This paper is a preliminary study focused on the astronomical manuscript Marcianus latinus VIII.31 (2614) and its socio-historical context of use and production, the Venetian colony of Crete in the 15th century. It is a relevant source for the study of scientific interactions in colonial, multilinguistic, and interreligious contexts in the Eastern Mediterranean for at least two reasons: (a) it contains an unpublished translation into Latin of a popular Byzantine handbook on how to use a set of astronomical (...) tables stemming from Islamic sources, namely the so-called Paradosis of the Persian Tables, a work extensively copied and annotated by very significant Byzantine and Jewish scholars active in Constantinople; and (b) it provides evidence of a Byzantine product being the object of exchange in the interactions between Christians and Jews in the Cretan territory under Venetian rule. (shrink)

According to Aristotle, the household was one of the constituent parts of the state. He defined the household in its complete form as consisting of slaves and freemen. Within the household he discerned three primary relationships: those between master and slave, husband and wife, and father and child.

What are the similarities and the differences of icons from the same workshop depicting the same subject? An important portable icon with the representation of the Dormition of the Virgin, hitherto unknown, preserved today in the Art Collection of the University of Göttingen, helps answering this question. The studydeals with the fascinating journey of this icon from Venetian-dominated Crete in the 15th century to Germany of the 18th century. Furthermore, this paper shows that the icon of Göttingen belongs (...) to a group of a numerous icons that they all derive from the same icon-workshop of the renowned Cretan painters Andreas and Nikolaos Ritzos in Candia. Finally, it turned out that this icon was also the inspiration for Cretan painters of the 17th CE such as Emmanuel Lambardos and Viktor. (shrink)

In _ Psychiatry in the Scientific Image, _Dominic Murphy looks at psychiatry from the viewpoint of analytic philosophy of science, considering three issues: how we should conceive of, classify, and explain mental illness. If someone is said to have a mental illness, what about it is mental? What makes it an illness? How might we explain and classify it? A system of psychiatric classification settles these questions by distinguishing the mental illnesses and showing how they stand in relation to one (...) another. This book explores the philosophical issues raised by the project of explaining and classifying mental illness. Murphy argues that the current literature on mental illness -- exemplified by the Diagnostic and Statistical Manual of Mental Disorders -- is an impediment to research; it lacks a coherent concept of the mental and a satisfactory account of disorder, and yields too much authority to commonsense thought about the mind. He argues that the explanation of mental illness should meet the standards of good explanatory practice in the cognitive neurosciences, and that the classification of mental disorders should group symptoms into conditions based on the causal structure of the normal mind. (shrink)

Given its brevity, Plato's Meno covers an astonishingly wide array of topics: politics, education, virtue, definition, philosophical method, mathematics, the nature and acquisition of knowledge and immortality. Its treatment of these, though profound, is tantalisingly short, leaving the reader with many unresolved questions. This book confronts the dialogue's many enigmas and attempts to solve them in a way that is both lucid and sympathetic to Plato's philosophy. Reading the dialogue as a whole, it explains how different arguments are related to (...) one another and how the interplay between characters is connected to the philosophical content of the work. In a new departure, this book's exploration focuses primarily on the content and coherence of the dialogue in its own right and not merely in the context of other dialogues, making it required reading for all students of Plato, be they from the world of classics or philosophy. (shrink)

[David Charles] Aristotle, it appears, sometimes identifies well-being with one activity, sometimes with several, including ethical virtue. I argue that this appearance is misleading. In the Nicomachean Ethics, intellectual contemplation is the central case of human well-being, but is not identical with it. Ethically virtuous activity is included in human well-being because it is an analogue of intellectual contemplation. This structure allows Aristotle to hold that while ethically virtuous activity is valuable in its own right, the best life available for (...) humans is centred around, but not wholly constituted by, intellectual contemplation. /// [Dominic Scott] In Nicomachean Ethics X 7-8, Aristotle distinguishes two kinds of eudaimonia, primary and secondary. The first corresponds to contemplation, the second to activity in accordance with moral virtue and practical reason. My task in this paper is to elucidate this distinction. Like Charles, I interpret it as one between paradigm and derivative cases; unlike him, I explain it in terms of similarity, not analogy. Furthermore, once the underlying nature of the distinction is understood, we can reconcile the claim that paradigm eudaimonia consists just in contemplation with a passage in the first book requiring eudaimonia to involve all intrinsic goods. (shrink)

Dominic Scott compares the Republic and Nicomachean Ethics from a methodological perspective. He argues that Plato and Aristotle distinguish similar levels of argument in the defence of justice, and that they both follow the same approach: Plato because he thinks it will suffice, Aristotle because he thinks there is no need to go beyond it.

Questions about learning and discovery have fascinated philosophers from Plato onwards. Does the mind bring innate resources of its own to the process of learning or does it rely wholly upon experience? Plato was the first philosopher to give an innatist response to this question and in doing so was to provoke the other major philosophers of ancient Greece to give their own rival explanations of learning. This book examines these theories of learning in relation to each other. It presents (...) an entirely different interpretation of the theory of recollection which also changes the way we understand the development of ancient philosophy after Plato. The final section of the book compares ancient theories of learning with the seventeenth-century debate about innate ideas, and finds that the relation between the two periods is far more interesting and complete than is usually supposed. (shrink)

For centuries, philosophers have identified beauty with what brings pleasure. Dominic McIver Lopes challenges this interpretation by offering an entirely new theory of beauty - that beauty engages us in action, in concert with others, in the context of social networks - and sheds light on why aesthetic engagement is crucial for quality of life.

Plato and Aristotle used moral philosophy to influence the way people actually live. Focusing on the Republic and the Nicomachean Ethics, this book examines how far they thought it could succeed in this.

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

There is not one but many ways to picture the world--Australian "x-ray" pictures, cubish collages, Amerindian split-style figures, and pictures in two-point perspective each draw attention to different features of what they represent. Understanding Pictures argues that this diversity is the central fact with which a theory of figurative pictures must reckon. Lopes advances the theory that identifying pictures' subjects is akin to recognizing objects whose appearances have changed over time. He develops a schema for categorizing the different ways pictures (...) represent--the different kinds of meaning they have--and argues that that depiction's epistemic value lies in its representational diversity. He also offers a novel account of the phenomenology of pictorial experience, comparing pictures to visual prostheses like mirrors and binoculars. (shrink)

The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units within many health systems, including the National Health Service in the UK. The experience (...) of Northern Italy—a couple of weeks ahead of the UK, suggests that it will simply not be possible to provide mechanical ventilation to every patient who might need it. When the crunch comes, the unpalatable question facing clinicians is which patient to save. There are some obvious strategies to avoid or reduce the problem—through measures to increase intensive care capacity, and via society-level interventions to reduce the spread of the virus. These are vitally important, but unfortunately they are unlikely to prevent the problem of demand outstripping supply from occurring. What, then, should clinicians do? How should they allocate the scarce resource of intensive care—particularly over the coming weeks as the crisis escalates? There are different values at stake in triage decisions, but at a basic level the key values are those of benefit and …. (shrink)

Images have power - for good or ill. They may challenge us to see things anew and, in widening our experience, profoundly change who we are. The change can be ugly, as with propaganda, or enriching, as with many works of art. Sight and Sensibility explores the impact of images on what we know, how we see, and the moral assessments we make. Dominic Lopes shows how these are part of, not separate from, the aesthetic appeal of images. His book (...) will be essential reading for anyone working in aesthetics and art theory, and for all those intrigued by the power of images to affect our lives. '...tightly focused and carefully argued... an exceptionally interesting contribution to the philosophy of art: it contains subtle, concise, and convincing discussions of a number of difficult concepts and contentious doctrines... lucid and meticulous'. (shrink)

This paper tackles some issues arising from Plato's account of the democratic man in Rep. VIII. One problem is that Plato tends to analyse him in terms of the desires that he fulfils, yet sends out conflicting signals about exactly what kind of desires are at issue. Scholars are divided over whether all of the democrat's desires are appetites. There is, however, strong evidence against seeing him as exclusively appetitive: rather he is someone who satisfies desires from all three parts (...) of his soul, although his rational and spirited desires differ significantly from those of the philosopher or the timocrat. A second problem concerns the question why the democrat ranks so low in Plato's estimation, especially why he is placed beneath the oligarch. My explanation is that Plato presents him as a jumble of desires, someone in whom order and unity have all but disintegrated. In this way he represents a step beyond the merely bipolarised oligarch. The final section of the paper focuses on the democrat's rational part, and asks whether it plays any role in shaping his life as a whole. For the disunity criticism to hold, Plato ought to allow very little global reasoning: if there were a single deliberating reason imposing a life plan upon his life, the fragmentation of life and character discussed earlier would only be superficial. I argue that Plato attributes very little global reasoning to the democrat. Aside from the fact that the text fails to mention such reasoning taking place, Plato's views on the development of character and his use of the state-soul analogy show that the democrat's lifestyle is determined just by the strength of the desires that he happens to feel at any one time. (shrink)

One of the few points of agreement to be found in mainstream responses to the logical and semantic problems generated by vagueness is the view that if any modification of classical logic and semantics is required at all then it will only be such as to admit underdetermined reference and truth-value gaps. Logics of vagueness including many valued logics, fuzzy logics, and supervaluation logics all provide responses in accord with this view. The thought that an adequate response might require the (...) recognition of cases of overdetermination and truth value gluts has few supporters. This imbalance lacks justification. As it happens, Jaskowski's paraconsistent discussive logic-a logic which admits truth value gluts-can be defended by reflecting on similarities between it and the popular supervaluationist analysis of vagueness already in the philosophical literature. A simple dualisation of supervaluation semantics results in a paraconsistent logic of vagueness based on what has been termed subvaluational semantics. (shrink)

Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively (...) weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non-equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time-limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions. (shrink)

End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support (...) agreement. We analyse subjective and objective accounts of moral reasoning: accord is neither necessary nor sufficient for decisions. We propose an alternative norm for decisions – that of ‘professional dissensus’. In the final part of the article we address the role of agreement in end-of-life policy. Such guidelines can ethically be based on dissensus rather than consensus. Disagreement is not always a bad thing. (shrink)

Care of the critically ill newborn includes support for the birth mother/parents with regular updates around the clinical condition of the baby, and involvement in discussions around complex decision-making issues. Discussions around continuation or discontinuation of life-sustaining are challenging even in the most straightforward of cases, but what happens when the birth mother is critically unwell? Such cases can lead to uncertainty around who should assume the parental role for these difficult discussions. In this round table discussion, we explore the (...) ethical, moral and legal uncertainties raised by coincident severe maternal and neonatal illness in the context of surrogacy. (shrink)

Philosophy of psychiatry has boomed in the last few years. We are now seeing a growing literature on the nature of psychiatric explanation, including work that makes contact with longstanding disputes in the philosophy of science as well as more specific work on mental disorders. This paper looks at some recent work on both representing and explaining mental illness. An emerging picture sees explanation of mental disorder as first constructing causal-statistical networks that represent disease pathways as they unfold in time, (...) and then choosing strategies for causal explanation. The epistemic problems in psychiatry are huge, and they arise from the extreme variety in the causes and trajectories of mental disorders across patients. Existing concepts of levels of explanation and mechanism may seem like an obvious epistemic armoury, but they may not fit psychiatry very well, and philosophical theories of psychiatric explanation stress different ways of trying to understand robust patterns amid the individual variation. (shrink)

The belief in innate knowledge has a history almost as long as that of philosophy itself. In our own century it has been propounded in a linguistic context by Chomsky, who sees himself as the heir to a tradition including such philosophers as Descartes, the Cambridge Platonists and Leibniz. But the ancestor of all these is, of course, Plato's theory of recollection or anamnesis. This stands out as unique among all other innatist theses not simply because it was the first, (...) but also because it is in some respects the strangest: Plato proposed not just a theory of innate knowledge, but of forgotten knowledge, and this, of course, goes hand in hand with his interest in the pre-existence of the soul. But my concern here is with another difference that makes Plato's theory unique, though it is not as clear as the previous one: in fact it has been for the most part over-looked by commentators and scholars. I wish to argue that while other theories of innate knowledge or ideas hold that much of what is innate in us is realized automatically and with ease, be it knowledge of moral principles, the idea of cause and effect or linguistic competence, anamnesis is concerned only with the attainment of hard philosophical knowledge, which most of us never reach. (shrink)

In a series of recent works, Ian Hacking has produced a model of social causation in mental illness and begun to sketch in outline how this might be integrated with the medical model of psychiatry. This article elaborates and revises Hacking 's model of social forces, criticizes him for attempting a merely semantic resolution of the tension between the social and the biological, and sketches an alternative approach that builds upon his substantial insights.

Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice.In this paper, I explore Derek Parfit’s arguments that blur the sharp line between harm to self and others. I analyse cases of treatment refusal by capacitous patients and describe (...) different forms of paternalism arising from a reductionist view of personal identity. I outline an Identity Relative Paternalistic Intervention Principle for determining when we should disallow refusal of treatment where the harm will be accrued by a future self, and consider objections including vagueness and non-identity.Identity relative paternalism does not always justify intervention to prevent harm to future selves. However, there is a stronger ethical case for doing so than is often recognised. (shrink)

Predictions of poor prognosis for critically ill patients may become self-fulfilling if life-sustaining treatment or resuscitation is subsequently withheld on the basis of that prediction. This paper outlines the epistemic and normative problems raised by self-fulfilling prophecies (SFPs) in intensive care. Where predictions affect outcome, it can be extremely difficult to ascertain the mortality rate for patients if all treatment were provided. SFPs may lead to an increase in mortality for cohorts of patients predicted to have poor prognosis, they may (...) lead doctors to feel causally responsible for the deaths of their patients, and they may compromise honest communication with patients and families about prognosis. However, I argue that the self-fulfilling prophecy is inevitable when life-sustaining treatment is withheld or withdrawn in the face of uncertainty. SFPs do not necessarily make treatment limitation decisions problematic. To minimize the effects of SFPs, it is essential to carefully collect and appraise evidence about prognosis. Doctors need to be honest with themselves and with patients and their families about uncertainty and the limits of knowledge. (shrink)

In early 2020, a number of countries developed and published intensive care triage guidelines for the pandemic. Several of those guidelines, especially in the UK, encouraged the explicit assessment...

Interpreters of Hume on causation consider that an advantage of the ‘quasi-realist’ reading is that it does not commit him to scepticism or to an error theory about causal reasoning. It is unique to quasi-realism that it maintains this positive epistemic result together with a rejection of metaphysical realism about causation: the quasi-realist supplies an appropriate semantic theory in order to justify the practice of talking ‘as if’ there were causal powers in the world. In this paper, I problematise the (...) quasi-realist reading of Hume on causation by showing how quasi-realism does not speak to inductive scepticism. I also offer evidence that Hume takes inductive scepticism to result from his theory of causation, and that his scepticism is tied to his rejection of metaphysical causal realism. (shrink)

We often ascribe possibility to the scenes that are displayed by mental or nonmental sensory images. The paper presents a novel argument for thinking that we are prima facie justified in ascribing metaphysical possibility to what is displayed by suitable visual images, and it argues that many of our imagery‐based ascriptions of metaphysical possibility are therefore prima facie justified. Some potential objections to the arguments are discussed, and some potential extensions of them, to cover nonvisual forms of imagery and nonmetaphysical (...) forms of possibility, are endorsed. (shrink)

This book offers a bold new approach to the philosophy of art. General theories of art don't work: they can't deal with problem cases. Instead of trying to define art, we should accept that a work of art is nothing but a work in one of the arts. Lopes's buck passing theory works well for the avant garde, illuminating its radical provocations.

While the role, architecture, and use of the port of Candia on Crete have been extensively studied, little is known about the island’s other ports and bays. This article considers key questions to evaluate the role of Fraschia Bay in Venetian Crete’s port system and, by extension, in Venetian shipping activities in the late fifteenth century and mainly during the sixteenth. What kind of shipping activities were carried out in Fraschia Bay - commercial (legitimate and illegitimate) (...) or/and military? What types of ships docked there? And under what circumstances was the bay used, especially compared to the port of Candia? The analysis, based on unpublished archival documents of the Archivio di Stato di Venezia, aims to determine whether the activities carried out in the bay of Fraschia were part of the integrated port system of Candia, or whether Fraschia Bay served only as an occasional substitute. The analysis concludes that Fraschia served a complex purpose in Candia’s port system and as a substitute port at times when Candia was unsuitable, due to weather conditions or construction operations. Moreover, Fraschia Bay’s role went well beyond official mercantile shipping, since it also supported military activities and the movement of contraband. (shrink)

Certain representations are bound in special ways to our sensory capacities; consider, for instance, pictures, sound recordings, and the various forms of mental sensory imagery. What do these representations have in common, and what makes them different from representations of other kinds? Dominic Gregory employs novel ideas on perceptual states and sensory perspectives to explain the special nature of the contents of distinctively sensory representations. The book contains extensive discussions of e.g. perceptual imagination, pictorial representation, and memories.

We observed that despite international declarations on child-rights, outsourced domestic girl-child labour still persists. Raising the question whether outsourced domestic girl-child labour constitutes hermeneutical injustice, we respond affirmatively. Relying on two indigenous victimology-narratives that are newspaper reports, we expose some of the horrors that the victims of outsourced domestic girl-child labour suffer. Comparing these reports with other victimology-narratives of hermeneutical injustice as reported by Miranda Fricker and Hilkje Hänel, we argue that the victims of outsourced domestic girl-child labour suffer a (...) hermeneutical gap and hermeneutical interference; and that the perpetuators of this practice, help to foster what we call ‘hermeneutical obstruction’. We recommend different counteracting measures such as: a radical feminization of educational curricula, which will allow for the introduction of the relevant hermeneutical resources that female children need in making sense of their experiences, into the classrooms and other places of learning; establishing feminist liberation agencies in all schools, religious institutions and hospitals, as ways of increasing the level of awareness about the rights of the girl-child in children and adults; feminizing legislation and legislative processes, to allow for the enactment of laws to protect the rights of the girl-child; and campaigning for a more rigorous enforcement of child-rights laws. (shrink)

This paper is a critical analysis of the concept of mental disorder recently advanced by Jerome Wakefield. Wakefield suggests that mental disorders are most aptly conceived as "harmful dysfunctions" involving two distinct and separable components: the failure of the mechanism in the person to perform a natural function for which the mechanism was designed by natural selection, and a value judgment that the dysfunction is undesirable.

This paper builds a three-part argument in favour of a more transcendentally focused form of ‘postphenomenology’ than is currently practised in philosophy of technology. It does so by problematising two key terms, ‘constitution’ and ‘postphenomenology’, then by arguing in favour of a ‘transcendental empiricist’ approach that draws on the work of Foucault, Derrida, and, in particular, Deleuze. Part one examines ‘constitution’, as it moves from the context of Husserl’s phenomenology to Ihde and Verbeek’s ‘postphenomenology’. I argue that the term tends (...) towards different senses in these contexts, and that this renders its sense more problematic than the work of Ihde and Verbeek makes it appear. Part two examines ‘postphenomenology’. I argue that putatively ‘poststructuralist’ thinkers such as Derrida, Foucault, and Deleuze may be better characterised as ‘postphenomenologists’, and that approaching them in this way may allow better access to their work from a philosophy of technology perspective. Part three argues for a ‘transcendental empiricist’ approach to philosophy of technology. In doing so, it argues for a rewriting of contemporary philosophy of technology’s political constitution: since an ‘empirical turn’ in the 1990s, I argue, philosophy of technology has been too narrowly focused on ‘empirical’ issues of fact, and not focused enough on ‘transcendental’ issues concerning conditions for these facts. (shrink)

The actions of pregnant women can cause harm to their future children. However, even if the possible harm is serious and likely to occur, the law will generally not intervene. A pregnant woman is an autonomous person who is entitled to make her own decisions. A fetus in-utero has no legal right to protection. In striking contrast, the child, if born alive, may sue for injury in-utero; and the child is entitled to be protected by being removed from her parents (...) if necessary for her protection. Indeed, there is a legal obligation for health professionals to report suspected harm, and for authorities to protect the child's wellbeing. We ask whether such contradictory responses are justified. Should the law intervene where a pregnant woman's actions risk serious and preventable fetal injury? The argument for legal intervention to protect a fetus is sometimes linked to the concept of ‘fetal personhood’ and the moral status of the fetus. In this article we will suggest that even if the fetus is not regarded as a separate person, and does not have the legal or moral status of a child, indeed, even if the fetus is regarded as having no legal or moral status, there is an ethical and legal case for intervening to prevent serious harm to a future child. We examine the arguments for and against intervention on behalf of the future child, drawing on the example of excessive maternal alcohol intake. (shrink)

In this paper, I will argue that the NIMH’s new Research Domain of Criteria is a useful test of the philosophical hypothesis of eliminative materialism and demonstrates the superiority of a moderate eliminativism over integrationism, which is a rival philosophical framework for the cognitive sciences. I begin by going over the motivation for RDOC, which rests on the problems with the existing Diagnostic and Statistical Manual of Mental Disorders framework in psychiatry. Then, I introduce the main tenets of RDoC before (...) discussing eliminativism and trying to show what a moderate eliminativism looks like through the example of addiction. I then contrast that approach with intregrationism to the latter’s detriment. I end by wondering whether the broadly political consequences of eliminativism give us non-scientific reasons for resisting it, as it threatens to rob ordinary people of important means of self-description. (shrink)

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste.In this paper we consider and evaluate a range of ways (...) to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation.We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care.Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives. (shrink)

In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness. First, what is the value or disvalue of a short life? Is it in the interests of a child to save her life if she will nevertheless die in infancy or very early childhood? Second, how does profound cognitive impairment affect the balance of positives and negatives in a child’s future life? Third, if the life of (...) a child with life-limiting illness is prolonged, how much suffering will she experience and can any of it be alleviated? Is there a risk that negative experiences for such a child will remain despite the provision of palliative care? We argue that both the subjective and objective components of well-being for children could be greatly reduced if they are anticipated to have a short life that is affected by profound cognitive impairment. This does not mean that their overall well-being will be negative, but rather that there may be a higher risk of negative overall well-being if they are expected to experience pain, discomfort, or distress. Furthermore, we point to some of the practical limitations of therapies aimed at relieving suffering, such that there is a risk that suffering will go partially or completely unrelieved. Taken together, these considerations imply that some life-prolonging treatments are not in the best interests of infants with severe life-limiting illness. (shrink)

Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a misuse of finite (...) health resources. In this paper, we argue in favour of permitting sub-optimal choices on the basis of value pluralism, uncertainty, patient autonomy and responsibility. There are diverse views about how to evaluate treatment options, and patients’ right to self-determination and taking responsibility for their own lives should be respected. We introduce the concept of cost-equivalence, as a way of defining the boundaries of permissible pluralism in publicly-funded healthcare systems. As well as providing the most effective, available treatment for a given condition, publicly-funded healthcare systems should provide reasonable suboptimal medical treatments that are equivalent in cost to the optimal treatment. We identify four forms of cost-equivalence, and assess the implications of CE for decision-making. We evaluate and reject counterarguments to CE. Finally, we assess the relevance of CE for other treatment decisions including requests for potentially superior treatment. (shrink)