Nurses are encountering an increasing number of ethical dilemmas in clinical practice. Ethics courses for baccalaureate nursing students provide the opportunity for the development of critical thinking skills in order to deal with these effectively. The purpose of this descriptive qualitative study was to describe ethical reasoning in 70 baccalaureate nursing students enrolled in a nursing ethics course. Reflective clinical journals were analyzed as appropriate for qualitative inquiry. The overriding theme emerging from the data was `in the process of becoming', (...) which includes: practicing as a professional, lacking the confidence as a student nurse to take an ethical stand, advocating for patients, being just in the provision of care, identifying the spiritual dimensions of nursing practice, confronting the `real world' of health care, making a commitment to practice with integrity, and caring enough to care. The development of critical thinking and ethical reasoning within the framework of knowing and connecting is essential in nursing education. (shrink)

: In “Hegel’s Phenomenological Method,” Kenley R. Dove maintains that the method of the Phenomenology of Spirit is not dialectical but instead wholly phenomenological. That is, Dove claims that Hegel’s method is purely descriptive. Dove’s interpretation has been highly influential and widely accepted. This article argues that, although there is a phenomenological aspect to Hegel’s method, that aspect itself presupposes a prior dialectical moment. Failure to account for that dialectical moment results in spirit being reduced to substance.

Increased productivity may have negative impacts on farm animal welfare in modern animal production systems. Efficiency gains in production are primarily thought to be due to the intensification of production, and this has been associated with an increased incidence of production diseases, which can negatively impact upon FAW. While there is a considerable body of research into consumer attitudes towards FAW, the extent to which this relates specifically to a reduction in production diseases in intensive systems, and whether the increased (...) incidence of diseases represents a barrier to consumer acceptance of their increased use, requires further investigation. Therefore a systematic review of public attitudes towards FAW was conducted, with a specific focus on production diseases in intensive systems. Four databases were searched to identify relevant studies. A screening process, using a set of pre-determined inclusion criteria, identified 80 studies, with the strength of evidence and uncertainty assessed for each. A thematic analysis led to the identification of 6 overarching themes constructed from 15 subthemes. The results demonstrate that the public are concerned about FAW in modern production systems. Concern varied in relation to age, gender, education and familiarity with farming. Naturalness and humane treatment were central to what was considered good welfare. An evidence gap was highlighted in relation to attitudes towards specific production diseases, with no studies specifically addressing this. However, the prophylactic use of antibiotics was identified as a concern. A number of dissonance strategies were adopted by consumers to enable guilt free meat consumption. (shrink)

Clark reports on a variationist analysis of intervocalic word‐medial /t/ from recorded spontaneous speech monologues. The results provide evidence that tokens are more likely to be realized as voiced if the preceding token was voiced, an effect which is weaker with increased temporal distance between the prime and target.

Dewey emphasizes the perception of “indirect consequences” of transactions as the basis of responsible public identity and organization. These consequences are external; they appear in the scientifically observable world and are susceptible to technical control. But transactions may have indirect affective consequences that are part of a culturally influenced inner reality, pose obstacles to speech and communication, and fund an irresponsible public identity-cum-organization. Rhetorical theory that builds on Dewey's “public” ignores these consequences at considerable cost. This claim is supported by (...) a social psychoanalytic conception of affects and by an interpretive-analysis of public speech-acts that moved from opposition to the largely unauthorized immigration of Latin Americans to Nashville-Davidson County, Tennessee, to reactionary endorsement and legislative passage of an “English-first” ordinance. (shrink)

In “Hegel’s Phenomenological Method,” Kenley R. Dove maintains that the method of the Phenomenology of Spirit is not dialectical but instead wholly phenomenological. That is, Dove claims that Hegel’s method is purely descriptive. Dove’s interpretation has been highly influential and widely accepted. This article argues that, although there is a phenomenological aspect to Hegel’s method, that aspect itself presupposes a prior dialectical moment. Failure to account for that dialectical moment results in spirit being reduced to substance.

Rather than focusing on political and legal debates surrounding attempts to determine if and when genocidal rape has taken place in a particular setting, this essay turns instead to a crucial, yet neglected area of inquiry: the moral significance of genocidal rape, and more specifically, the nature of the harms that constitute the culpable wrongdoing that genocidal rape represents. In contrast to standard philosophical accounts, which tend to employ an individualistic framework, this essay offers a situated understanding of harm that (...) features the importance of interdependence and relationality and that conceptualizes harms as embodied and contextual. The paper ultimately reveals what is distinctive about this particular crime of sexual violence by exploring the logic of genocidal rape: genocidal rape involves the harm of forced self-betrayal unleashed relationally, causing victims as representatives of their group to participate inadvertently in the destruction of that group. (shrink)

BackgroundThe ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines.MethodsIn a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March–June 2015) were randomly allocated to either requested completion of an ARRIVE checklist or current standard practice. Authors, academic editors, and peer reviewers were blinded to group allocation. Trained reviewers performed outcome adjudication (...) in duplicate by assessing manuscripts against an operationalised version of the ARRIVE guidelines that consists 108 items. Our primary outcome was the between-group differences in the proportion of manuscripts meeting all ARRIVE guideline checklist subitems.ResultsWe randomised 1689 manuscripts (control: n = 844, intervention: n = 845), of which 1269 were sent for peer review and 762 (control: n = 340; intervention: n = 332) accepted for publication. No manuscript in either group achieved full compliance with the ARRIVE checklist. Details of animal husbandry (ARRIVE subitem 9b) was the only subitem to show improvements in reporting, with the proportion of compliant manuscripts rising from 52.1 to 74.1% (X2 = 34.0, df = 1, p = 2.1 × 10−7) in the control and intervention groups, respectively.ConclusionsThese results suggest that altering the editorial process to include requests for a completed ARRIVE checklist is not enough to improve compliance with the ARRIVE guidelines. Other approaches, such as more stringent editorial policies or a targeted approach on key quality items, may promote improvements in reporting. (shrink)

At its inception innocent of philosophical or metaphysical designs, the Gaia hypothesis of James Lovelock and Lynn Margulis was soon liberated from the precincts of scientific cultivation to enter into cultural free association. Nonetheless, scientific and scholarly attention and debate have long precipitated a bona fide discourse of Gaia theory. Moreover, intellectually serious extra-scientific figures of Gaia have also been on the rise in the last decade. This essay treats a selection of these newer Gaian figures, specifically, Isabelle Stengers’s (...) Gaia the Intruder and Bruno Latour’s secular Gaia, in relation to Lovelock’s Gaia and Lynn Margulis’s evocations of autopoietic Gaia. When nuanced through second-order systems theory, the discourse of autopoietic Gaia satisfies Stengers’s and Latour’s demands for a non-holistic, heterogeneous yet coherent Gaia concept fit for communicative efficacy in the so-called Anthropocene epoch. (shrink)

Earth, Life & System: Evolution and Ecology on a Gaian Planet explores the multiple themes of Lynn Margulis's science: microbial evolution, ecology and symbiosis, the coupled interactions of environment and life in Gaia theory, and the connections of these newer scientific ideas to cultural and creative productions.

Biologists, historians of biology, and philosophers of biology often ask what is it to be an individual, really. This book does not answer that question. Instead, it answers a much more interesting one: How do biologists individuate individuals? In answering that question, the authors explore why biologists individuate individuals, in what ways, and for what purposes. The cross-disciplinary, dialogical approach to answering metaphysical questions that is pursued in the volume may seem strange to metaphysicians who are not biologically focused, but (...) it is adroitly achieved by the editors. Scott Lidgard (a paleontologist and marine ecologist) and Lynn K. Nyhart (a historian of biology) orchestrate a dialogue among historians of biology, philosophers of biology, and practicing biologists over 10 chapters. These are followed by three reflective commentaries written to frame the different disciplinary perspectives and to highlight the historical, biological, and philosophical themes across the chapters. The result is a volume—in structure and in content—that has much to be generously commended. Biological individuality is a hotly discussed topic, but it is also part of a series of long-standing arguments within both the history and philosophy of biology (HPB) and metaphysics. Notable and fervent debates have centered on evolution and the units of selection, predominantly on Michael T. Ghiselin’s and David L. Hull’s notion of species as individuals, Peter Godfrey-Smith’s Darwinian individuals, and Ellen Clarke’s individuating mechanisms. Lately, it has encompassed non-Darwinian individuals, symbiotic associations like Thomas Pradeu’s immunological individuals, and John Dupré and Maureen A. O’Malley’s metabolic individuals.2 The present volume is curated in a way to introduce the reader to new research in HPB that articulates these debates as well as to introduce and engage in the study of further notions of biological individuality. But its aim is more than an introduction. As the subtitle suggests, it is also intended to give the reader insight into the working together of biologists, historians of biology, and philosophers of biology in figuring out how the notion of biological individuality is instantiated. As such, the problem-centered dialogue that results does more than talk through biological individuality. It shows how the different and often divergent goals of the authors’ disciplines shape not only how they think about individuality but how they communicate this thinking in reciprocal collaboration with others in different disciplines. … cont’d…. (shrink)

In 2017, Bruce Clarke proposed that Gaia, the mythological goddess repurposed in the 1970s by James Lovelock and Lynn Margulis as geobiological trope, and later adapted for twenty-first century environmental discourse by Bruno Latour and Isabelle Stengers, is a vital resource in the cultivation of a “planetary imaginary” which attends to “our systemic entanglements”. Contemporary forms of Gaia discourse, Clarke argues, are “fit for communicative efficacy in the so-called Anthropocene epoch”. In an era marked by scalar and (...) communicative disjunctions, Clarke’s claim is significant. Whilst ultimately he deviates from Stengers and Latour, arguing that neither addresses “the cybernetics of Gaia” and... (shrink)

It is widely agreed that the intelligibility of modal metaphysics has been vindicated. Quine's arguments to the contrary supposedly confused analyticity with metaphysical necessity, and rigid with non-rigid designators.2 But even if modal metaphysics is intelligible, it could be misconceived. It could be that metaphysical necessity is not absolute necessity – the strictest real notion of necessity – and that no proposition of traditional metaphysical interest is necessary in every real sense. If there were nothing otherwise “uniquely metaphysically significant” about (...) metaphysical necessity, then paradigmatic metaphysical necessities would be necessary in one sense of “necessary”, not necessary in another, and that would be it. The question of whether they were necessary simpliciter would be like the question of whether the Parallel Postulate is true simpliciter – understood as a pure mathematical conjecture, rather than as a hypothesis about physical spacetime. In a sense, the latter question has no objective answer. In this article, I argue that paradigmatic questions of modal metaphysics are like the Parallel Postulate question. I then discuss the deflationary ramifications of this argument. I conclude with an alternative conception of the space of possibility. According to this conception, there is no objective boundary between possibility and impossibility. Along the way, I sketch an analogy between modal metaphysics and set theory. (shrink)

Although Aristotle (Metaphysics, Book IV, Chapter 2) was perhaps the first person to consider the part-whole relationship to be a proper subject matter for philosophic inquiry, the Polish logician Stanislow Lesniewski [15] is generally given credit for the first formal treatment of the subject matter in his Mereology.1 Woodger [30] and Tarski [24] made use of a specific adaptation of Lesniewski's work as a basis for a formal theory of physical things and their parts. The term 'calculus of individuals' was (...) introduced by Leonard and Goodman [14] in their presentation of a system very similar to Tarski's adaptation of Lesniewski's Mereology. Contemporaneously with Lesniewski's development of his Mereology, Whitehead [27] and [28] was developing a theory of extensive abstraction based on the two-place predicate, 'x extends over y\ which is the converse of 'x is a part of y\ This system, according to Russell [22], was to have been the fourth volume of their Pήncipia Mathematica, the never-published volume on geometry. Both Lesniewski [15] and Tarski [25] have recognized the similarities between Whitehead's early work and Lesniewski's Mereology. Between the publication of Whitehead's early work and the publication of Process and Reality [29], Theodore de Laguna [7] published a suggestive alternative basis for Whitehead's theory. This led Whitehead, in Process and Reality, to publish a revised form of his theory based on the two-place predicate, 'x is extensionally connected with y\ It is the purpose of this paper to present a calculus of individuals based on this new Whiteheadian primitive predicate. (shrink)

I argue for the usefulness of the evolutionary kind of biological individual.

On the text and translation of the De mysteriis -- Iamblichus the man -- The De mysteriis : a defence of theurgy, and an answer to Porphyry's letter to Anebo -- Iamblichus's knowledge of Egyptian religion and mythology -- The nature and contents of De mysteriis -- Iamblichus, De mysteriis : text and translation.

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

Drawing the line on physician assistance in physician-assisted death continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that (...) can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill. (shrink)

If people sometimes participate in research because of altruism—because they want to help in the search for treatments—should we revise our views about what kinds of experiments are ethical? If participants act out of altruism, we might let them accept greater risks than we would if they are motivated only by a desire for personal gain. But how can we know when participants are genuinely altruistic?

SummaryA sample of 104 British parents with criminal convictions had an average fertility of 3·91 children as compared with 2·21 for the general population. The result suggests that fertility for criminal behaviour is dysgenic involving an increase in the genes underlying criminal behaviour in the population.

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

This book is intended to address key issues in housing policy through the lens of the philosophical concepts that underpin them.

Three scientific societies devoted to the study of reproduction were established in Britain, France and USA in the middle of the twentieth century by clinical, veterinary and agricultural scientists. The principal motivation for their establishment had been the study of sterility and fertility of people and livestock. There was also a wider perspective embracing other biologists interested in reproduction more generally. Knowledge disseminated through the societies’ scientific meetings and publications would bear upon human and animal population problems as well as (...) basic reproductive physiology and its applications. New journals dealing with reproductive physiology, having worldwide appeal, were established in Britain and USA. The financial resources of at least one of the societies and its journal are directed towards charitable functions, including financial support for travel to scientific meetings, for visits to particular laboratories, and for research in the short term, including that of undergraduates. Perhaps the example of the British society has given rise to others having a more specialised focus, as well as to the formation of the European Society for the Study of Human Reproduction and Embryology. (shrink)

In this paper, we defend the ethics of clinical research against the charge of paternalism. We do so not by denying that the ethics of clinical research is paternalistic, but rather by defending the legitimacy of paternalism in this context. Our aim is not to defend any particular set of paternalistic restrictions, but rather to make a general case for the permissibility of paternalistic restrictions in this context. Specifically, we argue that there is no basic liberty-right to participate in clinical (...) research and that considerations of distributive fairness justify some paternalistic protections of research subjects. (shrink)

The allocation of vaccines and therapeutics for Covid‐19 obviously raises ethical questions, and physicians and ethicists have begun to address them. Writers have identified various criteria that should guide allocation decisions, but the criteria often conflict and need to be balanced against one another. This article proposes a model for thinking about how different considerations that are relevant to the distribution of vaccines and scarce treatments for Covid‐19 could be integrated into an allocation procedure. The model employs the construct of (...) a weighted lottery, which is a construct that has been employed in other contexts that involve the distribution of scarce resources. The article highlights the advantages of applying a weighted lottery to the Covid‐19 context and offers an illustration for how it might work in practice. The primary aim of the article is to articulate the structural features of a weighted lottery for this context and to bring out its advantages over other methods for allocating Covid‐19 medications. (shrink)

This paper provides a brief comparative overview of the development of the reproductive sciences especially in agriculture in the UK and the US. It begins with the establishment by F. H. A. Marshall in 1910 of the boundaries that framed the reproductive sciences as distinct from genetics and embryology. It then examines how and where the reproductive sciences were taken up in agricultural research settings, focusing on the differential development of US and UK institutions. The reproductive sciences were also pursued (...) in medical and biological settings, and I discuss how the intersections among all three allowed the circulation of both ideas and scientists’ careers. Across the twentieth century, scientific leadership in the reproductive sciences alternated between the UK and US, and these patterns are elucidated. I conclude with thoughts on future research that might emphasize the elaboration of industrialization processes in agriculture and new capacities to transform both reproductive processes and their products—life itself—as biopower comes to be more ambitiously understood as extending across all species. (shrink)

: "Clinical pragmatism" is an important new method of moral problem solving in clinical practice. This method draws on the pragmatic philosophy of John Dewey and recommends an experimental approach to solving moral problems in clinical practice. Although the method may shed some light on how clinicians and their patients ought to interact when moral problems are at hand, it nonetheless is deficient in a number of respects. Clinical pragmatism fails to explain adequately how moral problems can be solved experimentally, (...) it underestimates the relevance and importance of judgment in clinical ethics, and it presents a questionable account of the role that moral principles should play in moral problem solving. (shrink)

The term “exploitation” has gained wide currency in recent discussions of biomedical and research ethics. This is due in no small measure to the influence of Alan Wertheimer’s path-breaking work on the topic (Wertheimer 1999, 2011). Wertheimer presented a clear and compelling non-Marxist account of the concept of exploitation—one that stressed the connection between exploitation and unfair distributive outcomes. On this account, when one party exploits another, she takes advantage of the other to gain unfairly. A number of contemporary bioethicists (...) have accepted Wertheimer’s account of exploitation and have proceeded to apply it to a range of issues in research ethics (Hawkins and Emanuel 2008; Miller and Brody .. (shrink)

In The Racial Contract, Charles Mills introduces the notion of an ‘inverted epistemology,’ an epistemology that construes social and racial ignorance as knowledge (p.18). As Mills points out, such ignorance can be used to oppress people by creating alternate realities or ‘white mythologies’ about race (p. 19). If the racial contract results in a society that oppresses people of color and supports white supremacy, then the question of how to correct an inverted epistemology becomes critical. Mills proposes the correction of (...) history and the racist thinking underwriting it as a solution to the problem. Others, like Alison Bailey, seek to confront racial ignorance with active resistance by suggesting that individuals from historically marginalized groups exploit what members of dominant society don’t know (p. 77). While Bailey’s solution, referred to as strategic ignorance, may originate from good intentions, I argue that it is in general inappropriate for Indigenous people. Strategic ignorance is a product of the Western worldview, and it privileges Western values. In fact, both solutions offered by Mills and Bailey fail to consider Indigenous values. Mills’ proposed solution, however, is less objectionable. Instead of either solution, a more suitable form of resistance – one that embraces connectedness, balance, and harmony – would be ideal for the Indigenous communities of Turtle Island. (shrink)

Ethical research on human subjects requires that subjects, if they have the capacity to do so, give free and informed consent to participate in the trials in which they are enrolled. This requirement, which is commonly referred to as the principle of informed consent, was prominently endorsed by the authors of the Belmont Report in 1978, and it remains widely accepted today. Yet while the principle of informed consent is by now almost universally accepted, the responsibilities that it imposes on (...) those who conduct research on human subjects is a more contentious matter. New challenges to securing informed consent have emerged since the publication of the Belmont Report, and responding to these challenges requires... (shrink)

Lenin's name has been coupled with that of Marx as the co-founder of the theory of ‘Marxism-Leninism'. However, despite his emphasis on the role of revolutionary theory, Lenin's original theoretical contributions to the development of Marxism were very limited. His talents were those of a determined revolutionary, in the populist tradition of Chernyshevsky, and a brilliantly effective propagandist and political organiser. His contribution to ‘Marxism-Leninism’ was to modify Marxist orthodoxy in such a way as to integrate the political and organisational (...) principles of revolutionary populism into Marxism, on the basis of Plekhanov's ‘dialectical materialism', whose distinctive interpretation of Marxism was Lenin's constant guide and inspiration. In this paper I want to argue that Lenin never broke from the theoretical and political traditions of Russian populism, but completed Plekhanov's project by assimilating Marxism to the very different theoretical framework of populism. (shrink)

: Some commentators have recently proposed that "clinical equipoise," although widely accepted, is not necessary for morally acceptable research on human subjects. If this concept is rejected, however, we may find that trials not in the best medical interests of their subjects--bad deal trials--could be justified. To avoid exploiting participants, we must find a way to distribute the risks fairly, even if it means embracing radical changes in the way clinical research is conducted.

The ethical standards that regulate clinical research have multiple rationales. Among them is the need to protect potential subjects from making imprudent decisions, which extends beyond the soft paternalistic concern to protect people from making uninformed decisions to participate in trials. This article argues that a plausible risk/benefit restriction on clinical trials is presumptively justified by hard paternalism, which in turn is supported by a deeper fairness-based rationale. This presumptive case for hard paternalism in research is not defeated by the (...) alleged right to participate in clinical trials, by concerns about insult or status, by the need to conduct early phase trials that promise little to no benefit to participants, or by the recognition that some potential subjects are altruistically motivated. (shrink)

The movement in bioethics toward disclosure of financial conflicts of interest is well and good, most of the time. But in some cases, disclosure is not only unnecessary but destructive. When bioethicists advance arguments whose premises and logical moves are open to scrutiny, disclosure—far from clearing the air of bias—introduces bias.

Some commentators have recently proposed that “clinical equipoise,” although widely accepted, is not necessary for morally acceptable research on human subjects. If this concept is rejected, however, we may find that trials not in the best medical interests of their subjects—”bad deal trials”—could be justified. To avoid exploiting participants, we must find a way to distribute the risks fairly, even if it means embracing radical changes in the way clinical research is conducted.

Recent historical work on changing perceptions of the human body has been influenced by Michel Foucault’s contention that the self of western individualism was created by new regimes of disciplining the body. A different approach is taken here, one that focuses on how individual bodies came to be viewed as separate and inviolable, that is, as autonomous. The separateness and inviolability of bodies can be traced in the histories of bodily practices as different as portraiture and legal torture. After 1750, (...) regular public exhibitions, themselves a new feature of the social landscape, showed increasing numbers of portraits in London and Paris. The proliferation of individual likenesses encouraged the view that each person was an individual, that is, single, separate, distinctive and original. At the same time, the tide turned against judicially sanctioned torture and cruel punishment. Long-held notions of sacrificial punishment and truth through pain withered under the pressure of new experiences of the body that in turn facilitated the emergence of new conceptions of rights of individuals. (shrink)

ABSTRACT When applying moral principles to concrete cases, we assume a background shared understanding of the boundaries of the persons to whom the principles apply. In most contexts, this assumption is unproblematic. However, in end‐of‐life contexts, when patients are receiving ‘artificial’ life‐support, judgments about where a person's self begins and ends can become controversial. To illustrate this possibility, this paper presents a case in which a decision must be made whether to deactivate a patient's pacemaker as a means to hasten (...) his death. After discussing some common moral principles that are often applied to resolve ethical problems at the end of life and after explaining why they are of no help here, the paper argues that the correct analysis of this case, and of cases of this sort, turns on considerations that relate to the constitution of the self. These considerations, the paper further argues, sometimes resist resolution. The constitution of the self is fixed in large measure by our concepts and social conventions, and these do not always provide determinate grounds for delimiting the boundaries of the self. (shrink)

We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). In almost two-thirds of the cases death occurred with a decision to limit medical treatment or withdraw mechanical ventilation, implying that additional or further therapy was considered futile. We highlight this as a crucially important issue in the practice of intensive care. More comprehensive (...) studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care. (shrink)

In recent years, a number of writers have proposed voluntary stopping of eating and drinking as an alternative to physician-assisted suicide. This paper calls attention to and discusses some of the ethical complications that surround the practice of voluntary stopping of eating and drinking. The paper argues that voluntary stopping of eating and drinking raises very difficult ethical questions. These questions center on the moral responsibility of clinicians who care for the terminally ill as well as the nature and limits (...) of the authority they exercise over them. (shrink)

We are currently in the midst of a revival of interest in thevirtues. A number of contemporary moral philosophers havedefended a virtue-based approach to ethics. But does thisrenewal of interest in the virtues have much to contributeto medical ethics and medical practice? This paper criticallydiscusses this question. It considers and rejects a number ofimportant arguments that purport to establish the significanceof the virtues for medical practice. Against these arguments,the paper seeks to show that while the virtues have a genuinerole to (...) play in medical ethics, it is a limited role, one thatis subordinate to the role that other moral concepts such asrules and principles play. (shrink)

We are currently in the midst of a revival of interest in thevirtues. A number of contemporary moral philosophers havedefended a virtue-based approach to ethics. But does thisrenewal of interest in the virtues have much to contributeto medical ethics and medical practice? This paper criticallydiscusses this question. It considers and rejects a number ofimportant arguments that purport to establish the significanceof the virtues for medical practice. Against these arguments,the paper seeks to show that while the virtues have a genuinerole to (...) play in medical ethics, it is a limited role, one thatis subordinate to the role that other moral concepts such asrules and principles play. (shrink)