W B Gallie’s notion of essentially contested concepts remains of philosophical interest. I argue that medicine is one such concept and look at the consequences of this as regards the inappropriateness of looking for definitions and necessary and sufficient conditions to settle debates about what medicine is and is not.

I argue that the distinction which is current in much writing on medical ethics between autonomous and non-autonomous patients cannot cope comfortably with weak-willed (incontinent) patients. I describe a case involving a patient who refuses a blood transfusion even though he or she agrees that it would be in his or her best interests. The case is discussed in the light of the treatment of autonomy by B Brody and R Gillon. These writers appear to force us to treat an (...) incontinent patient either as autonomous, just like a rational agent whose decisions are in accordance with his beliefs or as non-autonomous, like comatose patients or children. Though neither is entirely satisfactory I opt for describing such patients as autonomous but point out that in cases like this the principle of respect for autonomy does not give a determinate answer about how the patient ought to be treated. (shrink)

I argue that the distinction which is current in much writing on medical ethics between autonomous and non-autonomous patients cannot cope comfortably with weak-willed patients. I describe a case involving a patient who refuses a blood transfusion even though he or she agrees that it would be in his or her best interests. The case is discussed in the light of the treatment of autonomy by B Brody and R Gillon. These writers appear to force us to treat an incontinent (...) patient either as autonomous, just like a rational agent whose decisions are in accordance with his beliefs or as non-autonomous, like comatose patients or children. Though neither is entirely satisfactory I opt for describing such patients as autonomous but point out that in cases like this the principle of respect for autonomy does not give a determinate answer about how the patient ought to be treated. (shrink)

ABSTRACT In his paper ‘The Survival Lottery’John Harris suggested that there could be situations where the rational thing to do would be to kill a healthy person and harvest his organs for transplantation, thereby saving several lives at the cost of one. Anne Maclean claims that such a proposal, far from being rational, does not qualify as a moral proposal at all since what it suggests is ‘plain murder’. I argue that she is correct to claim that the proposal is (...) not uniquely rational and that doctors could quite rationally reject it, but that she overreaches herself when she holds it not to be a moral proposal at all. (shrink)

Value pluralism does not imply relativism or subjectivism about values. What it does is allow respect for an at least limited toleration of values with which one may profoundly disagree. Thus a doctor can respect the autonomy of a patient whose values he does not share.

K. W. M. Fulford argues that illness can be defined as action failure where someone finds themselves unable to do something which they would normally ‘just get on and do’ though there is no external impediment. Thus a paralysed person intends to raise their arm but finds that they cannot or an alcoholic intends to stop drinking but is unable to. I argue that such people are ill whether or not they have the relevant intentions and that their illness may (...) consist in the fact that even if they had had those intentions they would have been unable to act on them. (shrink)

PLATO: PROTAGORAS, trans, with Notes by C. C. W. Taylor. Clarendon Press: O.U.P., 1976. vii+230 pp. £7.50 cloth, £3.75 paper.

Recent interest in ethical pluralism derives from Isaiah Berlin's reflections on the writings of Vico and Herder and their opposition to the views of the Enlightenment. I begin with two quotations from Berlin: It is not relativism. Members of one culture can, by the force of imaginative insight, understand … the values, the ideals, the forms of life of another culture or society, even those remote in time or space. They may find these values unacceptable, but if they open their (...) minds sufficiently they can grasp how one might be a full human being, with whom one could communicate, and at the same time live in the light of values widely different from one's own, but which nevertheless one can see to be values, ends of life, by the realisation of which men could be fulfilled. (shrink)