In July 2019, Stella Creasy MP and her team succeeded in attaching an amendment to a largely administrative bill which would require the UK government to liberalise abortion laws in Northern Ireland by 21 October 2019, provided the Northern Ireland government does not resume before that date.1 The amendment succeeded in the Commons, 332 votes to 99 and later, with some adjustments, in the Lords, 182 votes to 37. The Bill received Royal Assent on 24 July 2019. In Northern Ireland, (...) abortion remains a criminal offence punishable by up to life imprisonment in all except exceptional circumstances, that is, where it is ‘necessary to preserve the life of the woman’ or where there is a ‘risk of serious adverse effect which is either long term or permanent’.2 The law makes no provision for women who are pregnant as a result of rape, incest or in the case of fatal fetal abnormality. Because there is a lack of clarity around which circumstances or conditions would have a sufficiently ‘serious and long-term adverse effect’, it has been argued that the law has had a ‘chilling effect’ on service provision.3 As a result, only 13 abortions were performed in Northern Ireland in 2018/2019.4 Instead, more than 1000 women travelled from Northern Ireland to England to access legal abortion services.5 A recent review of the law in Northern Ireland concluded that this situation disadvantages women who cannot afford to or are unable to travel.3 Women are also reportedly purchasing abortifacients unlawfully online, exposing them to the risk of prosecution as well as to risks where the pills are unsafe or lead to complications. Creasey’s amendment requires the Secretary of State for …. (shrink)

The British Medical Association and Royal College of Physicians have published new guidance, endorsed by the General Medical Council, on decision-making about clinically assisted nutrition and hydration and adults who lack capacity to consent. The development of the guidance follows a series of legal cases which has created confusion about the precise circumstances in which an application to the court is required before CANH is withdrawn which has culminated with the decision of the Supreme Court in National Health Service Trust (...) versus Y. 1 This confirmed that there is no requirement to go to court, providing there is agreement as to the patient’s best interests, the provisions of the Mental Capacity Act 2005 have been observed, and the relevant professional guidance has been followed. The new guidance covers all decisions to start, restart, continue, or stop providing CANH in patients who are not imminently dying, in circumstances where CANH is the primary life-sustaining treatment being provided. It goes beyond the category of patients in permanent vegetative state or minimally conscious state who have previously been the subject of court applications, and also covers decisions for patients with neurodegenerative conditions and patients who have suffered a sudden onset brain injury in addition to having multiple comorbidities or general frailty which is likely to impact on life expectancy. It provides a clear statement of doctors’ legal responsibilities, covers the importance of robust best interests’ assessments and sets out the process to be followed for sufficient independent scrutiny of decisions. In light of some of the identified problems with decisions about CANH, a particular focus of the guidance is on the importance of regular best interests’ assessments, and it provides detailed practical guidance about how to approach these. The development of …. (shrink)

In mid-2018, following a survey of lesbian, gay, bisexual and transgender groups, the UK government issued a consultation on the proposed reform of the Gender Recognition Act for England and Wales.1 When it was first introduced in 2004, the GRA was considered innovative, even world-leading legislation.2 The act enables any adult to seek to change their legal gender provided several criteria are met. These include: If the applicant is successful, he or she is issued with a ‘gender recognition certificate’, their (...) birth certificate is changed and ‘for all purposes’ they become, legally, their acquired or affirmed gender. Since 2004, cultural change in relation to gender identity has been rapid. During the government’s preliminary survey, several concerns were raised about the GRA, particularly among those who have changed, or who may be seeking to change, their gender. These included: The government has stated that being trans is not a mental illness—more a fact of human diversity. It points to the World Health Organisation’s revision of the International Classification of Diseases, in which ‘gender incongruence’, another term for gender dysphoria, is no longer classed under ‘mental and behavioural disorders’.3 ### Draft proposals for change The government considers the reform of the GRA …. (shrink)

On 26 February 2019, the Organ Donation Bill completed its passage through the Westminster Parliament, creating the legislative basis to introduce an opt-out system for organ donation in England. The Bill now awaits Royal Assent, following which it is anticipated that the new system will come into effect in spring 2020. In the intervening period, there will be a significant publicity campaign to inform the public about the change in the law and the options open to them, which are to: (...) The family will continue to be consulted and as an additional safeguard, will be able to provide information about any unregistered objections held by the individual before they died. The legislation follows a similar model to that which was introduced in Wales on 1 December 2015. While it is too early to draw firm conclusions from the experience in Wales, the early signs are positive. The latest full-year data show an increase from 61 to 74 deceased donors over the previous 12 months;1 and in the first three-quarters of 2018/2019, there have been 72 deceased donors.2 Given the number of donors is small and subject to natural variation year-on-year, National Health Service Blood and Transplant has been analysing cumulative data to identify …. (shrink)

### Royal College of Physicians adopts neutral position on assisted dying In March 2019, the RCP announced that it would adopt a neutral position on assisted dying, following a survey of its UK fellows and members.1 The College had previously polled members and fellows on what the RCP position should be in 2014, at that time 44.4% of respondents thought the RCP should be opposed to assisted dying; 31% thought it should be neutral or have no position; and 24.6% thought (...) it should be in favour. On the basis of these figures, the College reaffirmed its position opposing assisted dying.2 In announcing the 2019 survey, the College’s Council resolved that they would require a ‘supermajority’ of 60% to adopt a position either supporting or opposing a change in the law; if no such majority was received, the College would move to a position of neutrality. This approach was not without controversy, and a legal challenge to the Council’s decision is pending.3 In response to the question of what the RCP’s position should be, 43.4% thought the RCP should be opposed; 31.6% thought the RCP should be supportive; and 25% thought the RCP should adopt a neutral position. Without a supermajority of 60% either way, the College’s position became one of neutrality.1 ### New Jersey legalises assisted suicide for the terminally ill New Jersey has become the ninth jurisdiction in the USA to legalise physician-assisted suicide after legislation was passed by the State senate in April 2019.4 The Medical Aid in Dying for the Terminally Ill Act will permit terminally ill adults, with 6 months or less to live, to request physician assistance in ending their life. Two doctors must confirm the patient’s diagnosis, prognosis, decision-making capacity and the voluntariness of their request, and if satisfied, can prescribe lethal medication, which the patient must self-administer. …. (shrink)

This is not your psychoanalyst's unconscious.

When people speak, their words never fully encode what they mean, and the context is always compatible with a variety of interpretations. How can comprehension ever be achieved? Wilson and Sperber argue that comprehension is an inference process guided by precise expectations of relevance. What are the relations between the linguistically encoded meanings studied in semantics and the thoughts that humans are capable of entertaining and conveying? How should we analyse literal meaning, approximations, metaphors and ironies? Is the ability (...) to understand speakers' meanings rooted in a more general human ability to understand other minds? How do these abilities interact in evolution and in cognitive development? MEANING AND RELEVANCE sets out to answer these and other questions, enriching and updating relevance theory and exploring its implications for linguistics, philosophy, cognitive science and literary studies. (shrink)

The doctor-patient relationship -- Consent, choice, and refusal : adults with capacity -- Treating adults who lack capacity -- Children and young people -- Confidentiality -- Health records -- Contraception, abortion, and birth -- Assisted reproduction -- Genetics -- Caring for patients at the end of life -- Euthanasia and physician assisted suicide -- Responsibilities after a patient's death -- Prescribing and administering medication -- Research and innovative treatment -- Emergency situations -- Doctors with dual obligations -- Providing treatment and (...) care in detention settings -- Education and training -- Teamwork, referral, delegation, and shared care -- Public health dimensions of medical practice -- Reducing risk, clinical error, and poor performance. (shrink)

This chapter explores how what is dismissed as “trans activism” is often public philosophy. It considers how so‐called “public philosophy” on trans issues often does a substantially worse job of living up to the name. The chapter discusses how the dichotomy between “trans activism” and “public philosophy” provides a pretext for marginalizing trans voices. To draw on Black feminist philosophical thought, lived experience is a criterion for knowledge of the needs of marginalized people. Like other marginalized communities, trans communities have (...) encountered many areas in which hermeneutical liberation is needed. Public philosophy as trans activism is often systemically and systematically ignored or willfully misinterpreted as being biased and motivated by self‐interest, whereas anti‐trans (public) philosophy is seen as asking the important questions. (shrink)

Distinctions in fundamentality between different levels of description are central to the viability of contemporary decoherence-based Everettian quantum mechanics (EQM). This approach to quantum theory characteristically combines a determinate fundamental reality (one universal wave function) with an indeterminate emergent reality (multiple decoherent worlds). In this chapter I explore how the Everettian appeal to fundamentality and emergence can be understood within existing metaphysical frameworks, identify grounding and concept fundamentality as promising theoretical tools, and use them to characterize a system of explanatory (...) levels (with associated laws of nature) for EQM. This Everettian level structure encompasses and extends the ‘classical’ levels structure. The ‘classical’ levels of physics, chemistry, biology, etc. are recovered, but they are emergent in character and potentially variable across Everett worlds. EQM invokes an additional fundamental level, not present in the classical levels picture, and a novel potential role for self-location in interlevel metaphysics. When given a modal realist interpretation, EQM also makes trouble for supervenience-based approaches to levels. (shrink)

In this paper, we examine the scientific, legal, and ethical foundations for inclusion of transgender women athletes in competitive sport, drawing on IOC principles and relevant Court of Arbitration for Sport decisions. We argue that the inclusion of trans athletes in competition commensurate with their legal gender is the most consistent position with these principles of fair and equitable sport. Biological restrictions, such as endogenous testosterone limits, are not consistent with IOC and CAS principles. We explore the implications for recognizing (...) that endogenous testosterone values are a ‘natural physical trait’ and that excluding legally recognized women for high endogenous testosterone values constitutes discrimination on the basis of a natural physical trait. We suggest that the justificatory burden for such prima facie discrimination is unlikely to be met. Thus, in place of a limit on endogenous testosterone for women, we argue that ‘legally recognized gender’ is most fully in line with IOC and CAS principles. (shrink)

At the outset of an ethnographic inquiry, we navigated national and international resources to search for theoretical and practical guidance on obtaining parents and children’s informed consent/assent. While much theoretical guidance debating ethical issues to children’s participation in research was found, a paucity of published papers offering practical guidance on assent processes and/or visual representations of child assent forms and information sheets was discovered. The purpose of this article is to describe our experiences, both theoretically and practically, of negotiating the (...) process of obtaining informed consent and assent with parents and children for a non-therapeutic qualitative research study. We hope this article instigates a platform for others to explicate their experience and contributes to the construction of a coherent body of knowledge which will clearly delineate important elements that must be considered when negotiating children’s agreement to participate in research. (shrink)

This paper argues that we can acknowledge the existence of moral truths and moral progress without being committed to moral realism. Rather than defending this claim through the more familiar route of the attempted analysis of the ontological commitments of moral claims, I show how moral belief change for the better shares certain features with theoretical progress in the natural sciences. Proponents of the better theory are able to convince their peers that it is formally and empirically superior to its (...) rivals, and the better theory may be promoted to the status of the truth. Yet there is no 'decision-procedure' for ethics any more than there is for molecular biology. The betterness of true theories can be grasped through what I term 'undirectional narratives' of progress. And while there are true moral claims and perhaps numerous moral truths yet to be discovered, we should reject currently popular forms of moral realism with bivalence. Some moral claims lend themselves to the construction of fully reversible, bi-directional narratives and are likely neither true nor false. (shrink)

Wilson R. Bachelor was a Tennessee native who moved with his family to Franklin County, Arkansas, in 1870. A country doctor and natural philosopher, Bachelor was impelled to chronicle his life from 1870 to 1902, documenting the family's move to Arkansas, their settling a farm in Franklin County, and Bachelor's medical practice. Bachelor was an avid reader with wide-ranging interests in literature, science, nature, politics, and religion, and he became a self-professed freethinker in the 1870s. He was driven by (...) a concept he called "fiat flux," an awareness of the "rapid flight of time" that motivated him to treat the people around him and the world itself as precious and fleeting. (shrink)

Religion and the Rebel, Colin Wilson's second volume from his internationally acclaimed Outsider Cycle, is a casebook about and for rebels. With inspirational wisdom and engaging clarity, Wilson shows us that the purpose of religion, of our personal relationship with the sacred and the all-pervading mystery of existence, is to expand our consciousness and intensify our sense of life. Wilson heroically claims that the power to create meaning resides in our mental and spiritual discipline. Examining the lives (...) and works of Nietzsche, Kierkegaard, Rilke, Shaw, Pascal, Swedenborg, Rimbaud and Scott Fitzgerald, among others, Wilson explores the main existential questions and shows how these remarkable writers, scientists, philosophers and poets faced their need for transcendence. Like many of us, they were driven by a need to become more than men. Religion and the Rebel is an outstanding and enjoyable book that combines philosophical analysis, historical interest, and religious insight. (shrink)

Restrictive border protection policies directed toward managing the flow of refugees coming into neoliberal democracies (and out of failing nation-states) are a defining feature of contemporary politics. In this book, Verónica Tello analyses how contemporary artists-such as Tania Bruguera, Isaac Julien, Rosemary Laing, Dinh Q. Lé, Dierk Schmidt, Hito Steyerl, Lyndell Brown and Charles Green-negotiate their diverse subject positions while addressing and taking part in the production of images associated with refugee experiences and histories. Tello argues that their practices, which (...) manifest across a range of contexts including Cuba, the United States, Australia and Europe, represent an emergent, global paradigm of contemporary art, 'counter-memorial aesthetics'. Counter-Memorial Aesthetics, Tello argues, is characterized by its conjunction of heterogeneous signifiers and voices of many times and places, generating an experimental, non-teleological approach to the construction of contemporary history, which also takes into account the complex, disorienting spatial affects of globalization. Spanning performance art, experimental 'history painting', aftermath photography and video installation, counter-memorial aesthetics bring to the fore, Tello argues, how contemporary refugee flows and related traumatic events critically challenge and conflict with many existing, tired if not also stubborn notions of national identity, borders, history and memory. Building on the writings of such thinkers as Michel Foucault and Jacques Rancière, this book offers a useful concept of 'counter-memory' for the twenty-first century. It shows how counter-memorial aesthetics is not only central to the nexus of contemporary art and refugee histories but also how it can offer a way of being critically present with many other, often interrelated, global crises in the contemporary era. (shrink)

En este trabajo presentamos el proceso del ordenamiento, catalogación y curaduría de los materiales fotográficos de un antropólogo estadounidense que realizó trabajo de campo en Atlixco, Puebla, México, con indígenas de la etnia nahua en las décadas de 1970 y 1980La metodología utilizada para este trabajo se basó en una propuesta propia de catalogación mínima de materiales fotográficos.Concluimos que la catalogación mínima es adecuada para la interoperabilidad con los estándares internacionales y resulta fácil de aplicar en los contextos universitarios y (...) de archivos locales. (shrink)

This article aims to reconstruct the essential lines of Kant’s theory of meaning as it appears in critical Kantian philosophy. More particularly, an originality of the Kantian theory of meaning is highlighted, namely the distinction that this theory introduces between two modalities of meaning, namely a theoretical modality and a practical, that is to say a moral modality.

I argue that the best explanation of the multiplicity of available frameworks for treating any given philosophical topic is that philosophy currently (though not insuperably) lacks fixed standards; I then go on to identify three barriers to philosophical progress associated with our present epistemic situation. First is that the lack of fixed standards encourages what I call “intra‐disciplinary siloing,” and associated dialectical and argumentative failings; second is that the lack of fixed standards makes room for sociological factors (including elite influence (...) and disciplinary inertia) to be determinative of which philosophical frameworks are embraced; third is that the lack of fixed standards encourages (implicit and/or explicit) bias. I close by offering some suggestions about how to move beyond these barriers, even in the absence of fixed standards. (shrink)

It is commonly thought that that the best system account of lawhood ((Mill (1843), Ramsey (1978)[fp. 1928], Lewis (1973)) makes available a nice explanation for why laws are ‘distinctively appropriate targets of scientific inquiry’ (Hall, 2015). The explanation takes the following general form: laws are especially valuable for agents like us because they efficiently encode a lot of valuable (non-nomic) information in a tractable format. The goal of this paper is to challenge this style of explanation: I argue that the (...) general principle it presupposes is in conflict with our best account of practical rationality. After considering and rejecting a number of proposals for dissolving the tension, I conclude that BSA proponents may need to scale back the explanatory ambitions of their theory; in particular, they may need to give up the hope of non-circular explanations of the value of nomic information. I end by outlining some challenges for the humean world-view that results after this shift. (shrink)

Horgan (1993) proposed that "superdupervenience" - supervenience preserving physicalistic acceptability - is a matter of robust explanation. I argued against him (1999) that (as nearly all physicalist and emergentist accounts reflect) superdupervenience is a matter of Condition on Causal Powers (CCP): every causal power bestowed by the supervenient property is identical with a causal power bestowed by its base property. Here I show that CCP is, as it stands, unsatisfactory,for on the usual understandings of causal power bestowal, it is trivially (...) satisfied or falsified. I offer a revision of CCP which incorporates the evident fact that causal powers are grounded in fundamental forces. (shrink)

Here I compare two accounts of metaphysical indeterminacy (MI): first, the 'meta-level' approach described by Elizabeth Barnes and Ross Cameron in the companion to this paper, on which every state of affairs (SOA) is itself precise/determinate, and MI is a matter of its being indeterminate which determinate SOA obtains; second, my preferred 'object-level' determinable-based approach, on which MI is a matter of its being determinate---or just plain true---that an indeterminate SOA obtains, where an indeterminate SOA is one whose constitutive object (...) has a determinable property, but no unique determinate of that determinable. In S1, I first note an important difference between our accounts, concerning whether MI is taken to induce propositional indeterminacy; in S2, I highlight and defend certain advantages of my account; in S3, I address certain of Barnes and Cameron's objections to my account. (shrink)

Un invito a vedere nella vita e nelle opere di don Sturzo delle risposte alle difficoltà del mondo attuale, approfondendo le ragioni di un impegno cristiano per il recupero della dimensione etica dell’economia, della politica e delle istituzioni.

Is there a need for a distinctively diachronic conception of metaphysical emergence? Here I argue to the contrary. In the main, my strategy consists in considering a representative sample of accounts of purportedly diachronic metaphysical emergence, and arguing that in each case, the purportedly diachronic emergence at issue either can (and should) be subsumed under a broadly synchronic account of metaphysical emergence, or else is better seen as simply a case of causation. In addition, I consider and argue against the (...) suggestion that 'in-principle unpredictability' accounts of diachronic emergence support there being distinctively diachronic metaphysical emergence. (shrink)

Background:Ethical competence in nursing practice helps clinical nurses to think critically, analyse issues, make ethical decisions, solve ethical problems and behave ethically in their daily work. Thus, ethical competence contributes to the promotion of high-quality care. However, studies on ethical competence in Malawi are scanty.Objectives:The aim of this study was to explore ethical competence among clinical nurses in selected hospitals in Malawi.Methodology:A cross-sectional survey was conducted in four selected hospitals in Malawi with a sample of 271 clinical nurses. Data were (...) collected using self-administered questionnaires, which included a Moral Competence Scale for Home Care Nurses. Descriptive statistics and logistic regression were computed for the dataset using STATA version 12.0.Ethical consideration:The study protocol complied with all ethical requirements and was approved by the College of Medicine Research Ethics Committee under the University of Malawi.Results:The clinical nurses in Malawi are ethically competent. However, there is a significantly high number (p 0.05). Three determinants of high ethical competence level (strong will, judgement skills and recognition of discrepancy of intention) were identified through a reduced model after stepwise logistic regression analysis. Furthermore, results show that indicators of ethical competence include caring, confidentiality and observance of nurses dressing code. The study has also confirmed that the Moral Competence Scale for Home Care Nurses is a reliable tool to assess ethical competence in low-resource settings.Conclusion:The majority of nurses who completed the survey had low ethical competence. However, clinical nurses with high ethical competence level are required to competently manage complex ethical challenges in health facilities. Strategies for enhancing ethical competence such as continuing ethics education, establishment of ethics committees and provision of supportive supervision are recommended to enable nurses in Malawi attain a high level of ethical competence. (shrink)

It’s relatively easy to say that the debates about whether trans and intersex women athletes deserve full and equal inclusion in women’s sport is a contentious contemporary issue. I’ve already argued for the legal, ethical, and scientific basis for full and equal inclusion of trans and intersex women in women’s sport. In this paper, I want to analyze what I take to be a representative selection of recent arguments against full and equal inclusion of trans and intersex women in women’s (...) sport. In short, these arguments tend to be based on mere assumption, unsupported “common sense,” straw arguments, fallacious question begging, and a number of hypotheticals and unsupported counterfactuals rather than established fact. Essentially, they’re based on a lot of “ifs.”. (shrink)

Abstract:Brain–computer interfaces (BCIs) can enable communication for persons in severe paralysis including locked-in syndrome (LIS); that is, being unable to move or speak while aware. In cases of complete loss of muscle control, termed “complete locked-in syndrome,” a BCI may be the only viable solution to restore communication. However, a widespread ignorance regarding quality of life in LIS, current BCIs, and their potential as an assistive technology for persons in LIS, needlessly causes a harmful situation for this cohort. In addition (...) to their medical condition, these persons also face social barriers often perceived as more impairing than their physical condition. Through social exclusion, stigmatization, and frequently being underestimated in their abilities, these persons are being locked out in addition to being locked-in. In this article, we (1) show how persons in LIS are being locked out, including how key issues addressed in the existing literature on ethics, LIS, and BCIs for communication, such as autonomy, quality of life, and advance directives, may reinforce these confinements; (2) show how these practices violate the United Nations Convention on the Rights of Persons with Disabilities, and suggest that we have a moral responsibility to prevent and stop this exclusion; and (3) discuss the role of BCIs for communication as one means to this end and suggest that a novel approach to BCI research is necessary to acknowledge the moral responsibility toward the end users and avoid violating the human rights of persons in LIS. (shrink)

This is a comprehensive discussion of determinables, determinates, and their relation ('determination', for short), covering the historical development of these notions, the theoretical options for understanding them, and certain of their contemporary applications.

The introduction of new medical treatments based on invasive technologies has often been surrounded by both hopes and fears. Hope, since a new intervention can create new opportunities either in terms of providing a cure for the disease or impairment at hand; or as alleviation of symptoms. Fear, since an invasive treatment involving implanting a medical device can result in unknown complications such as hardware failure and undesirable medical consequences. However, hopes and fears may also arise due to the cultural (...) embeddedness of technology, where a therapy due to ethical, social, political and religious concerns could be perceived as either a blessing or a threat. While Deep Brain Stimulation (DBS) for treatment resistant depression (TRD) is still in its cradle, it is important to be proactive and try to scrutinize both surfacing hopes and fears. Patients will not benefit if a promising treatment is banned or avoided due to unfounded fears, nor will they benefit if DBS is used without scrutinizing the arguments which call for caution. Hence blind optimism is equally troublesome. We suggest that specificity, both in terms of a detailed account of relevant scientific concerns as well as ethical considerations, could be a way to analyse expressed concerns regarding DBS for TRD. This approach is particularly fruitful when applied to hopes and fears evoked by DBS for TRD, since it can reveal if our comprehension of DBS for TRD suffer from various biases which may remain unnoticed at first glance. We suggest that such biases exist, albeit a further analysis is needed to explore this issue in full. (shrink)

The Making of British Bioethics provides the first in-depth study of how philosophers, lawyers and other 'outsiders' came to play a major role in discussing and helping to regulate issues that used to be left to doctors and scientists. It details how British bioethics emerged thanks to a dynamic interplay between sociopolitical concerns and the aims of specific professional groups and individuals who helped create the demand for outside involvement and transformed themselves into influential 'ethics experts'. Highlighting this interplay helps (...) us appreciate how issues such as embryo research and assisted dying became high-profile 'bioethical' concerns in the late twentieth century, and why different groups now play a critical role in developing regulatory standards and leading public debates. The book draws on a wide range of original sources and will be of interest to historians of medicine and science, general historians and bioethicists. (shrink)

This book examines the relationship between race, religion, and economics within the black church. The book features unheard voices of individuals experiencing economic deprivation and the faith communities who serve as their refuge. Thus, this project examines the economic ethics of black churches in the rural South whose congregants and broader communities have long struggled amidst persistent poverty. Through a case study of communities in Alabama's Black Belt, this book argues that if the economic ethic of the Black Church remains (...) accommodationist, it will continue to become increasingly irrelevant to communities that experience persistent poverty. Despite its historic role in combatting racial oppression and social injustice, the Church has also perpetuated ideologies that uncritically justify unjust social structures. Wilson shows how the Church can shift the conversation and reality of poverty by moving from a legacy of accommodationism and toward a legacy of empoweri ng liberating economic ethics. (shrink)