Evidence-Based Medicine (EBM) has now been part of the dominant medical paradigm for 15 years, and has been frequently debated and progressively modified. One question about EBM that has not yet been considered systematically, and is now particularly timely, is the question of the novelty, or otherwise, of the principles and practices of EBM. We argue that answering this question, and the related question of whether EBM-type principles and practices are unique to medicine, sheds new light on EBM and has (...) practical implications for those involved in all EBM. This is because one's answer to the question (whether explicit or implicit) affects the amount and type of funding and attention received by EBM, the extent to which EBM, and the generation, judgment and use of evidence more generally, can be appropriated by certain groups and questioned by others, and the extent to which truly unique socio-political developments in evidence, and in medicine more generally, are recognized and harnessed. (shrink)

High-dose chemotherapy and autologous stem cell transplantation is used to treat some advanced malignancies. It is a traumatic procedure, with a high complication rate and significant mortality. ASCT patients and their carers draw on many sources of information as they seek to understand the procedure and its consequences. Some seek information from beyond orthodox medicine. Alternative beliefs and practices may conflict with conventional understanding of the theory and practice of ASCT, and ‘contested understandings’ might interfere with patient adherence to the (...) strict and demanding protocols required for successful ASCT.The present study, conducted in Sydney, Australia, examines narrative-style interviews with 10 sequentially recruited ASCT patients and nine of their carers conducted at the time of transplant and three months later. Transcripts were read for instances of mention of alternative advice, and for instances of contested understanding of information relevant to the transplant.Patients and carer pairs expressed closely concordant views about alternative advice. Five pairs were consulting alternative practitioners. Contested understanding was expressed in four domains—understandings of the transplant itself and its underlying theory, of the relationship between the components of the ‘transplant’, of the nature and role of stem cells, and of beliefs about bodily function and life-style. Contested understandings of the transplant treatment were expressed as predominantly personal interpretations of orthodox informationPatients and carers seemed to recognise that alternative and conventional systems were discordant, yet they were able to separate the two, and adhere to each practice without prejudicing their medical treatment. A single case of late, post-transplant repudiation of Western medicine is discussed to emphasise some of the possible determinants of dissonance when it does occur. (shrink)

Objectives: The aims of this study were to: (1) investigate patients’ views on euthanasia and physician-assisted suicide (PAS), and (2) examine the impact of question wording and patients’ own definitions on their responses. Design: Cross-sectional survey of consecutive patients with cancer. Setting: Newcastle (Australia) Mater Hospital Outpatients Clinic. Participants: Patients over 18 years of age, attending the clinic for follow-up consultation or treatment by a medical oncologist, radiation oncologist or haematologist. Main Outcome Measures: Face-to-face patient interviews were conducted examining attitudes (...) to euthanasia and PAS. Results: 236 patients with cancer (24% participation rate; 87% consent rate) were interviewed. Though the majority of participants supported the idea of euthanasia, patient views varied significantly according to question wording and their own understanding of the definition of euthanasia. Conclusions: Researchers need to be circumspect about framing and interpreting questions about support of ‘euthanasia’, as the term can mean different things to different people, and response may depend upon the specifics of the question asked. (shrink)

Steven Lukes and Alasdair MacIntyre have accused analytical action theory of being motivated by reductionist aims and of ignoring the fact that what is distinctively human about actions is their essentially social character. These reductionist aims are said to 'subvert, the search for the distinctively human. Enterprises that have particularly come under fire are the search for 'basic' actions and attempts to solve problems regarding the 'individuation' of actions. Lukes and MacIntyre are mistaken however, both in their interpretation of the (...) aims which motivate analytical action theory, and in their characterisation of the search for the distinctively human. 'Individuated' or 'basic' actions are not complex social actions reduced down to their 'simplest elements'. They represent attempts to resolve problems which arise prior to the examination of the social character of actions. (shrink)

In what sense are persons equal, such that it is appropriate to treat them as equals? This difficult question has been strangely neglected by political philosophers. A plausible answer can be found by adopting a particular interpretation of the idea of respect. Central to this interpretation is the thought that in order to respect persons we need to treat them as ‘opaque', paying attention only to their outward features as agents. This proposed basis of equality has important implications for the (...) currency of egalitarian justice, ruling out a number of the equalizanda favored by contemporary egalitarians. (shrink)

It is often said that one person or society is `freer' than another, or that people have a right to equal freedom, or that freedom should be increased or even maximized. Such quantitative claims about freedom are of great importance to us, forming an essential part of our political discourse and theorizing. Yet their meaning has been surprisingly neglected by political philosophers until now. Ian Carter provides the first systematic account of the nature and importance of our judgements about (...) degrees of freedom. He begins with an analysis of the normative assumptions behind the claim that individuals are entitled to a measure of freedom, and then goes on to ask whether it is indeed conceptually possible to measure freedom. Adopting a coherentist approach, the author argues for a conception of freedom that not only reflects commonly held intuitions about who is freer than who but is also compatible with a liberal or freedom-based theory of justice. (shrink)

This paper is about the relevance, to the definition of freedom, of values or goods other than freedom. In this respect,its subject matter is not at all new. However, I do believe that new light can be thrown on the nature of this relationship by paying more attention to another relationship – one which exists within the concept of freedom itself. There are two senses in which we can be said to possess freedom. Firstly, there is the sense in which (...) we can be said to be free to do a certain particular thing. Secondly,there is the sense in which we can be said to possess a certain ‘amount’,‘degree’ or ‘quantity’ of freedom, in some overall sense. 1 I believe that most recent accounts of the relationship between freedom and other goods are inconsistent, because they see those other goods as affecting the truth value of claims about freedom in the second sense, but not in the first. (shrink)

How do we know when one person or society is 'freer' than another? Can freedom be measured? Is more freedom better than less? This book provides the first full-length treatment of these fundamental yet neglected issues, throwing new light both on the notion of freedom and on contemporary liberalism.

Capability theorists have suggested different, sometimes incompatible, ways in which their approach takes account of the value of freedom, each of which implies a different kind of normative relation between functionings and capabilities. This paper examines three possible accounts of the normative relation between functionings and capabilities, and the implications of each of these accounts in terms of degrees of paternalism. The way in which capability theorists apparently oscillate between these different accounts is shown to rest on an apparent tension (...) between anti-paternalism and anti-fetishism. The paper then advances a fourth account, which incorporates a concern with the content-independent or ‘non-specific’ value of freedom. Only the fourth account would remove all traces of paternalism from the capability approach. Whatever reasons advocates of the capability approach might have had for rejecting this fourth account, those reasons are not internal to the capability approach itself. (shrink)

Toleration and respect are often thought of as compatible, and indeed complementary, liberal democratic ideals. However, it has sometimes been said that toleration is disrespectful, because it necessarily involves a negative evaluation of the object of toleration. This article shows how toleration and respect are compatible as long as ‘ respect ’ is taken to mean recognition respect, as opposed to appraisal respect. But it also argues that recognition respect itself rules out certain kinds of evaluation of persons, and with (...) these, certain bases for toleration : if recognition respect is really distinct from appraisal respect, and if the fundamental rights assigned to people on the basis of recognition respect are to be equal rights, then recognition respect must itself involve a refusal to evaluate certain basic agential capacities of persons when deliberating about how to treat them. Even where ‘ respect ’ means recognition respect, then, there is some truth both in the thesis that toleration and respect are compatible, and in the thesis that they are incompatible. The different truths in these two theses help to shed light on the nature of toleration considered specifically as a liberal democratic virtue. This point can be illustrated by showing how the foregoing analysis provides a plausible solution to the so-called ‘paradox of the tolerant racist’. (shrink)

The nature of basic equality (what it is that makes us all equals) can have implications not only for the question of the currency of egalitarian justice but also for that of its . The latter question is raised by G. A. Cohen in his critique of John Rawls's theory of justice. In this paper I argue that Rawlsian liberals might provide an answer to Cohen's critique by establishing two distinct kinds of basic equality, thus providing a of basic equality. (...) A first kind of basic equality gains moral relevance in the context of respectful relations between individuals, and establishes egalitarian duties between them. A second kind of basic equality gains moral relevance in the context of respectful relations between the state and individual citizens, and establishes egalitarian duties of the state toward citizens. The strength of Cohen's critique depends, in part, on the fact that Rawls identified only one kind of basic equality while at the same time wishing to defend a dualist account of individual and state duties. (shrink)

According to the ‘starting-gate’ interpretation of equality of opportunity, individuals who enjoy equal starts can legitimately become unequal to the extent that their differences derive from choices for which they can be held responsible. There can be no coercive transfers of resources in favour of individuals who disregarded their own futures, and no limits on the right of an individual to distribute resources intrapersonally. This paper assesses two ways in which advocates of equality of opportunity might depart from the starting-gate (...) interpretation. The first involves limiting the degree to which people are liable to pay the costs of their past choices. The second involves limiting their initial opportunities so as to prevent certain risky or apparently short-sighted choices. The paper compares these alternatives in terms of their compatibility with a particular conception of persons as morally equal and temporally extended. It constructs this conception by combining reductionist premises about personal identity with the premise that our status as equals is based on the fundamental requirement of opacity respect. Two conclusions about equality of opportunity are shown to follow from this conception of persons as morally equal and temporally extended: the first is that an individual’s liability to pay the costs of her past choices does not diminish over time; the second is that the individual’s initial scope of choice, in bringing about intrapersonal distributions between her current and future selves, can nevertheless be permissibly limited. The two conclusions are consistent, and the second allows for departures from starting-gate equality of opportunity. (shrink)

Edited by leading contributors to the literature, Freedom: An Anthology is the most complete anthology on social, political and economic freedom ever compiled. Offers a broad guide to the vast literature on social, political and economic freedom. Contains selections from the best scholarship of recent decades as well as classic writings from Hobbes, Locke, Rousseau and Kant among others. General and sectional introductions help to orient the reader. Compiled and edited by three important contributors to the field.

How is a person's freedom related to his or her preferences? Liberal theorists of negative freedom have generally taken the view that the desire of a person to do or not do something is irrelevant to the question of whether he is free to do it. Supporters of the “pure negative” conception of freedom have advocated this view in its starkest form: they maintain that a person is unfree to Φ if and only if he is prevented from Φ-ing by (...) the conduct or dispositions of some other person. This definition of freedom is value-neutral in the sense that no reference is made to preferences over options or indeed to any other indicators of the values of options, either in the characterization of “Φ-ing” itself or in the characterization of the way in which Φ-ing can be constrained. (shrink)

Peer review of manuscripts for biomedical journals has become a subject of intense ethical debate. One of the most contentious issues is whether or not peer review should be anonymous. This study aimed to generate a rich, empirically-grounded understanding of the values held by journal editors and peer reviewers with a view to informing journal policy. Qualitative methods were used to carry out an inductive analysis of biomedical reviewers’ and editors’ values. Data was derived from in-depth, open-ended interviews with journal (...) editors and peer reviewers. Data was “read for” themes relevant to reviewer anonymisation and interactions among editors, reviewers, and authors. Editors and peer reviewers provided three arguments that would support a more open and interactive peer-review process. First, a number of participants emphasised the importance of not only ensuring the scientific quality of published research but also nurturing their colleagues and supporting their communities. Second, many spoke about the ongoing moral responsibilities that reviewers and editors felt toward authors. Finally, participants spoke at length about their enjoyment of social interactions and of the value of collective, rather than isolated, reasoning processes. Whether or not journal editors decide to allow anonymous review , the values of editors and reviewers need to be seriously addressed in codes of publication ethics, in the management of biomedical journals, and in the establishment of journal policies. (shrink)

This collection of original essays on political and legal theory concentrates on themes dealt with in the work of Felix Oppenheim, including fundamental political and legal concepts and their implications for the scope of morality in politics and international relations. Among the issues addressed are the relationship between empirical and normative definitions of "freedom", "power", and "interests", whether governments are free to act against the national interest, and whether they can ever be morally obliged to do so.

This is an interview by the Erasmus Journal for Philosophy and Economics with Ian Carter. The interview covers Carter's intellectual biography; his extensive writings on the measurement and value of freedom; his reflections on the use of formal methods in philosophical work on freedom and in political philosophy more broadly; his more recent work on basic equality and respect for persons; and, finally, his advice to young scholars.

Addressing the ‘virtue conflation’ problem requires the preservation of intuitive distinctions between virtue types, that is, between intellectual and moral virtues. According to one influential attempt to avoid this problem proposed by Julia Driver, moral virtues produce benefits to others—in particular, they promote the well-being of others—while the intellectual virtues, as such, produce epistemic good for the agent. We show that Driver's demarcation of intellectual virtue, by adverting to the self-/other distinction, leads to a reductio, and ultimately, that the prospects (...) for resolving the virtue conflation problem look dim within an epistemic consequentialist approach to the epistemic right and the epistemic good. (shrink)

:In this essay I attempt to vindicate the “asymmetry thesis,” according to which ownership of one’s own body is intrinsically different from ownership of other objects, and the view that self-ownership, as libertarians normally understand the concept, enjoys a special “fact-insensitive” status as a fundamental right. In particular, I argue in favor of the following claims. First, the right of self-ownership is most plausibly understood as based on the more fundamental notion of respect for persons, where the concept of a (...) person is in turn understood, along the lines set out by P. F. Strawson and P. M. S. Hacker, as referring to an entire biological organism with a certain set of mental and corporeal characteristics. If we restrict our attention to human persons, we can say on this basis that there is a special moral status attaching to the entire human body, and to no more than the human body. Second, self-ownership is not, as critics have sometimes supposed, based on a more fundamental right to equal freedom or autonomy. Criticisms of self-ownership as insufficiently justified on the basis of such rights are therefore off target. Rather, equal freedom and self-ownership are each based directly on the more fundamental notion of respect for persons. For left-libertarians, the asymmetry thesis serves to give priority to self-ownership when delineating a set of original property rights, given that there are many alternative ways of realizing equal freedom not all of which involve fully respecting people’s property rights in themselves. (shrink)

In this paper we steer a course between two views of the value of equality that are usually understood as diametrically opposed to one another: on the one hand, the view that equality has intrinsic value; on the other, the view that equality is a normatively redundant notion. We proceed by analysing the different ways in which the equal possession of certain relevant properties justifies distributive equality. We then present an account of ‘basic equality’ that serves to single out where (...) this equal possession is really doing normative work. Our account departs from some common assumptions about basic equality but is nevertheless plausible in as much as it assigns to that concept a precise and normatively significant role in grounding the non-instrumental value of distributive equality. By showing when, exactly, equality is basic, we are able to explain both what is right and what is wrong in each of the two opposed views of the value of equality. The argument proceeds at a fairly high level of abstraction and is therefore applicable to a number of rival egalitarian theories. (shrink)

It is often said that one person or society is 'freer' than another, or that people have a right to equal freedom, or that freedom should be increased or even maximized. Such quantitative claims about freedom are of great importance to us, forming an essential part of our political discourse and theorizing. Yet their meaning has been surprisingly neglected by political philosophers until now.Ian Carter provides the first systematic account of the nature and importance of our judgements about degrees (...) of freedom. He begins with an analysis of the normative assumptions behind the claim that individuals are entitled to a measure of freedom, and then goes on to ask whether it is indeed conceptually possible to measure freedom.Adopting a coherentist approach, the author argues for a conception of freedom that not only reflects commonly held intuitions about who is freer than whom but is also compatible with a liberal or freedom-based theory of justice. (shrink)

This paper is about the relevance, to the definition of freedom, of values or goods other than freedom. In this respect,its subject matter is not at all new. However, I do believe that new light can be thrown on the nature of this relationship by paying more attention to another relationship – one which exists within the concept of freedom itself. There are two senses in which we can be said to possess freedom. Firstly, there is the sense in which (...) we can be said to be free to do a certain particular thing. Secondly,there is the sense in which we can be said to possess a certain ‘amount’,‘degree’ or ‘quantity’ of freedom, in some overall sense.1 I believe that most recent accounts of the relationship between freedom and other goods are inconsistent, because they see those other goods as affecting the truth value of claims about freedom in the second sense, but not in the first. (shrink)

Discussion held in April at a Political Studies Association Roundtable in Manchester, England, on G. A. Cohen’s book If You’re an Egalitarian, How Come You’re So Rich?. --- Michael Otsuka's contribution sub-titled: "Il personale e politico? Il confine tra pubblico e private nella sfera della giustizia distributiva" = "Is the personal political? The boundary between the public and the private in the realm of distributive justice.".

Discussion held in April at a Political Studies Association Roundtable in Manchester, England, on G. A. Cohen’s book If You’re an Egalitarian, How Come You’re So Rich? (Cambridge, Massachusetts: Harvard University Press, 2000). --- Michael Otsuka's contribution sub-titled: "Il personale e politico? Il confine tra pubblico e private nella sfera della giustizia distributiva" = "Is the personal political? The boundary between the public and the private in the realm of distributive justice.".

This collection of original essays on political and legal theory concentrates on themes dealt with in the work of Felix Oppenheim, including fundamental political and legal concepts and their implications for the scope of morality in politics and international relations. Among the issues addressed are the relationship between empirical and normative definitions of "freedom", "power", and "interests", whether governments are free to act against the national interest, and whether they can ever be morally obliged to do so.

In attempting to clarify both the concept of toleration and its role in contemporary society several authors have interpreted it as based on the notion of respect for persons. Persons are due respect as moral agents and as such should be allowed to make their own choices, even if the content of those choices meets with our disapproval. According to a classical understanding of toleration, one can be said to tolerate something if one disapproves of it (this is commonly called (...) the ‘objection component’ of toleration); has the power to interfere with it (the ‘power component’); and yet abstains from interfering in the light of certain overriding reasons (the ‘acceptance component’ or ‘non-interference component’). Respecting people as autonomous and as able to formulate and follow a plan of life, individually or collectively, might well be thought to give us a reason for showing tolerance by supplying a basis for its acceptance component. However, the idea that toleration is an outcome of respect, rather than a distinct and sometimes conflicting notion, is far from uncontroversial. Indeed, the ideal of respect has sometimes been seen as incompatible with the objection component of toleration, which presupposes a negative evaluation and therefore seems to imply the other’s inferiority.The relation between respect and toleration therefore stands in need of further philosophical analysis. The articles in this collection aim to advance that analysis by addressing some of the core philosophical problems affecting the relative normative roles of respect and toleration understood as contemporary liberal democratic ideals. (shrink)

In ‘Bureaucratic respectful equality’, Christopher Nathan puts forward two challenges for the author’s claim that basic equality can be grounded in a form of ‘opacity respect’ appropriately shown b...

While euthanasia and assisted suicide have been the subject of continuing public debate, few studies have examined the attitudes of relevant patient groups. This study systematically reviews the research literature on patients’ attitudes from 1989 to 2003, to i) identify the number of studies, ii) evaluate study methods and measures, and iii) examine prevalence of favourable attitudes. A systematic search was undertaken across five databases. Methods of the 21 studies identified varied considerably. General support for euthanasia and assisted suicide was (...) substantial across patient groups, with lower support for these as a personal option. The cancer / terminally ill / palliative care patient group had the lowest median general support for euthanasia (60% [IQ1=47, IQ3=65]) and assisted suicide (50% [IQ1=38, IQ3=71]), while the general/older/younger patient group had the lowest median personal preference for these (18% [IQ1=14, IQ3=27]). The effect of question context on level of support was unclear, due to the variety and number of contexts used across questions. There is still work that needs to be done in this controversial area before any robust conclusions can be made concerning the attitudes of patients to euthanasia and assisted suicide, and the adoption of a minimum set of standard questions would enhance this work. (shrink)

Vi sono varie forme di impossibilità normativa. Una prima forma si incontra quando un fatto naturale al quale il diritto attribuisce un significato normativo è impossibile. Una seconda consiste nell’impossibilità di un atto o fatto la quale derivi dalla presenza o assenza di una norma. Vi è poi una terza forma di impossibilità normativa che si incontra quando si afferma che da una certa realtà oggetto di normazione derivano necessariamente limiti all’attività di normazione stessa. Di una quarta forma si può (...) parlare quando ci si riferisce a un’impossibilità derivante dalle specifiche relazioni che intercorrono tra norme di un sistema normativo dinamico. Le forme di impossibilità normativa sono indagate, nei contributi raccolti in questo volume, da diverse angolazioni: la filosofia del diritto, la filosofia morale, la logica, la filosofia della conoscenza, la scienza del diritto penale. (shrink)

Throughout the English-speaking world, and in the many other countries where analytic philosophy is studied, Hillel Steiner is esteemed as one of the foremost contemporary political philosophers. This volume is designed as a festschrift for Steiner and as an important collection of philosophical essays in its own right. The editors have assembled a roster of highly distinguished international contributors, all of whom are eager to pay tribute to Steiner by focusing on topics on which he himself has concentrated. Some of (...) the contributors engage directly with Steiner's work, whereas others focus not directly on his writings but instead grapple with issues that have figured prominently therein. Each essay seeks to advance the debates in which Steiner himself has so notably participated. The study concludes with a response by Steiner himself. (shrink)

Background. In some organisations, traumatic events via direct or indirect exposure are routine experiences. A NICE review (2005; updated in December 2018) of Post-Traumatic Stress Disorder (PTSD) management in primary and secondary care did not address early interventions for trauma in emergency response organisations. Aims. This scoping review was designed to identify previous research which evaluated the use of early interventions following exposure to primary or secondary trauma, to report on the effectiveness of early interventions models. Method. A scoping review (...) was conducted to examine early interventions for trauma with staff in roles potentially exposed to trauma including: emergency response, military and humanitarian aid. Relevant data was extracted from included studies and outcomes were assessed using meta-ethnography. Results. Fifty studies of mixed quality met the inclusion criteria for this review. Synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they: are delivered in a manner that respects distinct organisational culture; are supported by organisations and senior management, and; harness existing social cohesion and peer support systems within teams. Conclusions. This review demonstrates that early interventions support emergency responders following exposure to trauma when: tailored to the needs of the population, are supported by the host organisation, and harness existing social cohesion and peer support processes within a team or unit. We identify a number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organisations. (shrink)