Chapter 1 Who this book is for and who it is not for1 There are already too many books offering solutions to the problems of the health service. ...

This article examines the meaning and significance of the concept of constituent power in constitutional thought by showing how it acts as a boundary concept with respect to three types of legal thought: normativism, decisionism and relationalism. The concept can be fully appreciated, it suggests, only by adopting a relationalist method. This relationalist method permits us to deal with the paradoxical aspects of constitutional founding creatively and to grasp how constituent power, as the generative aspect of the political power relationship, (...) works not only at founding moments but also within the dynamics of constitutional development. Relationalism realizes this ambition by exposing the tension between unity and hierarchy in constitutional foundation and the tension between the people-as-one and the people-as-the governed in the course of constitutional development. It contends, contrary to normativist claims, that constituent power remains a central concept of constitutional thought. (shrink)

Editors' introduction to 3rd thematic issue on philosophy of medicine.

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

A collection of brand new and revised essays from eminent scholar of public law, Martin Loughlin, that systematizes his work on political jurisprudence - a school of thought that contends the key to understanding the nature of legal order lies in how political authority is constituted.

The success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness. Philosophical analysis of background assumptions of the current paradigmatic model. While these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that frame (...) our thinking about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency, to supplement the narrative of “the patient”. This narrative is conceptually linked to the developing philosophy of person-centred care. If patients are seen also as “agents” this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients’ motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from “treating” and “battling” diseases and their purported “mechanisms” to understanding complex contributing factors and their interplay. (shrink)

BackgroundThe success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness.MethodsPhilosophical analysis of background assumptions of the current paradigmatic model.ResultsWhile these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that frame our thinking (...) about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency, to supplement the narrative of “the patient”. This narrative is conceptually linked to the developing philosophy of person-centred care.ConclusionsIf patients are seen also as “agents” this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients’ motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from “treating” and “battling” diseases and their purported “mechanisms” to understanding complex contributing factors and their interplay. (shrink)

In the current academic climate, teaching is often seen as secondary to research. Teaching Philosophy seeks to bring teaching philosophy higher on the academic agenda.An international team of contributors, all of whom share the view that philosophy is a subject that can transform students, offers practical guidance and advice for teachers of philosophy. The book suggests ways in which the teaching of philosophy at undergraduate level might be facilitated. Some of the essays place the emphasis on individual self discovery, others (...) focus on the wider political context, many offer practical ideas for enhancing the teaching of philosophy through exercises that engage students in often unconventional ways. The integration of students' views on teaching provides a necessary reminder that teaching is not a one-way process, but a project that will ultimately succeed through cooperation and a shared sense of achievement amongst participants. (shrink)

Moss is right to state that management theory needs to address its epistemological foundations by considering questions in epistemology and the philosophy of science. Whether management theory needs Popper is a more tricky question. It is not clear that all theories should be falsifiable in Popper’s terms. His proposed methodology for social scientific research is inherently conservative and threatens to inhibit intellectual and social progress. But Popper’s philosophical realism and rationalism need to be preserved. Coherentism and associated forms of anti-rationalism (...) (including postmodernism and relativism) threaten to provide a rationale for the worst excesses of management theory. Indeed, the poverty of contemporary management theory is a symptom of a broader intellectual malaise: debate is increasingly characterised by the exchange of persuasive rhetoric, making it difficult to hold those in positions of power accountable for rationally justifying the positions they espouse. (shrink)

Moss is right to state that management theory needs to address its epistemological foundations by considering questions in epistemology and the philosophy of science. Whether management theory needs Popper is a more tricky question. It is not clear that all theories should be falsifiable in Popper’s terms. His proposed methodology for social scientific research is inherently conservative and threatens to inhibit intellectual and social progress. But Popper’s philosophical realism and rationalism need to be preserved. Coherentism and associated forms of anti-rationalism (...) (including postmodernism and relativism) threaten to provide a rationale for the worst excesses of management theory. Indeed, the poverty of contemporary management theory is a symptom of a broader intellectual malaise: debate is increasingly characterised by the exchange of persuasive rhetoric, making it difficult to hold those in positions of power accountable for rationally justifying the positions they espouse. (shrink)

Contributors to the debate on ethical rationing bring with them assumptions about the proper role of moral theories in practical discourse, which seem reasonable, realistic and pragmatic. These assumptions function to define the remit of bioethical discourse and to determine conceptions of proper methodology and causal reasoning in the area. However well intentioned, the desire to be realistic in this sense may lead us to judge the adequacy of a theory precisely with reference to its ability to deliver apparently determinate (...) answers to questions that strike most practitioners and patients as morally arbitrary. By providing ethical solutions that work given the world as it is, work in clinical ethics may serve to endorse or protect from scrutiny the very structures that need to change if real moral progress is to be possible. Such work can help to foster the illusion that fundamentally arbitrary decisions are ‘grounded’ in objective, impartial reasoning, bestowing academic credibility on policies and processes, making it subsequently harder for others to criticise those processes. As theorists, we need to reflect on our political role and how best to foster virtuous, critical practice, if we are to avoid making contributions to the debate that not only do no good, but may even be harmful. A recent debate in this journal illustrates these issues effectively. (shrink)

Different beliefs about the nature and justification of bioethics may reflect different assumptions in moral epistemology. Two alternative views (put forward by David Seedhouse and Michael H Kottow) are analysed and some speculative conclusions formed. The foundational questions raised here are by no means settled and deserve further attention.

This paper provides a commentary on “Vascular amputees: A study in disappointment” and its significance in the development of the disability rights movement, as well as the movements for values-based medicine and person-centred health and social care.

To someone coming fairly fresh to this debate, Sykes’ paper is somewhat shocking. The psychogenic inference seems such an obvious fallacy, yet he shows, with detailed reference to both diagnostic practice and the literature on mental disorders, the extraordinary pervasiveness of its influence, extending even to the systematic ambiguities built into key diagnostic terms. Sykes characterizes the inference in the following terms: “If there is no known physical cause for a symptom or disorder, the cause must be psychological” (2010, 290). (...) He notes the glaring fallacy of mistaking an epistemological point (that a physical cause is not, at present, known) for an ontological one (that no such cause exists) and .. (shrink)

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)