Next SectionThe dominant conception of medical ethics being taught in British and American medical schools is at best pointless and at worst dangerous, or so it will be argued. Although it is laudable that medical schools have now given medical ethics a secure place in the curriculum, they go wrong in treating it like a scientific body of knowledge. Ethics is a unique subject matter precisely because of its widespread familiarity in all areas of life, and any teaching has to (...) start from this shared ethical understanding and from the familiar ethical concepts of ordinary language. Otherwise there is a real risk that spurious technocratic jargon will be deployed by teacher and student alike in the futile search for intellectual respectability, culminating in a misplaced sense of having “done” the ethics module. There are no better examples of such jargon than “consequentialism”, “deontology”, and the “Four Principles”. At best, they cannot do the work they were designed to do and, at worst, they can lead student and practitioner into ignoring their own healthy ethical intuitions and vocabulary. (shrink)

Five proposals for admitting better applicants into medical school are discussed in this article: An A level in a humanity or social science would be required, to supplement—not replace—the stringent science requirement. This would ensure that successful candidates would be better “primed” for the medical curriculum. Extra points in the applicant’s initial screening would be awarded for an A level in English literature. There would be a minimum age of 23 for applicants, although a prior degree would not be required. (...) This is to ensure that the applicants are mature enough to know themselves and the world better, to make a more informed and motivated choice of career, and to get more out of the humanities components of the curriculum. A year’s full-time experience in a healthcare or charity environment would be desirable. Applicants would be given two lists of interview discussion topics to prepare: works of literature and topics in healthcare politics. (shrink)

The concept of business responsibility, usually termed as corporate social responsibility (CSR), originated in the early 1930s after the Wall Street crash of 1929 exposed corporate irresponsibility in large organisations. The understanding of CSR has evolved since then and its scope has now broadened from mere compliance to corporate laws to active alignment of internal business goals with externally set societal aspirations. Unfortunately, the significance of this multidimensional concept within the small and medium enterprise (SME) sector has continued to be (...) overshadowed by its application in large and multinational organisations. More importantly, this has led to the practice of judging SMEs, which are experiencing increasing pressure to engage in social activities, as if they are no different from their larger counterparts. This study therefore investigates CSR from the perspective of SMEs in Australia without any theoretical presumptions and then comments on the relevance and applicability of the two theories that have been commonly used to investigate business responsibility, namely, stakeholder theory (ST) and social capital theory (SCT). The research findings indicate that CSR within the SME sector is more aligned to the fundamentals of SCT, mainly owing to the unique resource and survival challenges that they face, and which are, arguably, not so pronounced in large organisations. (shrink)

This chapter applies the parity principle in discussing “active externalism,” which claims that the mind need not be confined within either the brain or body. Consequently, how one brain or body interacts with other brains and bodies must be explored, together with the problems that may arise out of this interaction. This chapter is not concerned with beliefs and desires as mental states but whether they play a role in controlling behavior. It argues the notion that any course of action (...) considered part of the cognitive process going on inside the brain is still part of the cognitive process no matter where it is being implemented. Divided into two parts, this chapter first establishes some points of reference regarding language and cognition, and then proceeds to an attempt to connect the issues by directly discussing the parity principle. (shrink)

Clark and Chalmers (1998) defend the hypothesis of an ‘Extended Mind’, maintaining that beliefs and other paradigmatic mental states can be implemented outside the central nervous system or body. Aspects of the problem of ‘language acquisition’ are considered in the light of the extended mind hypothesis. Rather than ‘language’ as typically understood, the object of study is something called ‘utterance-activity’, a term of art intended to refer to the full range of kinetic and prosodic features of the on-line behaviour of (...) interacting humans. It is argued that utterance activity is plausibly regarded as jointly controlled by the embodied activity of interacting people, and that it contributes to the control of their behaviour. By means of specific examples it is suggested that this complex joint control facilitates easier learning of at least some features of language. This in turn suggests a striking form of the extended mind, in which infants’ cognitive powers are augmented by those of the people with whom they interact. (shrink)

We trace how cognition arises beyond the skin. Experimental work on insight problem solving is used to examine how external artifacts can be used to reach the goal of assembling a `cheap necklace'. Instead of asking how insight occurs `in the head', our participants in Experiment 1 can either draw solution attempts or manipulate real objects . Even though performance with real chain links is significantly more successful than on paper, access to objects does not make this insight problem simple: (...) objects themselves do not shape cognition. This challenges extended mind views. While failure often results from the inappropriate application of hill-climbing, material artifacts can trigger solutions. In Experiment 2, we used `open link' conditions of the concretized problem to prompt participants to act . Solutions arrived via insight, serendipity, or trial-and-error. By investigating how objects are used, we show that they do more than supplement neural events. Rather, participants monitor and anticipate the effects of action within an organism-environment system. By analogy, language too draws on experience of monitoring real-time effects as bodily dynamics play out in a normative and cultural world. In engaging with public language, it is likely that verbal patterns function by constraining anticipatory cognitive processes. (shrink)

We trace how cognition arises beyond the skin. Experimental work on insight problem solving is used to examine how external artifacts can be used to reach the goal of assembling a ‘cheap necklace’. Instead of asking how insight occurs ‘in the head’, our participants in Experiment 1 can either draw solution attempts or manipulate real objects. Even though performance with real chain links is significantly more successful than on paper, access to objects does not make this insight problem simple: objects (...) themselves do not shape cognition. This challenges extended mind views. While failure often results from the inappropriate application of hill-climbing, material artifacts can trigger solutions. In Experiment 2, we used ‘open link’ conditions of the concretized problem to prompt participants to act. Solutions arrived via insight, serendipity, or trial-and-error. By investigating how objects are used, we show that they do more than supplement neural events. Rather, participants monitor and anticipate the effects of action within an organism-environment system. By analogy, language too draws on experience of monitoring real-time effects as bodily dynamics play out in a normative and cultural world. In engaging with public language, it is likely that verbal patterns function by constraining anticipatory cognitive processes. (shrink)

Neuroscience offers more than new empirical evidence about the details of cognitive functions such as language, perception and action. Since it also shows many functions to be highly distributed, interconnected and dependent on mechanisms at different levels of processing, it challenges concepts that are traditionally used to describe these functions. The question is how to accommodate these concepts to the recent evidence. A recent proposal, made in Philosophical Foundations of Neuroscience (2003) by Bennett and Hacker, is that concepts play a (...) foundational role in neuroscience, that empirical research needs to presuppose them and that changing concepts is a philosophical task. In defending this perspective, PFN shows much neuroscientific writing to be dualistic in nature due to our poor grasp of its foundations. In our review article we take a different approach. Instead of foundationalism we plead for a mild coherentism, which allows for a gradual and continuous alteration of concepts in light of new evidence. Following this approach it is also easier to deal with some neurological conditions (like blindsight, synaesthesia) that pose difficulties for our concepts. Finally, although words and concepts seem to seduce us to thinking that many skills and tasks function separately, it is language skill that – as neuroscientific evidence shows – co-emerges with action/perception cycles and thus seems to require revision of some of our central concepts. (shrink)

Advanced technologies such as drones, intelligent algorithms and androids have grave implications for human existence. With the purpose of exploring their basis for doing so, the paper proposes a framework for investigating the complex relationship between such devices and human practices and language-mediated cognition. Specifically, it centers on the importance of the typically neglected intermediate layer of culture which not only drives both technophobia and philia but also, more fundamentally, connects pre-reflective experience and socio-material practices by placing advanced technologies in (...) the loop. Theoretically, the paper draws on contributions from performativist Science and Technology Studies and Radically Embodied Cognitive Science and pushes new grounds by stressing their compatibility. Yet, it also emphasizes the importance of the enlanguaged side of cognition which is a requirement for human-style socio-material practices and, hence, the emergence of cultures that fetishizes certain technologies. (shrink)

In biosemiotics, some oppose the study of sign relations to empirical work on bio-mechanisms. Urging consilience between these views, we show the value of Alain Berthoz’s concept of simplexity. Its heuristic power is to present molecules, cells, organisms and communities as using tricks to self-fabricate by agglomerating ‘simplex’ bio-mechanisms. Their properties enable living systems to self-sustain, adapt and, at best, to thrive. But simplexity also empowers agents to engage with their surroundings in novel ways. Life thus not only generates know-how (...) but also social organisation. With languaging, people can act and inhibit: they can also simplexify. As a result, we can see a fruit as ripe, feel when things are awry or behave in ways likely to be judged to be apt. While all living beings make situated use of the historical and the local, humans also bind these with the use of both practices and artifacts. As a result, brains come to emulate what occurs in-between persons and their surroundings. In pursuing the basis for our powers, we focus on inhibition. This simplex trick enables a plant to use dormancy, a bird to learn, and a person to mesh languaging with other aspects of action/perception. Indeed, inhibition enriches human style phenomenology as impersonal resources are used to expand our epistemic horizons. Experience links a self-fabricating body, ancient bio-mechanisms, community-based concerns and epigenetically derived know-how. (shrink)

In their response to our article (Keestra and Cowley, 2009), Hacker and Bennett charge us with failing to understand the project of their book Philosophical Foundations of Neuroscience (PFN; Bennett and Hacker, 2003) and do this by discussing foundationalism, linguistic conservatism and the passivity of perception. In this rebuttal we explore disagreements that explain the alleged errors. First, we reiterate our substantial disagreement with Bennett and Hacker (B&H) regarding their assumption that, even regarding much debated concepts like ‘consciousness’, we (...) can assume conceptual consensus within a community of competent speakers. Instead, we emphasize variability and divergence between individuals and groups in such contexts. Second, we plead for modesty in conceptual analysis, including the use of conceptual ambiguities as heuristics for the investigation of explanatory mechanisms. Third, we elucidate our proposal by discussing the interdependence of perception and action, which in some cases appear to be problematic for PFN. Fourth, we discuss why our view of conceptual innovation is different from B&H’s, as we plead for linking explanatory ingredients with conceptual analysis. We end by repeating our particular agreement with their mereological principle, even though we present different reasons: psychological concepts should not be applied to mere components or operations of explanatory mechanisms, for which another vocabulary should be developed. (shrink)

In a recent Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious (...) objection in publicly-funded healthcare systems, at least in the area of abortion and end-of-life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access. (shrink)

There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they (...) argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism. (shrink)

Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’). Does the duty to refer morally undermine the professional's conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by (...) a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted—I will take both as given. I defend the objecting GP's duty to refer against those I call the ‘conscience absolutists’, who would claim that if a state is serious enough in permitting the GP's objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion. (shrink)

ABSTRACT In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice (...) of conscientious objection in publicly‐funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end‐of‐life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access. (shrink)

In a recent issue of Bioethics, Bernard Gesang asks whether a moral philosopher possesses greater moral expertise than a non-philosopher, and his answer is a qualified yes, based not so much on his infallible access to the truth, but on the quality of his theoretically-informed moral justifications. I reject Gesang's claim that there is such a thing as moral expertise, although the moral philosopher may well make a valid contribution to the ethics committee as a concerned and educated citizen. I (...) suggest that wisdom is a lot more interesting to examine than moral expertise. Again, however, moral philosophers have no monopoly on wisdom, and the study of philosophy may even impede its cultivation. (shrink)

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been (...) undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future. (shrink)

Language is coordination. Pursuing this, the present Special Issue of Pragmatics & Cognition challenges two widely held positions. First, the papers reject the claim that language is essentially ‘symbolic’. Second, they deny that minds represent verbal patterns. Rather, language is social, individual, and contributes the feeling of thinking. Simply, it is distributed. Elucidating this claim, the opening papers report empirically-based work on the anticipatory dynamics of reading, their cognitive consequences, Shakespearean theatre, what images evoke, and insight problem-solving. Having given reasons (...) for rejecting linguistic autonomy, the papers turn to theory building. Initially, attention is given to a possible origin for semiotic cognition. Then, it is claimed that language functions by realizing values. Next, it is argued that human dynamics are co-regulated by cultural and biological symbols. Finally, in a review article, the distributed view of language is used to contrast Clark’s organism-centered cognition with what is here called ecologically extended cognition. (shrink)

Temporality underpins how living systems coordinate and function. Unlike measures that use mathematical conventions, lived temporalities grant functional cohesion to organisms-in-the-world. In foxtail grasses, for example, self-maintenance meshes endogenous processes with exogenous rhythms. In embrained animals, temporalities can contribute to learning. And cowbirds coordinate in a soundscape that includes conspecifics: social learning allows them to connect copulating with past events such that females exert ‘long-distance’ control over male singing. Using Howard Pattee’s work, we compare the foxtail’s self-maintenance, gender-based cowbird learning (...) and how humans manage multi-scalar activity. We argue that, while all living things coordinate, temporal ranging is typical of vertebrates. As primates, humans too use temporal ranging – they can draw on social learning, anticipate winter and manage coordinated action. However language behaviour grants new control over the scales of time. People connect the impersonal to lived experience in narratives, as they draw on autobiography and enact cultural practices. Humans become singular individuals who use temporal experience to manage affect, relationships, beliefs, fictions, and knowledge. Individual subjectivity permits collaborative and competitive activity based on linking events with quite different histories. As a result, alone of the vertebrates, we claim that humans become time-rangers. (shrink)

Rather than ask if expertise is under threat, this paper uses case studies to show how expertise is enabled. Its appearance can be traced to how the already known evokes sensibility, judging, thinking and languaging. As defined below, it draws on epistemic cycles. Using Secchi and Cowley’s (2021) 3M model, this posits a second cut between the micro and the macro. In the mesosphere, people create temporary domains or what William James (1991) calls ‘little worlds’. Within these corpora popularia, (...) the new is made possible – expertise sets off unimagined outcomes. Thus, many concerns cannot be solved by scientific correlates of a natural ontological attitude: indeed, the truism clarifies many social challenges. We lack social institutions that dedicate expertise to goals like ecosocial justice and life-sustaining relations. Once the necessary expertise is traced to epistemic cycles, we can demand of institutions that they create bodies that seek to bring a rich future to evolution. (shrink)

Taking a distributed view of language, this paper naturalizes symbol grounding. Learning to talk is traced to — not categorizing speech sounds — but events that shape the rise of human-style autonomy. On the extended symbol hypothesis, this happens as babies integrate micro-activity with slow and deliberate adult action. As they discover social norms, intrinsic motive formation enables them to reshape co-action. Because infants link affect to contingencies, dyads develop norm-referenced routines. Over time, infant doings become analysis amenable. The caregiver (...) of a nine-month-old may, for example, prompt the baby to fetch objects. Once she concludes that the baby uses ‘words’ to understand what she says, the infant can use this belief in orienting to more abstract contingencies. New cognitive powers will develop as the baby learns to act in ways that are consistent with a caregiver’s false belief that her baby uses ‘words.’. (shrink)

The big issues of medical ethics are more in the news than ever before. And yet they remain as stubborn and often as incendiary as ever. This book claims that in an effort to deal with the issues, mainstream philosophers have arbitrarily omitted many ethically relevant features in order to reduce the central problems to more tractable technical puzzles. The most gratuitous omissions have been the patient's point of view on the problem; the patient's ordinary life, which provides the wider (...) context for his point of view; and the ordinary language and concepts by which the patient tries to make sense of the problem. (shrink)

Richard Brandt, following Hume, famously argued that suicide could be rational. In this he was going against a common ‘absolutist’ view that suicide is irrational almost by definition. Arguments to the effect that suicide is morally permissible or prohibited tend to follow from one’s position on this first issue of rationality. I want to argue that the concept of rationality is not appropriately ascribed – or withheld – to the victim or the act or the desire to commit the act. (...) To support this, I explore how the concept is ascribed and withheld in ordinary situations, and show that it is essentially future-oriented. Since the suicide victim has no future, it makes no sense to call his act rational or irrational. The more appropriate reaction to a declared desire for suicide, or to the news of a successful suicide, is horror and pity, and these are absent from Brandt’s account, as is a humble acknowledgement of the profound mystery at the heart of any suicide. (shrink)

In a recent thought-provoking piece, Peter Roberts argues against the central role of happiness as a guiding concept in education, and argues for more attention to be paid to despair. This does not mean cultivating despair in young people, but allowing them to make sense of their own natural occasional despair, as well as the despair of others. I agree with Roberts about happiness, and about the need for more attention to despair, but I argue that focusing too much on (...) despair is dangerous without paying simultaneous attention to goodness. Roberts argues that students must be helped to face the despair born of the realisation that we can never be sure of the moral grounds on which our actions are based, we can never fully know ourselves, and that education should make us more appreciative of what we don't know. I argue against all three claims: there are some moral truths that we can know; we can know enough of ourselves in certain contexts; education should not only teach intellectual humility, it should also give us confidence in appreciating the sources of meaning that are ordinarily available, e.g. personal relationships. The paper concludes with a response to the objection that my position is little more than old-fashioned moralism and conservatism. (shrink)

Charles Griswold’s 2007 book Forgiveness argues that genuine forgiveness of an unexcused, unjustified and unignored offence must be normgoverned and conditional. In the same way that gift-giving is governed by norms of appropriateness, so too is forgiveness; and the appropriateness of forgiving is centrally dependent on the offender’s repentance. In response, I claim that genuine forgiveness must always be elective and unconditional, and therefore genuinely unpredictable, no matter how much – or how little – the offender repents. I consider and (...) reject one defence of unconditional forgiveness, that of Garrard and McNaughton. I then develop my own account, which builds on Bernard Williams’ notion of practical necessity. (shrink)

Background We report a randomised controlled clinical trial of neurofeedback therapy intervention for ADHD/ADD in adults. We focus on internal mechanics of neurofeedback learning, to elucidate the primary role of cortical self-regulation in neurofeedback. We report initial results; more extensive analysis will follow. Methods Trial has two phases: intervention and follow-up. The intervention consisted of neurofeedback treatment, including intake and outtake measurements, using a waiting-list control group. Treatment involved $\sim$40 hour-long sessions 2-5 times per week. Training involved either theta/beta or (...) sensorimotor-rhythm regimes, adapted by adding a novel 'inverse-training' condition to promote self-regulation. Follow-up (ongoing) will consist of self-report and executive function tests. Setting Intake and outtake measurements were conducted at University of Helsinki. Treatment was administered at partner clinic Mental Capital Care, Helsinki. Randomisation We randomly allocated half the sample then adaptively allocated the remainder to minimise baseline differences in prognostic variables. Blinding Waiting-list control design meant trial was not blinded. Participants 54 adult Finnish participants (mean age 36 years; 29 females) were recruited after screening by psychiatric review. 44 had ADHD diagnoses, 10 had ADD. Measurements Symptoms were assessed by computerised attention test (T.O.V.A.) and self-report scales, at intake and outtake. Performance during neurofeedback trials was recorded. Results Participants were recruited and completed intake measurements during summer 2012, before assignment to treatment and control, September 2012. Outtake measurements ran April-August 2013. After dropouts, 23 treatment and 21 waiting-list participants remained for analysis. Initial analysis showed that, compared to waiting-list control, neurofeedback promoted improvement of self-reported ADHD symptoms, but did not show transfer of learning to T.O.V.A. Comprehensive analysis will be reported elsewhere. Trial Registration "Computer Enabled Neuroplasticity Treatment (CENT)", ISRCTN13915109. Partly funded by Finnish science agency TEKES, project #440078. (shrink)

In Kimberly Brownlee’s book, Conscience and Conviction, she argues that Thomas More’s paradigmatic ‘personal objection’ successfully meets the 4 conditions of her ‘Communicative Principle’. In this article I want to challenge Brownlee’s ‘universality’ condition and the ‘dialogical’ condition by focusing on a counter-example of a British GP conscientiously objecting to authorizing an abortion. I argue that such an objection can be morally admirable, even though the GP is not politically active, even though she is not open-minded to the possibility that (...) she might be wrong, and even if she refuses to condemn her non-objecting colleagues. I suggest that this particular counter-example can tell us more general things about the nature of ethical disagreement and ethical incomprehension. (shrink)

This paper asks three inter-related questions, proceeding chronologically through a divorcee’s experience: is it responsible and rational to make an unconditional marital vow in the first place? does divorce break that unconditional marital vow? And the main question: can the divorcee make a second unconditional marital vow in all moral seriousness? To the last question I answer yes. I argue that the divorce process is so disorienting – to use Amy Harbin’s term – as to transform the divorcee and therefore (...) partly release her from the original vow. Arguing this will require a specific understanding of personal identity and change. (shrink)

In a recent thought-provoking piece, Peter Roberts argues against the central role of happiness as a guiding concept in education, and argues for more attention to be paid to despair. This does not mean cultivating despair in young people, but allowing them to make sense of their own natural occasional despair, as well as the despair of others. I agree with Roberts about happiness, and about the need for more attention to despair, but I argue that focusing too much on (...) despair is dangerous without paying simultaneous attention to goodness. Roberts argues that students must be helped to face the despair born of the realisation that we can never be sure of the moral grounds on which our actions are based, we can never fully know ourselves, and that education should make us more appreciative of what we don't know. I argue against all three claims: there are some moral truths that we can know; we can know enough of ourselves in certain contexts; education should not only teach intellectual humility, it should also give us confidence in appreciating the sources of meaning that are ordinarily available, e.g. personal relationships. The paper concludes with a response to the objection that my position is little more than old-fashioned moralism and conservatism. (shrink)

This article is based on a qualitative empirical project about a distinct kinship group who were among the first identified internationally as having a genetic susceptibility to cancer. 50 were invited to participate. 15, who had all accepted testing, were interviewed. They form a unique case study. This study aimed to explore interviewees’ experiences of genetic testing and how these influenced their family relationships. A key finding was that participants framed the decision to be tested as ‘common sense’; the idea (...) of choice around the decision was negated and replaced by a moral imperative to be tested. Those who did not follow ‘common sense’ were judged to be imprudent. Family members who declined testing were discussed negatively by participants. The article addresses what is ethically problematic about how test decliners were discussed and whether these ethical concerns extend to others who are offered genetic testing. Discussions showed that genetic testing was viewed as both an autonomous choice and a responsibility. Yet the apparent conflict between the right to autonomy and the moral imperative of responsibility allowed participants to defend test decliners’ decisions by expressing a preference for or defending choice over responsibility. The ‘right not to know’ seemed an important moral construct to help ethically manage unpopular decisions made by close family who declined testing. In light of this research, the erosion of the ‘right not to know’ in the genomic age could have subtle yet profound consequences for family relationships. (shrink)

How and to what degree are we responsible for our characters, our lives, our misfortunes, our relationships and our children? This question is at the heart of "Moral Responsibility". The book explores accusations and denials of moral responsibility for particular acts, responsibility for character, and the role of luck and fate in ethics. Moral responsibility as the grounds for a retributivist theory of punishment is examined, alongside discussions of forgiveness, parental responsibility, and responsibility before God. The book also discusses collective (...) responsibility, bringing in notions of complicity and membership, and drawing on the seminal contemporary discussion of collective agency and responsibility: the Nuremberg trials. (shrink)

To unzip language from social behaviour one can hypothesise that language-systems are constituted by words and rules or, alternatively, constructions. The systems thus become autonomous and, if linked to individualist psychology, one can posit that each person’s brain operates a language faculty However, such views find little support in neuroscience. Brains self-organize by linking phonetic (and manual) gestures with action-perception. Far from being housed in the skull,language activity links people across time-scales. Not only does articulation give rise to speech but,together (...) with gesture, this is partly anticipatory, uses long term and working memory, and links with both previous interactions and linguistic history. Further, without conscious acting and perceiving, what we call language would be no more than sound or visible pattern. Accordingly,language can be viewed as what Fowler (2010) calls ‘between person public activity.’ As such, it arises as people co-ordinate while using cultural history and circumstances. On this distributed view(see, Cowley, 2007a; 2009), this results in skills with affective, verbal and social resources for doings things together Genotypes build phenotypes as persons or selves (Ross, 2007) arise under biological, linguistic and cultural constraints. As we concert activity, we re-enact the phonetic gestures and visible expression of our fellows. We come to hear phenomenological patterns that can be described as languages and their parts. (shrink)

Most discussions of conscientious objection in healthcare assume that the objection is universal: a doctor objects to all abortions. I want to investigate selective objections, where a doctor objec...

Ronald Dworkin introduced the example of Margo, who was so severely demented that she could not recognise any family or friends, and could not remember anything of her life. At the same time, however, she seemed full of childish delight. Dworkin also imagines that, before her dementia, Margo signed an advance refusal of life-saving treatment. Now severely demented, she develops pneumonia, easy to treat, but lethal if untreated. Dworkin argues that the advance refusal ought to be heeded and Margo be (...) allowed to die of that pneumonia, on the basis that the prior refusal expresses her true wishes. In this paper I want to challenge Dworkin’s understanding of identity and his conclusion about advance refusals, and I develop my argument in two directions. First, I argue that the demented Margo is not some ‘lesser’ version of the ‘true’ Margo, but instead that the present Margo’s wishes should take precedence over those of the past Margo, on the grounds that all of us are entitled to change our minds. Second, I argue for a stronger role for friends and family members in sustaining the demented Margo’s identity through her years of decline. Based on this, I argue for a presumption against the advance refusal, but I allow that in extreme cases, a friend might have the authority to demand that it be heeded. (shrink)