After a unilateral focus on medical professional obligations to patients in most of the 20th century, there is a growing, if modest, interest in patient responsibility. This article critiques some public assertions, explores the ethics literature, and attempts to find some consensus and moral grounds for positions taken on the question, "Does a patient have moral obligations in the process of interactions with medical and other professional caregivers?" There is widespread agreement on a few responsibilities, such as "truth telling" and (...) "avoiding harm to others," but no apparent consensus either on the list of duties or on the appropriate justification for such duties. The context and clinical realities of patient interactions are noted to suggest that feasibility is important in making judgments of patient obligations. (shrink)

It is argued that cultural attitudes of a speciesist nature are background to the current practice of animal use in teaching medical students and residents. The scope of this activity is estimated, and educational theory is enlisted to suggest that many assumptions about the effectiveness of the practice are not valid. An assessment of one course used for ob-gyn training is presented. Since it is clear that animal suffering should be avoided when possible, the case is made that alternatives to (...) animals may be used to replace animal use in much of current medical education. Medical educators should routinely question and offer adequate justification for any use of animals in medical education. (shrink)

We are living in an unprecedented era of biomedical revolution. Medicine is remaking humans, and controversy surrounds such topics as abortion, artificial organs, brain circuitry, eugenics, euthanasia, and gene therapy. At the same time, medical advances are posing complex ethical problems for both patients and professionals. The most comprehensive and up-to-date collection of its kind, Case Studies in Biomedical Ethics: Decision-Making, Principles, and Cases explores fundamental ethical questions arising from real situations faced by health professionals, patients, and others. Featuring a (...) wide range of more than 100 case studies drawn from current events, court cases, and physicians' experiences, the book is divided into three parts. Part I presents a basic framework for ethical decision-making in healthcare, covering such issues as separating evaluative questions from questions of fact; distinguishing between ethical and nonethical evaluations; and identifying the source of ethical judgments. Expanding upon this framework, Part II explains the ethical principles: beneficence and nonmaleficence, justice, respect for autonomy, veracity, fidelity, and avoidance of killing. Parts I and II provide students with the background to analyze the ethical dilemmas presented in Part III, which features cases on a broad spectrum of issues including abortion, genetics, mental health, confidentiality, health insurance, experimentation on humans, the right to refuse treatment, and death and dying. Each case is accompanied by the authors' commentary, which guides students in considering the issues. Ideal for undergraduate and graduate courses in biomedical ethics, bioethics, and medical ethics, Case Studies in Biomedical Ethics incorporates opening text boxes in each chapter that cross-reference relevant cases in other chapters. It also includes an appendix of important ethical codes and a glossary of key terms. (shrink)

Si le nombre permet de comparer d’une manière qui est pleinement significative les philosophies transcendantales de Kant et de Husserl, c’est parce qu’il peut faire apparaître à la fois ce qu’elles ont eu en commun dans le relevé des emplacements qu’elles ont attribués aux différents facteurs constitutifs de la subjectivité transcendantale et ce qui les a fait néanmoins diverger l’une de l’autre dans l’établissement du réseau des affinités où elles ont dû aussi les faire entrer en deçà comme au-delà de (...) ce dispositif central. (shrink)

Books Reviewed in this Article: Transforming Bible Study. By Walter Wink. Pp.175, London, SCM Press, 1981, £3.50. Isaiah 1–39. By R.E. Clements. Pp.xvi. 301, London, Marshall, Morgan and Scott, 1980, £3.95. Isaiah 40–66. By R.N. Whybray. Pp.301, London, Marshall, Morgan and Scott, 1975, Reprinted 1981, £3.95. Die Gestalt Jesu in den synoptischen Evangelien. By Heinrich Kahlefeld. Pp.264, Frankfurt, Verlag Josef Knecht, 1981, no price given. Following Jesus: Discipleship in the Gospel of Mark. By Ernest Best. Pp.283, Sheffield, JSOT Press, 1981, (...) £15.00, £5.95. The Origin of Paul's Gospel. By Seyoon Kim. Pp.xii, 391, Tübingen, J.C.B. Mohr, 1981, 78 DM. An die Römer. By Ernst Käsemann. Pp.xvi, 411, Tübingen, J.C.B. Mohr, 1980, 48 DM. Les Récits de Resurrection des Morts dans le Nouveau Testament. By Gerard Rochais. Pp.xv, 252, Cambridge, Cambridge University Press, 1981, £15.00. Prêtres Anciens, Prétre Nouveau selon le Nouveau Testament. By Albert Vanhoye. Pp.366, Paris Editions du Seuil, 1980, no price given. Woman in the World of Jesus. By Evelyn and Frank Stagg. Pp.292, Edinburgh, The St Andrew Press, 1981, no price given. Jesus, Man and the Church. By Karl Rahner. Pp.260, London, Darton Longman & Todd, 1981, £14.50. Jesus Lord and Savior: A Theopathic Christology and Soteriology. By William M. Thompson. Pp.ix, 287, Leominster, Fowler Wright, 1981, £7.45. God and World in Schleiermacher's ‘Dialektik’ and ‘Glaubenslehre’. Criticism and the Methodology of Dogmatics. By John E. Thiel. Pp.xiv, 239, Bern, Frankfurt and Las Vegas, Peter Lang, 1981, SF 49.50. Ministry: A Case for Change. By Edward Schillebeeckx. Pp.ix, 165, London, SCM Press, 1981, £4.95. The Sacraments: Readings in Contemporary Sacramental Theology. Edited by Michael J. Taylor. Pp.274, New York, Alba House, 1981, $7.95. Believing in the Church: The Corporate Nature of Faith. A Report by the Doctrine Commission of the Church of England. Pp.ix, 310, London, SPCK, 1981, £8.50. Confessing the Faith in the Church of England Today. By R.T. Beckwith. Pp.36, Oxford, La timer House, 1981, £1.00. A Kind of Noah's Ark? The Anglican Commitment to Comprehensiveness. By J.I. Packer. Pp.39, Oxford, Latimer House, 1981, £1.00. Reasonable Belief: A Survey of the Christian Faith. By Anthony Hanson and Richard Hanson. Pp.xii, 283, Oxford University Press, 1981, £8.50. Doctrine in the Church of England. The 1938 Report with a new introduction by G.W.H. Lampe. Pp.lx, 242, London, SPCK, 1982, £8.50. The Divine Right of the Papacy in Recent Ecumenical Theology. By J. Michael Miller. Pp.xvi, 322, Rome, Università Gregoriana Editrice, 1980, 18,000 Lire. Der heilige Geist in der Theologie von Heribert Mühlen: Versucheiner Darstellung und Würdigung. By John B. Banawiratma. Pp.ix, 310, Frankfurt and Bern: Peter D. Lang, 1981, SFr. 60.00. Standing Before God: Studies on Prayer in Scriptures and Tradition with Essays in Honor of John M. Oesterreicher. Edited by Asher Frinkel and Lawrence Frizzell. Pp.410, New York, Ktav Publishing House, 1981, $29.50. Judaism and Healing. By J. David Bleich. Pp.xiii, 199, New York, Ktav, 1981, $15.00. The Diversity of Moral Thinking. By Neil Cooper. Pp.x, 303, Oxford, Clarendon Press: Oxford University Press, 1981, £15.00. L'Homme: Sujet ou Objet? By Jacques Croteau. Pp.260, Montreal, Bellarmin: Tournai, Desclée et Cie, 1981, $15.00. The Texture of Knowledge: An Essay on Religion and Science. By James W. Jones. Pp.97, Washington, University Press of America, 1981, no price given. Cosmos and Creator. By Stanley L. Jaki. Pp.xii, 168, Edinburgh, Scottish Academic Press, 1980, £6.75. Dante, Philomythes and Philosopher: Man in the Cosmos. By Patrick Boyde. Pp.vii, 408, Cambridge, Cambridge University Press, 1981, £30.00. Dissidence et Philosophie au Mayen Âge. By E.L. Fortin. Pp.201, Montreal, Bellarmin, 1981, $12.00. The Philosophy of John Norris of Bemerton. By Richard Acworth. Pp.x, 388, Hildesheim, Georg Olms, 1979, 74 DM. Philosophy and Ideology in Hume's Political Thought. By David Miller. Pp.xii, 218, Oxford, Clarendon Press, 1981, £15.00. Hegelianism. By John Edward Toews. Pp.x, 450, Cambridge, Cambridge University Press, 1980, £25.00. One Hundred Years of Thomism. Edited by V.B. Brezik. Pp.210, Houston, Centre for Thomistic Studies, 1981, no price given. Gramsci's Political Thought: Hegemony, Consciousness and the Revolutionary Process. By J.V. Femia. Pp.xiii, 303, Oxford, Clarendon Press, 1981, £17.50. Greek and Roman Slavery. By Thomas Wiedemann. Pp.xvi, 284, London, Croom Helm, 1981, £10.95, £5.95. Prophecy and Millenarianism. Essays in Honour of Marjorie Reeves. Edited by Ann Williams. Pp.x, 355, London, Longman, 1980, £25.00. Of Prelates and Princes: A Study of the Economic and Social Position of the Tudor Episcopate. By Felicity Heal. Pp.xv, 353, Cambridge, Cambridge University Press, 1980, £17.50. Radical Religious Movements in Early Modern Europe. By Michael Mullett. Pp.xxiv, 193, London, George Allen & Unwin, 1980, £10.50. The Jesuits. By J.C.H. Aveling. Pp.390, London, Blond and Briggs, 1981, £16.95. The Beginnings of Ideology. By Donald R. Kelley. Pp.xv, 351, Cambridge, Cambridge University Press, 1981, £24.00. Utopia and the Ideal Society: A Study of English Utopian Writing 1516–1700. By J.C. Davis. Pp.x, 427, Cambridge, Cambridge University Press, 1981, £25.00. Eastern Politics of the Vatican 1917–1979. By Hansjakob Stehle. Pp.466, Athens, Ohio University Press, 1981, £16.20, £8.10. Structuralism or Criticism? By Geoffrey Strickland. Pp.viii, 209, Cambridge, Cambridge University Press, 1981, £17.50. The Call of God: The Theme of Vocation in the Poetry of Donne and Herbert. By Robert B. Shaw. Pp.xiii, 123, Cambridge, Mass., Cowley Publications, 1981, $5.00. John and Charles Wesley: Selected Prayers, Hymns, Journal Notes, Sermons, Letters and Treatises. Edited by Frank Whaling. Pp.xx, 412, London, SPCK, 1981, £8.95. The Trickster in West Africa: A Study of Mythic Irony and Sacred Delight. By Robert D. Pelton. Pp.312, Berkeley, University of California Press, 1980, £15.00. (shrink)

Vegetarians have argued at great length that meat-eating is wrong. Even so, the vast majority of people continue to eat meat, and even most vegetarians eventually give up on their diets. Does this prove these people must be morally corrupt? In Why It’s OK to Eat Meat, Dan C. Shahar argues the answer is no: it’s entirely possible to be an ethical person while continuing to eat meat—and not just the "fancy" offerings from the farmers' market but also the regular (...) meat we find at most supermarkets and restaurants. Shahar’s examination forcefully echoes vegetarians’ concerns about the meat industry’s impacts on animals, workers, the environment, and public health. However, he shows that the most influential ethical arguments for avoiding meat on the basis of these considerations are ultimately unpersuasive. Instead of insisting we all become vegetarians, Shahar argues each of us has broad latitude to choose which of the world’s problems to tackle, in what ways, and to what extents, and hence people can decline to take up this particular form of activism without doing anything wrong. (shrink)

This volume is the translation of a work published originally in English by St Paul’s Publications, Alba House, in 1962 under the title: Karl Barth on God. The Knowledge of the Divine Existence. With a French reading public in mind the author himself made certain modifications in the text itself, and in the introduction presents briefly the different theories concerning the existence of God. The bibliography has been brought up to date. The author approaches the object of his enquiry (...) with what may be called critical understanding. The work may well be regarded as one of the most satisfying on Barthian existential fideism. When treating the question of analogy Matczak has occasion to go into the scholastic and more especially the Thomistic teaching on the matter. With regard to our knowledge of God Thomas ever held that our knowledge of his existence is double. It may either be quasi innate and confused, and that is common to all men; or it may be formal and distinct. And this latter is not common to all men but proper to those ‘qui per Dei auxilium cum magno studio et labore a corporalibus ad spiritualia sublevantur’. With regard, however, to God’s nature St Thomas constantly maintained that, even under the light of faith, we rather know what he is not than what he really is. He even goes further and asserts categorically in this life God remains completely hidden to man, omnino ignotus. These Thomistic insights are missing from M’s study. And it may be submitted that they could be of help in attempting to enter into the Barthian fideist approach to God and his existence. (shrink)

Liberal political theory seeks to enable diverse groups to coexist respectfully despite their differences. According to liberals, this requires embracing certain political institutions and refraining from imposing controversial views on others. The liberal formula has enjoyed considerable success. However, green political theorists insist liberal societies will precipitate an ecological crisis unless they are transformed in line with (controversial) green views. These perspectives highlight a longstanding gap in liberal theory. Liberalism rose to prominence only after Reformation-era Christians accepted that societal success (...) did not require the ascendancy of any particular doctrine. Liberals never had to show how their recommendations could be reconciled with the once-common view that toleration would be catastrophic. Yet today’s greens once again anticipate catastrophe unless they can remake civilization around their doctrines. Liberals must find a way to respond to these concerns if they are to sustain their paradigm amidst environmental conflicts. (shrink)

Personal carbon footprints have become a subject of major concern among those who worry about global climate change. Conventional wisdom holds that individuals have a duty to reduce their impacts on the climate system by restricting their carbon footprints. However, I defend a new argument for thinking that this conventional wisdom is mistaken. Individuals, I argue, have a duty to take actions to combat the world’s problems. But since climate change is only one of a nearly endless list of such (...) problems, individuals’ obligations to take action as activists do not specifically require reductions in personal carbon footprints. Moreover, this is true even in spite of the fact that we are personally implicated in causing climate change. This paper also argues that many of those who decide to combat climate change by reducing their carbon footprints are likely doing more than they can justify in this regard. Although most people are not doing enough to combat world problems, a proper devotion to activism would seek a balance with other life demands that many climate activists currently eschew. (shrink)

Global climate change is one of the most widely discussed problems of our time. However, many libertarian thinkers have not participated in the ethical dimensions of this discussion due to a narrow focus on the scientific basis for concern about climate change. In this paper, I reject this approach and explore the kind of response libertarians should be offering instead. I frame the climate change problem as one which concerns potential rights-infringements and explore different ways in which climate change might (...) be thought to infringe upon rights. I conclude that there are some ways in which climate change might be expected to result in rights-infringements, but that some of the current concern about climate change cannot be reconciled with a rights-oriented paradigm. I close by outlining future directions for research, emphasizing that much remains to be done in order to formulate a complete libertarian perspective on climate change. (shrink)

Libertarians often emphasize courts’ potential to alleviate pollution problems without the need for legislation and regulation. However, this chapter argues courts cannot completely replace these other tools. Because of the historical conditions in which pollution law develops, we should expect courts in industrial societies to initially develop legal standards that deliver limited protection against many common pollution threats. As societies grow wealthier and citizens begin favoring stricter defenses against pollution, courts honoring longstanding precedents will struggle to keep pace with changing (...) priorities. Because legislators and regulators are authorized to create and alter laws deliberately in a way judges are not, they can perform an essential function by updating legal standards amidst changing circumstances. Libertarianism stands the best chance of addressing the challenges pollution creates by allowing each branch of the liberal division of powers to perform its role, not by substituting the judiciary for all other branches. (shrink)

Paul Taylor has argued that all living organisms have equal inherent worth. David Schmidtz objects, insisting that there is little to be gained by talk of “equality” in interspecific contexts. On Schmidtz’s view, ethicists should be satisfied simply to say that all organisms deserve respect, while leaving unspecified how such claims to respect measure up to one another. Yet in this paper, I contend that Schmidtz’s position cannot be sustained in the face of predictable and ongoing conflict between species. When (...) sacrifices of some organisms’ interests and lives are inevitable, it is facile to demand simply that all living things deserve respect. Ethicists must be able to say how such conflicts are to be resolved, which means that they must have something to say about how organisms and their interests compare to one another in their moral significance. Paul Taylor may be wrong to think that such questions should be answered by appeal to the moral equality of all living things, but his mistake lies in thinking that all beings’ natures as “teleological centers of life” captures all that is relevant from a moral point of view. (shrink)

Although libertarianism is often regarded as “weak” on environmental issues, the truth is more complicated. Because of its commitment to defending private property rights, libertarianism actually lends itself to aggressive protections against pollution—to the point where an interpretive challenge arises in establishing how to reconcile it with any pollution at all. To meet this challenge, libertarians must explicate how societies should delimit and allocate rights over the environment and identify who will be responsible for making these determinations. The most ideologically (...) salient libertarian paths to addressing these questions demand heavy lifting from courts in adjudicating conflicting claims. However, there are reasons to doubt that courts would be up to this task. Libertarians might thus be well-advised to embrace a role for government administration in regulating environmental impacts. Although this would depart from the role libertarians have traditionally ascribed to governments, it would align in spirit with familiar libertarian arguments for government provision of policing, courts, and national defense. Libertarianism so understood would resemble more mainstream views on the environment, though with a stricter emphasis on the protection of individual rights. Libertarians thus have fewer deep disagreements with environmentalists than is generally appreciated. To the extent these disagreements exist, they revolve specifically around the use of state coercion to protect the environment for reasons other than defending rights. Although environmentalists generally approve of such coercion, libertarianism opposes it as a matter of principle. Whether this is so much the worse for libertarianism or environmentalism is ultimately for the reader to decide. (shrink)

Kevin Elliott observes that environmental protection efforts often benefit humans, not just because the natural environment is useful, but also because activities that result in environmental protections can also promote a range of other human values. Elliott argues that environmentalists could gain practical advantages by emphasizing these indirect benefits. He also insists that even for environmentalists who believe that nature ought to be protected for its own sake, deploying such arguments would not necessarily pose problems of integrity since more explicitly (...) non-anthropocentric arguments could be employed to complement the ones he favors. In this paper I push back on Elliott’s proposal, arguing that the practical benefits he promises are unlikely to materialize if environmentalists do not reign in their moralistic non-anthropocentrism in public discourse. In practice, environmentalists who understand the demands of integrity in the way Elliott describes will see in his proposal a thorny dilemma, forcing them to choose between their practical efficacy and their integrity as environmentalists. (shrink)

Significantly revised in this third edition, Environmental Ethics: What Really Matters, What Really Works examines morality from an environmental perspective. Featuring accessible selections—from classic articles to examples of cutting-edge original research—it addresses both theory and practice. -/- Asking what really matters, the first section of the book explores the abstract ideas of human value and value in nature. The second section turns to the question of what really works—what it would take to solve our real-world environmental problems. Moving beyond the (...) "hype," it presents authoritative essays on applying environmental ethics to the issues that matter right now. The selections present philosophical, biological, and socially scientific approaches to the major issues. Environmental Ethics also features first-hand descriptions from people who have actually been involved in wildlife and conservation initiatives. (shrink)

In previous Ethics briefings 1 we have highlighted the developments in the case of Bell & Another v the Tavistock and Portman NHS Foundation Trust. The case concerned a judicial review of the practice of prescribing puberty blocking treatment to children and young people at the Gender Identity Development Service managed by the Tavistock and Portman NHS Foundation Trust. The Court of Appeal in its judgement2 found the Trust’s practices to be lawful, and overturned previous guidance given by the High (...) Court which had contradicted the 'Gillick principle' regarding whether a child or young person could consent to medical treatment, without the consent of its parent. Despite this legal success, concerns over the GIDS continued. In September, NHS England commissioned an independent and wide-ranging review of gender identity services for children and young people led by Dr Hilary Cass, past president of the Royal College of Paediatrics and Child Health. Dr Cass’s Interim review, published in March,3 has resulted in a decision by NHS England to close the GIDS at the Trust by Spring 2023, and replace it with regional centres at existing children’s hospitals offering more 'holistic care' with ’strong links to mental health services’. It is proposed that regional centres will be established at Great Ormond Street Hospital, and Alder Hey Children’s NHS Foundation Trust. Dr Cass was critical of the clinic’s failure to collect sufficient data on the impact of puberty blockers in under-16s. …. (shrink)

Maurice Blondel, best known for his 1893 work on Action, offers a window on the world of philosophers who negotiated the scientific disciplines at the turn of the twentieth century. During this amazing era of discoveries, Blondel encouraged the bold, encyclopedic spirit of science as well as the new standards coming into use for accumulating and judging observational evidence. However, he warned of reductionism, determinism, and phenomenism, trends which could be avoided or corrected if the nature and scope of science (...) were broadened. Such a broadening would introduce a more integrated and holistic understanding of the scientific quest. (shrink)

Most human beliefs are acquired through communication, and so are most misbeliefs. Just like the misbeliefs discussed by McKay & Dennett (M&D), culturally transmitted misbeliefs tend to result from limitations rather than malfunctions of the mechanisms that produce them, and few if any can be argued to be adaptations. However, the mechanisms involved, the contents, and the hypothetical adaptive value tend to be specific to the cultural case.

Lying in an area bounded by the Wabash, Ohio, and Mississippi rivers, the Southern Illinois country is rich in history, folklore, scenery, and natural resources. At about the latitude of southern Virginia, and extending from the flat prairie farmland of central Illinois to the rugged "Illinois Ozarks,” the area is the natural terminal boundary for hundreds of plant species reaching out to all points of the compass. It is also the oldest and most sparsely populated part of Illinois, a region (...) of small towns and independent people, typical of the vast heartland of the U.S.A. Surveying the area in words and pictures the authors sensitively and appreciatively portray the region’s special qualities. An uncommon portrayal of American life in a distinctive region, the book provides a memorable journey both in time and place. (shrink)

Many areas of business ethics research are “sensitive.” We provide an empirical assessment of the randomized response techniquewhich provides absolute anonymity to subjects and “legal immunity” to the researcher. Beyond that, RRT techniques provide complete disclosure to subjects, unconditional privacy is maintained, and there is no deception.

Between 1934 and 1937 Maurice Blondel, the French Roman Catholic philosopher best known for his 1893 work, Action, published a trilogy of writings. Out of these writings came a theological ontology of tremendous force, creativity, and coherence. The purpose of the present dissertation is to reassess the viability of Blondel's ontology for contemporary theology. The retrieval begins with John Milbank's 1990 investigation of Blondel's early philosophy. While Milbank focuses on the strengths of Blondel, he also highlights some critical weaknesses. The (...) dissertation argues that Blondel later came to recognize and correct these weaknesses in his trilogy. ;La pensee, the first volume of the trilogy, discusses the nature and development of thought. Recognizing the ontological structure of thought leads Blondel to present his doctrine of the transnatural elan for assimilation to God. The transnatural desire for God is compared with Henri de Lubac's notion of naturae desiderium and then applied to the modern problem of the relationship between nature and supernature. ;The second installment of the trilogy, L'etre et les etres , explores the mysterious relation of Being and beings. Blondel situates the discussion within the language of creation, identifying Being as Creator and beings as creatures. The analogy of creation allows him to forge the proper relationship between Being and beings. After Blondel's death, two different schools of thought emerged on the mystery of being: Karl Rahner's Thomism and Jean-Luc Marion's new phenomenology. Each school is reviewed and critiqued from a Blondelian perspective. ;The trilogy concludes with a long-awaited revision of L'action . It begins by distinguishing the idea of action from action itself and establishing the ontological difference of action. Action is presented ontologically as enacted power, which is investigated in its individual, social, and metaphysical forms. Individual action is identified as making, practicing, and contemplating. Social action is studied next, with the conclusion that the social being of enacted power is determined by either a philosophy of peace or violence. Finally, divine action is evaluated with regards to the language of causality and absolute power. Blondel proposes instead to describe God's activity in terms of pure action. (shrink)

From philosophy to theology -- Structure -- Mystery -- Power.

Many areas of business ethics research are “sensitive.” We provide an empirical assessment of the randomized response technique which providesabsoluteanonymity to subjects and “legal immunity” to the researcher. Beyond that, RRT techniques provide complete disclosure to subjects, unconditional privacy is maintained, and there is no deception.

Health, ethics and COP27 On the 20 November 2022, the United Nations Climate Change COP27 announced a breakthrough agreement to provide ‘loss and damage’ funding for resource-poor countries seriously affected by climate change. 1 The establishment of the funding stream acknowledges, and attempts to address, one of many thorny ethical issues driven by climate change – to what extent countries that have benefited economically from past emissions of greenhouse gases owe reparative obligations to countries who have contributed minimally to climate (...) change but are most at risk of its harms? One of the many reasons why this is such an important breakthrough is that it brings into the centre of climate policy-making questions of global – and intergenerational – justice and fairness. It acknowledges the critical importance of ethics in climate change deliberations. It is probably fair to say that climate change policy has been dominated to... (shrink)

In February 2020, the British Medical Association will be surveying members for their views on what the BMA’s position on physician-assisted dying should be. The BMA is currently opposed to physician-assisted dying in all its forms, a position that was agreed in 2006 at the annual representative meeting, the Association’s policy-making conference.1 As previously reported in Ethics briefing,2 the decision to survey members follows a motion passed at last year’s ARM which called on the BMA to “carry out a poll (...) of members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying”. The results from the survey will not determine BMA policy. Rather, the results be published ahead of this year’s ARM and provided to those attending to inform a debate and discussion on the BMA’s policy position. More information about the survey, including a briefing pack of useful information, and information for BMA members on how to participate can be found online at www.bma.org.uk/PAD. ### High Court rejects Judicial reviews on assisted suicide The High Court has refused permission for two separate challenges to the law on assisted suicide in the UK to proceed to a full hearing. In the first case, Phil Newby, who has motor neuron disease, applied for judicial review of the law on assisted suicide and asked for the court to carry out a detailed examination of what he termed “legislative facts” – that is, an examination of the existing evidence on the “costs, risks and benefits” of regulating assisted suicide – including a cross-examination of relevant expert witnesses.1 Handing down the judgement, Lord Justice Irwin and Mrs Justice May, held that assisted dying …. (shrink)

Healthcare professionals are currently working under extreme pressure as they respond to the pandemic outbreak of COVID-19. At the time of writing, there is currently no effective vaccine or anti-viral treatment. The pandemic is fast-moving, relatively unpredictable and of uncertain duration. In many countries, it is placing an enormous stress on healthcare resources and providing care to existing standards is proving difficult. Unfortunately, in some countries, health services have been overwhelmed. The impact of the pandemic on resource-poor countries is of (...) particular concern. This extraordinary situation is raising, or has the potential to raise, many ethical challenges for doctors delivering care to patients. It is possible, for example, that there may be points in this pandemic where decisions need to be made about who should have access to finite specialised intensive care beds, drugs and equipment. This has happened in some countries and, despite efforts by the UK Government to reduce demand and increase supply, it is still possible that this could happen in the UK. Some hospital trusts in the UK are already reporting concerningly low supplies of oxygen and vital medicines such as propofol and alfentanil.1 In these circumstances, where not everyone can be treated, difficult ethical decisions will have to made. For example, can some patients be prioritised over others? How should a doctor decide on which patients to treat? Can treatment be withdrawn from patients who are currently being treated, but are not responding, in order to offer treatment to those who may have a better chance of benefiting? The UK is also reporting concerningly low supplies of vital personal protective equipment for frontline workers, raising the question - what are a doctor’s obligations to treat patients, in circumstances that present a high …. (shrink)

Doctors and medical students in the UK have voted in support of the decriminalisation of abortion for women who self-administer abortions and healthcare professionals who provide abortions within the context of their clinical practice. Abortion should be treated as a medical issue rather than a criminal one. ### Background to the vote The vote took place at the end of June during the British Medical Association’s Annual Representative Meeting, where representatives of doctors and medical students from across the British Isles (...) gathered to set BMA policy through democratic procedures. Representatives considered the issue of decriminalisation during a 2-hour debate, where diverse and opposing viewpoints were heard. The debate was informed by a neutral discussion paper that was published by the BMA in February, which provided a guide to some of the key legal and ethical issues raised by the debate around decriminalisation.1 The BMA’s new policy only relates to whether abortion should or should not be a criminal offence; the policy does not address the broader issue of when and how abortion should be available. The BMA has established policy on these issues which remains unchanged.2 ### The law on abortion Induced abortion is currently a crime throughout the British Isles. There are, however, a range of exceptions to the crime laid out in statute and/or common law, for example, in England, Scotland and Wales, under the Abortion Act 1967. Any healthcare professionals operating within those defined exceptions, which include grounds for authorising an abortion and procedural requirements, can lawfully carry out an abortion as a clinical procedure. Outside these defined exceptions, the criminal offences potentially apply both to those who participate in carrying out abortions for others, including doctors, nurses and midwives, and to women who carry out abortions on themselves. For example, healthcare professionals who do not follow procedural requirements can attract criminal sanctions …. (shrink)

In June 2021, the BMA published its report on moral distress and moral injury in UK doctors.1 The report includes definitions of the terms ‘moral distress’ and ‘moral injury’ as well as a summary of how the concepts have developed over time. There is also an analysis of the BMA’s pan-profession survey of moral distress and moral injury of doctors in the UK, the first of its kind. The impact of COVID-19 and recommendations for tackling moral distress also feature. Many (...) may be unfamiliar with the concepts of ‘moral distress’ and ‘moral injury’. These terms are relatively new, and debate is ongoing in academic circles on the best way to understand them.2 Some use the terms interchangeably. The BMA defines moral distress as the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action. Even without an understanding of the morally correct action, moral distress can arise from the sense of a moral transgression. More simply, it is the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. This can be as a result of a lack of power or agency, or structural limitations, such as insufficient staff, resources, training or time. The individual suffering from moral distress need not be the one who has acted or failed to act; moral distress can be caused by witnessing moral transgressions by others. Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger and profound ‘moral disorientation’. It has also been linked to severe mental health issues. There is increasing recognition across the UK of the problem …. (shrink)

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long‐term benefits of such research, and seemingly minimal risk, a strong claim could be made that all non‐acute psychiatric inpatients, including forensic and involuntary patients, should be included in such research, provided they have capacity to consent. There are tensions, however, regarding the ethics of (...) recruiting psychiatric inpatients into such studies. In this paper our intention is to elucidate the source of these tensions from the perspective of research ethics committee interests and decision‐making. We begin by defining inpatient status and outline some of the assumptions surrounding the structures of inpatient care. We then introduce contemporary conceptions of vulnerability, including Florencia Luna’s account of vulnerability which we use as a framework for our analysis. While psychiatric inpatients could be subject to consent‐related vulnerabilities, we suggest that a particular kind of exploitation‐related vulnerability comes to the fore in the context of our case study. Moreover, a subset of these ethical concerns takes on particular weight in the context of genetic research in low‐ and middle‐income countries. At the same time, the automatic exclusion of inpatients from research elicits justice‐related vulnerabilities. (shrink)