United Kingdom. (shrink)

Recent Developments Content Type Journal Article DOI 10.1007/s11673-010-9235-5 Authors John Coggon, University of Manchester Centre for Social Ethics and Policy, Institute for Science, Ethics, and Innovation, School of Law Manchester UK Cameron Stewart, University of Sydney Centre for Health Governance, Law and Ethics, Sydney Law School Sydney NSW 2006 Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 7 Journal Issue Volume 7, Number 2.

Many publicly-funded health systems apply cost-benefit frameworks in response to the moral dilemma of how best to allocate scarce healthcare resources. However, implementation of recommendations based on costs and benefit calculations and subsequent challenges have led to ‘special cases’ with certain types of health benefits considered more valuable than others. Recent debate and research has focused on the relative value of life extensions for people with terminal illnesses. This research investigates societal perspectives in relation to this issue, in the UK.

Knowledge and its Limits presents a systematic new conception of knowledge as a kind of mental stage sensitive to the knower's environment. It makes a major contribution to the debate between externalist and internalist philosophies of mind, and breaks radically with the epistemological tradition of analyzing knowledge in terms of true belief. The theory casts new light on such philosophical problems as scepticism, evidence, probability and assertion, realism and anti-realism, and the limits of what can be known. The arguments are (...) illustrated by rigorous models based on epistemic logic and probability theory. The result is a new way of doing epistemology and a notable contribution to the philosophy of mind. (shrink)

I. An argument is presented for the conclusion that the hypothesis that no one will ever decide a given proposition is intuitionistically inconsistent. II. A distinction between sentences and statements blocks a similar argument for the stronger conclusion that the hypothesis that I have not yet decided a given proposition is intuitionistically inconsistent, but does not block the original argument. III. A distinction between empirical and mathematical negation might block the original argument, and empirical negation might be modelled on Nelson''s (...) strong negation, but only on intuitionistically unacceptable assumptions. IV. Intuitionists may have to accept the original argument, and therefore be committed to a dubious view of time on which there cannot be merely inductive evidence for statements about the infinite future. (shrink)

Second-order logic and modal logic are both, separately, major topics of philosophical discussion. Although both have been criticized by Quine and others, increasingly many philosophers find their strictures uncompelling, and regard both branches of logic as valuable resources for the articulation and investigation of significant issues in logical metaphysics and elsewhere. One might therefore expect some combination of the two sorts of logic to constitute a natural and more comprehensive background logic for metaphysics. So it is somewhat surprising to find (...) that philosophical discussion of secondorder modal logic is almost totally absent, despite the pioneering contribution of Barcan. (shrink)

Religion within the Boundaries of Mere Reason remains one of the most opaque of Kant's published writings. Though this opacity belongs, partly, to the text itself, a key claim of this article is that this opacity stems also from the narrow lenses through which his readers view this text. Often read as part of Kant's moral philosophy or his universal history, the literature has thus far neglected a different vantage point on the Religion, one that does not refute the utility (...) of these lenses but complements them. This paper places the Religion alongside parts of Kant's corpus that it is less typically paired with, namely his natural history writings—in particular, his writings on the concept of race and the development of the human races. I argue that by doing so, we can shed much light on Kant's infamous claim that there is a radical evil in the human species. More precisely, we will come to appreciate that this evil is not, as it is usually understood, a static property or fixed characteristic of human beings. Instead, radical evil concerns a dynamic, changing defect in human nature that increasingly threatens our aspirations to collective moral perfection. (shrink)

The Fold is a book of practical philosophy that takes a radical new approach to aesthetics. Laura U. Marks calls this philosophy "enfolding-unfolding aesthetics," based in ideas derived from Gilles Deleuze and others (G.F.W. Leibniz, David Bohm, and Édouard Glissant) that the universe is folded in on itself. She proposes a theory of mediation as contact and connection across the folds and a set of embodied methods for detecting such cosmic connections. In drawing out this aesthetics, Marks considers the (...) embodied and sensuous dimensions of engaging with audiovisual works and works of art-dimensions that Marks suggests are composed of the very folds that compose everything and everyone: all living beings, from humans to particles, sandwiches to stars, technologies, thoughts and images, in the present, the past, and the future. Making use of art and film, with a focus on African diaspora and Arab cinema, Marks opens ways to strengthen connections to the cosmos and to better trace processes of becoming that are immanent within the fold. (shrink)

Neoliberal Techniques of Social Suffering: Political Resistance and Critical Theory from Latin America and Spain is the result of the critical and political commitment of various Latin American and Spanish philosophers who share a critical approach to the global “stealth revolution” in recent decades, where neoliberalism has forced the well-being and reproduction of life to adapt to a system devastating for both humans and non-humans. The authors voice the shared concern of contemporary Spanish and Latin American societies to build new (...) conceptions of the public and the common through mobilizing affects usually disavowed in political theory. If, in Ancient Greece, the idea of strengthening the most vulnerable and weakest was deplored as the art of sophists, this collection edited by Laura Quintana and Nuria Sánchez Madrid explores the other side of our social world to revive grassroots strategies of resistance and emancipation, which are able to bring about new distributions of power, welfare, and discursive legitimation and to extend our goal of creating a radically democratic world. (shrink)

Is it possible for the churches to take a joint stand on human dignity, even though they hold different positions in certain ethical questions? This study paper by the (Roman-Catholic) German Bishops' Conference and the United Evangelical Lutheran Church of Germany, which is available in English for the first time, explores new paths in the ecumenical handling of ethical questions. Using the methodology of "differentiated consensus", the authors outline the theological similarities of the churches' teaching of anthropology, whilst still doing (...) justice to their differences in the ethical assessment of individual issues of human conduct. In this way, Catholics and Lutherans adopt a common position and make a theologically responsible contribution to ethical judgement. (shrink)

The chapter argues that a model‐building methodology like that widespread in contemporary natural and social science already plays a significant role in philosophy. One neglected form of progress in philosophy over the past fifty years has been the development of better and better formal models of significant phenomena. Examples are given from both philosophy of language and epistemology. Philosophy can do still better in the future by applying model‐building methods more systematically and self‐consciously, with consequent readjustments to its methodology. Although (...) it is neither likely nor desirable for model‐building to become the sole or even main philosophical method, its use enhances the power and reliability of philosophical thinking. (shrink)

Laura Nader is a towering figure as anthropologist, teacher, and public intellectual. Her letters give a glimpse of academic life mostly unseen by academics and by the general public. The collection includes letters from academic colleagues, but it also contains correspondence from lawyers, politicians, citizens, people on death row, Peace Corps workers, members of the military, scientists, and more.

This highly original book examines, for the first time, how the patient movement, which works to improve the quality of healthcare, can actually be considered an emancipation movement when led by its radical elements.

Insights into the intelligence throughout the natural and technical environment, in the fabric of our devices and dwellings, in our clothes, and under our skin. Is there a way to understand the materials that surround us not as passive objects, but as other intelligences interacting with our own? In Parallel Minds, expert in materials science and nanotechnology Laura Tripaldi delivers not only detailed insights into the properties and emergent behaviors of matter as revealed by state-of-the-art chemistry, synthetic biology, and (...) nanotech, but also a rich philosophical reflection that crosses the frontier between nature and culture, where the most cutting-edge scientific syntheses resonate with ancient myth. The result is a technomaterial bestiary full of unexpected encounters with “strange minds”—from cobwebs to kevlar and carbon fibre, from centaurs to amoebas to arachnids, from polycephalic slime to resonating plasmons, from viruses to golems. Parallel Minds reveals the intelligence at large throughout the natural and technical environment, in the fabric of our devices and dwellings, in our clothes, and even under our skin. Full of lateral ideas and unexpected images, Tripaldi’s book imbues the study and synthesis of materials with a new urgency. For not only do the materials that surround us participate actively in the construction of the world in which we live, but harnessing their ability to interact intelligently with their environment could be the key to the future of our species. (shrink)

The philosophical relevance of experimental psychology is hard to dispute. Much more controversial is the so‐called negative program's critique of armchair philosophical methodology, in particular the reliance on ‘intuitions’ about thought experiments. This chapter responds to that critique. It argues that, since the negative program has been forced to extend the category of intuition to ordinary judgments about real‐life cases, the critique is in immediate danger of generating into global scepticism, because all human judgments turn out to depend on intuitions. (...) Recently, some proponents of the negative program have tried to demarcate the target of their critique more narrowly. However, their attempts are still far too indiscriminate, and over‐generate scepticism. Nevertheless, once experimental philosophy has refined its own methodology, it may contribute to the refinement of the methodology of mainstream philosophy, by filtering out the effects of cognitive bias, although it offers no prospect of doing without judgments on real or imaginary cases. (shrink)

Experiences of embodied remembering are familiar and diverse. We settle bodily into familiar chairs or find our way easily round familiar rooms. We inhabit our own kitchens or cars or workspaces effectively and comfortably, and feel disrupted when our habitual and accustomed objects or technologies change or break or are not available. Hearing a particular song can viscerally bring back either one conversation long ago, or just the urge to dance. Some people explicitly use their bodies to record, store, or (...) cue memories. Others can move skilfully, without stopping to think, in complex and changing environments thanks to the cumulative expertise accrued in their history of fighting fires, or dancing, or playing hockey. The forms of memory involved in these cases may be distinct, operating at different timescales and levels, and by way of different mechanisms and media, but they often cooperate in the many contexts of our practices of remembering. (shrink)

This paper explores how a regime recognizable as a Rawlsian property-owning democracy might be enshrined constitutionally in the context of the U.S. Five specific constitutional amendments are proposed: establishing an equal right to education, establishing a guaranteed social minimum, clarifying the legitimacy of regulating corporate political speech for the sake of political equality: establishing an individual right to a share of society’s productive wealth, and assuring communities of significant size the right to remain economically viable over time. The substance and (...) reasoning behind each proposal is discussed in length, and the paper also briefly discusses why a focus on constitutional amendments may be helpful both in clarifying how a property-owning democracy might be realized in practice and in establishing clear goals for social movements motivated by the aim of establishing a more equitable distribution of wealth, power, and opportunity in the United States. (shrink)

This paper offers a novel solution to the Wrong Kind of Reason problem that afflicts Fitting-Attitude analyses of value. I argue that we can distinguish reasons of the right kind from reasons of the wrong kind by being clear about what our reasons are for. In Wrong Kind of Reason cases, our reason to have a certain affective attitude is a reason for an action, and it is this category-mistake that is the source of the problem.

Operational epistemology is, to a first approximation, the attempt to provide cognitive rules such that one is in principle always in a position to know whether one is complying with them. In Knowledge and its Limits, I argue that the only such rules are trivial ones. In this paper, I generalize the argument in several ways to more thoroughly probabilistic settings, in order to show that it does not merely demonstrate some oddity of the folk epistemological conception of knowledge. Some (...) of the generalizations involve a formal semantic framework for treating epistemic probabilities of epistemic probabilities and expectations of expectations. The upshot is that operational epistemology cannot work, and that knowledge-based epistemology has the right characteristics to avoid its problems. (shrink)

Language and thought share a unitary cognitive activity, addressed by an interpretative function. This interpretative effort reveals the assonance between the attribution of meaning to an utterance and the discovery of a solution via restructuring in insight problem solving. We suggest a view of complex integrated analytical thinking, which assumes that thinking processes information in different ways, depending on the characteristics of the tasks the subject has to solve, so that reasoning results in a stepwise, rule-based process or in a (...) widespread activity of search where implicit parallel processes are also involved. We investigated the interrelationship between language and thought in insight problem solving, in both its positive (Experiments 1 and 3) and its negative effects (Experiment 2). Our results are discussed in the light of the debate on dual processing theories. (shrink)

This chapter contains sections titled: Why a Politics of Property‐Owning Democracy Is Needed Property‐Owning Democracy and Public Opinion Property‐Owning Democracy Versus the Welfare State, Revisited The Viability of Property‐Owning Democracy The Core Issue: The Morality of Large‐Scale Taxation of the Very Rich From Moral Critique to Mobilization: Who Would Be For Property‐Owning Democracy? Conclusion: Going Public With Property‐Owning Democracy References.

Despite the centrality of the term within the title, the meaning of ?care? in residential child care remains largely unexplored. Shifting discourses of residential child care have taken it from the private into the public domain. Using a care ethics perspective, we argue that public care needs to move beyond its current instrumental focus to articulate a broader ontological purpose, informed by what is required to promote children's growth and flourishing. This depends upon the establishment of caring relationships enacted within (...) the lifespaces shared by children and those caring for them. We explore some of the central features of caring in the lifespace and conclude that residential child care is best considered to be a practical/moral endeavour rather than the technical/rational one it has become. It requires morally active, reflexive practitioners and containing environments. (shrink)