Majority cycling and related social choice paradoxes are often thought to threaten the meaningfulness of democracy. But deliberation can prevent majority cycles – not by inducing unanimity, which is unrealistic, but by bringing preferences closer to single-peakedness. We present the first empirical test of this hypothesis, using data from Deliberative Polls. Comparing preferences before and after deliberation, we find increases in proximity to single-peakedness. The increases are greater for lower versus higher salience issues and for individuals who seem to have (...) deliberated more versus less effectively. They are not merely a byproduct of increased substantive agreement. Our results both refine and support the idea that deliberation, by increasing proximity to single-peakedness, provides an escape from the problem of majority cycling. (shrink)

An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change—both are common pool resource challenges that require massive, long-term political commitments—the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for (...) AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support. (shrink)

ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the (...) experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. (shrink)

From Hippocrates to paternalism to autonomy : the new hegemony -- From autonomy to consent -- Consent, autonomy, and the law -- Autonomy at the end of life -- Autonomy and pregnancy -- Autonomy and genetic information -- Autonomy and organ transplantation -- Autonomy, consent, and the law.

As support for clinical ethics committees in the UK grows, care must be taken to define their function, membership and method of working and the status of their decisions.The modern practice of medicine raises a plethora of complex issues—medical, ethical and legal. Doctors and other healthcare professionals increasingly must try to resolve these and may sometimes have to do so in the face of contrary opinion expressed by patients and/or their surrogates. While clearly qualified in the medical arena, and although (...) there is now more ethics teaching in the medical curriculum, healthcare professionals are seldom qualified to adjudicate on ethical or legal matters, or even, perhaps, to recognise them when they arise. Yet, as Doyal says, “clinical life must go on and moral and legal indeterminacy within medicine cries out for practical resolution.”1 Meanwhile, the expectations of patients and their families—and, indeed, of wider society—are that decisions about patient care, resources and therapeutic regimes should be soundly based on appropriate ethicolegal, as well as scientific, principle.Recognition of these additional burdens on healthcare professionals has generated some interest in the provision of ethics consultation. In the USA this has been undertaken by a variety of tribunals and individuals. Hospital ethics committees and ethics consultants feature in many US hospitals and perform a variety of roles. In Europe, a number of countries have also established clinical ethics committees and they are becoming more common in the UK—primarily in England and Wales for the moment. Whereas, however, “[i]n North America, CECs have … become an integral part of the organisational infrastructure of hospitals ...”,1 in the United Kingdom they remain essentially ad hoc bodies, generated for a variety of reasons and with different goals, structures, membership, methods of working and functions. The initial impetus for the …. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

In recent work, Peter Hanks and Scott Soames argue that propositions are types whose tokens are acts, states, or events. Let’s call this view the type view. Hanks and Soames think that one of the virtues of the type view is that it allows them to explain why propositions have semantic properties. But, in this paper, we argue that their explanations aren’t satisfactory. In Section 2, we present the type view. In Section 3, we present one explanation—due to Hanks (2007, (...) 2011) and Soames (2010)—of why propositions have semantic properties. We criticize this first explanation in Section 4. In Section 5, we present another explanation—due to Soames (2104)—of why propositions have semantic properties. We criticize this second explanation in Section 6. (shrink)

Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and (...) several strategies for achieving these goals using existing “legal hooks” that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR. (shrink)

This article argues that thinking about entrepreneurship as a potential instrument for relief from endemic poverty and disadvantage, especially among the Indigenous, has all too often been captive to a concept of entrepreneurship that is built out of constrained economic and cultural assumptions. The authors develop this argument from a critical discussion of contributions by Karl Polanyi and Robert Heilbroner. The result is that approaches to venture have been encouraged that are sometimes a poor fit for the circumstances of those (...) they are meant to benefit, and other forms that could have considerable promise have gone unexplored. This article outlines some features of Indigenous culture and build on the analysis of David Harper to construct an improved notion of entrepreneurship that allows for these distinctive features. The article concludes that research and policy making concerning entrepreneurship as an instrument of development among the Indigenous need to be undertaken with this reconstructed understanding of entrepreneurship that is a better fit for the realities of Indigenous culture. (shrink)

In 2005, Ethiopia changed its abortion law to curb its high maternal mortality. This has led to a considerable reduction in deaths from unsafe abortions. Abortion is now legal if the woman’s pregnancy is a result of rape or incest, if her health is endangered, if the fetus has a serious deformity, if she suffers from a physical or mental deficiency, or if she is under 18 years of age. The word of the woman, if in compliance with the law, (...) is sufficient to qualify for an abortion. In this context, where the law makes the door slightly open, health workers become important in deciding who gets access to safe services and who doesn’t, thus creating considerable ethical dilemmas. The objective of this study was to explore abortion service providers’ personal experiences and reflections, perceptions of the abortion law, and ethical and dilemmas that arise. Data collection took place from March to May 2016 in Addis Ababa, at different health clinics providing abortion services. Thirty in-depth interviews and three focus group discussions were conducted with 41 abortion service providers at governmental and non-governmental clinics. Content analysis was drawn upon in the interpretation of the findings. When working in a context where the law has slightly opened the door for abortion seeking women, the health workers describe conflicting concerns, burdensome responsibilities, and ambiguity concerning how to interpret and implement the law. They describe efforts to balance their religious faith and values against their professional obligations and concern for women’s health and well-being. This negotiation is particularly evident in the care of women who fall outside the law’s indications. They usually handle ethical dilemmas and decision-making alone without guidance. Moreover, many health workers face a stigma from fellow colleagues not performing abortions and therefore keep their job a secret from family and friends. Health workers in Ethiopia experience ethical dilemmas trying to maneuver between the abortion law, their personal values, and their genuine concern for the health of women. More research is needed to further explore this. (shrink)

Drawing on interviews with 140 young British males, this article explores the ways in which men talk about their own bodies and bodily practices, and those of other men. The specific focus of interest is a variety of body modification practices. We argue, however, that the significance of this analysis extends beyond the topic of body modification. In discussing the appearance of their bodies, the men we interviewed talked less about muscle and skin than about their own selves located within (...) particular social, cultural and moral universes. This article shows that, in talking about seemingly trivial questions such as whether to have one’s nose pierced or join a gym, men are actively engaged in regulating normative masculinity. Our analysis lends support to the claim that the body has become a new (identity) project in high/late/post-modernity, but shows how fraught with difficulties this project is for young men who must simultaneously work on and discipline their bodies while disavowing any (inappropriate) interest in their own appearance. The analysis highlights the pervasive individualism of young men’s discourses, and the absence of alternative ways of making sense of embodied experiences. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

This book applies philosophical hermeneutics to biblical studies. Whereas traditional studies of the Bible limit their analysis to the exploration of the texts' original historical sense, this book discusses how to move beyond these issues to a consideration of biblical texts' existential significance for the present. In response to the rejection of biblical significance in the late nineteenth century and the accompanying crisis of nihilism, B. H. McLean argues that the philosophical thought of Heidegger, Bultmann, Gadamer, Habermas, Ricoeur, Levinas, Deleuze (...) and Guattari provides an alternative to historically oriented approaches to biblical interpretation. He uses basic principles drawn from these philosophers' writings to create a framework for a new 'post-historical' mode of hermeneutic inquiry that transcends the subject-based epistemological structure of historical positivism. (shrink)

Featuring chapters by emerging and established scholars as well as by leading practitioners in the field, this Handbook both describes the state of algorithmic composition and also set the agenda for critical research on and analysis of algorithmic music.

Antimicrobial resistance is one of the greatest public health crises of our time. The natural biological process that causes microbes to become resistant to antimicrobial drugs presents a complex social challenge requiring more effective and sustainable management of the global antimicrobial commons—the common pool of effective antimicrobials. This special issue of Health Care Analysis explores the potential of two legal approaches—one long-term and one short-term—for managing the antimicrobial commons. The first article explores the lessons for antimicrobial resistance that can be (...) learned from recent climate change agreements, and the second article explores how existing international laws can be adapted to better support global action in the short-term. (shrink)

The development of clinical ethic support in the UK arguably brings with it a series of legal questions, which need to be addressed. Most particularly, these concern questions of due process and formal justice, which I argue are central to the provision of appropriate ethical advice. In this article, I will compare the UK position with the more developed system in the USA, which often provides a template for development in the UK. While it is not argued that the provision (...) of clinical ethics support in the UK will necessarily follow the path mapped in the USA, there are lessons that can be learned from the US experience – particularly in terms of attention to process – from which UK clinical ethics support service might well benefit. (shrink)

Antipathy towards the possibility that God exists is a common attitude, which has recently been clearly expressed by Thomas Nagel. This attitude is presumably irrelevant to the question whether God does exist. But it raises two other interesting philosophical issues. First, to what extent does this attitude motivate irrational belief? And secondly, how should the attitude be evaluated? This paper investigates that latter issue. Is the hope that God does not exist a morally proper hope? I simplify this question by (...) interpreting the relevant attitude as an aversion towards the Christian picture of the world coupled with a preference for the naturalist atheistic picture. And comparing the content of those two world pictures, I argue that the attitude, though partly explicable, is morally unjustifiable, for clearly recognisable reasons. Regardless, then, of further concerns about the doxastic influence of this attitude, we ought to be ashamed of our antipathy to God, which reflects badly upon us. (shrink)

The Black community has a long, well-documented history of being disproportionately harassed by law enforcement. While psychological research has studied this phenomenon, more in-depth research on Black men’s lived-experience of police harassment is needed. This qualitative study used descriptive phenomenology to investigate Black men’s experience of being harassed by law enforcement officers. An analysis of non-structured interviews with a sample of four participants revealed several essential aspects of this experience, including: anxiety in response to the initial awareness of law enforcement’s (...) presence, fear and confusion in response to abrupt escalation of aggression and hostility by officers, a sense of humiliation in response to degrading police tactics, anger over inability to pursue redress through the justice system, ongoing negative emotion, and a sense of having been psychologically harmed by the harassment. The implications of the findings are discussed. (shrink)

The controversies in Bristol, Alder Hey and elsewhere in the UK surrounding the removal and retention of human tissue and organs have led to extensive law reform in all three UK legal systems. This paper reports a short study of the reactions of a range of health professionals to these changes. Three main areas of ethical concern were noted: the balancing of individual rights and social benefit; the efficacy of the new procedures for consent; and the helpfulness for professional practice (...) of the new legislation and regulation. Recognition of these concerns may help in forging a new partnership between professionals and patients and their families. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 65-66, June 2011.

I read Robert Card's recent paper entitled ‘Is there no alternative? Conscientious objection by medical students’ with great interest.1 That Muslim students in America are able to conscientiously object to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five-and-a-half years , and, to the best of my knowledge, even in the conservative, gender-segregated traditional Muslim culture of the United Arab Emirates, not once did a male or female (...) student refuse to examine a patient of the opposite sex.Several issues, many of which have been described by Padela and del Pozo,2 should be taken into consideration in relation to Muslim students’ conscientious objection to the cross-gender consultation on religious grounds. Although Islam prohibits touching or physical contact by the opposite gender, unless appropriate , in some circumstances, the ‘prohibited becomes permissible’.3 Medicine is one such circumstance. Islam does not …. (shrink)

Drawing on interviews with 140 young British males, this article explores the ways in which men talk about their own bodies and bodily practices, and those of other men. The specific focus of interest is a variety of body modification practices. We argue, however, that the significance of this analysis extends beyond the topic of body modification. In discussing the appearance of their bodies, the men we interviewed talked less about muscle and skin than about their own selves located within (...) particular social, cultural and moral universes. This article shows that, in talking about seemingly trivial questions such as whether to have one’s nose pierced or join a gym, men are actively engaged in regulating normative masculinity. Our analysis lends support to the claim that the body has become a new (identity) project in high/late/post-modernity, but shows how fraught with difficulties this project is for young men who must simultaneously work on and discipline their bodies while disavowing any (inappropriate) interest in their own appearance. The analysis highlights the pervasive individualism of young men’s discourses, and the absence of alternative ways of making sense of embodied experiences. (shrink)

Topics discussed in this work are abortion, euthanasia, medical negligence and human experimentation.

Steve Biko died in detention in South Africa in 1977. Critical ethical issues are raised both by the conduct of the doctors responsible for Biko's care and by the subsequent response of the medical profession as a whole. Because those issues are relevant to all healthcare professionals everywhere, the Biko affair provides a useful case study in medical ethics. We discuss the case in this article, describing how we use it in our teaching.

The system of clinical ethics committees (CECs) in the United Kingdom is based on goodwill. No formal requirements exist as to constitution, membership, range of expertise or the status of their recommendations. Healthcare professionals are not obliged to use CECs where they exist, nor to follow any advice received. In addition, the make-up of CECs suggests that ethics itself may be under-represented. In most cases, there is one member with a training in ethics – the rest are healthcare professionals or (...) administrators, although a lawyer is generally also included in the membership. This begs the question as whether CECs can ‘do ethics’, as well whether or not they can take seriously the requirements of due process, formal justice and human rights. Moreover, the role of the patient in this system is opaque. (shrink)

Many think doing animal ethics demands we see moral humanism as a speciesist prejudice of the kind found with sexism and racism. The only serious case for this rests on the Argument from Marginal Cases. We find that argument to the point, but show that properly understood it supports humanism. Understanding why it does this lets us see how we ought to go on in animal ethics.