During the COVID-19 pandemic, the media have repeatedly praised healthcare workers for their ‘heroic’ work. Although this gratitude is undoubtedly appreciated by many, we must be cautious about overuse of the term ‘hero’ in such discussions. The challenges currently faced by healthcare workers are substantially greater than those encountered in their normal work, and it is understandable that the language of heroism has been evoked to praise them for their actions. Yet such language can have potentially negative consequences. Here, I (...) examine what heroism is and why it is being applied to the healthcare workers currently, before outlining some of the problems associated with the heroism narrative currently being employed by the media. Healthcare workers have a clear and limited duty to treat during the COVID-19 pandemic, which can be grounded in a broad social contract and is strongly associated with certain reciprocal duties that society has towards healthcare workers. I argue that the heroism narrative can be damaging, as it stifles meaningful discussion about what the limits of this duty to treat are. It fails to acknowledge the importance of reciprocity, and through its implication that all healthcare workers have to be heroic, it can have negative psychological effects on workers themselves. I conclude that rather than invoking the language of heroism to praise healthcare workers, we should examine, as a society, what duties healthcare workers have to work in this pandemic, and how we can support them in fulfilling these. (shrink)

In a recent response to our paper on developing a philosophical framework to guide the design and delivery of a just health service, Sarela raises several objections. We feel that although Sarela makes points which are worthy of discussion, his critique does not undermine either the need for, or the worth of, our proposed model. First, the law does not negate the need for ethics in determining just healthcare policy. Reliance on legal processes can drive inappropriate focus on ensuring policies (...) avoid judicial review, as opposed to ensuring they are truly just; the law affords protection against unjust policies but does not put a commitment to avoiding them at the heart of policy-making. We defend the need for Scanlonian supplementation by emphasising the practical value of adding a step based on reasonable rejection, particularly in ensuring that the views of vulnerable stakeholders are robustly considered. We discuss the similarities and differences between the work of Daniels and Sen in considering the relationship between health and opportunity, concluding that Sen’s capability approach is both valuable and compatible with our proposed model. Finally, the practical use of our model requires consideration of what constitutes a reasonable person. Our model is explicitly intended to help develop a healthcare system which is just to all its users. With this in mind, we suggest that those involved in decision-making should meet Scanlon’s definition of reasonable: they should be motivated to justify their actions to, and seek agreement with, others. (shrink)

Bioethics, Volume 36, Issue 4, Page 434-444, May 2022.

Asymptomatic COVID‐19 testing programmes are being introduced in higher education institutions, but stakeholder views regarding the acceptability of mandating or incentivizing participation remain little understood. A mixed‐method study (semi‐structured interviews and a survey including open and closed questions) was undertaken in a case study university with a student testing programme. Survey data were analysed descriptively; analysis for interviews was based on the framework method. Two hundred and thirty‐nine people participated in the study: 213 in the survey (189 students, 24 staff), (...) and 26 in interviews (19 students, 7 staff). There was majority (62%) but not universal support for voluntary participation, with a range of concerns expressed about the potentially negative effects of mandating testing. Those who supported mandatory testing tended to do so on the grounds that it would protect others. There was also majority (64%) opposition to penalties for refusing to test. Views on restricting access to face‐to‐face teaching for non‐participants were polarized. Three‐quarters (75%) supported incentives, though there were some concerns about effectiveness and unintended consequences. Participants emphasized the importance of communication about the potential benefits of testing. Preserving the voluntariness of participation in student asymptomatic testing programmes is likely to be the most ethically sound policy unless circumstances change. (shrink)

To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should act (...) when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders, we ensure that conflicting needs are considered robustly.We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just. (shrink)

We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls’ principles – using his ‘veil of ignorance’ and both the ‘difference’ and ‘just savings’ principles which it generates – provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making (...) them did not know if one was patient, doctor, nurse or manager – in this generation or the next. We first offer a brief summary of Rawls’ approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls’ approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls’ thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil. (shrink)

Intersectionality emphasizes numerous points of difference through which those who occupy multiple disadvantaged statuses are penalized. Applying this consideration to the workplace, we explore ways in which status-based and structural aspects of work undermine women and people with physical disabilities and diminish psychological well-being. We conceptually integrate research on the workplace disadvantages experienced by women and people with disabilities. Drawing on a longitudinal analysis of community survey data that includes a diverse sample of people with and without physical disabilities, we (...) explore the claim that women with disabilities are burdened by greater disadvantage in work settings compared to men with disabilities and women and men without disabilities. We find evidence that in comparison with these groups, women with disabilities on average are more psychologically affected by inequitable workplace conditions, partly because they earn less, are exposed to more workplace stress, and are less likely to experience autonomous working conditions. (shrink)

This longitudinal, qualitative study investigated the genesis and transformation of the social representations of organ transplants. A search of the West Australian newspaper, from 1954 to 1995 found 672 articles pertaining to organ transplants. Two distinct, but conflicting, representations emerged in the analyses. In the first representation, found from 1967/68, the surgeon was paramount and organ transplants were iconised as ‘spare part surgery’. In the second representation, found from 1984/85, the role of the donor was emphasised and transplants iconised as (...) a ‘gift of life’. Both representations were discernible in 1994/95. We consider the question whether there are now two conflicting representations or one representation with two conflicting sets of beliefs at its core. The results are discussed in terms of anchoring, objectification, transformation, and structure, as well as Moscovici’s notion of canonic themata. (shrink)

Methodological triangulation is the use of more than one method to investigate a phenomenon. Nurse researchers investigate health phenomena using methods drawn from the natural and social sciences. The methodological debate concerns the possibility of confirming a single theory with different kinds of methods. The nursing debate parallels the philosophical debate about how the natural and social sciences are related. This article critiques the presuppositions of the nursing debate and suggests alternatives. The consequence is a view of triangulation that permits (...) different methods to confirm a single theory. The article then explores the consequences for the philosophy of social sciences. (shrink)

A growing body of literature critical of ethics review boards has drawn attention to the processes used to determine the ethical merit of research. Citing criticism on the bureaucratic nature of ethics review processes, this literature provides a useful provocation for (re)considering how the ethics review might be enacted. Much of this criticism focuses on how ethics review boards _deliberate,_ with particular attention given to the lack of transparency and opportunities for researcher recourse that characterise ethics review processes. Centered specifically (...) on the conduct of ethics review boards convened within university settings, this paper draws on these inherent criticisms to consider the ways that ethics review boards might enact more communicative and deliberative practices. Outlining a set of principles against which ethics review boards might establish strategies for engaging with researchers and research communities, this paper draws attention to how _Deliberative communication_, _Engagement with researchers_ and the _Distribution of responsibility_ for the ethics review might be enacted in the day-to-day practice of the university human ethics review board. This paper develops these themes via a conceptual lens derived from Habermas’ (The theory of communicative action. Volume 1: Reason and the rationalization of society, 1984 ) articulation of ‘communicative action’ and Fraser’s (Social Text, 25(26), 56–80, 1990 ) consideration of ‘strong publics’ to cast consideration of the role that human ethics review boards might play in supporting university research cultures. _Deliberative communication_, _Engagement with researchers_ and the _Distribution of responsibility_ provide useful conceptual prompts for considering how ethics review boards might undertake their work. (shrink)

Moloney, Francis J Jesus' teaching on divorce is a question of central importance to the Christian churches. The ministry of Pope Francis, and the agenda of the Synod of Bishops on the Family, has again drawn attention to the issue. Given the paucity of material on marriage and divorce in the entire Bible, it is not surprising that very little material in the New Testament is dedicated to Jesus' attitude to the issue. But what is found in Paul, Mark, (...) Matthew and Luke is confronting to contemporary sensitivities, and calls for clear analysis. An uncritical affirmation that Jesus prohibited divorce does not do justice to what is recalled in our inspired Scriptures. The fact that he did so must be given its due importance, but Jesus' prohibition of divorce and remarriage is not the only word on marriage and divorce in the pages of the New Testament. A neglect of the subtleties expressed across the pastoral and theological reinterpretations of Paul, Mark, and Matthew, accepted by the church as the inspired Word of God, call for close attention. (shrink)

Moloney, Francis J In 1996 the American sociologist, Rodney Stark, published a provocative sociological study called The Rise of Christianity. He wrote this book because his reading of the work of the historians of early Christianity showed that their history was good, but their sociology was nonexistent. He minimalised many theories about the rise of Christianity. Theologians and church historians regularly point to the transforming effect of the purity of the doctrine, the teaching of the resurrection, the blood of (...) the martyrs, a sacramental life, and other such central Christian beliefs and phenomena as the reasons for its rapid spread in the Roman Empire. Stark questions this, insisting that the fundamental motivation for the phenomenon was that the Christians cared for one another, especially their women. (shrink)

Christian Smith has described the religious attitudes of American youth and many adults as Moralistic Therapeutic Deism. In this formulation the word “therapeutic” does much work, and is meant to indicate that the goal of life is to be happy, to which end religion is instrumental. Martha Nussbaum has argued that Hellenistic schools of philosophy were therapeutic and instrumental in much the same way, and that this is a possible mode of philosophy even today. Appealing to the historical investigations of (...) Pierre Hadot and Giovanni Reale, this paper shows that Neoplatonism was an even more successful form of therapeutic philosophy, a fact which Augustine recognized and to which he responded in his therapeutic masterpiece Confessions, through his depiction of his mother as a sage. This suggests that Catholicism can be powerful when presented therapeutically, which might be a more appropriate mode for evangelism in our therapeutic age. (shrink)

In 1970, exactly fifty years ago, I took entrance examinations in Hebrew and Greek to begin studies at the Pontifical Biblical Institute, Rome. I have shared in various ministries since then, sometimes in positions that distracted from my academic interests. Nevertheless, I have been a privileged 'insider' to the development of critical studies of the New Testament over the past fifty years. Given my history, the title of this essay shamelessly plagiarises Geoffrey Blainey's delightful recollections of his early years, 'Before (...) I Forget'. (shrink)

An account of the transition from the Edenic to the state of nature discourse in the late sixteenth and early seventeenth centuries has yet to be written. The contention of this paper is that Hobbes's work is a useful place to begin an investigation of this process of change. Though not the initiator of this transformation, Hobbes must take much of the credit for the eventual eclipse of one discourse by the other. An exposition of the Edenic discourse, kept alive (...) in the theological tracts of English divines, sets the proper context for an appreciation of Hobbes's state-of-nature scheme. As is made evident in a number of his Latin publications, Hobbes came to realize that the viability of his own narrative of political creation required the subversion of traditional glosses on Genesis. By attending to two particular features of the Edenic discourse that Hobbes sought to negate -- the language Adam spoke and the knowledge he possessed and transmitted to his posterity -- important connections are made with Hobbes's general theory of signs and his absolutist theory of sovereignty. (shrink)

Addressing the National Directors of the Pontifical Mission Societies on 1 June 2018, Pope Francis advised: 'Your regular book for prayer and meditation should be the Acts of the Apostles. Go there to find your inspiration. And the protagonist of that book is the Holy Spirit'.1 It is widely accepted that the Gospel of Luke and the Acts of the Apostles form a single work, highlighted by three distinct 'eras'.2 Each of them depends upon the creative presence of the Spirit.