A practical and thought provoking introduction to the most important ethical issues in medicine today. Over 700 entries, from short essays to brief definitions of key terms and concepts, have been contributed by leading clinicians and medical ethicists.

Health care services today lack the resources to meet everybody's exspectations. Patients, professional workers and trade unions have legitimate but frequently conflicting claims, and so too have the different interest groups and specialties within medicine. This book provides an account of how resource allocation dilemmas appear to those confronted by them, in the hospital, on health boards and in the community, and it offers a critique of the moral and political arguments most commonly employed in discussing them.

The symposium in this issue, on equality and disability, helps to clarify some areas of continuing disagreement in disability studies, but also uncovers substantial consensus. All of the contributors appear to endorse John Harris's statement that “No disability, however slight, nor however severe, implies lesser moral, political or ethical status, worth, or value”.1 It seems safe to assume, moreover, that few if any readers of the Journal of Medical Ethics are likely to disagree with this, or indeed to challenge Kate (...) Diesfeld's initial assumption that “Generally speaking, it is both immoral and unlawful to discriminate between people on the ground of disability”.2Some, of course, might challenge Diesfeld's choice of the word “between” rather than “against”. What is generally agreed to be both immoral and unlawful is discrimination in the modern sense of treating people unjustly on the basis of distinctions that are not morally relevant to the matter in hand. It is neither immoral nor illegal, for example, for a transport employee to discriminate between members of the travelling public in order to offer some but not others the use of a wheelchair or a wheelchair ramp. Nor is it immoral or illegal for society to discriminate between its members through legislation which offers, to some but not others, special forms of aid or protection, based on the recognition of their respective disabilities.Legislation designed to protect people …. (shrink)

Like many other locals, I was unprepared for the global media's invasion of Roslin. The former mining village just outside the southern city limits is best known to most Edinburgh citizens for its tiny, ornately carved medieval chapel. Constructed for Crusading Knights and long associated with Freemasons, Rosslyn Chapel was made famous by Sir Walter Scott's LayoftheLastMinstrel. Nowadays it is visited, in coachloads, by devotees of less literary and historically more dubious esoterica, many of whom believe that the Holy Grail (...) and/or a version of the gospels are buried beneath it. In the local media, demands for the chapel's foundations to be excavated in search of secret clues to the meaning of life, death, and everything, have figured just as prominently as articles agonizing over scientific developments at the Roslin Institute, half a country mile away. (shrink)

An Institute of Medical Ethics working party supports the view that explicit permission should normally be sought in the case of testing for HIV antibody. It discusses this in relation to anonymised HIV testing for epidemiological purposes, concluding that this is to be welcomed, given certain safeguards. It next argues that pregnant women may have a greater and more immediate need than others to know their HIV status. It concludes that this need does not justify testing them without their permission, (...) but can be met by voluntary diagnostic testing on an 'opting-out' basis, supported by adequate briefing. (shrink)

This book is the result of a three-year study undertaken by a multidisciplinary working party of the Institute of Medical Ethic (UK). The group was chaired by a moral theologian, and its members included biological and ethological scientists, toxicologists, physicians, veterinary surgeons, an expert in alternatives to animal use, officers of animal welfare organizations, a Home Office Inspector, philosophers, and a lawyer. Coming from these different backgrounds, and holding a diversity of moral views, the members produced the agreed report as (...) a result of detailed and rigorous discussions. The book sets out facts about animal experiments and about animal abilities to experience pain, distress and anxiety. There is a detailed examination of the moral claims related to the benefits likely to accrue from animal research, and of strategies for weighing these benefits against the harm caused to animals, in order to decide whether particular research projects ought or ought not to proceed. This leads to consideration of the statutory and non-statutory controls which safeguard standards in such research. The final section explores a variety of philosophical arguments about the use of animals in research, and offers a philosophical justification for the Working Party's more practical conclusions. Written in clear, nontechnical language, this book is accessible to lay people as well as to scientists. It is the first such document to emerge from a meeting of people with such widely differing views on this highly controversial subject, and represents a major contribution towards informing and raising the quality of contemporary debate. The book is unique in drawing together material and ideas never before found in one volume. It will interest a broad spectrum of readers, from ethicists and animal rights advocates to scientific researchers and laboratory administrators, along with general readers concerned about this compelling issue. (shrink)

Based on a study undertaken by the Institute of Medical Ethics and the Royal College of Nursing, this book examines what nurses, midwives and health visitors are taught about ethics in the UK. It defines ethics and related terms and discusses their relevance to the practice of nursing.

Ethics in nursing: continuity and change -- Cultural issues, methods and approaches to nursing ethics -- Nursing ethics: what do we mean by 'ethics'? -- Becoming a nurse and member of the profession -- Power and responsibility in nursing practice and management -- Professional responsibility and accountability in nursing -- Classical areas of controversy in nursing and biomedical ethics -- Direct responsibility in nurse/patient relationships -- Conflicting demands in nursing groups of patients -- Ethics in healthcare management: research, evaluation and (...) performance management -- The political ethics of healthcare: health policies and resource allocation -- Corporate ethics in healthcare: strategic planning and ethical policy development -- Making moral decisions and being able to justify our actions -- The relevance of moral theory: justifying our ethical policies. (shrink)

What is the nature of law and what is the best way to discover it? This book argues that law is best understood in terms of the social functions it performs wherever it is found in human society. In order to support this claim, law is explained as a kind of institution and as a kind of artefact. To say that it is an institution is to say that it is designed for creating and conferring special statuses to people so (...) as to alter their rights and responsibilities toward each other. To say that it is an artefact is to say that it is a tool of human creation that is designed to signal its usability to people who interact with it. This picture of law's nature is marshalled to critique theories of law that see it mainly as a product of reason or morality, understanding those theories via their conceptions of law's function. It is also used to argue against those legal positivists who see law's functions as relatively minor aspects of its nature. -/- This method of conceptualizing law's nature helps us to explain how the law, understood as social facts, can make normative demands upon us. It also recommends a methodology for understanding law that combines elements of conceptual analysis with empirical research for uncovering the purposes to which diverse peoples put their legal activities. (shrink)

At the beginning of his Metaphysics, Aristotle attributed several strange-sounding theses to Plato. Generations of Plato scholars have assumed that these could not be found in the dialogues. In heated arguments, they have debated the significance of these claims, some arguing that they constituted an 'unwritten teaching' and others maintaining that Aristotle was mistaken in attributing them to Plato. In a prior book-length study on Plato's late ontology, Kenneth M. Sayre demonstrated that, despite differences in terminology, these claims correspond (...) to themes developed by Plato in the Parmenides and the Philebus. In this book, he shows how this correspondence can be extended to key, but previously obscure, passages in the Statesman. He also examines the interpretative consequences for other sections of that dialogue, particularly those concerned with the practice of dialectical inquiry. (shrink)

The primary aim of this chapter is to show that several missteps made by others in in their thinking about law as an artefact are due to misconceptions about the role of intentions in understanding law as an artefact. I first briefly recap my own contention that law is a genre of institutionalized abstract artefacts (put forth in The Functions of Law (OUP 2016) and subsequent papers), mostly following Searle’s understanding of institutions and Thomasson’s understanding of public artefacts. I highlight (...) the central place that this theory affords law’s functions, without requiring the theorist to say that possession or performance of the function is either necessary or sufficient for inclusion in the class of law. Some of the most common misunderstandings are exemplified in Brian Leiter’s paper ‘Legal Positivism about the Artifact Law’. He thinks that holding an intentionalist view of artefacts commits the theorist to privileging drafters’ intentions when interpreting law. (It doesn’t.) He also has confusions about the differences between artefact tokens and artefact types leading him to a problematically broad understanding of artefacts. Another problem can be seen in thinking that functional understandings of artefacts are vulnerable to the same problems that arise in functional explanations for biological systems. I go on to consider the work of Luka Burazin and Corrado Roversi, addressing worries that making intentionality central to artefacts implies too much conscious thought is required to make one, noting that several theories of intentionality do not require conscious thought in the execution of intentional action. While those who think a central place for intentionality threatens to leave us unable to explain customary law, this can be dealt with by noting the important distinction between customary rules and customary laws (where the latter requires a decision to enlist public aid in redressing violations). I claim that authors’ intentions are communicated requests for the artefacts’ audiences to see the artefacts as members of their putative kinds. Finally, I address the question of whether or not legal systems are themselves artefacts and institutions, given that they may or may not have been intentionally created. An early lawgiver might have created a legal system by accident in the process of handing down the first laws. I raise the possibility that we might want to impute intentionality to necessary by-products of artefact creation, seeing those by-products as artefacts as well. (shrink)

Corporate social responsibility (CSR) is increasingly becoming a popular business concept in developed economies. As typical of other business concepts, it is on its way to globalization through practices and structures of the globalized capitalist world order, typified in Multinational Corporations (MNCs). However, CSR often sits uncomfortably in this capitalist world order, as MNCs are often challenged by the global reach of their supply chains and the possible irresponsible practices inherent along these chains. The possibility of irresponsible practices puts global (...) firms under pressure to protect their brands even if it means assuming responsibilities for the practices of their suppliers. Pressure groups understand this burden on firms and try to take advantage of the situation. This article seeks to challenge the often taken-for-granted-assumption that firms should be accountable for the practices of their suppliers by espousing the moral (and sometimes legal) underpinnings of the concept of responsibility. Except where corporate control and or corporate grouping exist, it identifies the use of power as a critical factor to be considered in allocating responsibility in firm-supplier relationship; and suggests that the more powerful in this relationship has a responsibility to exert some moral influence on the weaker party. The article highlights the use of code of conducts, corporate culture, anti-pressure group campaigns, personnel training and value reorientation as possible sources of wielding positive moral influence along supply chains. (shrink)

The COVID-19 pandemic that struck New York City in the spring of 2020 was a natural experiment for the clinical ethics services of NewYork-Presbyterian (NYP). Two distinct teams at NYP’s flagship academic medical centers—at NYP/ Columbia University Medical Center (Columbia) and NYP/ Weill Cornell Medical Center (Weill Cornell)—were faced with the same pandemic and operated under the same institutional rules. Each campus used time as an heuristic to analyze our collective response. The Columbia team compares consults during the pandemic with (...) the same period during the year prior. The Weill Cornell service describes the phases of the pandemic to depict its temporal evolution and subsequent ethical challenges. Both sites report that the predominant ethical challenges centered around end-of-life decision making, setting goals of care, and medical futility, all complicated by resource allocation questions and the ambiguity of state law under crisis standards of care. The Columbia campus saw a statistically significant increase in ethics consultations provided to Hispanic patients, perhaps reflective of the disproportionate burden of COVID-19 suffered by this demographic. While Weill Cornell and Columbia saw a surge in clinical ethics consultations, the two services assumed a more expansive role than one normally played in institutional life. Serving as intermediaries between frontline clinicians and senior hospital administrators, consultants provided critical intelligence to hospital leadership about the evolution of the pandemic, disseminated information to clinicians, and attended to the moral distress of colleagues who were asked to provide care under truly extraordinary circumstances. The COVID-19 surge in New York City revealed latent capabilities in ethics consultation that may prove useful to the broader clinical ethics community as it responds to the current pandemic and reconceptualizes its potential for future service. (shrink)

A new edition of a classic work compares Plato's dialogues to Aristotle's depiction of them. Reprint.

The most influential theory of law in current analytic legal philosophy is legal positivism, which generally understands law to be a kind of institution. The most influential theory of institutions in current analytic social philosophy is that of John Searle. One would hope that the two theories are compatible, and in many ways they certainly are. But one incompatibility that still needs ironing out involves the relation of the social rule that undergirds the validity of any legal system (H.L.A. Hart's (...) rule of recognition) to Searle's notion of codification: the idea that institutions need official declarations of their constitutive rules in order to enjoy the full benefits of institutions. The incompatibility arises from the fact that, in order to do its institutional work, the basic validity rule must be codified in Searle's sense—yet, given the particular role it has in legal positivism, it may be impossible to codify in the Searlean sense. In this paper I develop the incompatibility in detail, consider and reject consigning the basic validity rule to Searle's “Background” capacities that support institutional facts, and conclude that the best route to eliminating it while doing a minimum of damage to the two theories is to make a slight emendation to Searle's theory of institutions. (shrink)

This chapter provides an explanation of precedent as a kind of artefact, in keeping with broader accounts of law that do so, specifically the author’s account of law as a genre of institutionalized abstract artefact. The chapter develops its explanation by responding to an argument by Dan Priel against seeing the common law as an artefact when understood to be a form of custom. The chapter shows that customs can themselves be artefacts but also that the precedential elements of common (...) law are not necessarily quite as customary as sometimes considered, showing that the common law built from precedents fits within a distributed design model of artefacts and that stare decisis has a wider systemic function of upholding certain rule of law principles. It ends with some considerations about the institutional nature of precedents, specifically that judicial decisions are most often both applications and developments of legal norms, but also determinations of legal validity. (shrink)

I have argued that law is a genre of institutionalized abstract artifact, meaning that laws are purposive products of human creation designed to signal norms of behavior with respect to them. Its institutional nature is seen in the fact that it is a system of artificial statuses that convey deontic powers to status holders understood in their institutional roles. Following Searle in explaining institutions, however, is also to see the institution as the 'continuing possibility of a practice.' Hence there is (...) no tension in seeing law as both a practice and a genre of artifact. (shrink)

Just as recognition and pursuit of the human good take place in language and action, so too do they unfold in encounter with the material and visual. The ethical crises, projects, and striving we see in everyday religious life are worked out not just in the intersubjective play and politics of language but also in encounter with, in dwelling with, material and visual substances and forms. This essay considers the material conditions that make possible the “ethical pleasures” sought by Indonesian (...) painter A. D. Pirous in making and displaying contemporary works of “Islamic art,” most especially works that make “visual recitation” of passages from the Qur'an. (shrink)

This book, published in 1976, presents an entirely original approach to the subject of the mind-body problem, examining it in terms of the conceptual links between the physical sciences and the sciences of human behaviour. It is based on the cybernetic concepts of information and feedback and on the related concepts of thermodynamic and communication-theoretic entropy. The foundation of the approach is the theme of continuity between evolution, learning and human consciousness. The author defines life as a process of energy (...) exchange between organism and environment, and evolution as a feedback process maintaining equilibrium between environment and reproductive group. He demonstrates that closely related feedback processes on the levels of the behaving organism and of the organism’s nervous system constitute the phenomena of learning and consciousness respectively. He analyses language as an expedient for extending human information-processing and control capacities beyond those provided by one’s own nervous system, and shows reason to be a mode of processing information in the form of concepts removed from immediate stimulus control. The last chapter touches on colour vision, pleasure and pain, intentionality, self-awareness and other subjective phenomena. Of special interest to the communication theorist and philosopher, this study is also of interest to psychologists and anyone interested in the connection between the physical and life sciences. (shrink)

Applying the analytical methods of modern logic to problems of interpretation in Plato, the author traces the development of Plato's analytic method from the crude form expressed in the Phaedo to the considerably more sophisticated and powerful techniques practiced in the later methodological dialogues.

The charged debate on the ‘C‐S‐R‐ization’ of organizational practices seems to have produced two opposing and seemingly incompatible explanations for why organizations should engage in corporate social responsibility (CSR): one, the normative rationale based on an appeal to ethics; and the other, the instrumental rationale, based on an appeal to business pragmatism. This paper argues that a missing link in this debate is the failure to recognize that the normative and instrumental approaches to corporate social responsibility are underpinned by substantively, (...) differentiating, relative logics of emotional rationalism on the one hand, and instrumental rationalism on the other. The paper makes a case that for CSR as a management practice to be practicable and actionable within a sustainable business agenda, it will need to be stripped of its current normative undertone and reconstructed in the instrumentally, pragmatic (utlish) language of business. Otherwise, the whole concept of CSR may continue to dwell in the realm of abstract theorizing without yielding many beneficial and practicable outcomes. The paper concludes that such an approach that situates CSR within a pragmatic business lingua, rather than a non‐business lingua, will help in legitimizing CSR as a ‘neutral’ management practice. (shrink)

An examination of the unconscious as it relates to popular music and the first truly interdisciplinary book on philosophy and popular music with equal weight given to each discipline.

In ‘(Really) Defending Exclusionary Reasons’, Monti seeks to defend Raz’ notion of exclusionary reasons from the attack made by Daniel Whiting. Monti agrees with Whiting that exclusionary reasons cannot motivate and so suggests that they operate by guiding rather than motivating. However, Monti’s account of guiding omits the key feature that they can guide even when one’s action is the opposite to what the exclusionary reason seems to recommend. An amended account of what it is to be guided by exclusionary (...) reasons is needed to give the Razian account the explanatory power it is due. (shrink)

If medical complicity is understood as compliance with a directive to act against the professional's best medical judgment, the question arises whether it can ever be justified. This paper will trace the contours of what would legitimate a directive to act against a professional's best medical judgment (and in possible contravention of her oath) using Joseph Raz's service conception of authority. The service conception is useful for basing the legitimacy of authoritative directives on the ability of the putative authority to (...) enable subjects to comply better with reasons that already apply to them. Hence, the service conception bases the legitimacy of practical authority on a certain kind of greater knowledge or expertise. This helps to focus the conundrum regarding complicity on the clash of expertise between the medical expert and the governing body tasked with coordinating behaviour and otherwise devising rules for the social good. The ethical dilemma presented by a hypothetically legitimate directive to act against a professional's best medical judgment also serves to highlight the moral dimension of one's duty to obey a legitimate authority. (shrink)

I argue that law is best understood as an institutionalized abstract artifact. Using the ideas of John Searle on institutions and Amie Thomasson on artifacts, I show how the law is capable of generating new reasons for action, arguing against recent work by David Enoch who holds that legal reason-giving is ultimately a form of triggering conditional reasons.

In his 1827 work Rationale of Judicial Evidence, Jeremy Bentham famously argued against exclusionary rules such as hearsay, preferring a policy of “universal admissibility” unless the declarant is easily available. Bentham’s claim that all relevant evidence should be considered with appropriate instructions to fact finders has been particularly influential among judges, culminating in the “principled approach” to hearsay in Canada articulated in R. v. Khelawon. Furthermore, many scholars attack Bentham’s argument only for ignoring the realities of juror bias, admitting universal (...) admissibility would be the best policy for an ideal jury. This article uses the theory of epistemic contextualism to justify the exclusion of otherwise relevant evidence, and even reliable hearsay, on the basis of preventing shifts in the epistemic context. Epistemic contextualism holds that the justification standards of knowledge attributions change according to the contexts in which the attributions are made. Hearsay and other kinds of information the assessment of which rely upon fact finders’ more common epistemic capabilities push the epistemic context of the trial toward one of more relaxed epistemic standards. The exclusion of hearsay helps to maintain a relatively high standards context hitched to the standard of proof for the case and to prevent shifts that threaten to try defendants with inconsistent standards. (shrink)

Matter as such produces nothing, changes nothing, does nothing; and however convenient it may afterwards be to abbreviate our nomenclature and our descriptions, we must most carefully realize in the outset that the spermatozoon, the nucleus, the chromosomes or the germ-plasma can never act as matter alone, but only as seats of energy and as centres of force.Science is a human endeavor that is rarely if ever just about science: it is also a social, political, and economic enterprise. As such (...) it is structured around an ethos: a belief system, or theory, that accounts for the nature of relevant aspects of existence. Much like other belief systems in the broader culture in which they occur, we build stories in defense... (shrink)

Under John Searle’s theory of institutional facts, the law can be understood both as an institution governed by foundational documents and practices, and as a method for creating new institutions through the codification of the assignment of functions, usually of the form ‘X counts as Y in circumstances C’. The architect Christopher Alexander’s notion of pattern languages, schematic templates for problem-solving widely adopted by computer programmers, can be developed within a legal system as a coherence constraint on the assignment of (...) functions such that codified legal solutions do not conflict with other legal solutions to related or distinct problems. (shrink)

Scott Shapiro’s theory that law is a social plan is helpful in seeing law essentially as a tool of human creation and as such is sympathetic to understanding law in terms of the social functions it performs, a method I argue for elsewhere. I focus here on two problems with the theory as presented. The planning theory does not adequately explain the persistence of law beyond the utility of those who implement it. Generally, plans can cease to exist as soon (...) as those engaged in them have no more use for them. Laws however, must usually be declared invalid or otherwise nullified for them to have no further effect. Shapiro’s use of self-certification to explain how law is differentiated from other forms of social planning is ad hoc and threatens circularity when he admits it to be a matter of degree. Both of these issues can be better solved by seeing law as an institutionalised abstract artefact, with a greater emphasis upon the nature of institutions doing much of the work done by the idea of planning. (shrink)

Dear Ursula,Sidewalker here. Since we have exchanged letters by snail or e-mail for more than forty years, I see no reason why the Sidewalker-Porcupine correspondence should stop with your passing. There are so many things I want to share with you, comments I wish I had made earlier, explanations of why I admire you so much. Of course, one problem is that I don't know your current address. I'm hoping that where you are you have access to Utopian Studies. I (...) know in the past you thought kindly of the journal. You even allowed Utopian Studies to reprint "The Ones Who Walk Away from Omelas" for $10.1 So I'm hoping you still glance at the journal. One disadvantage to this means of communication is that... (shrink)

Volume 10, Issue 2, June 2019, Page 255-280.