If a person is competent to consent to a treatment, is that person necessarily competent to refuse the very same treatment? Risk relativists answer no to this question. If the refusal of a treatment is risky, we may demand a higher level of decision-making capacity to choose this option. The position is known as asymmetry. Risk relativity rests on the possibility of setting variable levels of competence by reference to variable levels of risk. In an excellent 2016 article inJournal of (...) Medical Ethics(JME), Rob Lawlor defends asymmetry of this kind by defending risk relativity, using and developing arguments and approaches found in earlier work such as that of Wilks. He offers what we call the two-scale approach: a scale of risk is to be used to set a standard of competence on a scale of decision-making difficulty. However, can this be done in any rational way? We argue it cannot, and in this sense, and to this extent, risk relativity is a nonsense. (shrink)

In this paper, we outline a framework for understanding the different kinds of knowledge required for medical practice and use this framework to show how scientism undermines aspects of this knowledge. The framework is based on Michael Polanyi’s claim that knowledge is primarily the product of the contemplations and convictions of persons and yet at the same time carries a sense of universality because it grasps at reality. Building on Polanyi’s ideas, we propose that knowledge can be described along two (...) intersecting “dimensions”: the tacit–explicit and the particular–general. These dimensions supersede the familiar “objective−subjective” dichotomy, as they more accurately describe the relationship between medical science and medical practice. Scientism, we argue, excludes tacit and particular knowledge and thereby distorts “clinical reality” and impairs medical practice and medical ethics. (shrink)

This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it from three different kinds of hope, or ‘hopes for’, and then relate these distinctions back to differing (...) accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make. (shrink)

In their article “Three Kinds of Decision-Making Capacity for Refusing Medical Interventions,” Navin et al. (2022) argue that we should recognize two forms of decision-making capacity (DMC) besides...

In this essay I discuss a passage from William Styron’s memoir of his long struggle with chronic severe depression, from the standpoint of a Spinozian understanding of agency and self-worth. In this passage Styron relates how in hearing a piece of music he was abruptly struck by a recollection of “all the joys [his] house had known” and how this brought a realization that it would be wrong for him to kill himself: wrong because it would be an abandonment of (...) those who had shared in those joys and a “desecration” of himself. He tells how this realization led him to admit himself to hospital for treatment and thereby to a slow and difficult recovery. This, I propose, illustrates the Spinozian idea that the value of an individual life is properly understood in terms of that individual’s participation in the actualization of a shared value and that individual agency is empowered by the knowledge of such value. (shrink)

Mental health legislation that requires patients to accept ‘care’ has come under increasing scrutiny, prompted primarily by a human rights ethic. Epistemic issues in mental health have received some attention, however, less attention has been paid to the possible epistemic problems of mental health legislation existing. In this manuscript, we examine the epistemic problems that arise from the presence of such legislation, both for patients without a prior experience of being detained under such legislation and for those with this experience. (...) We also examine how the doctor is legally obligated to compound the epistemic problems by the knowledge they prioritise and the failure to generate new knowledge. Specifically, we describe the problems of testimonial epistemic injustice, epistemic silencing, and epistemic smothering, and address the possible justification provided by epistemic paternalism. We suggest that there is no reasonable epistemic justification for mental health legislation that creates an environment that fundamentally unbalances the doctor–patient relationship. Significant positive reasons to counterbalance this are needed to justify the continuation of such legislation. (shrink)

The issue of apologising to patients harmed by adverse events has been a subject of interest and debate within medicine, politics, and the law since the early 1980s. Although apology serves several important social roles, including recognising the victims of harm, providing an opportunity for redress, and repairing relationships, compelled apologies ring hollow and ultimately undermine these goals. Apologies that stem from external authorities’ edicts rather than an offender’s own self-criticism and moral reflection are inauthentic and contribute to a “moral (...) flabbiness” that stunts the moral development of both individual providers and the medical profession. Following a discussion of a recent case from New Zealand in which a midwife was required to apologise not only to the parents but also to the baby, it is argued that rather than requiring health care providers to apologise, authorities should instead train, foster, and support the capacity of providers to apologise voluntarily. (shrink)

:This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand’s medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the “professionalism” and “professional development” in medical curricula.

In this short response to Gray’s article Capacity and Decision Making we double down on our argument that risk-relativity is a nonsense. Risk relativity is the claim that we should set a higher standard of competence for a person to make a risky choice than to make a safe choice. Gray’s response largely involves calling attention to the complexities, ramifications and multiple value implications of decision-making, but we do not deny any of this. Using the notion of quality of care (...) mentioned by Gray, we construct an argument that might be used to support risk relativity. But it is no more persuasive than the arguments put forward by risk-relativists. (shrink)