The Human Rights Act 1998, which came into force in the UK in October 2000, has not prompted the flood of litigation or radical decisions that some commentators predicted. There was speculation, for instance, that the act might be used to challenge the current law on assisted suicide and in fact this has been considered in detail by the courts. A woman with motor neurone disease applied to the court for a guarantee that if her husband helped her to commit (...) suicide, he would not be prosecuted.1 Discussion was particularly interesting in the court of first instance prior to the case going to the House of Lords in November 2001. Although the case before the court of first instance fell on other grounds, the human rights issues were addressed in detail. Assisting suicide is illegal in the UK under the Suicide Act 1961. “A person who aids, abets counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.”2 The court heard it argued that this universal prohibition on assisting suicide was incompatible with the rights of a person who wanted to commit suicide, and was mentally competent but physically unable to do so. The conflict between two fundamental human rights in the European Convention on Human Rights3—the right to life (article 2) and the right to decide what will and will not be done with one's own body (article 3)—was central to the case. Article 2 requires states to prevent people being “deprived of life”. It doesn't, however, require states to take positive steps to force life on the unwilling. Thus the court concluded that article 2 might permit the state to allow assisted suicide, …. (shrink)

On 8 August 2000 conjoined twins, known as Mary and Jodie, were born to Maltese parents at St Mary's Hospital in Manchester. Cases of conjoined twins are rare, affecting around one in every 100,000 live births. Mary and Jodie were joined at the lower abdomen. Jodie, the stronger twin kept Mary alive since Mary's vital organs were too damaged to sustain her. Had she been a singleton, Mary would not have survived. Mary's brain was described as having only primitive function (...) whereas Jodie's appeared normal. They shared Jodie's aorta so that Jodie's heart supplied blood to Mary, which was oxygenated in Jodie's lungs. In sustaining Mary's life, considerable strain was exerted on Jodie's heart which, according to expert opinion, would fail within three to six months, resulting in both their deaths. To withdraw that life-line through separation would inevitably lead to Mary's death but give hope of survival to Jodie. The parents, however, said they could not consent to separation if this would result in Mary's death. The twins were equally precious to their parents who felt that it was “not God's will” for them or anyone to choose death for one. They could not agree to kill one even to save the other. Furthermore, it was uncertain that Jodie would survive surgery. If she did, she would require considerable care and further operations to build a vagina and anus. She might never be able to walk and her parents were uncertain that they would be able to look after her. Doctors sought a declaration from the High Court as to whether the operation was lawful in the light of the parents' refusal to consent.1 The doctors considered that they should try and save one twin rather than allowing both to die. The High Court authorised the doctors to …. (shrink)

In February 2020, the British Medical Association will be surveying members for their views on what the BMA’s position on physician-assisted dying should be. The BMA is currently opposed to physician-assisted dying in all its forms, a position that was agreed in 2006 at the annual representative meeting, the Association’s policy-making conference.1 As previously reported in Ethics briefing,2 the decision to survey members follows a motion passed at last year’s ARM which called on the BMA to “carry out a poll (...) of members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying”. The results from the survey will not determine BMA policy. Rather, the results be published ahead of this year’s ARM and provided to those attending to inform a debate and discussion on the BMA’s policy position. More information about the survey, including a briefing pack of useful information, and information for BMA members on how to participate can be found online at www.bma.org.uk/PAD. ### High Court rejects Judicial reviews on assisted suicide The High Court has refused permission for two separate challenges to the law on assisted suicide in the UK to proceed to a full hearing. In the first case, Phil Newby, who has motor neuron disease, applied for judicial review of the law on assisted suicide and asked for the court to carry out a detailed examination of what he termed “legislative facts” – that is, an examination of the existing evidence on the “costs, risks and benefits” of regulating assisted suicide – including a cross-examination of relevant expert witnesses.1 Handing down the judgement, Lord Justice Irwin and Mrs Justice May, held that assisted dying …. (shrink)

### British Medical association survey on physician-assisted dying closes Previous Ethics briefings have highlighted the survey of members on physician-assisted dying being carried out by the British Medical Association.1 This survey closed at midnight on Thursday 27 February. In total, 29 011 members responded – 20.1% of all members who received an invitation to participate – making this one of the largest surveys of medical opinion carried out on this issue, ever. The results of the survey will not make BMA (...) policy, but will inform a debate and discussion at the organisation’s main policy-making conference, the annual representative meeting in June this year. You can find out more about the survey and how it was carried out at www.bma.org.uk/PAD This page will continue to be updated when more information about the survey results is available. ### Royal College of General Practitioners remains opposed to a change in the law on assisted dying In October 2019, the Royal College of General Practitioners began surveying its members on the College’s position on physician-assisted dying. The College published its results on 21 February. Of the 49 539 members invited to participated, 6674 responded – a response rate of 13.47%.2 In response to a question about what the College’s position on the law on assisted dying should be: Following the results of the survey, the RCGP Council decided that the College should continue to oppose a change in the law on assisted dying. ### Belgian doctors acquitted in country’s first criminal euthanasia case As noted in previous Ethics briefings, three Belgian doctors faced criminal charges of “unlawfully poisoning” a …. (shrink)

House of Lords ruling on assisted dyingIn July 2009, the House of Lords ruled that the Director of Public Prosecutions must produce clear guidelines on the prosecution of those who help friends or relatives travel abroad for assisted suicide. 1 As previously reported here, both the High Court and Court of Appeal had rejected Debbie Purdy’s case before it reached the Lords.2 As a person with primary progressive multiple sclerosis, she had asked the court to rule that her husband (...) would not face prosecution if he accompanied her to Switzerland if she decides to end her life. 3By requiring the DPP to publish offence-specific guidelines about the circumstances in which a prosecution would be brought, the law lords did not go so far as to assert a right to assistance in dying by legalising assisted suicide. It was reiterated that any change to the criminal law against aiding and abetting suicide remained a political matter for Parliament. The Lords did, however, acknowledge that the right to privacy, and the associated right to autonomy, was potentially infringed by the absence of a transparent policy about those who are competent and terminally ill, or severely and incurably disabled, and who need help to travel abroad for assisted dying. The five law lords unanimously agreed that Ms Purdy’s right to a private life, as protected by article 8 of the European Convention on Human Rights, included the right to clarity regarding the exercise of the DPP’s discretion as to whether or not to prosecute.Following the Lords’ ruling, the DPP, Keir Starmer, confirmed that the new guidance would apply to all acts of assisted suicide, those taking place within and outside of the jurisdiction.4 He then published an interim policy for wide consultation in September 2009, and is expected to produce the final policy in …. (shrink)

In Beck, focus intervention is used as an argument for reducing Hamblin’s semantics for questions to Rooth’s focus semantics. Drawing on novel empirical evidence from Mandarin and English, we argue that this reduction is unwarranted. Maintaining both Hamblin’s original semantics and Rooth’s focus semantics not only allows for a more adequate account for focus intervention in questions, but also correctly predicts that focus intervention is a very general phenomenon caused by interaction of alternatives in different dimensions.

In July 2019, Stella Creasy MP and her team succeeded in attaching an amendment to a largely administrative bill which would require the UK government to liberalise abortion laws in Northern Ireland by 21 October 2019, provided the Northern Ireland government does not resume before that date.1 The amendment succeeded in the Commons, 332 votes to 99 and later, with some adjustments, in the Lords, 182 votes to 37. The Bill received Royal Assent on 24 July 2019. In Northern Ireland, (...) abortion remains a criminal offence punishable by up to life imprisonment in all except exceptional circumstances, that is, where it is ‘necessary to preserve the life of the woman’ or where there is a ‘risk of serious adverse effect which is either long term or permanent’.2 The law makes no provision for women who are pregnant as a result of rape, incest or in the case of fatal fetal abnormality. Because there is a lack of clarity around which circumstances or conditions would have a sufficiently ‘serious and long-term adverse effect’, it has been argued that the law has had a ‘chilling effect’ on service provision.3 As a result, only 13 abortions were performed in Northern Ireland in 2018/2019.4 Instead, more than 1000 women travelled from Northern Ireland to England to access legal abortion services.5 A recent review of the law in Northern Ireland concluded that this situation disadvantages women who cannot afford to or are unable to travel.3 Women are also reportedly purchasing abortifacients unlawfully online, exposing them to the risk of prosecution as well as to risks where the pills are unsafe or lead to complications. Creasey’s amendment requires the Secretary of State for …. (shrink)

Court of appeal ruling on assisted dyingIn July 2013, the Court of Appeal ruled on an assisted dying case brought by Paul Lamb, a 58-year-old man who has been quadriplegic and without function in any of his limbs, apart from a little movement in his right hand, since a car accident in 1990.1 Mr Lamb was permitted by the Court to take over the legal case of Tony Nicklinson, who died in August 2012, less than a week after (...) his request for judicial review was rejected by the High Court.2 Like Mr Nicklinson, the severity of Mr Lamb's injuries means that he is unable to take his own life, other than by starvation. He would like his life to be ended, preferably by lethal injection administered at home, and does not want to travel to Switzerland for an assisted suicide.Mr Lamb's case was heard, along with that of Mr Nicklinson's wife and that of another man, ‘Martin’, in the Court of Appeal in May.The Court identified three issues from the parties’ submissions: The common law should provide a defence to murder where that takes the form of euthanasia in circumstances where another party is giving effect to the settled wish of a competent person. The legal prohibitions on those providing assistance constitute a disproportionate interference with Article 8 rights to a private and family life. The Director of Public Prosecution's policy statement on factors which he will take into account when considering whether or not to exercise his discretion in favour of prosecuting does not satisfy the …. (shrink)

### High Court rejects assisted dying challenge The High Court has rejected the latest challenge to the law on assisted dying in the UK, brought by Noel Conway. Mr Conway, a retired college lecturer, was diagnosed with motor neuron disease in 2012. Since his diagnosis, his health has deteriorated and he is dependent on ever-increasing levels of assistance with daily life, including the use of non-invasive ventilation to help him breathe. He sought a declaration from the court that section 2 (...) of the Suicide Act 1961 was incompatible with his right to a private and family life under Article 8 of the European Convention on Human Rights. As part of his case, Mr Conway submitted the outline of an alternative statutory scheme, which he argued, if implemented, would provide sufficient safeguards. He submitted that the prohibition on assisted suicide should not apply where an individual is aged 18 and over; has been diagnosed with a terminal illness and has a clinically assessed prognosis of 6 months or less to live; has the mental capacity to make the decision; makes that decision in a voluntary, clear and settled manner; and retains the ability to undertake the final act. Additionally, two doctors must confirm that the individual meets the criteria, and permission for the provision of assistance must be authorised by a High Court judge. Previous challenges to the UK law on assisted dying, including Pretty and Nicklinson, had established that section 2 of the Suicide Act does engage individual’s Article 18 rights, but that such an interference could be justified under Article 8 of the ECHR, which permits interference ‘such as is in accordance with the law and necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country’. The question …. (shrink)

In previous Ethics briefings 1 we have highlighted the developments in the case of Bell & Another v the Tavistock and Portman NHS Foundation Trust. The case concerned a judicial review of the practice of prescribing puberty blocking treatment to children and young people at the Gender Identity Development Service managed by the Tavistock and Portman NHS Foundation Trust. The Court of Appeal in its judgement2 found the Trust’s practices to be lawful, and overturned previous guidance given by (...) the High Court which had contradicted the 'Gillick principle' regarding whether a child or young person could consent to medical treatment, without the consent of its parent. Despite this legal success, concerns over the GIDS continued. In September, NHS England commissioned an independent and wide-ranging review of gender identity services for children and young people led by Dr Hilary Cass, past president of the Royal College of Paediatrics and Child Health. Dr Cass’s Interim review, published in March,3 has resulted in a decision by NHS England to close the GIDS at the Trust by Spring 2023, and replace it with regional centres at existing children’s hospitals offering more 'holistic care' with ’strong links to mental health services’. It is proposed that regional centres will be established at Great Ormond Street Hospital, and Alder Hey Children’s NHS Foundation Trust. Dr Cass was critical of the clinic’s failure to collect sufficient data on the impact of puberty blockers in under-16s. …. (shrink)

### Challenge to the abortion act 1967 dismissed In September, the High Court dismissed a judicial review of the Abortion Act 1967 that sought a judgement of incompatibility with the European Convention on Human Rights.1 The case focused on a clause in the Act which permits abortion in England, Scotland and Wales after 24 weeks if there is a substantial risk that, if the child were born, it would suffer from ‘such physical or mental abnormalities as to be seriously (...) handicapped’. The case was brought by three parties: Heidi Crowter, a 24 year old woman living independently with Downs Syndrome and a campaigner for disability rights; a 2 year old boy with DS; and his mother who, when pregnant with him, felt pressure to terminate the pregnancy. The claimants sought a declaration that the clause was incompatible with the right to life; freedom from torture, inhuman or degrading treatment; right to private and family life; and protection from discrimination. Further to this it was also argued that the Act does not permit abortion on the basis that an unborn child has been diagnosed with a non-fatal fetal disability such as DS and that such abortions should not be funded by the state. In dismissing the claim, the judges focused on the ‘margin of appreciation’ that the European law allows domestic states on this issue and the fact that a foetus has never been deemed to have personhood status under the ECHR. The judges noted the ability to provide for a disabled child would vary significantly and that some conditions would only be found late in a pregnancy, after 24 weeks. Stating that the case by its nature did not permit the Court to hear from other perspectives, including women who may be affected by any change to the law and further criminalisation of abortion, the judges emphasised …. (shrink)

The medical profession consistently strives to uphold patient empowerment, equality and safety. It is ironic that now, at a time where advances in technology and knowledge have given us an increased capacity to preserve and prolong life, we find ourselves increasingly asking questions about the value of the lives we are saving. A recent editorial by Professor Raanan Gillon questions the emphasis that English law places on the sanctity of life doctrine. In what was described by Reverend Nick Donnelly (...) as a “manifesto for killing patients”, Professor Gillon argues that the sanctity of life law has gone too far because of its disregard for distributive justice and an incompetent person’s previously declared autonomy. This review begins by outlining the stance of the sanctity of life doctrine on decisions about administering, withholding and withdrawing life-prolonging treatment. Using this as a foundation for a rebuttal, a proposal is made that Professor Gillon’s assertions do not take the following into account. (shrink)

This article will provide a critique of tworecent English marriage law decisions, thefirst concerning a (female to male) transgenderman and the second a (male to female)intersexed woman. It will do so throughconsideration of the dialogue between each andthe landmark transgender case of Corbett v. Corbett. It will highlight howboth decisions, in seeking to minimise the factof `departure' from Corbett, serve toreproduce key elements of that decision whichserve to undermine the future prospects fortransgender law reform in the English (...) context.In particular, both decisions, in differentways, or with different emphases, ensure that`legal sex' continues to be determined by(bio)logical and temporal factors. Crucially,however, as in Corbett, it is legalanxiety over the boundaries of the `natural',and the homophobia of law, that underscoresthis anxiety, that account for these particularconstructions of `legal sex'. (shrink)

This Article discusses the first steps of Israeli copyright law, dating it back to Ottoman times, which is earlier than thus far discussed in the literature. The account provides an early case of legal globalization through colonialism. The imposition of copyright law in Palestine enables us to observe the difficulties of applying an uninvited legal transplant and to trace its dynamics. The discussion queries the fate of copyright law in Mandate Palestine from two perspectives. First, the Colonial-Imperial point of (...) view: I ask why the British government imposed copyright law in the newly administered territory only a month after the establishment of the civil administration in 1920 and then replaced it in 1924. The answers are to be found in the general imperial agenda, its Palestine agenda, as well as the nature of copyright and the personal background of those involved. Second, from the local point of view, I trace the first steps of copyright law within the Hebrew community and especially within the literary circle in the 1920s. The local needs of the literary field concerned the author-publisher relationship, attribution, the integrity of the work and international transactions. However, the answers to these problems were not found in the law but rather in private ordering, namely contracts and social norms. (shrink)

Wittgenstein said in the Investigations, ‘A philosophical problem has the form: “I don’t know my way about”’ (§ 123). The problem of mirror reversal – specifically the twentieth-century transatlantic controversy between the psychologist Richard Gregory, the mathematical columnist Martin Gardner, the physicist Richard Feynman and various analytic philosophers, including David Pears, Ned Block and Don Locke – is presented here as an instructive case of our not knowing our way about. ‘Why do mirrors reverse left and right but not (...) up and down?’ We discover that our perplexity disappears as we get clearer about the employment of the familiar oppositions left and right, up and down, back and front, and others. Finding our way about in these logico-grammatical fells, we see connections with our troubles in more vertiginous landscapes. Our disquietude may not be deep (§ 111) but the ‘battle against the bewitchment of our intelligence’ (§ 109) is surprisingly severe. (shrink)

This paper aims to investigate the differences between the concepts of libel and slander as understood by the Polish statutory and English common law. As it turns out, the above terms are not only divergent with regard to language but also with regard to corresponding acts in the real world. Western cultures cherish such values as dignity, honour and self-fulfillment as the underlying rights of a citizen in democratic countries. The above terms are being constantly referred to in international (...) treaties and conventions but the question which should be asked is whether they receive due attention in legal practice. As regards interpretation, not only in theory, but also in practice the important issue is not how the defamatory statement makes the person referred to feel, but the impression it is likely to make on those reading it. The subsequent analysis of particular cases in the practical part supports the above claim. Although it is reiterated by the Polish legal academics that civil regulations are not sufficient to guarantee legal protection of dignity, there is an equal or even greater amount of supporters of the broadly conceived “freedom of speech”. The discussion might be summarized as involving the proponents of liberal and democratic policies on the one hand, and those who wish to avoid complete decriminalization of libel and slander and deem them necessary components of balance in a democratic state. (shrink)

The doctor-patient relationship -- Consent, choice, and refusal : adults with capacity -- Treating adults who lack capacity -- Children and young people -- Confidentiality -- Health records -- Contraception, abortion, and birth -- Assisted reproduction -- Genetics -- Caring for patients at the end of life -- Euthanasia and physician assisted suicide -- Responsibilities after a patient's death -- Prescribing and administering medication -- Research and innovative treatment -- Emergency situations -- Doctors with dual obligations -- Providing treatment and (...) care in detention settings -- Education and training -- Teamwork, referral, delegation, and shared care -- Public health dimensions of medical practice -- Reducing risk, clinical error, and poor performance. (shrink)

The English School analytical framework concerning theformation of order in international relations posits that states establish orderthrough rules and institutions within the framework of common interests andvalues to protect against anarchy. State-centred orders with limited civil societycooperation are pluralistic, while their converse are solidarist. The Association of Southeast Asian Nations was established in 1967 by Malaysia, Thailand, the Philippines, Singapore,and Indonesia based on common interests, such as strengthening sovereigntyand creating stable relations in the face of anarchic problems like communismand (...) internal instability. In numerous conventions ASEAN has adopted variousnorms, such as respect for the sovereignty of the states, the rule of law, non-useof power, peaceful resolution of disputes, and non-interference in other states.All these norms showed that the primary purpose of ASEAN is to protect statesovereignty and interests and to establish peaceful regional relations. The factthat state sovereignty is at the forefront, with limited cooperation of non-stateactors, shows that the ASEAN regional order is pluralist. This article analysesthe emergence and appearance of the ASEAN regional order in the context of the ES. (shrink)

This fourth edition of Precedent in English Law presents a basic guide to the current doctrine of precedent in England, set in the wider context of the jurisprudential problems which any treatment of this topic involves. Such problems include the nature of _ratio_ _decidendi_ of a precedentand of its binding force, the significance of precedents alongside other sources of law, their role in legal reasoning, and the account which must be taken of them by any general theory of law. (...) Considerable re-writing has been undertaken to update case-law and take account of the possibleimplications for the doctrine of precedent of the impact of European Community law, making it an indispensable work of reference for readers interested in the past history, present state, and future developments of English rules of precedent. (shrink)

It is argued that cultural attitudes of a speciesist nature are background to the current practice of animal use in teaching medical students and residents. The scope of this activity is estimated, and educational theory is enlisted to suggest that many assumptions about the effectiveness of the practice are not valid. An assessment of one course used for ob-gyn training is presented. Since it is clear that animal suffering should be avoided when possible, the case is made that alternatives (...) to animals may be used to replace animal use in much of current medical education. Medical educators should routinely question and offer adequate justification for any use of animals in medical education. (shrink)

There is an old and powerful argument for the claim that divine foreknowledge is incompatible with the freedom to do otherwise. A recent response to this argument, sometimes called the “dependence response,” centers around the claim that God’s relevant past beliefs depend on the relevant agent’s current or future behavior in a certain way. This paper offers a new argument for the dependence response, one that revolves around different cases of time travel. Somewhat serendipitously, the argument also paves the way (...) for a new reply to a compelling objection to the dependence response, the challenge from prepunishment. But perhaps not so serendipitously, the argument also renders the dependence response incompatible with certain views of providence. (shrink)

Much business ethics and corporate social responsibility literature suggests, implicitly or explicitly, that firms ought to engage in activities that can be characterized as philanthropy, namely, expending resources beyond what is required by law and market norms to promote others’ welfare at the expense of firm profits. However, this literature has struggled to provide a normative framework for evaluating corporate philanthropy, although scholars have noted that such expenditures can potentially remedy market failures and provide public goods more efficiently. I articulate (...) two specific rationales that can justify corporate philanthropy based on considerations of welfare economics: 1) firms making strategic but high-risk investments in activities that are likely to generate positive externalities even if they prove unprofitable and 2) firms possessing a strong comparative advantage in their ability to address a social problem at lower social cost. Moreover, these rationales can be evaluated by a concept I develop called the philanthropy multiplier, indicating the ratio of net positive externalities to net costs. I suggest that firms consider publicizing their philanthropy multipliers, and I discuss theoretical and practical implications. (shrink)

This article reports on a study of children's deductive reasoning in solving novel relational problems. Detailed protocols were obtained from 264 children (aged 9- 12 years) who verbalised their thinking as they solved the problems. The study included the development of a three-phase theory based on Johnson-Laird and Byrne's mental models perspective, but with some distinct modifications. These include a focus on the relational complexity entailed in model construction and in premise integration, and the advancement of four reasoning principles that (...) are applied throughout problem solution (in contrast to Johnson-Laird's falsification processes as the hallmark of deductive reasoning). The reported case studies and the results of statistical analyses supported predictions arising from the proposed theory, including the key role of the reasoning principles. The results also showed that problem difficulty is a function of relational complexity, not of the number of models to be constructed, as argued by Johnson-Laird and Byrne. (shrink)

This article presents two cases of women doing development work for civil society organizations in the Global South. The author uses the cases to explicate the relationship of global civil society, development work, feminism, and Christianity. The case studies were collected through life history interviews with the participants. The cases, interpreted in light of the ‘third space’ cultural theory of Homi Bhabha, destabilize the fixed identity of these women as ‘development workers’, ‘feminists’, ‘Western’, and ‘Christian’.

Female genital mutilation generates passionate argument about child abuse and the limits of cultural independence. The Sudanese Women's Rights Group (SWRG), which is based in the United Kingdom (UK) issued a press release expressing grave concern about the Sudanese government's intention to legalise female genital mutilation (circumcision) (Sudanese Women's Rights Group press release Legalisation of female circumcision in Sudan, 18 June 2002). The Sudanese Ministry of Religious Affairs and Endowment, together with an Islamic university, held a workshop entitled Towards the (...) Legalisation of Female Circumcision & Establishment of Training Centers for Operators (excisors). It recommended that female circumcision should be legalised, awareness about its importance in society should be raised, and the Islamic University should establish centres all over the country for training practitioners of female circumcision. The SWRG is concerned about the strong support for the recommendations among government officials, in a country where 89% of women have been mutilated.1 The Sudanese government's actions came just a few months before female genital mutilation was rejected at a 190 country strong world summit.2 The summit agreed that health care services must “conform to basic human rights and fundamental freedoms”, a provision designed to prevent female genital mutilation. Around the same time the American embassy in Nairobi said that Somali refugees who had rushed to circumcise their daughters before being moved to the US would probably be barred from emigrating.3 The statement prompted fierce debate, and the US later backtracked.4 Recent debate in the UK focused on taking young girls abroad for mutilation. Nothing in UK law specifically prohibits families from taking daughters abroad for female genital mutilation, but doctors must consider what action they should take to protect a child at risk of being mutilated. The government is exploring ways to strengthen the Prohibition of Female …. (shrink)

There is growing international debate about the so-called “right to health” and the likely content of such a right as it is gradually defined by international bodies such as the UN committee on economic, social, and cultural rights. Although some countries, such as Mexico, have incorporated the right of access to basic treatment into their national constitution, practical implications generally remain to be fully articulated. Lawyers have been trying to do this by developing internationally accepted indicators which can be used (...) to measure a nation's progress towards compliance with social, economic and cultural rights.1 Clearly, compliance can only be judged against the yardstick of resources. Restructuring of health services and the need to contain spiralling health costs have led many countries to focus on developing a basic health care package as a “right”. The USA, in the Clinton era, had inconclusive discussions about this and basic packages have been implemented by governments as diverse as Brazil, Germany, Israel, and the Netherlands. As the BMA has discussed,2 the prime responsibility for ensuring that rights are fulfilled rests with governments who are signatory to international human rights declarations. Nevertheless, hospitals and other health facilities may logically be deemed to have some obligations, by delegation from government, to respect the rights of people needing urgent treatment. The question of what this right means to health professionals needs exploring. Access to health care, particularly in a life-threatening emergency, appears to be a fundamental component of any such postulated right. Also, individual health professionals are generally perceived as having an ethical duty to respond to “need” when they are able to help. In July 2001, the potential legal consequences of failing to do so were highlighted by a case in India where the medical administrator of a Delhi hospital refused emergency treatment to …. (shrink)

The aim of the paper is to investigate the impact of the Greek language on modern legal languages in the United Kingdom and United States of America. The focus is placed on terms with the prefix cyber- of Greek origin that have recently enriched the English legal languages in connection with the fact that certain new phenomena have been regulated by laws as a result of the development of new technologies. Therefore, the authors have investigated the occurrence of terms (...) with the prefix cyber- in legislation and other legal texts. Apart from the analysis of borrowings in the English legal languages, the authors have also investigated the occurrence of equivalent terms in Greek and Cypriot legislation and other genres of legal texts. Furthermore, the analysis involved the investigation of the occurrence of terms with the analysed prefix cyber- in European Union legislation and terminological databases to find out whether the borrowings may become internationalisms of Greek origin. Furthermore, the authors have also investigated whether for those terms with a prefix of Greek origin there are synonyms in the languages under scrutiny of non-Greek origin. (shrink)

This paper investigates force shift, a phenomenon in which the canonical discourse conventions, or force, associated with a clause type can be overridden to yield polar questions with the help of additional force-indicating devices. Previous studies attribute force shift to the presence of a complex question force component operating on semantic content. Based on utterance particles and particle clusters in Cantonese, we analyze force shift as resulting from compositional operations on force-bearing expressions. We propose that a simplex force, such as (...) assertion or question, denotes unanchored sentence acts, while a force-shifting particle like Cantonese _ho2_ is an anchoring function anchoring a sentence act to the speaker while querying whether or not the addressee can perform the sentence act. The proposed semantics makes predictions about _ho2_’s interactions with addressee-changing operations and imperatives, as well as about a larger family of force shift phenomena. (shrink)

Suppose Molinism is true and God placed Adam in the garden because God knew Adam would freely eat of the fruit. Suppose further that, had it not been true that Adam would freely eat of the fruit, were he placed in the garden, God would have placed someone else there instead. When Adam freely eats of the fruit, is he free to do otherwise? This paper argues that there is a strong case for both a positive and a negative (...) answer. Assuming such cases are possible under Molinism, we are left with a puzzling question: if Molinism is true, what can you do? (shrink)

Despite the long history of beliefs about the therapeutic properties of work for people with mental ill health, rarely has therapeutic work itself been a focus for historical analysis. In this article, the development of a therapeutic work ethic (1813—1979) is presented, drawing particular attention to the changing character and quality of beliefs about therapeutic work throughout time. From hospital factories to radical ‘antipsychiatric’ communities, the article reveals the myriad forms of activities that have variously been considered fit work for (...) people with mental health problems. While popular stereotypes of basket-weaving paint a hapless portrait of institutional work, a more nuanced reading of therapeutic work and its political and philosophical commitments is advanced. The article concludes by arguing that the non-linear and inherently contested development of therapeutic work is less the effect of paradigmatic shifts within the therapeutic professions, but rather evidence of a broader human struggle with work. (shrink)

Due to new innovations and changes, every language needs new words simply because there is a need for new words to name new things. It is a common occurrence for a speaker to use some words in a way that has never been used before in order to communicate directly about certain facts or ideas. When new inventions and changes come into people’s lives, there is a need to name them and talk about them. If a new word is used (...) by many speakers of the language, it will probably survive, and the same word will one day become an everyday word and enter the vocabulary of a language. This paper looks at compounding as one of the most productive word formation process in English. The term compounding refers to a process in which two or more lexemes are combined into one new word. When a word is formed by merging two or more words, each of which can be used separately, it is called a compound word. The term “word formation” has no universally accepted use. Word formation is sometimes defined as a process associated with changing the form of a word, for example, affixation, which is, in fact, the subject of morphology. In a broader sense, word formation covers the processes of creating new lexical items. In English, word formation is of great importance because this phenomenon affects the English dictionary, which in addition to borrowing from various other languages is enriched in this way. The aim of this paper was to investigate the context based vs. non-context interpretation of English compounds by EFL students in legal discourse. The findings from the test run-questionnaire showed that students of English as a foreign language found it more difficult to apply compound words in context rather than choosing an appropriate definition for them, with or without a given context. Furthermore, students scored lower when 50% of the compounds were given in context. (shrink)

In this paper we question whether the concept of "genetic privacy" is a contradiction in terms. And, if so, whether the implications of such a conclusion, inevitably impact on how society comes to perceive privacy and responsibility generally. Current law and ethical discourse place a high value on self-determination and the rights of individuals. In the medical sphere, the recognition of patient "rights" has resulted in health professionals being given clear duties of candour and frankness. Dilemmas arise, however, when patients (...) decline to know relevant information or, knowing it, refuse to share it with others who may also need to know. This paper considers the notions of interconnectedness and responsibility to others which are brought to the fore in the genetic sphere and which challenge the primacy afforded to personal autonomy. It also explores the extent to which an individual's perceived moral obligations can or should be enforced. (shrink)

Assistive technology is widely used in contemporary special needs education. Our interest is in the extent to which we can conceive of certain uses of AT in this educational context as a form of extended cognition. It is argued that what is critical to answering this question is that the relationship between the student and the AT is more than just that of subject-and-instrument, but instead incorporates a fluidity and spontaneity that puts it on a functional par with their use (...) of the student’s biological cognitive traits. It is claimed that AT use in special needs education offers an especially plausible case of extended cognition for just this reason. It is further maintained that understanding AT in this fashion has some important philosophical and practical ramifications, including how we should conceive of mainstream education, given that this is increasingly conducted within highly technologically-embedded environments. (shrink)

Hudson has formulated two local deterministic theses and argued that both are incompatible with freedom. We argue that Hudson has half the story right. Moreover, reflection on Hudson’s theses brings out an important point for debates about freedom generally: that instead of focusing on the notion of entailment, debates about freedom should focus on the notions of explanation and sourcehood. Hudson’s theses provide an excellent case study for why the latter notions ought to take precedence over the former in (...) debates about freedom. (shrink)

Doctors and medical students in the UK have voted in support of the decriminalisation of abortion for women who self-administer abortions and healthcare professionals who provide abortions within the context of their clinical practice. Abortion should be treated as a medical issue rather than a criminal one. ### Background to the vote The vote took place at the end of June during the British Medical Association’s Annual Representative Meeting, where representatives of doctors and medical students from across the British Isles (...) gathered to set BMA policy through democratic procedures. Representatives considered the issue of decriminalisation during a 2-hour debate, where diverse and opposing viewpoints were heard. The debate was informed by a neutral discussion paper that was published by the BMA in February, which provided a guide to some of the key legal and ethical issues raised by the debate around decriminalisation.1 The BMA’s new policy only relates to whether abortion should or should not be a criminal offence; the policy does not address the broader issue of when and how abortion should be available. The BMA has established policy on these issues which remains unchanged.2 ### The law on abortion Induced abortion is currently a crime throughout the British Isles. There are, however, a range of exceptions to the crime laid out in statute and/or common law, for example, in England, Scotland and Wales, under the Abortion Act 1967. Any healthcare professionals operating within those defined exceptions, which include grounds for authorising an abortion and procedural requirements, can lawfully carry out an abortion as a clinical procedure. Outside these defined exceptions, the criminal offences potentially apply both to those who participate in carrying out abortions for others, including doctors, nurses and midwives, and to women who carry out abortions on themselves. For example, healthcare professionals who do not follow procedural requirements can attract criminal sanctions …. (shrink)

In June 2021, the BMA published its report on moral distress and moral injury in UK doctors.1 The report includes definitions of the terms ‘moral distress’ and ‘moral injury’ as well as a summary of how the concepts have developed over time. There is also an analysis of the BMA’s pan-profession survey of moral distress and moral injury of doctors in the UK, the first of its kind. The impact of COVID-19 and recommendations for tackling moral distress also feature. Many (...) may be unfamiliar with the concepts of ‘moral distress’ and ‘moral injury’. These terms are relatively new, and debate is ongoing in academic circles on the best way to understand them.2 Some use the terms interchangeably. The BMA defines moral distress as the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action. Even without an understanding of the morally correct action, moral distress can arise from the sense of a moral transgression. More simply, it is the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. This can be as a result of a lack of power or agency, or structural limitations, such as insufficient staff, resources, training or time. The individual suffering from moral distress need not be the one who has acted or failed to act; moral distress can be caused by witnessing moral transgressions by others. Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger and profound ‘moral disorientation’. It has also been linked to severe mental health issues. There is increasing recognition across the UK of the problem …. (shrink)

The British Medical Association and Royal College of Physicians have published new guidance, endorsed by the General Medical Council, on decision-making about clinically assisted nutrition and hydration and adults who lack capacity to consent. The development of the guidance follows a series of legal cases which has created confusion about the precise circumstances in which an application to the court is required before CANH is withdrawn which has culminated with the decision of the Supreme Court in National Health Service Trust (...) versus Y. 1 This confirmed that there is no requirement to go to court, providing there is agreement as to the patient’s best interests, the provisions of the Mental Capacity Act 2005 have been observed, and the relevant professional guidance has been followed. The new guidance covers all decisions to start, restart, continue, or stop providing CANH in patients who are not imminently dying, in circumstances where CANH is the primary life-sustaining treatment being provided. It goes beyond the category of patients in permanent vegetative state or minimally conscious state who have previously been the subject of court applications, and also covers decisions for patients with neurodegenerative conditions and patients who have suffered a sudden onset brain injury in addition to having multiple comorbidities or general frailty which is likely to impact on life expectancy. It provides a clear statement of doctors’ legal responsibilities, covers the importance of robust best interests’ assessments and sets out the process to be followed for sufficient independent scrutiny of decisions. In light of some of the identified problems with decisions about CANH, a particular focus of the guidance is on the importance of regular best interests’ assessments, and it provides detailed practical guidance about how to approach these. The development of …. (shrink)

This paper asks whether geographically localised, or ‘hyperlocal’, uses of Twitter succeed in creating peer-to-peer neighbourhood networks or simply act as broadcast media at a reduced scale. Literature drawn from the smart cities discourse and from a UK research project into hyperlocal media, respectively, take on these two opposing interpretations. Evidence gathered in the case study presented here is consistent with the latter, and on this basis we criticise the notion that hyperlocal social media can be seen as a (...) community in itself. We demonstrate this by creating a network map of Twitter followers of a popular hyperlocal blog in Brockley, southeast London. We describe various attributes of this network including its average degree and clustering coefficient to suggest that a small and highly connected cluster of visible local entities such as businesses form a clique at the centre of this network, with individual residents following these but not one another. We then plot the locations of these entities and demonstrate that sub-communities in the network are formed due to close geographical proximity between smaller sets of businesses. These observations are illustrated with qualitative evidence from interviews with users who suggest instead that rather than being connected to one another they benefit from what has been described as ‘neighbourhood storytelling’. Despite the limitations of working with Twitter data, we propose that this multi-modal approach offers a valuable way to investigate the experience of using social media as a communication tool in urban neighbourhoods. (shrink)

The extent to which English law remedies injury to autonomy as a stand-alone actionable damage in negligence is disputed. In this article I argue that the remedy available is not only partial and inconsistent but also gendered and discriminatory against women. I first situate the argument within the broader feminist critique of tort law as failing to appropriately remedy gendered harms, and of law more broadly as undervaluing women’s interest in reproductive autonomy. I then show by reference to (...) class='Hi'>English remedies law’s first principles how imposed motherhood cases—Rees v Darlington and its predecessor McFarlane v Tayside Health Board—result in gender injustice when compared with other autonomy cases such as Chester v Afshar and Yearworth v North Bristol NHS Trust: A minor gender-neutral ITA is better remedied than the significant gendered harm of imposing motherhood on the claimant; men’s reproductive autonomy is protected to a greater extent than women’s; women’s reproductive autonomy is protected by an exceptional, derisory award. Worst of all, courts refuse to recognise imposed motherhood as detriment; and the deemed, mansplained, nonpecuniary joys of motherhood are used to offset pecuniary upkeep costs, forcing the claimant into a position she sought to avoid and thus further undermining her autonomy. The recent Singaporean case ACB v Thomson Medical Pte Ltd, awarding compensation for undermining the claimant’s genetic affinity in an IVF wrong-sperm-mix-up demonstrates some improvement in comparison to English law, and some shared gender injustices in the context of reproductive autonomy. ACB’s analysis is oblivious to the nature of reproductive autonomy harm as gendered; and prioritises the father’s interest in having genetic affinity with the baby over a woman’s interest in not having motherhood imposed upon her. (shrink)

In Mengzi 6A4, Gaozi states that “yì 義 (propriety, rightness) is external, not internal.” In 6A5, Meng Jizi says of yì that “...it is on the external, not from the internal.” Their defenses are met with Mengzi’s resistance. What does he perceive and resist in these statements? Focusing on several key passages, I compare six promising interpretations. 6A4 and a relevant part of 2A2 can be rendered comparably sensible under each of the six. However, what Gaozi says in 6A1 clearly (...) is evidence to Mengzi that, of the six views, Gaozi holds three although he does not convey them in his statement. As for Meng Jiz’s defense of his statement, Meng Jizi cites a special occasion where one is required to act one way even though one would feel a different way. Mengzi’s response has been traditionally interpreted as boiling down to a dissenting opinion about empirical psychology, that the agent on that special occasion would in fact feel the same way as they ought to act. But on a more charitable reading, the point Mengzi makes is conceptual: Though the satisfaction of yì may not require that the feeling and the act align perfectly in this case, cases where the alignment obtains are conceptually prior. This not only refutes Meng Jizi’s statement but also enables a more elegant explanation of why the Mengzi rightly has no record of Mengzi affirming that yì is internal. I conclude that 6A5 itself uniquely favors one interpretation, as far as Meng Jizi’s position is concerned: How one feels is irrelevant to whether one satisfies yì. (shrink)

Fire safety expertise was in great demand following the Grenfell Tower fire in London in June 2017. The government established a review of building regulations and an expert panel to inform its responses to Grenfell, and many other relevant organisations also formed their own expert panels. However, expert knowledge in fire safety is a highly contested domain, with knowledge claims based on differing sources. Fire fighters can claim expertise based on their experience of fighting fires, scientists and science-based engineers can (...) claim expertise from experimentation, and those who create and enact regulations can claim expertise in what can termed ’codespeak’—the language of regulation. Although distanced from fundamental empirical experience of fire, codespeak is powerful because of its relative clarity and certainty, and legal status. Building users also bring their own form of ‘local’ expertise—they have first-hand experience of the practicalities of the solutions wrought by the other experts. Policy-makers thus face many competing forms of expert advice on fire safety, and their ability to judge what is most relevant in any particular case rests on the existence of a sufficient range and depth of in-house government expertise. (shrink)

This volume presents cutting edge research by many of the leading researchers in the field of religious epistemology, a field that has seen major development in recent years. This book attempts to answer the questions of: how reasonable is belief in God? Can a good evidential case be made either for the existence of God, or against the existence of God? Does the existence of enormous suffering, or religious disagreement, provide significant evidence against the existence of God? How might (...) we best come to know God? What's required for religious belief to qualify as rational? All of the papers included in this volume aim to be accessible to the interested layperson. (shrink)

Wittgenstein and Kripke disagree about the status of the proposition: the Standard Metre is one metre long. Wittgenstein believes it is necessary. Kripke argues that it is contingent. Kripke's argument depends crucially on a certain sort of thought‐experiment with which we are invited to test our intuitions about what is and isn’t necessary. In this paper I argue that, while Kripke's conclusion is strictly correct, nevertheless similar Kripke‐style thought experiments indicate that the metric system of measurement is after all relative (...) in something like the way Wittgenstein seems to think. Central to this paper is a thought‐experiment I call The Smedlium Case. (shrink)

On 26 February 2019, the Organ Donation Bill completed its passage through the Westminster Parliament, creating the legislative basis to introduce an opt-out system for organ donation in England. The Bill now awaits Royal Assent, following which it is anticipated that the new system will come into effect in spring 2020. In the intervening period, there will be a significant publicity campaign to inform the public about the change in the law and the options open to them, which are to: (...) The family will continue to be consulted and as an additional safeguard, will be able to provide information about any unregistered objections held by the individual before they died. The legislation follows a similar model to that which was introduced in Wales on 1 December 2015. While it is too early to draw firm conclusions from the experience in Wales, the early signs are positive. The latest full-year data show an increase from 61 to 74 deceased donors over the previous 12 months;1 and in the first three-quarters of 2018/2019, there have been 72 deceased donors.2 Given the number of donors is small and subject to natural variation year-on-year, National Health Service Blood and Transplant has been analysing cumulative data to identify …. (shrink)