Last year (1998) saw the celebration of the 50th Anniversaryof the British National Health Service (NHS). One ofthe few completely nationalised systems of health carein the world, the NHS is seen by many as a moralbeacon of what it means to provide equitable medicaltreatment to all citizens on the basis of need andneed alone. However, others argue that it has failedto achieve the overall goals for which it was created.Because of scarce resources, some urgently needed careis not available at all, (...) while that which is receivedis sometimes second class. For these reasons, it isclaimed that the NHS should be scrapped and replacedby other systems of health care delivery.This paper outlines the history of the NHS,indicating some of the problems and innovations whichhave led to its current organization and structure.The philosophical foundations of the NHS are then articulated and defended on the grounds that it stillrepresents a morally coherent and economicallyefficient approach to the delivery of health care.Scarce resources are the key problem facing the NHS,making rationing inevitable and it is shown thatthis is not incompatible with the moral foundations ofthe service. However, there can be little doubt thatthe NHS is now becoming dangerously under-funded. Thepaper concludes with arguments about why this is soand what might be done about it. (shrink)

Originally published in 1986. All students of social science must confront a number of important philosophical issues. This introduction to the philosophy of the social sciences provides coherent answers to questions about empiricism, explanation and rationality. It evaluates contemporary writings on the subject which can be as difficult as they are important to understand. Each chapter has an annotated bibliography to enable students to pursue the issues raised and to assess for themselves the arguments of the authors.

It has become fashionable to question attempts to derive internationally agreed duties of clinical care from more general theories of human rights. For example, some argue that such attempts risk moral abstraction through their neglect for the importance of culture and community in shaping moral consciousness and are thus often unhelpful in the resolution of concrete moral dilemmas within medicine. Others denounce the importance of general moral principles altogether in bioethics and attempt to articulate what are claimed to be more (...) practical approaches to resolving moral conflict. This paper challenges such arguments. It does so through arguing that: i) all humans everywhere have the same basic human needs; ii) the satisfaction of these needs varies with culture; iii) the imputation of moral duties on others entails respect for their right to basic need satisfaction, including the right to choose between cultures; iv) internationally accepted clinical duties of care embrace presumptions about the duties and rights of patients which follow from these more general principles and v) problems of moral indeterminacy that arise from putting these principles into practice can be resolved through associated procedural policies of rational negotiation and compromise. The moral importance and practicality of respect for individual human rights within the practice of medicine is thus defended. Indeed, the paper concludes by arguing that without belief in human rights linked to a theory of basic human needs, communitarian theories of morality are incoherent. (shrink)

Originally published in 1986. All students of social science must confront a number of important philosophical issues. This introduction to the philosophy of the social sciences provides coherent answers to questions about empiricism, explanation and rationality. It evaluates contemporary writings on the subject which can be as difficult as they are important to understand. Each chapter has an annotated bibliography to enable students to pursue the issues raised and to assess for themselves the arguments of the authors.

Originally published in 1986. All students of social science must confront a number of important philosophical issues. This introduction to the philosophy of the social sciences provides coherent answers to questions about empiricism, explanation and rationality. It evaluates contemporary writings on the subject which can be as difficult as they are important to understand. Each chapter has an annotated bibliography to enable students to pursue the issues raised and to assess for themselves the arguments of the authors.

In his review of my book, Better never to have been, Len Doyal suggests, contrary to my view, that rational beings in the original position might prefer coming into existence to the alternative of never existing, if their lives were to include enough good and not too much bad. I argue, in response, that Professor Doyal fails to make his case.

Benatar argues that it is better never to have been born because of the harms always associated with human existence. Non-existence entails no harm, along with no experience of the absence of any benefits that existence might offer. Therefore, he maintains that procreation is morally irresponsible, along with the use of reproductive technology to have children. Women should seek termination if they become pregnant and it would be better for potential future generations if humans become extinct as soon as humanely (...) possible. These views are challenged by the argument that while decisions not to procreate may be rational on the grounds of the harm that might occur, it may equally rational to gamble under certain circumstances that future children would be better-off experiencing the harms and benefits of life rather than never having the opportunity of experiencing anything. To the degree that Benatar’s arguments preclude the potential rationality of any such gamble, their moral relevance to concrete issues concerning human reproduction is weakened. However, he is right to emphasise the importance of foreseen harm when decisions are made to attempt to have children. (shrink)

There are very few medical ethics courses in British medical schools which are a formal part of the clinical curriculum. Such a programme is described in the following, along with the way in which the long-term curriculum committee of the University College and Middlesex Hospital Joint Medical School was persuaded to make it compulsory for first-year students. Pedagogical lessons which have been learned in its planning and implementation are outlined and teaching materials are included concerning student and course assessment which (...) should be useful for others engaged in similar work. Finally, some of the institutional obstacles facing such attempts are discussed, particularly problems concerning timetabling, different types of opposition and the consequent importance of building alliances among clinical teaching staff. (shrink)

The theory of needs has a political problem. Whilst contemporary theorists largely recognise that politics plays an important part in many of the processes surrounding our needs, they nevertheless hang onto the notion that our most important needs can be determined outside of the political. This article challenges that framing. It does so through a taxonomy and critique of the major contemporary approaches to needs. Considering the works of Len Doyal and Ian Gough, Martha Nussbaum, and Lawrence Hamilton, I (...) divide these into three strands: theories that attempt to avoid, solve, and improve the politics of need. Despite some major differences, these approaches share an understanding of the underlying challenges involved in discerning which needs matter. That framing, I argue, is responsible for certain intractable difficulties that leave needs theorists unable to provide the solutions they demand to the theoretical dilemma they posit. Moreover, in attempting to find those solutions, these theories end up ignoring their partisan implications. The conclusion I reach is that the political theory of needs is not very ‘political’ at all, and that this represents the root of the problem. I thus suggest an alternative, politically realist framing that conceptualises needs as constitutively political. (shrink)

Quantifiers are a test case for an interface between psychological questions, which attempt to specify the numerical content that supports the semantics of quantifiers, and linguistic questions, which uncover the range of possible quantifier meanings allowable within the constraints of the syntax. Here we explore the development of comprehension of most in English, of particular interest as it calls on precise numerical content that, in adults, requires an understanding of large exact numerosities (e.g., 23 blue dots and 17 yellow is (...) an instance of “most of the dots are blue”). In a sample of 100 children 2 to 5 years of age we find that (a) successful most comprehension in cases with two salient subsets is achieved at 3 years, 7 months of age, and (b) most comprehension is independent of knowledge of large exact number words; that is, knowledge of large exact number words is neither necessary, as evidenced by children who understand “most” but not “four,” nor sufficient, as evidenced by children who understand “nine” but not “most.”. (shrink)

Invited media scholars and journalists examine the general issue of nuclear waste, risk and the sicentific promises that were made, but not kept, about safe disposal. The mass media uncovered and reported on nuclear waste problems at Rocky Flats in Colorado and Hanford in Washington. Two environmental journalists review efforts to expose problems at these sites, how secrecy hampered reporting, and the effects of media coverage on nearby residents. An environmental communications scholar evaluates media coverage, the role of the U.S. (...) Department of Energy, and the impact of secrecy on public risk perceptions and attitudes toward government nuclear waste policies. (shrink)

The intensity of the opposition to health reform in the United States continues to shock and perplex proponents of the Patient Protection and Affordable Care Act. The emotion and the apocalyptic rhetoric, render civil and evidence-based debate over the implications and alternatives to specific provisions in the law difficult if not problematic. The public debate has largely barreled down two non-parallel yet non-intersecting paths: opponents focus on their fear of government expansion in the future if PPACA is implemented now, while (...) proponents focus on the urgency and specifics of our health care market problems and the limited number of tools we have to address them. Frustration on both sides has led opponents to deny the seriousness of our health system’s problems and proponents to ignore the risk of governmental overreach. These non-intersecting lines of argument are not moving us closer to a desired and necessary resolution. (shrink)

This book is a compilation of some of the wise sayings of M Fethullah Gülen, each of which is a criterion or pearl of wisdom by which we may seek and find our way in todays world, or a light illuminating our way, to live as a responsible ...

In reply to a chapter by Robert Ware on the need to include, rather than eliminate, institutions in theories of liberation, the author warns that liberation theory must walk on both social and psychological legs and then argues that Ware’s comparative analysis of institutions fails to lead analysis into crucial reflection on how individuals are transformed. Drawing on the work of John Dewey and George Benello, the author argues that an educational philosophy can offer a helpful framework for thinking about (...) relationships between institutions and individuals, such that genuinely democratic institutions would be recognized as being more developmentally educative for individuals involved. The chapter also contains a brief reply by Ware. (shrink)