This new edition of Law and Medical Ethics continues to chart the ever-widening field that the topics cover. The interplay between the health caring professions and the public during the period intervening since the last edition has, perhaps, been mainly dominated by wide-ranging changes in the administration of the National Health Service and of the professions themselves but these have been paralleled by important developments in medical jurisprudence.

Transhumanism’s ideology is marked by a commitment to the “progress” or “perfection” of the human species through technological means. What transhumanists are after is not just therapeutic intervention or optimization of current human capabilities, but an ontological change from human to posthuman. In this article, I critique transhumanist ideology on the grounds that it fundamentally misunderstands human moral perfection as resulting from forces acting upon us (i.e., technological interventions), rather than an internal change of character. This misunderstanding reflects an impoverished (...) view of the concept of motion brought about by the rise of modern science, which entails certain ontological commitments that are not Christian in nature. I conclude transhumanism is untenable because it rests on a shaky foundation of Newtonian physics, and reduces the world to mere matter and forces. Furthermore, Christian transhumanism is especially flawed, because it is complicit in this severing of creation from its sacramental ontology, from the Being of God. (shrink)

Recent literature on the ethics of medical error disclosure acknowledges the feelings of injustice, confusion, and grief patients and their families experience as a result of medical error. Substantially less literature acknowledges the emotional and relational discomfort of the physicians responsible or suggests a meaningful way forward. To address these concerns more fully, I propose a model of medical error disclosure that mirrors the theological and sacramental technique of confession. I use Aquinas’ description of moral acts to show that all (...) medical errors are evil, and some accidental medical errors constitute venial sins; all sin and evil should be confessed. As Aquinas urges confession for sins, here I argue that confession is necessary to restore physicians to the community and to provide a sense of absolution. Even mistakes for which physicians are not morally culpable ought to be confessed in order to heal the physician–patient relationship and to address feelings of professional distress. This paper utilizes an Episcopal theology of confession that affirms verbal admission and responsibility-taking as freeing and relationally restoring acts, arguing that a confessional stance toward medical error both leads to better outcomes in physician–patient relationships and is more compassionate toward physicians who err. (shrink)

This article offers an interpretation of the concept of ‘zheng 正’ as it appears in Daodejing and Zhuangzi. My aim is to reveal and develop the contributions that the Dao...

Honor walks are ceremonies that purportedly honor organ donors as they make their final journey from the ICU to the OR. In this paper, we draw on Ronald Grimes’ work in ritual studies to examine honor walks as ceremonial rituals that display medico-technological power in a symbolic social drama (Grimes, 1982). We argue that while honor walks claim to honor organ donors, ceremonies cannot primarily honor donors, but can only honor donation itself. Honor walks promote the quasi-religious idea of donation (...) as a “good death,” and mask the ambiguity and discomfort inherent in organ donation to promote greater acceptance by the medical community. While some goods may be achieved through honor walks, particularly for donor families, it is still important to examine the negative work done by this practice. (shrink)

This book, originally published in 1989 discusses an issue central to all philosophical argument – the relation between persuasion and truth. The techniques of persuasion are indirect and not always fully transparent. Whether philosophers and theoreticians are for or against the use of rhetoric, they engage in rhetorical practice none the less. Focusing on Plato, Descartes, Kant, Kierkegaard, Nietzsche and Wittgenstein, this book uncovers philosophical rhetoric at work and reminds us of the rhetorical arena in which philosophical writings are produced (...) and considered. (shrink)

In the middle of the 19th century a new value began to appear in Western Europe - the belief that (in the words of Matthew Arnold) 'the exercise of a creative activity is the true function of man'. This book gives an account of the stages by which, and the reasons why, this development occurred at that time. In so doing it reveals a historical puzzle, for the main factors which can be seen to have given rise to the new (...) value - mainly scientific, technological, economic and political - were not reflected in the value itself, for that was applied almost exclusively to artistic and cultural activity. John Hope Mason sets out to explain this puzzle by showing how throughout European history there have been two radically different views of the creative attribute. An early example of one view was the character of Prometheus in Greek mythology; influential examples of the second were the figures of God the Creator in Judaeo-Christian theology and the neo-Platonic One in Hellenistic philosophy. The book shows how the contrast represented by those figures informed discussions of genius in the 18th century and indicates why the notion of creativity which came to prevail then assimilated it with purely aesthetic and moral concerns. Combining a broad perspective with a close analysis of key figures - from Adam Smith, Rousseau and Kant, to Arnold, Marx and Nietzsche - this book casts a new light on a central value of the modern world. (shrink)

The objective of this paper is to discuss the tradition of adversarialism as it relates to mediation and to suggest ways in which good practice can be encouraged amongst mediation advocates. Mediation is a key mechanism for dispute resolution in the English and Welsh jurisdiction. The practice of the lawyers involved in the mediation process is shaped by various factors including training, codes of practice, behavioural norms and court guidance. The default skill set the legal professionals bring to the process (...) is founded on the principle of adversarialism which is not suited to the core values of mediation. The developing professional group of mediation advocates, many of whom are from the legal professions, may benefit from a voluntarily assumed code of practice. The alternatives are to include provisions covering behaviour in mediation into existing codes of conduct for legal professionals and the adoption of more collaborative pre-meditation agreements which include lawyers. A combination of these measures is recommended as a way to assist the process of realignment of the advocate role from that of legal adversary to collaborator. (shrink)

Here we identify approximately 40,000 healthy human volunteers who were intentionally exposed to infectious pathogens in clinical research studies dating from late World War II to the early 2000s. Microbial challenge experiments continue today under contemporary human subject research requirements. In fact, we estimated 4,000 additional volunteers who were experimentally infected between 2010 and the present day. We examine the risks and benefits of these experiments and present areas for improvement in protections of participants with respect to safety. These are (...) the absence of maximum limits to risk and the potential for institutional review boards to include questionable benefits to subjects and society when weighing the risks and benefits of research protocols. The lack of a duty of medical care by physician–investigators to research subjects is likewise of concern. The transparency of microbial challenge experiments and the safety concerns raised in this work may stimulate further dialogue on the risks to participants of human experimentation. (shrink)

Mason and McCall Smith's classic textbook discusses the relationship of medical practice and ethics with the operation of the law. The subjects covered include natural and assisted reproduction, the impact of modern genetics on medicine, medical confidentiality, consent to medical treatment, the use of resources and problems surrounding death in the new medical era. It is of significance to anyone with an interest in the ethical and legal practice of medicine.

This paper traces the development of parental rights to accept or to refuse treatment for a defective newborn infant in the United Kingdom and in the United States of America; its main purpose is to explore the common trends from which an acceptable policy may be derived. It is probable that the British law on parental decision-making in respect of infants suffering from Down's syndrome is to be found in the civil case of In Re B rather than in the (...) criminal case of R v Arthur. United States court decisions are strongly influenced by constitutional law and reflect the right to personal privacy. The position on each side of the Atlantic seems very similar but this similarity includes a sense of uncertainty as to legal responsibility. There is a case for agreed guidelines and a suggested format is offered for consideration. (shrink)

Drosophila telomeres comprise DNA sequences that differ dramatically from those of other eukaryotes. Telomere functions, however, are similar to those found in telomerase‐based telomeres, even though the underlying mechanisms may differ. Drosophila telomeres use arrays of retrotransposons to maintain chromosome length, while nearly all other eukaryotes rely on telomerase‐generated short repeats. Regardless of the DNA sequence, several end‐binding proteins are evolutionarily conserved. Away from the end, the Drosophila telomeric and subtelomeric DNA sequences are complexed with unique combinations of proteins that (...) also modulate chromatin structure elsewhere in the genome. Maintaining and regulating the transcriptional activity of the telomeric retrotransposons in Drosophila requires specific chromatin structures and, while telomeric silencing spreads from the terminal repeats in yeast, the source of telomeric silencing in Drosophila is the subterminal arrays. However, the subterminal arrays in both species may be involved in telomere–telomere associations and/or communication. BioEssays 30:25–37, 2008. © 2007 Wiley Periodicals, Inc. (shrink)

Medical ethics and medical practice -- Public health and the state-patient relationship -- Health rights and obligations in the European Union -- Consent to treatment -- Liability for medical injury -- Medical confidentiality -- Genetic information and the law -- The management of infertility and childlessness -- The control of fertility -- Civil and criminal liability in reproductive medicine -- Health resources and dilemmas in treatment -- Treatment of the aged -- Mental health and human rights -- The body as (...) property -- Medical futility -- The diagnosis of death -- The donation of organs and transplantation -- Euthanasia and assistance in dying -- Biomedical human research and experimentation -- Research on children, fetuses and embryos. (shrink)

This book, originally published in 1989 discusses an issue central to all philosophical argument – the relation between persuasion and truth. The techniques of persuasion are indirect and not always fully transparent. Whether philosophers and theoreticians are for or against the use of rhetoric, they engage in rhetorical practice none the less. Focusing on Plato, Descartes, Kant, Kierkegaard, Nietzsche and Wittgenstein, this book uncovers philosophical rhetoric at work and reminds us of the rhetorical arena in which philosophical writings are produced (...) and considered. (shrink)

In recent years, increasingly advanced artificial intelligence (AI), and in particular machine learning, has shown great promise as a tool in various healthcare contexts. Yet as machine learning in medicine has become more useful and more widely adopted, concerns have arisen about the “black-box” nature of some of these AI models, or the inability to understand—and explain—the inner workings of the technology. Some critics argue that AI algorithms must be explainable to be responsibly used in the clinical encounter, while supporters (...) of AI dismiss the importance of explainability and instead highlight the many benefits the application of this technology could have for medicine. However, this dichotomy fails to consider the particular ways in which machine learning technologies mediate relations in the clinical encounter, and in doing so, makes explainability more of a problem than it actually is. We argue that postphenomenology is a highly useful theoretical lens through which to examine black-box AI, because it helps us better understand the particular mediating effects this type of technology brings to clinical encounters and moves beyond the explainability stalemate. Using a postphenomenological approach, we argue that explainability is more of a concern for physicians than it is for patients, and that a lack of explainability does not introduce a novel concern to the physician–patient encounter. Explainability is just one feature of technological mediation and need not be the central concern on which the use of black-box AI hinges. (shrink)

In 1993, Jim Mason, journalist, advocate, and pioneering figure in the contemporary animal advocacy movement, published An Unnatural Order-a sweeping overview of the origins of our hatred and destruction of the natural world and its creatures, from the dawn of agriculture to the present day. Now fully revised and updated to reflect developments in paleoanthropology and ethology, as well as greater awareness of, and urgency regarding, the climate crisis, An Unnatural Order offers an expansive overview of what has changed (both (...) for good and for ill) and what has unfortunately remained the same. His message is clear: until we grapple with the question of the animal, and our relationship with animality and the natural world, we will not be able to confront the consequences of our perpetuation of environmental destruction, biodiversity collapse, and our alienation from the Earth and one another. As brilliantly polemical and richly descriptive as it was when it was published almost three decades ago, this new version of An Unnatural Order is sure to excite a passionate debate about our role in either saving the ecosystems upon which all species (including our own) rely, or bringing it all to an end. (shrink)

Open peer commentary on the article “Building Bridges to Algebra through a Constructionist Learning Environment” by Eirini Geraniou & Manolis Mavrikis. Upshot: In striving to support transition or bridging between arithmetic and algebra through software, Geraniou & Mavrikis come up against the need for learners not simply to “reflect” on what they have been doing, but to withdraw from action every so often, consider what actions have been effective, and construct their own narrative to hold together actions and goals and (...) connections to past experience with other topics. (shrink)

Fully automated vehicles (AVs) hold promise toward providing numerous societal benefits including reducing road fatalities. However, we are uncertain about how individuals’ perceptions will influence their ability to accept and adopt AVs. The 28-item Automated Vehicle User Perception Survey (AVUPS) is a visual analog scale that was previously constructed, with established face and content validity, to assess individuals’ perceptions of AVs. In this study, we examined construct validity, via exploratory factor analysis and subsequent Mokken scale analyses. Next, internal consistency was (...) assessed via Cronbach’s alpha (α) and 2-week test–retest reliability was assessed via Spearman’s rho (ρ) and intraclass correlation coefficient (ICC). The Mokken scale analyses resulted in a refined 20-item AVUPS and three Mokken subscales assessing specific domains of adults’ perceptions of AVs: (a)Intention to use; (b)perceived barriers; and (c)well-being. The Mokken scale analysis showed that all item-coefficients of homogeneity (H) exceeded 0.3, indicating that the items reflect a single latent variable. The AVUPS indicated a strong Mokken scale (Hscale= 0.51) with excellent internal consistency (α = 0.95) and test–retest reliability (ρ = 0.76, ICC = 0.95). Similarly, the three Mokken subscales ranged from moderate to strong (rangeHscale= 0.47–0.66) and had excellent internal consistency (range α = 0.84–0.94) and test–retest reliability (range ICC = 0.84–0.93). The AVUPS and three Mokken subscales of AV acceptance were validated in a moderate sample size (N= 312) of adults living in the United States. Two-week test–retest reliability was established using a subset of Amazon Mechanical Turk participants (N= 84). The AVUPS, or any combination of the three subscales, can be used to validly and reliably assess adults’ perceptions before and after being exposed to AVs. The AVUPS can be used to quantify adults’ acceptance of fully AVs. (shrink)

An ongoing debate in comparative research is about whether we should see cultural diversities as manifestations of essential differences or as superficial variations on a universal blueprint. Edward Slingerland has pointed to cognitive science and the use of embodied metaphors to emphasize the universality of concept formation and cognition across cultures. He suggests that this should quiet the “cultural essentialists” who take fundamental differences in Eastern and Western thinking as their starting points. Michael Puett has also leveled a critique of (...) cultural essentialism in support of a presuppositionless approach, and Slingerland’s conclusions seem to offer him support. However, I will argue that even if all modern humans are broadly similar in metaphor use and cognitive processes, research in the humanities must continue to account for the differences implied by the particular metaphors employed and emphasized in diverse traditions. I contend that responsible hermeneutic practice does this through provisional, yet indispensable, generalizations. (shrink)

The push by some bioethicists to excise religion from the clinical ethics consultative process has received institutional support from the American Society for Bioethics and the Humanities. Their certification program, Healthcare Ethics Consultant-Certified, is intended to identify and assess “a national standard for the professional practice of clinical healthcare ethics consulting” devoid of religious content. As Christian ethicists who wish to preserve the morally evaluative nature of healthcare ethics, we must pause and theologically reflect on the meaning of such a (...) program. The five articles in this issue offer rich theological responses to the religion-free standardized methodology endorsed by the ASBH and reified in the HEC-C certification program. They offer a depth of theological reflection we see previously lacking in the literature, attending to the real possibilities of a “terraformed bioethics” effecting metaphysical harm, severing of clinical ethics from its sources, eliminating possibilities for conversion, and confusing the meaning of moral expertise. (shrink)

This paper examines the metaphor of harmony as a criterion of hermeneutic understanding. Taking harmony as a play of integrated parts within a dynamic whole, we can see the hermeneutic task of interpretation as a process of harmonizing parts meaningfully with each other and with the larger whole. Holding up a sufficiently rich notion of harmony as an ideal of interpretation can guide our hermeneutic practices. After distinguishing subtle differences in the Greek and Chinese conceptions of harmony, I argue that (...) the Chinese conception more closely aligns with the metaphysical and epistemological assumptions of Hans-Georg Gadamer’s approach to hermeneutic understanding. In the end, I suggest that these insights can lead us to progress in social harmony. (shrink)