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)

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)

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)

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)

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)

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.

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)

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...

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)

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...

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...

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...

S'appuyant sur l'analyse philosophique, la recherche historique, l'évolution des pratiques médicales, cet ouvrage met en lumière les articulations entre les idées scientifiques du médecin et idéologue Pierre Jean Georges Cabanis (1757-1808), son analyse des rapports sociaux et sa philosophie de la connaissance.

A broadly liberal politics requires political compassion; not simply in the sense of compassion for the victims of injustice, but also for opponents confronted through political protest and (more broadly) dissent. There are times when, out of a sense of compassion, a just cause should not be pressed. There are times when we need to accommodate the dreadfulness of loss for opponents, even when the cause for which they fight is unjust. We may also have to come to terms with (...) the irreversibility of historic injustice and reconcile. Political compassion of this sort carries risks. Pushed too far, it may weaken our commitment to justice through too great a sympathy for those on the other side. It would be convenient if such compassion could be constrained by a clear set of political principles. But principles run the quite different risk of promoting an 'ossified dissent', unable to respond to change. In this book, Tony Milligan argues that principles are only a limited guide to dissent in unique, contingent circumstances. They will not tell us how to deal with the truly difficult cases such as the following: Should the Lakota celebrate Thanksgiving? When is the crossing of a picket-line justified? What kind of toleration must animal rights advocates cultivate to make progress within a broadly liberal political domain? And how should we respond to the entangling of aspiration towards social justice with anger and prejudice (such as the 'anti-Zionist' discourse)? We may be tempted to answer these questions by presupposing that alignment (the business of choosing sides) is ultimately more important than compassion, but sometimes political compassion trumps alignment. Sometimes, being on the right side is not the most important thing. (shrink)

We use a quantum electrodynamics model, to study the evolution of maximally entangled bipartite states, as well as a maximally entangled tripartite states as a multipartite system. Furthermore, we study the entanglement behaviour of these output states in cavity QED as function of interaction time and the coupling strength. The present study discusses the separability and the entanglement limit of such states after interaction with a cavity QED.

The Philosophy of Representation -- The Transition -- The Sign-Systems of 1908 -- Rhetorical Concerns -- Interpretation, Worldviews and the Object.

In this paper we examine some of the economic and ethical consequences of different credit market regulations, including usury laws, complete prohibition of interest and providing ease to the borrower upon default. The references to these credit market regulations can be found in many religious and moral philosophy texts. We first examine the effectiveness of these regulations in deterring exploitative lending by developing a model that shows lending can be regulated through either act-based or harm-based regulations. We show that act-based (...) regulations which comprise usury laws and complete prohibition of interest deter lenders more than harm-based regulations which constitute bankruptcy laws. We then analyze that while the regulations may deter certain forms of lending behavior, they may also create certain externalities by contributing towards inequity and societal risk. We propose that a regulator’s choice of implementing credit market regulations maybe dependent on her ethical commitment towards growth and reduction of inequity. We suggest the usury laws are more ethical than bankruptcy laws; however, discouraging the use of debt contracts through prohibition of interest and encouraging the use of risk sharing contracts maybe the most ethical way to regulate the credit markets. (shrink)

To address the underrepresentation of women in philosophy effectively, we must understand the causes of the early loss of women. In this paper we challenge one of the few explanations that has focused on why women might leave philosophy at early stages. Wesley Buckwalter and Stephen Stich offer some evidence that women have different intuitions than men about philosophical thought experiments. We present some concerns about their evidence and we discuss our own study, in which we attempted to replicate their (...) results for 23 different responses to 14 scenarios . We also conducted a literature search to see if other philosophers or psychologists have tested for gender differences in philosophical intuitions. Based on our findings, we argue that that it is unlikely that gender differences in intuitions play a significant role in driving women from philosophy. (shrink)

The aesthetic exception theorises anew the relation between art and politics. It challenges critical trends that discount the role of aesthetic autonomy, to impulsively reassert art as an effective form of social engagement. But it equally challenges those on the flipside of the efficacy debate, who insist that art's politics is limited to a recondite space of 'autonomous resistance'. The book shows how each side of the efficacy debate overlooks art's exceptional status and its social mediations. Mobilising philosophy and cultural (...) theory, and employing examples from visual art, performance, and theatre, it proposes four alternative tests to 'effect' to offer a nuanced account of art's political character. Those tests examine how art relates to politics as a practice that articulates its historical conjuncture, and how it prefigures the 'new' through simulations capable of activating the political life of the spectator. (shrink)

In 1925, David Katz published an influential monograph on touch, Der Aufbau der Tastwelt, which was translated into English in 1989. Although it is called “the world of touch,” it also discusses the thermal and the nociceptive senses, albeit briefly. In this chapter, we will follow this approach, but we will speak about “somatosensory senses” in general in order to remind ourselves that perceptions of temperatures and pains should also be considered together in this context.

Pastor and trusted Bible teacher Dr. Tony Evans answers fundamental questions about the Christian faith to help children understand who God is and why they can trust Him with their lives. Help children build a firm foundation of faith.

Re-reading Derrida: Perspectives on Mourning and its Hospitalities, edited by Tony Thwaites and Judith Seaboyer, is a uniquely collaborative exploration of the legacies of Jacques Derrida. Scholars from a wide variety of fields respond to his work by addressing such issues as the politics of the memorial, poetry, trauma, film, neoliberalism, the novel, and psychoanalysis--and then, in the processes of revision, they respond to each other.

Gratitude, the proper or fitting response to benevolence, has often been conceptualized as a virtue—a temporally stable disposition to perceive, think, feel, and act in certain characteristic ways in certain situations. Many accounts of gratitude as a virtue, however, have not analyzed this disposition accurately, and as a result, they have not revealed the rich variety of ways in which someone can fail to be a grateful person. In this paper, I articulate an account of the virtue of gratitude, and (...) I use this account to explore various vices that can manifest in its absence. (shrink)

En este trabajo se sostiene que la teoría del derecho iberoamericana ha malinterpretado la teoría del razonamiento jurídico de Jeremy Waldron, presentándola como una teoría formalista de la adjudicación, y a Waldron como un positivista excluyente. Esto se debe a una lectura sesgada de su teoría del derecho, que se explica, a su vez, por la imagen que el constitucionalismo ha construido en torno a Waldron, como un opositor de Dworkin. Este trabajo muestra que Waldron suscribe a una teoría “dworkiniana” (...) del razonamiento jurídico, la que opera como eslabón entre su teoría de la democracia y su teoría más reciente de la dignidad humana. Ambas cuestiones han sido virtualmente ignoradas por el medio académico hispanoparlante. (shrink)

Reason and Doctrinepresents a simple, straightforward outline of Christian dogmas that not only contradict the scientific world view, they have no foundation in scripture. The author considers a wide range of ancient texts in Greek, Hebrew, and Latin, and their contemporary translations, and discusses the texts that have come to be known as Paul's letters, where he finds distinct errors from the references to Genesis to the accepted story of Jesus as a blood sacrifice. While fully documented and founded on (...) a scholarly investigation, the book is written for general readers. (shrink)