In his recent article, Ben-Moshe offers an account of conscientious objection in terms of the truth of the underlying moral objections, as judged by the standards of an impartial spectator. He seems to advocate for the view that having a valid moral objection to X is the sole criteria for the instantiation of a right to conscientiously object to X, and seems indifferent to the moral status of the prevailing moral attitudes. I argue that the moral status of the prevailing (...) moral attitudes is relevant, and that a good faith disagreement between those who condone the relevant act and those who object to it is a criterion for CO. In this light, I suggest that CO is a sociopolitical device for managing differing ethical perspectives, particularly in the context of collective moral change. Thus, it is misguided to equate having a valid moral objection with the recognition of a CO. (shrink)

InWhere the ethical action is, Hardman and Hutchinson make some interesting and compelling points about the way in which ‘the ethical’—various values and various kinds of values—are embedded in everyday life, including the everyday life one finds in clinical interactions, understood as scientific or scientifically informed activities. However, even when one considers ‘the ethical’ from within the horizon of understanding adopted in their essay, they neglect several important features of healthcare and medical education. In this rejoinder, I argue that a (...) fuller understanding would go some way to indicating the complexity of ethics and ‘ethical action’ in the clinic, as well as the nature of and need for ‘expert’ analysis and philosophical reflection on the ethical questions that modern healthcare continues to engender. (shrink)

There is a diversity of ‘ethical practices’ within medicine as an institutionalised profession as well as a need for ethical specialists both in practice as well as in institutionalised roles. This Brief offers a social perspective on medical ethics education. It discusses a range of concepts relevant to educational theory and thus provides a basic illumination of the subject. Recent research in the sociology of medical education and the social theory of Pierre Bourdieu are covered. In the end, the themes (...) of Bourdieuan Social Theory, socio-cultural apprenticeships and the ‘characterological turn’ in medical education are draw together the context of medical ethics education. ​. (shrink)

With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical (...) benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously. (shrink)

Until recently, Northern Ireland was infamous for having one of the most restrictive legal frameworks for abortion in Europe. This meant that few were performed in the country, and those who wished to terminate a pregnancy were forced to travel to other parts of the UK or further afield. In 2019 a continuing political stalemate in Northern Ireland has indirectly resulted in the relevant legislation recently being repealed by the UK government. For a short time, this meant that the legal (...) position in Northern Ireland regarding abortion became one of the most permissive in Europe. This short paper sets out the current position and, in the light of the political and legislative roadmap set out by the Northern Ireland Office, identifies and briefly discusses some potential problems that might arise. Most notable are the points raised with regard to conscientious objection. Specifically, the potential for developments in Northern Ireland to further calls for healthcare professional’s ability to rely upon conscientious objection to be removed. (shrink)

This paper takes the philosophical notion of suberogatory acts or morally permissible moral mistakes and, via a reinterpretation of a thought experiment from the medical ethics literature, offers an initial demonstration of their relevance to the field of medical ethics. That is, at least in regards to this case, we demonstrate that the concept of morally permissible moral mistakes has a bearing on medical decision-making. We therefore suggest that these concepts may have broader importance for the discourse on medical ethics (...) and should receive fuller consideration by those working the field. The focus of the discussion we present is on a particular thought experiment originally presented by Sulmasy and Sugarman. Their case formed the basis of an exchange about the moral equivalence of withdrawing and withholding life-saving treatment. The analysis Sulmasy and Sugarman set out is significant because, contrary to common bioethical opinion, it implies that the difference between withdrawing and withholding life-saving treatment holds, rather than lacks, moral significance. Following a brief discussion of rejoinders to Sulmasy and Sugarman’s article, we present a constructive reinterpretation of the thought experiment, one that draws on the idea of suberogatory acts or “morally permissible moral mistakes.” Our analysis, or so we suggest, accounts for the differing moral intuitions that the case prompts. However, it also calls into question the degree to which this thought experiment can be thought of as illustrating the moral equivalence of withdrawing and withholding life-saving treatment. Rather, we conclude that it primarily illuminates something about the ethical parameters of healthcare when family members, particularly parents, are involved in decision-making. (shrink)

While there is a great deal to agree with in the essay Expanded Terminal Sedation in End-of-Life Care there is, we think, a need to more fully appreciate the humanistic side of both palliative and end-of-life care.1 Not only does the underlying philosophy of palliative care arguably differ from that which guides curative medicine,2 dying patients are in a uniquely vulnerable position given our cultural disinclination towards open discussions of death and dying. In this brief response, we critically engage Gilbertson (...) et al ’s essay and seek to contextualise the perspective they put forward. According to Cassell, we should distinguish between pain and suffering.3 The former often gives rise to the latter, but suffering has other causes. This includes existential distress, indicating that, unlike pain, suffering is not simply physiological phenomena. Suffering involves the disintegration of the person, meaning that it can impact patient autonomy. Certainly, that a patient is suffering does not equate to a lack autonomy. Nevertheless, we should take care when making decisions in circumstance where the integrity of our embodied personhood is under threat, something that is clearly the case for those who are dying, particularly those who have refractory symptoms while doing so. Generally speaking, refractory symptoms are those which are intractable. They persist despite attempts at palliation. While this implies that such symptoms—and the suffering they cause—cannot be reversed this is not necessarily the case. Not only can the symptoms experienced by dying patients change …. (shrink)

This paper considers the roles and definitions of expert and lay members of ethics committees, focussing on those given by the National Research Ethics Service which is mandated to review all research conducted in National Health Service settings in the United Kingdom. It questions the absence of a specified position for the ‘professional ethicist’ and suggests that such individuals will often be lay members of ethics committees, their participation being a reflection of their academic interest and expertise. The absence of (...) a specified position for professional ethicists and the concomitant but implicit denial of ethical expertise appear to be an anomalous state of affairs if one considers that the training offered to members of ethics committees is often delivered by academic ethicists. It is suggested that this is based on a misunderstanding of the concept ‘ethical expertise’ and that properly understood the ethicist can assist the work of ethics committees by drawing on their expert knowledge. (shrink)

This paper considers the disciplines of literature and history and the contributions each makes to the discourse of bioethics. In each case I note the pedagogic ends that can be enacted though the appropriate use of the each of these disciplines in the sphere of medical education, particularly in the medical ethics classroom.1 I then explore the contribution that both these disciplines and their respective methodologies can and do bring to the academic field of bioethics. I conclude with a brief (...) consideration of the relations between literature and history with particular attention to the possibilities for a future bioethics informed by history and literature after the empirical turn. (shrink)

In this essay I consider whether the political perspective of third wave science studies – ‘elective modernism’ – offers a suitable framework for understanding the policy-making contributions that (bio)ethical experts might make. The question arises as a consequence of the fact that I have taken inspiration from the third wave in order to develop an account of (bio)ethical expertise. I offer a précis of this work and a brief summary of elective modernism before considering their relation. The view I set (...) out suggests that elective modernism is a political philosophy and that although its use in relation to the use of scientific expertise in political and policy-making process has implications for the role of (bio)ethical expertise it does not, in the final analysis, provide an account that is appropriate for this latter form of specialist expertise. Nevertheless, it is an informative perspective, and one that can help us make sense of the political uses of (bio)ethical expertise. (shrink)

Although one can argue that they do not represent a radical departure from existing practices, protocols for reverse triage certainly step beyond what is ordinarily done in medicine and healthcare. Nevertheless, there seems to be some degree of moral concern regarding the ethical legitimacy of practicing reverse triage in the context of a pandemic. Such concern can be taken as a reflection of the moral antipathy some exhibit towards current practices of withdrawing treatment—that is, when withdrawal of treatment is arguably (...) in the best interests of patients—and a rejection of the purported normative insignificance of withholding and withdrawing. Given that the relevance of the psychological attitudes of some healthcare professionals to the moral assessment of withdrawing and withholding treatment continues to be debated, it would seem that some thought should be given to the introduction and implementation of reverse triage decisions in response to a pandemic. This brief paper will consider if provision should be made for healthcare professionals to conscientiously refuse to participate in reverse triage. (shrink)

This essay responds to an article, ‘Variation in university research ethics review’, published in this issue. It argues that the authors of that paper do not fully distinguish the usual function of university research ethics committees from that of a gatekeeper. The latter term more accurately describes the task they happen to have asked them to fulfil in the course of conducting some empirical research. Whilst they are not alone in making it, the result of this conflation is that the (...) reflections they offer are misguided. In this short comment I briefly discuss the distinction between a REC and a gatekeeper, and indicate how it impacts on the proposals sketched by Vadeboncoeur et al. (shrink)

This article considers the moral notion of care in the context of Quality of Care discourses. Whilst care has clear normative implications for the delivery of health care it is less clear how Quality of Care, something that is centrally involved in the governance of UK health care, relates to practice.

This paper focuses on the practice of injecting patients who are dying with a relatively high dose of sedatives in response to a catastrophic event that will shortly precipitate death, something that we term ‘crisis sedation.’ We first present a confabulated case that illustrates the kind of events we have in mind, before offering a more detailed account of the practice. We then comment on some of the ethical issues that crisis sedation might raise. We identify the primary value of (...) crisis sedation as allowing healthcare professionals to provide some degree of reassurance to patients, their families and the professionals who are caring for them. Next we focus on the issue of informed consent. Finally, we ask whether continuous deep sedation might be preferable to crisis sedation in scenarios where potential catastrophic events can be anticipated. (shrink)

This collection focuses on virtue theory and the ethics of social science research. A moral philosophy that has been relatively neglected in the domain of research ethics, virtue ethics has much to offer those who wish to go beyond the difficulties generated by the biomedical model of research ethics and positively engage with the ethics of social scientific research. As the chapters contained in this volume show, the perspective provided by virtue ethics also exhibits a certain affinity with the emerging (...) discourse regarding research integrity. Contributors develop various facets of virtue ethics in order to illuminate a range of issues in the practice and governance of social science, including integrity, the ethics of ethical review, ethics education, and the notion of phrónēsis (wisdom). (shrink)

This essay comments on the British Medical Association's recent suggestion that protocols for Elective Ventilation (EV) might be revived in order to increase the number of viable organs available for transplant. I suggest that the proposed revival results, at least in part, from developments in the contemporary political landscape, notably the decreasing likelihood of an opt-out system for the UK's Organ Donor Register. I go on to suggest that EV is unavoidably situated within complex debates surrounding the epistemology and ontology (...) of death. Such questions cannot be settled a priori by medical science, bioethics or philosophical reflection. As Radcliffe-Richards suggests, the determination of death has become a moral question, and therefore, now extends into the political arena. I argue for the conclusion that EV, and wider debates about organ donation and the constitution of the organ donation register, are matters of ‘biocitizenship’ and must, therefore, be addressed as ‘biopolitical’ questions. (shrink)

Making particular use of Shale’s analysis, this paper discusses the notion of leadership in the context of palliative medicine. Whilst offering a critical perspective, I build on the philosophy of palliative care offered by Randall and Downie and suggest that the normative structure of this medical speciality has certain distinctive features, particularly when compared to that of medicine more generally. I discuss this in terms of palliative medicine’s distinctive morality or ethos, albeit one that should still be seen in terms (...) of medical morality or the ethos of medicine. I argue that, in the context of multi-disciplinary teamwork, the particular ethos of palliative medicine means that healthcare professionals who work within this speciality are presented with distinct opportunities for leadership and the dissemination of the moral and ethical norms that guide their practice. I expand on the nature of this opportunity by further engaging with Shale’s work on leadership in medicine, and by more fully articulating the notion of moral ethos in medicine and its relation to the more formal notion of medical ethics. Finally, and with reference to the idea of medical education as both on going and as an apprenticeship, I suggest that moral and ethical leadership in palliative medicine may have an inherently educational quality and a distinctively pedagogical dimension. The nature of palliative medicine is such that it often involves caring for patients who are still receiving treatment from other specialists. Whilst this can create tension, it also provides an opportunity for palliative care professionals to disseminate the philosophy that underpins their practice, and to offer leadership with regard to the moral and ethical challenges that arise in the context of End of Life Care. (shrink)

This paper considers the utility of Ethnomethodology (EM) for the study of healthcare ethics as part of the empirical turn in Bioethics. I give a brief introduction to EM through its respecification of sociology, the specific view on the social world this generates and EM's posture of ‘indifference’. I then take a number of EM concepts and articulate each in the context of an EM study of healthcare ethics in professional practice. Having given an overview of the relationship and perspective (...) EM might bring to the professional practice of healthcare ethics I consider whether and how such an approach could be deployed. Whilst an ethnographic study might be problematic I suggest a number of alternative methods through which such EM research could be accomplished. I conclude with the suggestion that, as a particular approach to sociological research, EM offers good deal of potential for the empirical study of healthcare ethics in practice which could result in an improved reflexive understanding of professional ethical practices in bioethics. (shrink)

Recent research offers good reason to think that various psychedelic drugs—including psilocybin, ayahuasca, ketamine, MDMA, and LSD—may have significant therapeutic potential in the treatment of various mental health conditions, including post-traumatic stress disorder, depression, existential distress, and addiction. Although the use of psychoactive drugs, such as Diazepam or Ritalin, is well established, psychedelics arguably represent a therapeutic step change. As experiential therapies, their value would seem to lie in the subjective experiences they induce. As it is the only way for (...) trainee psychedelic therapists to fully understand their subjective effects, some have suggested that firsthand experience of psychedelics should form part of training programs. We question this notion. First, we consider whether the epistemic benefits offered by drug-induced psychedelic experience are as unique as is supposed. We then reflect on the value it might have in regard to the training of psychedelic therapists. We conclude that, absent stronger evidence of the contribution drug-induced experiences make to the training of psychedelic therapists, requiring trainees to take psychedelic drugs does not seem ethically legitimate. However, given the potential for epistemic benefit cannot be entirely ruled out, permitting trainees who wish to gain first-hand experience of psychedelics may be permissible. (shrink)

Some contributions to the current literature on conscience objection in healthcare posit the notion that the requirement to refer patients to a non-objecting provider is a morally questionable undertaking in need of explanation. The issue is that providing a referral renders those who conscientiously object to being involved in a particular intervention complicit in its provision. This essay seeks to engage with such claims and argues that referrals can be construed in terms of what Harman calls morally permissible moral mistakes. (...) I go on to suggest that one might frame the (in)actions of those who exercise the right of non-participation generated by the claim to conscientiously object in similar terms; they can also be considered morally permissible moral mistakes. Finally, and given that the arguments already advanced involve simultaneously looking at the same issue from competing ethical perspectives, I offer some brief remarks that support viewing conscientious objection as an ethicopolitical device. (shrink)

There was a spelling error in the second author’s last name in the original publication. The name is correct in this erratum.

This article presents the notions of ethos and eidos as field level concepts for the sociology of morality and the anthropology of ethics. This is accomplished in the context of Bourdieuan social theory and, therefore, from the broad standpoint of practice theory. In the first instance these terms are used to refer to the normative structures of social fields and are conceived so as to represent the way in which such structures fall between two planes, that of the implicit and (...) the explicit. Subsequently, they are used to further understand a distinction between morality—roughly, the implicit moral order of a social field—and ethics—the more explicit and often codified elements of a social field’s normative structure. When presented in relation to academic philosophical inquiries into the ethical issues in healthcare and the life sciences—meaning the disciplines of applied ethics in general and applied ethics in particular—the analytic perspective these terms facilitate enables us to represent the fundamental conditions required for academic enquiry; taken together the ethos and eidos of an intellectual field constitute the requisite background of its normative epistemic and methodological commitments, thereby providing the structures of disciplined intellectual practices. Seen in this light it not only becomes possible to grasp applied ethics as a socially structured practice but to understand it in terms that can also be used to frame our everyday moral practices. In this way applied ethics can be acknowledged as a relatively unique part of our contemporary moral culture. (shrink)

In this essay I consider whether the political perspective of third wave science studies – ‘elective modernism’ – offers a suitable framework for understanding the policy-making contributions that ethical experts might make. The question arises as a consequence of the fact that I have taken inspiration from the third wave in order to develop an account of ethical expertise. I offer a précis of this work and a brief summary of elective modernism before considering their relation. The view I set (...) out suggests that elective modernism is a political philosophy and that although its use in relation to the use of scientific expertise in political and policy-making process has implications for the role of ethical expertise it does not, in the final analysis, provide an account that is appropriate for this latter form of specialist expertise. Nevertheless, it is an informative perspective, and one that can help us make sense of the political uses of ethical expertise. (shrink)

It is increasingly common for universities to provide cross-curricular education in bioethics as part of contemporary attempts to produce 'global citizens.' In this article I examine three perspectives drawn from research into pedagogy that has been conducted from the perspective of cognitive anthropology and consider its relevance to bioethics education. I focus on: two metaphors of learning, participation and acquisition, identified by Sfard; the psychological notion of moral development; and the distinction between socialization and enculturation. Two of these perspectives have (...) been particularly fruitful in understanding the processes of teaching and learning in a variety of domains. The third perspective has been developed in relation to the formal ethical education of medical students. I examine their relevance for 'non-professional' bioethics education suggesting that if we take seriously the idea that it is part of 'educating for citizenship' then the distinction between 'ethics' and 'politics' is blurred as such programmes aim at the development of student's political subjectivity. (shrink)

Whilst Colin Parker and I are in broad disagreement we would nevertheless agree that RECs have both political and ethical functions, albeit to differing degrees, and that a proper account of ethical expertise needs to be given. The uses RECs make of ethical experts and expertise and the way in which this might be recognised remains, from my perspective, open for debate. My only conclusion is that it should be recognised.

The COVID-19 pandemic has occasioned a great deal of ethical reflection both in general and on the issue of reverse triage; a practice that effectively reallocates resources from one patient to another on the basis of the latter having a more favourable clinical prognosis. This paper addresses a specific concern that has arisen in relation to such proposals: the potential reallocation of ventilators relied upon by disabled or chronically ill patients. This issue is examined via three morally parallel scenarios. First, (...) the standard reallocation of a ventilator in accordance with reverse triage protocols; second, the reallocation of a personal ventilator from a chronically ill patient ordinarily reliant on it; and, third, the reallocation of a personal ventilator owned by a financially privileged individual but who is not ordinarily reliant on it. This paper suggests that whilst property rights cannot resolve these scenarios in a satisfactory manner, it may be possible to do so if we draw on the resources of phenomenology. However, in contradistinction to a recent paper on this topic, we argue that ethical claims to ventilators are not well grounded by the overly demanding notion that they are embodied objects. We suggest that the alternative phenomenological notion of homelikeness provides for a more plausible resolution of the issue. The personal ventilators of individuals who commonly rely upon them become part of their ordinary, everyday or homelike being. They are a necessary part of the continuation or maintenance of their basic state of health or wellbeing and the reallocation of such objects is unethical. Keywords: Phenomenology, COVID-19, Pandemic, Triage, Reverse triage, Ventilation, Chronic illness, Allocation of resources. (shrink)

In a globalised world, healthcare professionals will inevitably find themselves caring for patients whose first language differs from their own. Drawing on experiences in Australia, this paper examines a specific problem that can arise in medical consultations using professional interpreters: whether the moral objections of interpreters should be accommodated as conscientious objections if and when their services are required in contexts where healthcare professionals have such entitlements, most notably in relation to consultations concerning termination of pregnancy and voluntary assisted dying. (...) We argue that existing statements of professional ethics suggest that interpreters should not be accorded such rights. The social organisation of healthcare and interpreting services in Australia may mean those who have serious objections to particular medical practices could provide their services in restricted healthcare contexts. Nevertheless, as a general rule, interpreters who have such objections should avoid working within healthcare. (shrink)

Review of Jonathan B. Imber, Trusting Doctors: The Decline of Moral Authority in American Medicine. Oxford: Princeton University Press 2008. Pp. xix+275. US$29.95 £21.95 HB.

Review of Andrew Webster, Health, Technology and Society: A Sociological Critique. Hampshire: Palgrave MacMillan, 2007. Pp. 213. UK£20.99 PB.

Whilst the notion of bioethical expertise might raise a host of questions concerning moral authority it is nevertheless the case that bioethicists continue to advance well thought out, detailed and comprehensive arguments concerning the ethical implications of the biosciences and healthcare. Not to make use of such work or those who produce it when it comes to the work of government and the development of policies would seem misguided at best. Thus, in the light of existing analysis of scientific expertise (...) and its proper contribution to democratic political processes, this essay explores the role expert bioethicists might legitimately play in the production of policy and broader public moral debates. However, given that ethics can shade into politics and, furthermore, does so in a way that is not the case for science and politics, the ethico-political limitations that constrains and constructs the exercise of bioethical expertise is examined. Particular attention is paid to the implications of this view when it comes to bioethical research predicated on religious perspectives in the context of public reason, the validity of which has recently been called into question. We conclude with the suggestion that, if they are to act as experts in political contexts, bioethicists cannot simply make expert contributions to policymaking processes, they should also acknowledge they are responsible for shaping the broader public moral discourses about science and medicine. (shrink)

There have been many reports of medical students performing pelvic exams on anaesthetised patients without the necessary consent being provided or even sought. These cases have led to an ongoing discussion regarding the need to ensure informed consent has been secured and furthermore, how it might be best obtained. We consider the importance of informed consent, the potential harm to both the patient and medical student risked by the suboptimal consent process, as well as alternatives to teaching pelvic examinations within (...) medical school. The subsequent discussion focuses on whether medical students should perform pelvic examinations on anaesthetised patients without personally ensuring that they have given their explicit consent. Whilst we question the need to conduct pelvic examinations on anaesthetised patients in any circumstance, we argue that medical students should not perform such exams without personally securing the patients informed consent. (shrink)

The study of bioethics has always been conducted by multiple disciplines. However the interaction between these disciplines has sometimes been marked by division, discord and disagreement, especially so between philosophically and sociologically minded contributors. This has been particularly true in recent years, and post the ‘empirical turn’ in bioethics. In our introduction we trace these disagreements and then take a wider look at the nature of disciplines and of interdisciplinary relations. These considerations are then brought back to the disciplines that (...) contribute work to bioethics as an explanation of why relationships within the field are difficult, and how we can start to address these divides. (shrink)

In the introduction to this volume we have argued that being an interdisciplinary scholar involves managing a complex interplay of disciplinary identities, as well as the ontologies and ways of knowing and understanding that are associated with the subject matter. We argued that trying to force a bioethical interdiscipline without a special regard to the individual epistemological, ontological and social aspects of the disciplines is unlikely to bear fruit in the long-term. Although bioethics has always been a multidisciplinary activity, the (...) relations between the various disciplines involved have traditionally been fraught, particularly so at the intersection between sociological and philosophical bioethics. We therefore proposed approaching bioethical interdisciplinarity in a manner that is careful and measured. This does not involve abandoning disciplines or disciplinarity, rather we are advocating for an increased level of cross-fertilisation between established disciplines or the way in which research is done, in the broadest sense. (shrink)

This book is an interdisciplinary contribution to bioethics, bringing together philosophers, sociologists and Science and Technology Studies researchers as a way of bridging the disciplinary divides that have opened up in the study of bioethics. Each discipline approaches the topic through its own lens providing either normative statements or empirical studies, and the distance between the disciplines is heightened not only by differences in approach, but also disagreements over the values, interpretations and problematics within bioethical research. In order to converse (...) across these divides, this volume includes contributions from several disciplines. The volume examines the sociological issues faced by interdisciplinary research in bioethics, the role of expertise, moral generalisations, distributed agency, and the importance of examining what is not being talked about. Other contributions try to take an interdisciplinary look at a range of specific situations, fetal alcohol syndrome in the media, citizen science, electronic cigarettes and bioethical issues in human geography. (shrink)

Anti-theory is a multi-faceted critique of moral theory which, it appears, is undergoing something of reassessment. In a recent paper Hämäläinen discusses the relevance of an anti-theoretical perspective for the activity of applied ethics. This paper explores her view of anti-theory. In particular I examine its relevance for understanding the formal guidance on pandemic flu planning issues by the Department of Health in the UK and some subsequent discussions around triage and reverse triage decisions which may be considered by both (...) Primary and Secondary Care Trusts. in setting their own policies and which may face clinicians in the eventuality of a pandemic. Following Hämäläinen in contrasting reflective equilibrium with her anti-theory inspired suggestion of an instrumental approach to moral theory in practice I demonstrate how this understanding complements the diversity of our intuitive moral judgements. Consequentially I suggest that this anti-theoretical instrumental approach is in greater accord with the conditions under which such policy planning and decision making is, or will be, made. Furthermore, on the grounds of keeping open the ethical dimensions of medical practice in conditions of uncertainty, i.e. during a pandemic, I suggest that the anti-theoretical instrumental perspective is, ethically, the preferable approach to producing such policies and guidelines. (shrink)

Nathan Emmerich, in a recent issue of Research Ethics Review, has suggested that the ‘professional ethicist’ should be considered an ‘expert member’ in the research ethics committee. He raised a number of interesting questions and in seeking to answer them one may come to what may be regarded as an unexpected conclusion – that there is a prior need to clearly explain the concept of ‘ethical expertise’ and the ‘ethics professional’.

Recently, Michael Huemer has defended the Principle of Phenomenal Conservatism: If it seems to S that p, then, in the absence of defeaters, S thereby has at least some degree of justification for believing that p. This principle has potentially far-reaching implications. Huemer uses it to argue against skepticism and to defend a version of ethical intuitionism. I employ a reductio to show that PC is false. If PC is true, beliefs can yield justification for believing their contents in cases (...) where, intuitively, they should not be able to do so. I argue that there are cases where a belief that p can behave like an appearance that p and thereby make it seem to one that p. (shrink)