The classification of techniques used in mitochondrial donation, including their role as purported germ-line gene therapies, is far from clear. These techniques exhibit characteristics typical of a variety of classifications that have been used in both scientific and bioethics scholarship. This raises two connected questions, which we address in this paper: how should we classify mitochondrial donation techniques?; and what ethical implications surround such a classification? First, we outline how methods of genetic intervention, such as germ-line gene therapy, are typically (...) defined or classified. We then consider whether techniques of mitochondrial donation fit into these, whether they might do so with some refinement of these categories, or whether they require some other approach to classification. To answer the second question, we discuss the relationship between classification and several key ethical issues arising from mitochondrial donation. We conclude that the properties characteristic of mitochondrial inheritance mean that most mitochondrial donation techniques belong to a new sub-class of genetic modification, which we call ‘conditionally inheritable genomic modification’. (shrink)

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person’s best interests and that the new legislation introduces only an advisor, not (...) a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people’s desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people’s thought processes indicates that we are unlikely ever to achieve accurate simulations of others’ wishes in making a proxy decision. Third, even if we could accurately simulate other people’s beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements. (shrink)

Professor Charles S. Chihara has criticized the views on the subject of inconsistency which Wittgenstein put forward in his recently published 1939 lectures. Chihara notes that these views are not peculiar to the 1939 lectures, and in fact they are to be found in all Wittgenstein's later writings on mathematics . So these ideas about inconsistency appear not to be just a momentary aberration on Wittgenstein's part. One would therefore expect that he had some good reasons for holding them. But (...) Chihara justly complains that the kind of strong argumentation one would hope for is not forthcoming in these lectures. Instead Wittgenstein's usual procedure is to try to defend his views by producing series of rather unconvincing examples. (shrink)

Mitochondrial replacement techniques have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer and Maternal Spindle Transfer. It examines how questions of identity impact (...) on the ethical evaluation of each technique and argues that there is an important difference between the two. PNT, it is argued, is a form of therapy based on embryo modification while MST is, instead, an instance of selective reproduction. The article's main ethical conclusion is that, in some circumstances, there is a stronger obligation to use PNT than MST. (shrink)

Non-Identity arguments have a pervasive but sometimes counter-intuitive grip on certain key areas in ethics. As a result, there has been limited success in supporting the alternative view that our choices concerning future generations can be considered harmful on any sort of person-affecting principle. However, as the Non-Identity Problem relies overtly on certain metaphysical assumptions, plausible alternatives to these foundations can substantially undermine the Non-Identity argument itself. In this paper, I show how the pervasive force and nature of Non-Identity arguments (...) rely upon a specific adoption of a theory of modality and identity and how adopting an alternative account of modality can be used to reject many conclusions formed through Non-Identity type arguments. By using Lewis’s counterpart-theoretic account to understand ways we might have been, I outline the basis of a modal account of harm that incorporates a person-affecting aspect. This, in turn, has significant implications for ethical decision-making in areas such as reproductive choice and the welfare of future generations. (shrink)

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a (...) sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a (...) satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories. (shrink)

European Journal of Philosophy, Volume 30, Issue 2, Page 578-600, June 2022.

Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) essentialist arguments for the necessity (...) of origin. I offer an alternative account of modal harms based on counterpart theory such as that offered by David Lewis (1986). On this account, individuals can make legitimate harm claims in regard to pre-conception choices made in determining their genetic constitution by appeal to their counterparts across possible worlds. (shrink)

The question is raised of the source of the extreme verificationist views which Wittgenstein put forward immediately after his return to philosophy in 1929. Since these views appear to be radically different from the ideas put forward in theTractatus some explanation of this dramatic new turn in Wittgenstein''s thought certainly seems to be called for. Wittgenstein''s very low level of interest in philosophy between 1918 and shortly before his return to philosophy is documented. Attention then focuses on the crucial period (...) immediately before Wittgenstein''s return to Cambridge, and it is shown that in this period he encountered only two new philosophical influences. These were the ideas of Brouwer and the ideas of the Vienna Circle. Each of these is examined and neither is found capable of providing an explanation of the source of Wittgenstein''s verificationism. This leads to a reconsideration of the underlying assumption that Wittgenstein''s verificationism does represent the radical departure from the ideas of theTractatus which it appears to. It is argued that the only way we can account for Wittgenstein''s evident approval of the reading of theTractatus which he must have encountered in his meetings with members of the Vienna Circle is by concluding that, far from being incompatible with his earlier ideas, some form of verificationism must always have been implicit in theTractatus. (shrink)

Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) essentialist arguments for the necessity (...) of origin. I offer an alternative account of modal harms based on counterpart theory such as that offered by David Lewis (1986). On this account, individuals can make legitimate harm claims in regard to pre-conception choices made in determining their genetic constitution by appeal to their counterparts across possible worlds. (shrink)

The standard by which we apply decision-making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision-making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by providing (...) the truth-conditions for the substituted judgement in terms of counterfactual reasoning using a possible worlds semantics. In this paper, I show how these underpinnings fail to support the substituted judgement approach as a reasonable standard for decision-making. Firstly, I show how this counterfactual element has been poorly interpreted. I then explain how various accounts have failed to reflect problems and limitations associated with providing an interpretation of their truth-conditions using counterfactuals. Finally, I argue that, even when we attend to the initial problems of providing a counterfactual analysis, it still deeply problematic as a means of determining the validity of substituted judgements for two main reasons. Firstly, making determinate judgements as to the truth-value of these judgements will often not be possible and, secondly, there is a strong requirement when interpreting many counterfactual claims to charitably accede to their being true. I conclude that substituted judgements, as interpreted through counterfactual reasoning and possible worlds semantics, do not therefore provide an adequate standard for surrogate decision-making. (shrink)

The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for (...) the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication, and ethical decision-making, without the added demand to end the Liverpool Care Pathway would have resulted in a genuine advance in end of life care. (shrink)

In response to Hirsch's deflationary arguments, Sider attempts to introduce a special Ontologese quantifier to preserve the substantivity of fundamental debates in metaphysics. He claims that this strategy can be effected by two distinct means, one of which is a list of instructions for metaphysicians, which he argues suffice to give the new quantifier a meaning that carves nature at the joints. I argue that these instructions will not allow someone to start speaking Ontologese if their prior language is sufficiently (...) deviant with respect to it, and that natural languages may be in just such a position. (shrink)

Volume 20, Issue 8, August 2020, Page 27-29.

Indigenous nurse scholars across nations colonised by Europeans articulate the need for accomplices (as opposed to mere performative allies) to work alongside them and support their ongoing struggle for health equity and respect and to prioritise and promote culturally safe healthcare. Although cultural safety is now being mandated in nursing codes of practice as a strategy to address racism in healthcare, it is important that white nurse educators have a comprehensive understanding about cultural safety and the pedagogical skills needed to (...) teach it to undergraduate nurses. We open this article with stories of our journeys as two white nurses in becoming accomplices and working alongside Indigenous Peoples, as patients and colleagues. Our lived experience of the inertia of healthcare and education organisations to address systemic and institutional resistance to the practice of cultural safety underpins the intention of this article. We understand that delivering this challenging and complex topic effectively and respectfully is best achieved when Indigenous and white educators work together at the cultural interface. Doing so requires commitment from white nurses and power holders within universities and healthcare institutions. A decolonising approach to nurse education at individual and institutional levels is fundamental to support and grow the work that needs to be done to reduce health inequity and increase cultural safety. White nurse accomplices can play an important role in teaching future nurses the importance of critical reflection and aiming to reduce power imbalances and racism within healthcare environments. Reducing power imbalances in healthcare environments and decolonising nursing practice is the strength of a cultural safety framework. (shrink)

IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of who might be suitable (...) as a proxy in cases where there was no clear appointment of them by a still competent individual. and is now widely seen as a useful means through which we can exercise control over decisions that affect our lives when we have lost capacity to make these decisions for ourselves.I will here limit myself to discussion of proxy consent for adults appointed prior to the loss of competence by the person they are acting as proxy for. The issue of p. (shrink)

Euclid’s Elements inspired a number of foundationalist accounts of mathematics, which dominated the epistemology of the discipline for many centuries in the West. Yet surprisingly little has been written by recent philosophers about this conception of mathematical knowledge. The great exception is Imre Lakatos, whose characterisation of the Euclidean Programme in the philosophy of mathematics counts as one of his central contributions. In this essay, we examine Lakatos’s account of the Euclidean Programme with a critical eye, and suggest an alternative (...) picture which builds on his work, but differs in a number of important respects. (shrink)

In this paper I provide an account of the metaphysical foundations of mental illness in terms of a realism debate. I motivate the importance of such metaphysical analysis as a means of avoiding some intractable problems that beset discussion of the concept of mental illness. I apply aspects of the framework developed by Crispin Wright for realism debates in order to examine the ontological commitments to mental illness as a property that humans may exhibit and to examine the various arguments (...) that realists and anti-realists can use to defend their position on mental illness. I pay particular attention to characterising Szasz's account of mental illness as that of an anti-realist error-theory and present ways in which a realist may counter such a position. Ultimately I argue that in order to hold a realist position on mental illness one would have to adopt some form of realism towards values, such as moral realism. (shrink)

The Euclidean Programme embodies a traditional sort of epistemological foundationalism, according to which knowledge – especially mathematical knowledge – is obtained by deduction from self-evident axioms or first principles. Epistemologists have examined foundationalism extensively, but neglected its historically dominant Euclidean form. By contrast, this book offers a detailed examination of Euclidean foundationalism, which, following Lakatos, the authors call the Euclidean Programme. The book rationally reconstructs the programme's key principles, showing it to be an epistemological interpretation of the axiomatic method. It (...) then compares the reconstructed programme with select historical sources: Euclid's Elements, Aristotle's Posterior Analytics, Descartes's Discourse on Method, Pascal's On the Geometric Mind and a twentieth-century account of axiomatisation. The second half of the book philosophically assesses the programme, exploring whether various areas of contemporary mathematics conform to it. The book concludes by outlining a replacement for the Euclidean Programme. (shrink)

This paper examines the potential for abstracting propositions – an as yet untested way of defending the realist thesis that propositions as abstract entities exist. I motivate why we should want to abstract propositions and make clear, by basing an account on the neo-Fregean programme in arithmetic, what ontological and epistemological advantages a realist can gain from this. I then raise a series of problems for the abstraction that ultimately have serious repercussions for realism about propositions in general. I first (...) identify problems about the number of entities able to be abstracted using these techniques. I then focus on how issues of language relativity result in problems akin to the Caesar problem in arithmetic by exposing circularity and modal concern over the status of the criterion of identity for propositions. (shrink)

The extra propositions which Wittgenstein added to Ramsey's copy of\nthe 'Tractatus' during their discussions in 1923 provide evidence,\nWrigley argues, that Wittgenstein's view of mathematics was quite\ndifferent from logicism. Contrary to this, Frascolla tries to prove\nthat the label 'no-classes logicism' tallies with the 'Tractarian'\nview of arithmetic.

NThere are many problems with Levi and Green’s (2010) suggestion that a computer-based decision aid will overcome the major objections to advance directives (ADs). We focus on just two here. First, we argue that the key assumption underlying Levi and Green’s paper, that autonomy always ought to take priority over other values, is false. Second, we argue that the paper misses the point of the most telling objections to the use of ADs: they lack the relevant moral authority to determine (...) treatments. It is not that they are merely subject to a set of contingent problems related to capturing the wishes of individuals or being open to misinterpretation by others.We conclude that the plug should be pulled on Levi and Green’s computer-based proposal. (shrink)

Two notable limitations exist on the use of personhood arguments in establishing moral status. Firstly, although the attribution of personhood may give us sufficient reason to grant something moral status, it is not a necessary condition. Secondly, even if a person is that which has the ‘highest’ moral status, this does not mean that any interests of a person are justifiable grounds to kill something that has a ‘lower’ moral status. Additional justification is needed to overcome a basic wrongness associated (...) with killing something possessing moral status. There are clear arguments already available in this regard in the case of a foetus that are not available in the case of a newborn infant. Hence, there is scope to consistently hold that abortion may be permissible but that after-birth abortion may not be permissible. (shrink)

Sustaining hope in patients is an important element of health care, allowing improvement in patient welfare and quality of life. However in the palliative care context, with patients who are terminally ill, it might seem that in order to maintain hope the palliative care practitioner would sometimes have to deceive the patient about the full nature or prospects of their condition by providing a ‘false hope’. This possibility creates an ethical tension in palliative practice, where the beneficent desire to improve (...) patient welfare through sustaining hope appears to be in conflict with an autonomy-based requirement not to deceive patients about their condition. In order to resolve this ethical tension, we provide an analysis of the concept of hope and argue that there is at least one conception – the ‘absolute’ conception of hope – which when properly understood allows practitioners to foster hope in terminally-ill patients while avoiding any need to deceive them about their condition. Practitioners therefore do not need to shy away from using the language of hope in the palliative setting, as on this understanding of hope it can be used in a way that both promotes patient welfare and respects patient autonomy. (shrink)

Gödel argued that the incompleteness theorems entail that the mind is not a machine, or that certain arithmetical propositions are absolutely undecidable. His view was that the mind is not a machine, and that no arithmetical propositions are absolutely undecidable. I argue that his position presupposes that the idealized mathematician has an ability which I call the recursive-ordinal recognition ability. I show that we have this ability if, and only if, there are no absolutely undecidable arithmetical propositions. I argue that (...) there are such propositions, but that no recognizable example of one can be identified, even in principle. (shrink)

Innovation is a key driver of care provision in assisted reproductive technologies (ART). ART providers offer a range of add‐on interventions, aiming to augment standard in vitro fertilization protocols and improve the chances of a live birth. Particularly in the context of commercial provision, an ever‐increasing array of add‐ons are marketed to ART patients, even when evidence to support them is equivocal. A defining feature of ART is hope—hope that a cycle will lead to a baby or that another test (...) or intervention will make a difference. Yet such hope also leaves ART patients vulnerable in a variety of ways. This article argues that previous attempts to safeguard ART patients have neglected how the use of add‐ons in commercial ART can exploit patients’ hopes. Commercial providers of ART should provide add‐ons only free of charge, under a suitable research protocol. (shrink)

Deriving ethical conclusions from arguments that rely heavily on metaphysical foundations, as Parfit (1984) does in generating his Nonidentity Problem, is an approach fraught with problems. Sparrow...

Evelyn Underhill was one of the most widely read writers in spirituality in the first half of the twentieth century. In addition to her nearly 40 books and hundreds of articles and reviews, Underhill wrote a significant number of letters of spiritual direction and led spiritual retreats in England in the 1920s and 1930s. Darkness and light are recurring themes in both Underhill’s letters of spiritual nurture and in the prayers that she wrote and selected for use when leading retreats. (...) These two themes also operate as a lens for exploring Underhill’s own personal, spiritual journey. In this article, the themes of darkness and light are explored in Underhill’s spiritual journey, in her soul care of others, as revealed through her letters, and in her prayers for retreat leading. Underhill provides us with wisdom concerning soul care for people experiencing darkness. She shows us how to help them endure and trust God when the light is gone. (shrink)

This paper explores the connections between School Effectiveness as a research paradigm and developments in policy and practice. With a particular focus on the English school system, 'effectiveness' is examined as a discourse which underpins the accountability regime, and in terms of its influence on the related field of School Improvement. Anti-democratic tendencies in areas such as school leadership, teacher professionalism, curriculum and pedagogy are related to a failure, at the heart of the 'effectiveness' concept, to give critical consideration to (...) social and educational aims. (shrink)