In this paper, we reflect upon shame and humiliation as threats to personal and professional integrity and moral agency within contemporary health care. A personal narrative, written by a nurse about a particular shift in a British National Health Service Accident and Emergency Department, is provided as a case study. This is critically reflected and commented upon in dialogue with insights into the nature of shame and humiliation. It is suggested that Accident and Emergency is a locus that is latently (...) prone to dynamics of shame and humiliation, a potential exacerbated within a culture subject to externally‐determined time targets that are enforced by a top‐down system of surveillance and management. The result is that nurses may lose their sense of professional competence and responsibility, moral agency, and integrity, to their own personal detriment, as well as to the detriment of patients with whom they work. Insofar as examining a small part of a whole may suggest insights into the operation and ethos of a very large system, this very particular case study narrative/reflection has some important implications and lessons for the wider organization and provision of health care in Britain and beyond. (shrink)

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of (...) the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term ‘spirituality’ is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service. (shrink)

In 2008 the United Kingdom Nursing and Midwifery Council (NMC) published the latest version of its code of conduct (The code: standards of conduct, performance and ethics for nurses and midwives). The new version marked a significant change of style in the Code compared with previous versions. There has been considerable controversy and the accrual of an extensive body of literature over the years in the UK and Europe criticizing nursing codes of ethics and questioning their ethical standing and their (...) usefulness. In this article we review the current NMC Code. We argue that the NMC has been misguided in labelling the Code as a code of ethics, and suggest that the new document falls short in many respects. (shrink)

The paper offers an account of integrity as the capacity to deliberate and reflect usefully in the light of context, knowledge, experience, and information (that of self and others) on complex and conflicting factors bearing on action or potential action. Such an account of integrity seeks to encompass the moral complexity and conflict of the professional environment, and the need for compromises in professional practice. In addition, it accepts that humans are social beings who must respect and engage with the (...) moral position of others. This account is contrasted with a more traditional view of integrity as the rigid maintenance of consistency between professional practice and deeply held, but inflexible, moral principles. While this strong sense of moral conviction may be valuable as a source of moral motivation, e.g. in the case of whistle‐blowers, it is equally likely to lead to dogmatism and hubris. Professionals and their organizations are encouraged to foster the more complex and reflective form of integrity. (shrink)

This special issue of Health Care Analysis originated in an conference, held in Birmingham in 2014, and organised by the group Think about Health. We introduce the issue by briefly reviewing the understandings of the concept of ‘flourishing’, and introducing the contributory papers, before offering some reflections on the remaining issues that reflection on flourishing poses for health care provision.

The whole subject of values is surrounded by partiality, ignorance, confusion and ambiguity from the conceptual level down to the nitty gritty level of everyday practice. Some of these problems have been exposed in a preliminary way in this paper. A great deal more, and more detailed, work at conceptual and practical levels needs to be undertaken before we can really start to talk intelligibly and in a non-confusing way about value and values. One thing is clear. We will never (...) completely escape from the relativity and conceptual slipperiness that inheres in the very nature of valuing some things over others. Values are created in an ongoing dynamic process, not revealed. In the short-term, however, this knowledge will not convince politicians and other ideologues that values may not be in and of themselves a wholly desirable thing! (shrink)

ConclusionThe whole subject of values is surrounded by partiality, ignorance, confusion and ambiguity from the conceptual level down to the nitty gritty level of everyday practice. Some of these problems have been exposed in a preliminary way in this paper. A great deal more, and more detailed, work at conceptual and practical levels needs to be undertaken before we can really start to talk intelligibly and in a non-confusing way about value and values. One thing is clear. We will never (...) completely escape from the relativity and conceptual slipperiness that inheres in the very nature of valuing some things over others. Values are created in an ongoing dynamic process, not revealed. In the short-term, however, this knowledge will not convince politicians and other ideologues that values may not be in and of themselves a wholly desirable thing! (shrink)

ConclusionThe whole subject of values is surrounded by partiality, ignorance, confusion and ambiguity from the conceptual level down to the nitty gritty level of everyday practice. Some of these problems have been exposed in a preliminary way in this paper. A great deal more, and more detailed, work at conceptual and practical levels needs to be undertaken before we can really start to talk intelligibly and in a non-confusing way about value and values. One thing is clear. We will never (...) completely escape from the relativity and conceptual slipperiness that inheres in the very nature of valuing some things over others. Values are created in an ongoing dynamic process, not revealed. In the short-term, however, this knowledge will not convince politicians and other ideologues that values may not be in and of themselves a wholly desirable thing! (shrink)

The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is (...) argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one’s life as a narrative. To flourish, it is argued, is to tell a story of one’s life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one’s life. (shrink)

The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is (...) argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one’s life as a narrative. To flourish, it is argued, is to tell a story of one’s life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one’s life. (shrink)

The paper offers an account of integrity as the capacity to deliberate and reflect usefully in the light of context, knowledge, experience, and information (that of self and others) on complex and conflicting factors bearing on action or potential action. Such an account of integrity seeks to encompass the moral complexity and conflict of the professional environment, and the need for compromises in professional practice. In addition, it accepts that humans are social beings who must respect and engage with the (...) moral position of others. This account is contrasted with a more traditional view of integrity as the rigid maintenance of consistency between professional practice and deeply held, but inflexible, moral principles. While this strong sense of moral conviction may be valuable as a source of moral motivation, e.g. in the case of whistle‐blowers, it is equally likely to lead to dogmatism and hubris. Professionals and their organizations are encouraged to foster the more complex and reflective form of integrity. (shrink)

This article aims to challenge and expand notions of health, health care and health promotion, particularly in relation to smoking, via a consideration of the autobiographical literary work of the English playwright, Simon Gray. Gray died in 2008, having written a series of reflective autobiographical books, The Smoking Diaries. Gray was a lifelong smoker, perpetually trying to give up his habit. This article introduces Gray’s diaries and their reflections on life, death, health care and smoking. It then enquires what can (...) be learned about contemporary health care practices and assumptions from Gray’s work. Finally, it reflects on the limits of views of health and health promotion when considered in the light of a fully lived life. In the life under consideration, health care risks are very differently understood to those prevalent in the medical community. Literary approaches to thinking about smoking are thus seen to place health and health care in broader, richer, and less instrumental perspectives than those that are common amongst contemporary health professionals and institutions. (shrink)

This paper raises some issues about understanding religion, religions and spirituality in health care to enable a more critical mutual engagement and dialogue to take place between health care institutions and religious communities and believers. Understanding religions and religious people is a complex, interesting matter. Taking into account the whole reality of religion and spirituality is not just about meeting specific needs, nor of trying to ensure that religious people abandon their distinctive beliefs and insights when they engage with health (...) care institutions and policies. Members of religious groups and communities form an integral part of the structure and fabric of health care delivery, whether as users or in delivery capacities. Religion is both facilitator and resistor, friend and critic, for health care institutions, providers and workers. (shrink)

A Brief History of Time: From the Big Bang to Black Holes is a popular-science book on cosmology (the study of the origin and evolution of the universe) by British physicist Stephen Hawking. It was first published in 1988. Hawking wrote the book for readers who have no prior knowledge of the universe and people who are interested in learning.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

A comprehensive reassessment of the concept of mimesis in the history of ancient Greek aesthetics and philosophy of art, with particular attention to Plato, Aristotle, Hellenistic philosophy, and neoplatonism. There is also a wide-ranging review of arguments pro and contra the idea of artistic mimesis from the Renaissance to modern literar theory. The book challenges standard accounts in numerous respects and builds a new dialectical model with which to make sense of the entire history of mimeticist thinking in aesthetics.

Aboutness has been studied from any number of angles. Brentano made it the defining feature of the mental. Phenomenologists try to pin down the aboutness-features of particular mental states. Materialists sometimes claim to have grounded aboutness in natural regularities. Attempts have even been made, in library science and information theory, to operationalize the notion. But it has played no real role in philosophical semantics. This is surprising; sentences have aboutness-properties if anything does. Aboutness is the first book to examine through (...) a philosophical lens the role of subject matter in meaning. A long-standing tradition sees meaning as truth-conditions, to be specified by listing the scenarios in which a sentence is true. Nothing is said about the principle of selection--about what in a scenario gets it onto the list. Subject matter is the missing link here. A sentence is true because of how matters stand where its subject matter is concerned. Stephen Yablo maintains that this is not just a feature of subject matter, but its essence. One indicates what a sentence is about by mapping out logical space according to its changing ways of being true or false. The notion of content that results--directed content--is brought to bear on a range of philosophical topics, including ontology, verisimilitude, knowledge, loose talk, assertive content, and philosophical methodology. Written by one of today's leading philosophers, Aboutness represents a major advance in semantics and the philosophy of language. (shrink)

The International Commission on Intervention and State Sovereignty's report, The Responsibility to Protect, argues that when a state is unable or unwilling to uphold its citizens? basic human rights, such as in cases of genocide, ethnic cleansing, and crimes against humanity, the international community has a responsibility to protect these citizens by undertaking humanitarian intervention. An essential issue, however, remains unresolved: which particular agent in the international community has the duty to intervene? In this article, I critically examine four ways (...) of assigning this duty. Although I highlight the benefits of institutionalising the responsibility to protect, I argue that we should adopt, in the short term at least, a consequentialist solution: humanitarian intervention should be the responsibility of the intervener that will be the most effective. (shrink)

This introductory chapter discusses the primary themes in this handbook and introduces the works of Danish philosopher Soren Kierkegaard.

In Return to Reason, Stephen Toulmin argues that the potential for reason to improve our lives has been hampered by a serious imbalance in our pursuit of ...

Stephen Hetherington's prominent career within epistemology has been a series of distinctive, bold, varied and provocative arguments and ideas. Bringing together Hetherington's unique body of writing for the first time, this collection features previously published as well as new material that link his approaches to key issues including knowledge, justification, fallibility, scepticism and the Gettier Problem. Advancing our understanding of the systemic nature of Hetherington's thinking, Stephen Hetherington on Epistemology presents his distinctive perspective on some of philosophy's central (...) questions about knowledge - an inviting blend of forensic detail and 'big picture' proposals. (shrink)

'God is Being-Itself' -- Revolution -- Revelation -- Love -- The shaking of the foundations.

This study shows how Kierkegaard's mature theological writings reflect his engagement with the wide range of theological positions which he encountered as a student, including German and Danish Romanticism, Hegelianism and the writings of Fichte and Schleiermacher. George Pattison draws on both major and lesser-known works to show the complexity and nuances of Kierkegaard's theological position, which remained closer to Schleiermacher's affirmation of religion as a 'feeling of absolute dependence' than to the Barthian denial of any 'point of contact', (...) with which he is often associated. Pattison also explores ways in which Kierkegaard's theological thought can be related to thinkers such as Heidegger and John Henry Newman, and its continuing relevance to present-day debates about secular faith. His volume will be of great interest to scholars and students of philosophy and theology. (shrink)

This chapter examines the role of Copenhagen, Denmark in the career of Soren Kierkegaard, explaining that the city had an active presence in his writings. It analyses the wide range of meanings embedded in the daily life of the city in which Kierkegaard lived, moved, and wrote, and identifies some of the places that were believed to have a significant influence in his works, which include Tivoli, Ostergade, the market-town, and the Church of Our Lady.

Defenders of pragmatic encroachment in epistemology (or what I call practicalism) need to address two main problems. First, the view seems to imply, absurdly, that knowledge can come and go quite easily—in particular, that it might come and go along with our variable practical interests. We can call this the stability problem. Second, there seems to be no fully satisfying way of explaining whose practical interests matter. We can call this the “whose stakes?” problem. I argue that both problems can (...) be addressed in roughly the same terms. More exactly, I argue that by first clarifying the whose stakes? problem an answer to the stability problem naturally falls out. (shrink)

Can hybridism about moral claims be made to work? I argue it can if we accept the conventional implicature approach developed in Barker (Analysis 2000). However, this kind of hybrid expressivism is only acceptable if we can make sense of conventional implicature, the kind of meaning carried by operators like ‘even’, ‘but’, etc. Conventional implictures are a form of pragmatic presupposition, which involves an unsaid mode of delivery of content. I argue that we can make sense of conventional implicatures, but (...) doing so requires we embrace a form of pure, non-hybrid expressivism. This is a cognitivist expressivism I have developed elsewhere. We need cognitivist expressivism to make sense of how we evaluate—judge as correct or incorrect—implicature-bearing sentences. Once we embraced the possibility of this pure expressivism, we might as well be pure expressivists about normative discourse too. I show how we can do that. The motivations for a specifically hybrid theory are dialectically undercut. (shrink)

Elizabeth Anscombe famously argued that "modern moral philosophy" centrally involved unsupported notions of obligation and culpability. Modern Moral Philosophy: From Grotius to Kant exhibits, for the first time, resources that modern moral philosophers had to respond to Anscombe's challenge, also enhancing our own philosophical grasp of morality and its foundations.