Doctors and dentists have traditionally used antibiotic prophylaxis in certain patient groups in order to prevent infective endocarditis (IE). New guidelines, however, suggest that the risk to patients from using antibiotics is higher than the risk from IE. This paper analyses the relative risks of prescribing and not prescribing antibiotic prophylaxis against the background of Pascal’s Wager, the infamous assertion that it is better to believe in God regardless of evidence, because of the prospective benefits should He exist. Many doctors (...) seem to believe the parallel proposition that it is better to prescribe antibiotics, regardless of evidence, because of the prospective benefit conferred upon the patient. This has been called the “no lose philosophy” in medicine: better safe than sorry, even if the evidence inconveniently suggests that following this mantra is potentially more likely to result in sorry than safe. It transpires that, just as Pascal’s Wager fails to convince because of a lack of evidence to support it and the costs incurred by trying to believe, so the “belts and braces” approach of prescribing antibiotic prophylaxis is unjustifiable given the actual evidence of potential risk and benefit to the patient. Ultimately, there is no no-lose if your clinical decisions, like Pascal’s Wager, are based on faith rather than evidence. (shrink)
Many ethical issues are posed by public health interventions. Although abstract theorizing about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation's children and reduce dental inequalities through a combination of targeted and universal interventions. With (...) Scotland's level of dental caries among the worst in Europe, Childsmile represents one of the largest programmes of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility. (shrink)
By reconstructing it and tracing its vicissitudes, David Conway rehabilitates a time-honored conception of philosophy, originating in Plato and Aristotle, which makes theoretical wisdom its aim. Wisdom is equated with possessing a demonstrably correct understanding of why the world exists and has the broad character it does. Adherents of this conception maintained the world to be the demonstrable creation of a divine intelligence in whose contemplation supreme human happiness resides. Their claims are defended against various latter-day skepticisms.
Those who vote intelligently vote for principles as much as they do for policy. The problem is that bodies of principle tend to be incompatible with each other. In fact, they normally conflict, head-on. Conservatism and socialism are two obvious examples here. My point, therefore, is that, with this type of incompatibility, it is difficult to see how any coalition could be maintained for long without a considerable sacrifice of principle – not to say integrity – by at least one (...) of the parties to it. (shrink)
Most recent writers of informal logic texts draw a distinction between "linked" and "convergent" arguments. According to its inventor, Stephen Thomas, the distinction is of the utmost importance; it "seems crucial to the analysis and evaluation of reasoning in natural language." I argue that the distinction has not been drawn in any way that makes it both clear and of any real originality or importance. Many formulations are obscure or conceptually incoherent. One formulation of the distinction does seem tolerably clear (...) and I develop another, but neither promises to make it matter much. We can well do without it. (shrink)