The management of an infant after a decision to withdraw active treatment creates dilemmas. Both lingering death and active killing are undesirable, but palliative interventions can hasten death. We investigated what staff on our neonatal unit thought were the limits of acceptable practice and why. We administered a structured interview to elucidate their views, and asked them to justify their answers. The interviews were analysed quantitatively and qualitatively. A total of 25 participants (15 nurses and 10 doctors) were recruited. 80% (...) emphasized the importance of pain relief following withdrawal, 60% mentioned meeting parental needs at that time. 76% agreed that death can be a desired consequence of withdrawal, yet 52% felt that death should never be hastened. 96% felt that morphine is acceptable after withdrawal, and 72% would give a higher than normal dose if necessary. 56% would stop paralysis at extubation but not reverse it, while 24% would continue paralysis. 16% would consider a drug that ended life instantly in some cases. A wide variety of views emerged, but there were two main positions, a cautious majority, and a more proactive minority. Apparent contradictions within the majority position could be explained using the doctrine of double effect and the acts and omissions distinction. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority . Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and (...) information about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18 . This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

Objective The UK Human Papillomavirus (HPV) vaccine programme commenced in the autumn of 2008 for year 8 (age 12–13 years) schoolgirls. We examine whether the vaccine should be given when there is a difference of opinion between daughters and parents or guardians. Design Qualitative study using semi-structured interviews. Participants A sample of 25 stakeholders: 14 professionals involved in the development of the HPV vaccination programme and 11 professionals involved in its implementation. Results Overriding the parents' wishes was perceived as problematic (...) and could damage the relationship between school and parents. A number of practical problems were raised in relation to establishing whether parents were genuinely against their daughter receiving the vaccine. Although many respondents recognised that the Gillick guidelines were relevant in establishing whether a girl could provide consent herself, they still felt that there were significant problems in establishing whether girls could be assessed as Gillick competent. In some areas school nurses had been advised not to give the vaccine in the absence of parental consent. None of the respondents suggested that a girl should be vaccinated against her consent even if her parents wanted her to have the vaccine. Conclusions While the Gillick guidelines provide a legal framework to help professionals make judgements about adolescents consenting to medical treatment, in practice there appears to be variable and confused interpretation of this guidance. Improved legal structures, management procedures and professional advice are needed to support those who are assessing competence and establishing consent to vaccinate adolescents in a school setting. (shrink)

Update on donation of bodily material in the UKIn March 2010, the Human Tissue Authority announced that the first pooled kidney transplants, each involving three living donors and three recipients, had been performed in the UK. 1 While the vast majority of living donor transplants take place between people who are genetically related or are otherwise emotionally close, the Human Tissue Act 2004 introduced greater flexibility, permitting, for example, altruistic, paired and pooled donation. The HTA commented that these types of (...) donation represent one in three of all kidney transplants in the UK. Under the system of paired and pooled donation, in which someone needs a donor organ and has a friend or relative willing to donate, but the two are not compatible with each other, they can pair up with one or more other incompatible donor and recipient pairs in an organ exchange. In paired donation, donor A gives an organ to recipient B and donor B gives to recipient A; in pooled donation, more than two donor–recipient pairs take part in an organ exchange, coordinated by the HTA . Under the human tissue legislation, all cases of paired and pooled donation need to be considered by an independent assessor and approved by a panel of at least three members of the HTA, to ensure that all parties fully understand the risks involved and the donors are not under any pressure to donate.The first pooled transplant took place late in 2009, and was followed shortly afterwards by a second. Several paired living kidney transplants, involving two couples, had already taken place, however, with 16 such transplants going ahead between 1 April 2008 and 31 March 2009. Also in March 2010, a …. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority. Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and information (...) about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18. This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

Open any history or hand-book of Greek literature in general, or Greek lyric in particular, and you will very soon come across several references to monody and choral lyric as important divisions within the broader field of melic poetry. And the terms loom larger than the mere question of handy labels: they permeate and pervade the whole approach to archaic Greek poetry. Chapters or sub-headings in literary histories bear titles like ‘Archaic choral lyric’ or ‘Monody’. Indeed it is possible to (...) write a whole book and call it Early Greek Monody. Diehl's Anthologia Lyrica Graeca was structured around this distinction, which it adopted in preference to the chronological arrangement that is the obvious alternative. Indeed, it went so far as ‘to invent Greek titles “μονωιδίαι” and “χορωιδίαι” ’. Most scholars would now agree that this is to go too far. But most would also continue to accept the validity and importance of the division, which a scholar has recently termed ‘the most fundamental generic distinction within ancient lyric poetry’. (shrink)

The issue of the recognition scene in Euripides' Electra, if not as ‘eternal’ as the controversy over the relative dating of the Sophoclean and Euripidean plays of that name, is certainly recurrent. After Eduard Fraenkel's resurrection of the problem at the end of his great commentary on Aeschylus' Agamemnon, the contributions of Hugh Lloyd-Jones and the late Godfrey Bond seemed to have settled the case in favour of authenticity. But soon after, David Bain and then M. L. West, G. Basta (...) Donzelli and finally David Kovacs, all writing in the same journal, raised some new and awkward questions, which, at the very least, require more in the way of answers than they have yet received. The last word, as the saying goes, has not yet been spoken. In this article I try to provide the last word—no, that would be too much to expect, but further reflections on the issue—yes. In particular, I try to set the matter in a wider context, seeking analogies for what, if w. 518–44 are Euripidean, the playwright may have been aiming at in this particular scene. Such analogies should be important, for scholars have generally by contrast stressed the uniqueness of the recognition scene: ‘in the extant remains of Greek tragedy we have indeed nothing’, says Bond, ‘comparable to the Electra parody’. (shrink)

Our only fully extant satyr play begins with the following address to Dionysus and his statue.

Our only fully extant satyr play begins with the following address to Dionysus and his statue.

In England, Wales and Scotland, the vast majority of abortions take place in the first trimester of pregnancy. In 2009, for example, 91% of abortions were carried out at under 13 weeks gestation for women resident in England and Wales. 1 Early abortion opens up the opportunity for a woman to have a medical abortion rather than a surgical abortion. Medical abortion is considered to be less invasive and less expensive than surgical abortion, and is increasingly becoming the preferred method. (...) 1 The proportion of medical abortions to surgical abortions has doubled in the last five years with 52% of abortions being medical abortions under 9 weeks gestation in 2009. A medical abortion typically involves taking mifepristone to block the hormones that help a pregnancy to continue, and then later on misoprostol, which makes the womb expel the embryo/fetus, usually within 4–6 h. Current legislation requires that both sets of drugs are administered in an NHS hospital or approved place, but women can go home after taking the second dose of drugs to complete the abortion. There has long been disagreement between the Department of Health and the British Pregnancy Advisory Services about what constitutes ‘any treatment for the termination of pregnancy’ under the Abortion Act 1967, specifically whether a woman taking the second set of drugs is considered to be undergoing the ‘treatment’ and is therefore required to be present in premises permitted under the Act. At the end of 2010, BPAS went to the High Court to challenge the Department of Health's view that the legislation requires women to take both sets of drugs in an approved place. BPAS argued that ‘treatment’ stops at the point of prescription and women should be able to go home, …. (shrink)

The thesis identifies two strands in Rorty’s philosophy. One is an orientation towards practice in opposition to the traditional philosophical emphasis on theoretical knowledge. The other is Rorty’s anti-representationalist conception of knowledge. Rorty argues that these strands are mutually supporting, while the author argues they are incompatible. The nominal aim of Rorty’s anti-representationalism is to overcome many traditional dualisms of theoretical philosophy, such as subject and object, mind and world, and theory and practice. The thesis argues that anti-representationalism does not (...) and cannot achieve this aim, since what is required to overcome these dualisms is the recognition of the practical basis of knowledge, with which anti-representationalism is incompatible. The author agrees with much of Rorty’s critique of foundationalist epistemology, but argues in opposition to Rorty that anti-representationalism does not follow necessarily from this critique. Where Rorty locates the error of traditional epistemology in the very notion that knowledge and language can represent the world, the author argues that this idea is benign. The fundamental problem is the desire to anchor our conceptual scheme to an external structure independently of human practice — but this idea can be rejected without abandoning the notion of representation. The thesis also looks to explain why Rorty takes anti-representationalism to follow naturally from a rejection of foundationalism. The motivation is located in Rorty’s fundamental metaphysical orientation, which is naturalistic. Anti-representationalism is the product of the wish to promote a naturalistic worldview without succumbing to scientism. In this way Rorty hopes to unite the manifest and scientific images of man. The author argues that this cannot be done from within a naturalistic metaphysics. (shrink)

Lecture given Wednesday 27 October 1993 at a Physics - Computer Science Colloquium at the University of New Mexico. The lecture was videotaped; this is an edited transcript. It also incorporates remarks made at the Limits to Scientific Knowledge meeting held at the Santa Fe Institute 24-26 May 1994.