Health care systems across the world are unable to afford the best treatment for all patients in all situations. Choices have to be made. One key ethical issue that arises for health authorities is whether the principle of the “rule of rescue” should be adopted or rejected. According to this principle more funding should be available in order to save lives of identifiable, compared with unidentifiable, individuals. Six reasons for giving such priority to identifiable individuals are considered. All are rejected. (...) It is concluded that the principle of the rule of rescue should not be used in determining the allocation of health resources. (shrink)

There is a long history of medical research that involves intentionally infecting healthy people in order to study diseases and their treatments. Such research—what might be called “human challenge studies”—are an important strand of much current research—for example, in the development of vaccinations. The many international and national guidelines about the proper conduct of medical research do not specifically address human challenge studies. In this paper we review the guidelines on the risk of harm that healthy volunteers may be exposed (...) to in the course of medical research. We examine the ethical arguments that are implicit or explicit in these guidelines. We then ask whether there is reason for limiting such studies on grounds independent of risk of harm. We conclude that the major ethical concern with challenge studies is that of risk of harm and that the fact that a study is a challenge study is not a wrong in itself. (shrink)

We describe the teaching programme in ethics, law and communication skills for clinical medical students which is being developed as part of the Oxford Practice Skills Project. These three elements of practice are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centred health care in guiding the teaching is described. Although the final aim of the teaching is to improve actual practice, we have found three 'sub-aims' helpful in (...) the development of the programme. These sub-aims are: increasing students' awareness of ethical issues; enhancing their analytical thinking skills, and teaching specific knowledge. (shrink)

There are some ideas that at first seem simple, but which become more complex and profound the more they are explored. Great art, of course, is like that. When I first saw Vermeer's Girl with a Pearl Earring I was excited by its fresh simplicity. I thought, however, it a painting I would soon understand. I was wrong. It becomes increasingly mysterious with increasing familiarity. It has recently inspired a novel.1The distinction between acts and omissions is one of these simple, (...) complex, ideas. When I first studied philosophy I thought I would rapidly be able to decide once and for all whether the distinction is of moral importance or not. I did in fact come to a decision. The problem is that I have kept revising that decision ever since. The issues raised by the arguments over acts and omissions continue to inspire philosophical discussion. They also continue to haunt doctors and relatives at the bedsides of those near the end of their lives.Donna Dickenson, in this issue of the journal,2 reports the results of a survey of opinions from those taking part in an Open University course on death and dying. She believes that for many bioethicists the acts/omissions distinction has been shown to be wrong as a distinction of moral worth. Her survey suggests, however, that for many health professionals this distinction is seen as morally important. She asks whether the bioethical consensus, as she sees it, against the distinction is a result of clear thinking, or whether the views of practitioners result from their taking into account, in a way bioethicists do not, the richness of reality.There is I believe, less consensus amongst bioethicists than Dickenson suggests. In this issue of the journal, Marc Stauch3 argues in favour of the acts/omissions …. (shrink)

The Mental Capacity Act is an impressive piece of legislation that deserves serious ethical attention, but much of the commentary on the Act has focussed on its legal and practical implications rather than the underlying ethical concepts. This paper examines the approach that the Act takes to best interests. The Act does not provide an account of the underlying concept of best interests. Instead it lists factors that must be considered in determining best interests, and the Code of Practice to (...) the Act states that this list is incomplete. This paper argues that this general approach is correct, contrary to some accounts of best interests. The checklist includes items that are unhelpful. Furthermore, neither the Act nor its Code of Practice provides sufficient guidance to carers faced with difficult decisions concerning best interests. This paper suggests ways in which the checklist can be developed and discusses cases that could be used in an updated Code of Practice. (shrink)

The “best interests” of the patient are widely seen as a cornerstone of medical practice. They are the explicit legal standard for medical care in the case of patients who lack capacity to consent to treatment.The best interests of the individual patient have, of course, long been compromised for the sake of other potential patients—in infectious disease control for example. The question of the ethics of such compromise became a hot issue, for UK doctors, about fifteen years ago in the (...) context of health care rationing. At that time the fact that there are insufficient resources to provide all patients, in all circumstances, with the best possible treatment became explicit. Faced with this uncomfortable truth, doctors tended to divide into two camps. Some wanted to play no role in decisions about resource allocation. They continued to be guided by the single ethic of each individual patient's best interests. However, “best interests” could be interpreted as “best” given the treatments that were made available by those who determined the allocation of resources. Others took the opposite approach: since choices had to be made as to the best use of available resources, doctors ought to be playing a significant role in making these choices.This polarisation has softened over time. Doctors have become more at ease with the idea that some treatments are not, given the overall resources, cost-effective, even if they are the best available. Clinical guidelines increasingly are influenced by cost-effectiveness. To provide the best health care overall, within the available resources, doctors aim to provide good care for each individual patient, but they do not always provide the best care. (shrink)

Background: Priority setting is necessary in current healthcare services. Discussion of fair process has highlighted the value of developing reasons for allocation decisions on the basis of experience gained from real cases.Aim: To identify the reasons that those with experience of real decision-making concerning resource allocation think relevant in deciding on the priority of a new but expensive drug treatment.Methods: Semistructured interviews with members of committees with responsibility for making resource allocation decisions at a local level in the British National (...) Health Service, analysed using modified grounded theory.Results: 22 interviews were carried out. 14 reasons were identified. Four reasons were almost universally considered most important: cost effectiveness; clinical effectiveness; equality and gross cost. No one reason was considered dominant. Some considerations, such as political directives and fear of litigation, were thought by many participants to distort decision-making. There was a substantial lack of agreement over the relevance of some reasons, such as the absence of alternative treatment for the condition.Conclusions: There is a clear consensus on the importance and role of a limited number of reasons in allocation decisions among participants. A focus on the process of decision-making, however, does not obviate the need for those involved in the process to engage with problematical ethical issues, nor for the importance of further ethical analysis. (shrink)

We bear witness to a sweeping social movement for change—fostered and driven by a powerful group of Black nurses and nursing students determined to call out and dismantle anti‐Black racism and discrimination within the profession of nursing. The Black Nurses Task Force, launched by the Registered Nurses' Association of Ontario (RNAO) in July 2020, is building momentum for long‐standing change in the profession by critically examining the racist and discriminatory history of nursing, listening to and learning from the lived experiences (...) of the Black nursing community, and shaping concrete, actionable steps to confront anti‐Black racism and discrimination in academic settings, workplaces, and nursing organizations. The Black Nurses Task Force and the RNAO are standing up and speaking out in acknowledgment of the magnitude of anti‐Black racism and discrimination that exist in our profession, health system, justice system, and economic system. This social movement is demonstrating, in actions, how individuals and a collective act as change agents to drive meaningful and widespread change for our present and future Black nurses. We also acknowledge the Black nurses who have gone before us. (shrink)

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions.

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology (...) were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs. (shrink)

Alternative proteins, including plant-based and cell-based meat and dairy analogues, are discursively positioned as a new form of meat and dairy and as a solution to the myriad of issues associated with conventional animal agriculture. Animal agricultural industries across various nations have resisted this positioning in regulatory spaces by advocating for laws that restrict the use of meat and dairy terms on the labels of alternative proteins products. Underlying this contestation are differing understandings of, and vested interests in, desirable futures (...) for animal agriculture. In Australia, this broader contestation led to a national-level inquiry by a Senate parliamentary committee entitled _Definitions of meat and other animal products_ (the Inquiry). This paper reports findings from a study of the problematizations developed through the Inquiry using a framework for policy discourse analysis referred to as Bacchi’s ‘What’s the Problem Represented to be’ methodology. It shows how the dominant discourse throughout the Inquiry moved away from the initial problematization of alternative proteins as a threat to animal agriculture. Instead, both industries were ultimately positioned as not in competition and only labelling laws were problematized with the solution being amendments to ensure ‘consumer clarity’. This outcome ignored a range of alternative problematizations related to the ethical, environmental, health, social and economic issues raised by animal agriculture and by alternative proteins. This lack of scrutiny benefits both industries, by closing off the policy discourse to consideration of a range of alternative interests, voices, and potential solutions, such as stricter health and welfare regulation. (shrink)

With Western cultures becoming more pluralistic, the question of "truth" in politics has become a game of interpretations. Today, we face the demise of the very idea of truth as an objective description of facts, though many have yet to acknowledge that this is changing. Gianni Vattimo explicitly engages with the important consequences for democracy of our changing conception of politics and truth, such as a growing reluctance to ground politics in science, economics, and technology. Yet in Vattimo's conception, a (...) farewell to truth can benefit democracy, exposing the unspoken issues that underlie all objective claims. The end of absolute truth challenges the legitimacy of policies based on perceived objective necessities—protecting the free market, for example, even if it devastates certain groups or classes. Vattimo calls for a truth that is constructed with consensus and a respect for the liberty of all. By taking into account the cultural paradigms of others, a more "truthful" society—freer and more democratic—becomes possible. In this book, Vattimo continues his reinterpretation of Christianity as a religion of charity and hope, freeing society from authoritarian, metaphysical dogmatism. He also extends Nietzsche's "death of God" to the death of an authoritarian God, ushering in a new, postreligious Christianity. He connects the thought of Martin Heidegger, Karl Marx, and Karl Popper with surprising results and accommodates modern science more than in his previous work, reconciling its validity with an insistence that knowledge is interpretive. Vattimo's philosophy justifies Western nihilism in its capacity to dispense with absolute truths. Ranging over politics, ethics, religion, and the history of philosophy, his reflections contribute deeply to a modern reconception of God, metaphysics, and the purpose of reality. (shrink)

In response to a collection of essays in Jonathan Kvanvig's (1996) Warrant in Contemporary Epistemology: Essays in Honor of Plantinga's Theory of Knowledge, Alvin Plantinga notices that certain Gettier-style examples undermine his (1993b) canonical account of epistemic warrant as delineated in Warrant and Proper Function. In hopes to clarify how his account survives Gettier's purchase, he (1996; 2000) argues that a belief has warrant sufficient for knowledge only when produced in a favorable cognitive mini-environment. In Warranted Christian Belief Plantinga (2000) (...) specifies a condition required for a cognitive mini-environment's favorability. I argue that this condition falls prey to counterexample. Then I investigate a possible solution, which I reason fails as well. (shrink)

This article reviews and corrects frequent misunderstandings of somaesthetics, the multidisciplinary field of study of the lived body conceived by Richard Shusterman. After responding to an article published in Contemporary Pragmatism, I extend the discussion to cover larger topics of discussion related to somaesthetics and misapprehensions by its critics, including the nature of somatic experience, the role of pleasure, and the relevance of culture. In rectifying mistakes of understanding, it is hoped the effort will foster better understanding and better critique.

Can a rule be followed by one person who has lived all his life in as complete isolation from other human beings as is consistent with his mere physical survival? This question divides philosophers as sharply today as it did over thirty years ago when, prompted by their reading of Wittgenstein, they first asked it. My aim here is to suggest a way of reconciling the two opposing sides in the current debate. I also hope to explain why it (...) was that Wittgenstein did not concern himself with the complexities I am about to discuss, which none the less are, I believe, at the root of the difficulties we experience when we try to understand what Wittgenstein said about following a rule and to think clearly about this question. (shrink)

Can a rule be followed by one person who has lived all his life in as complete isolation from other human beings as is consistent with his mere physical survival?This question divides philosophers as sharply today as it did over thirty years ago when, prompted by their reading of Wittgenstein, they first asked it. My aim here is to suggest a way of reconciling the two opposing sides in the current debate. I also hope to explain why it was (...) that Wittgenstein did not concern himself with the complexities I am about to discuss, which none the less are, I believe, at the root of the difficulties we experience when we try to understand what Wittgenstein said about following a rule and to think clearly about this question. (shrink)

The Homeridae bear the name of Homer, and should point a path by which we may climb to his personality. In antiquity they were known to be a γένος, a constituted family-corporation, though the accounts of the functions they fulfilled are scanty. Modern criticism, with its usual fluctuation, began by taking them at their apparent value; then adopted from a Roman grammarian a rationalistic explanation of them; invented other similar rationalistic explanations; and finally my lamented colleague Mr. Binning Monro robbed (...) them of all significance by treating the word as an adjective, an equivalent of Ὁμηρικοí Men who are called Sons of Homer should not be lightly dismissed, and it may be worth while to go over the familiar evidence once more in the hope that this obvious avenue to Homer may not turn out a blind alley. (shrink)

Enough and too much has been written about the Epic Cycle. Upon scanty quotations and a jejune epitome a tedious literature has been built. The older writers, such as Welcker, tried to ‘reconstruct’—as profitable and satisfying a task as inferring a burnt manor-house from its cellars; later scholars have gone out in tracing the tradition of the poems through the learned age of Greece—a scaffolding without ties, by which this or that conclusion is reached according to temperamental disposition to this (...) or that fallacy. I do not intend to enter more than is needful into a controversy where so far as I can see everyone has gone beyond the evidence. If I add to the bulk of the literature, it is in the hope of putting things in their proper places and of presenting the data as they appear to a future editor. (shrink)

This paper is an attempt to elucidate the senses in which this place-name is used in Homer; to assign meanings to the Homeric terms Achaean, Iason and Pelasgic Arge, to ‘Argive’ as a synonym for Greek, and to establish the nature of the Argos over which Agamemnon ruled. I take the Homeric poems as the unity which they profess to be, and which they must be for historical enquiry. Whatever liberties Homer took with his materials it is plain he was (...) careful to respect events. The effort to distinguish between old and new in the Iliad and Odyssey has caused needless and fruitless encumbrance to the official historians, such as Busolt; the Unitarian position has given us the remarkable results of Professor Myres' . The consistency of Mr. Myres' account, and I venture to hope of mine, allows a fresh inference back to the homogeneity of the poems which are their source. (shrink)

This volume brings together essays written at the cutting edge of an emerging sub-field of environmental philosophy, relating to the nature and role of hope.

Trenton Merricks, among others, has recently championed in a series of papers what he takes to be a novel and simple solution to an age-old problem concerning the compatibility of divine omniscience and human freedom. The solution crucially involves the thesis that God’s beliefs about the future actions of human persons asymmetrically depend on the future actions of those persons. I show that Merricks’s defense of this thesis is inadequate and that the prospects for improving his defense of it would (...) require him to enter the fray of articulating and defending a view about the mechanics whereby divine foreknowledge is achieved—something he and other advocates of the strategy he advances had hoped to avoid. (shrink)

The article considers Richard Rorty’s thought on pragmatic religion and meliorism. It begins with Rorty’s critique of theism and Platonism, and his attempt to rehabilitate religion using a pragmatist framework. The article then offers an analysis of Rorty’s “unjustifiable hope”. Here, the author distinguishes the differentsenses of unjustifiable hope. With a tension between the “romantic” and “utilitarian” aspects of this outlook, the paper concludes with the advent of Rorty’s pragmatic religion.

Two protechnology arguments, the “hopeful principle” and the “automatic escalator”, often used in bioethics, are identified and critically analysed in this paper. It is shown that the hopeful principle is closely related to the problematic precautionary principle, and the automatic escalator argument has close affinities to the often criticised empirical slippery slope argument. The hopeful principle is shown to be really hopeless as an argument, and automatic escalator arguments often lead nowhere when critically analysed. These arguments should therefore only be (...) used with great caution. (shrink)

: This response to my seven critics is organized under five topics: 1. The book's scope and approach; 2. Physicalism, idealism, anthropomorphism; 3. Final causation; 4. Peirce's development; 5. Signs, objects, interpretants. No ground is ceded, but I have found the interchange clarifying and hope that the reader will find it so, too.

Jc Beall is known for defending modest dialetheism; this is the view that there are dialetheia, but only in the form of “spandrels” arising otherwise reasonable semantic terminology (e.g., the Liar paradox). Beall also regards his view as modest in partaking of a deflationary view of truth, a view where ‘true’ is a device of disquotational inference which expresses no “substantive property.” Beall supports deflationism by an appeal to Ockham’s razor; however, the premise that ‘true’ is fundamentally disquotational is found (...) dubious. Nonetheless, we can craft an ultra-modest dialetheism which assumes only that at least one utterance of ‘This sentence is not true’ uses ‘true’ as a disquotational device, and maintains neturality on whether it expresses a substantive property. The limited scope of the ultra-modest view will be disappointing to formal semanticists hoping to capture the behavior of ‘true’ throughout the language. But its modest basis gives dialetheism the best hope for wider acceptance in the discipline. (shrink)

The living body appears like an endlessly renewable reservoir of authenticity, hope, and taboo. But, for the sake of conceptual clarity, we are often been told that the (mere) body should be distinguished from the flesh. That is, it’s undeniable that I have a body; that I notice yours; that we worry about their birth and death and upkeep. But the flesh is a more transcendentalized, loaded concept – not least given its frequently religious background (incarnation: the Word made (...) Flesh). It is the body ‘kicked upstairs’, ‘bumped up’ one ontological level. Flesh is like a mantra, an obsessive leitmotif. Is the difference just one of abstraction? Indeed, crucial to the narrative of phenomenology (most obviously in Merleau-Ponty but really, throughout, including in enactivism), to the story of ancestor worship and identity it tells itself and its acolytes around the campfire, is a basic distinction between the merely physical body and the flesh as something requiring ‘mineness’, namely, an understanding of it as uniquely ‘my own’, a feeling of ‘what it is like to be embodied’. This goes back to the Husserlian distinction between Körper, ‘body’ in the sense of one body among others in a vast mechanistic universe of bodies, and Leib, ‘flesh’ in the sense of a subjectivity which is the locus of experience. In this essay I reflect on this vision of the body’s authenticity and its costs, and contrast it with insights derived from Georges Canguilhem, whose critique of mechanism/mechanicism is not done in the name of a wholescale organicism and/or an unproblematized éloge of embodiment and privacy. (shrink)

In this article, we review the psychology of hero development and hero worship. We propose that heroes and hero narratives fulfill important cognitive and emotional needs, including the need for wisdom, meaning, hope, inspiration, and growth. We propose a framework called the heroic leadership dynamic to explain how need-based heroism shifts over time, from our initial attraction to heroes to later retention or repudiation of heroes. Central to the HLD is idea that hero narratives fulfill both epistemic and energizing (...) functions. Hero stories provide epistemic benefits by providing scripts for prosocial action, by revealing fundamental truths about human existence, by unpacking life paradoxes, and by cultivating emotional intelligence. To energize us, heroes promote moral elevation, heal psychic wounds, inspire psychological growth, and exude charisma. We discuss the implications of our framework for theory and research on heroism, leadership processes, and positive psychology. (shrink)

I argue here that in the end Bourdieu's theory of practice fails to overcome the problem on which it expressly centers, namely, subject-object dualism. The failure is registered in his avowed materialism, which, though significantly "generalized," remains what it says: a materialism. In order to substantiate my criticism, I examine for their ontological presuppositions three areas of his theoretical framework pertaining to the questions of (1) human agency (as seen through the conceptual glass of the habitus), (2) otherness, and (3) (...) the gift. By scrutinizing Bourdieu's powerful and progressive social theory, with an eye to finding fault, I hope to show the need to take a certain theoretical action, one that is patently out of keeping with the usual self-presentation and self-understanding of social science. The action I have in mind is this: because the problem of subject-object dualism is in the first place a matter of ontology, in order successfully to address it there must take place a direct shift of ontological starting point, from the received starting point in Western thought to one that projects reality in terms of ambiguity that is basic. With this shift the dualism of subject and object dissolves by definition, leaving a social reality that, for reasons of its basic ambiguity, is best approached as a question of ethics before power. (shrink)

In this article, we review the psychology of hero development and hero worship. We propose that heroes and hero narratives fulfill important cognitive and emotional needs, including the need for wisdom, meaning, hope, inspiration, and growth. We propose a framework called the heroic leadership dynamic to explain how need-based heroism shifts over time, from our initial attraction to heroes to later retention or repudiation of heroes. Central to the HLD is idea that hero narratives fulfill both epistemic and energizing (...) functions. Hero stories provide epistemic benefits by providing scripts for prosocial action, by revealing fundamental truths about human existence, by unpacking life paradoxes, and by cultivating emotional intelligence. To energize us, heroes promote moral elevation, heal psychic wounds, inspire psychological growth, and exude charisma. We discuss the implications of our framework for theory and research on heroism, leadership processes, and positive psychology. (shrink)