First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Some health-care institutions have ethics committees. The experience of the Ethical Issues Committee at the Royal College of Physicians is described. Ethics committees in institutions may be reactive or creative, must determine an agenda and must deal with dissent.

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration . This withdrawal is deemed necessary because (...) patients in PDOC can survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession. (shrink)

Following the death of James Joseph Sylvester in 1897, contributions were collected in order to mark his life and work by a suitable memorial. This initiative resulted in the Sylvester Medal, which is awarded triennially by the Royal Society for the encouragement of research into pure mathematics. Ironically the main advocate for initiating this medal was not a fellow mathematician but the chemist and naturalist Raphael Meldola. Religion, not mathematics, provided the link between Meldola and Sylvester; they were among (...) the very few Jewish Fellows of the Royal Society. This paper focuses primarily on the politics of the Anglo-Jewish community and why it, together with a number of scientists and mathematicians, supported Meldola in creating the Sylvester Medal. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:David Hume to Alexander Dick: A New Letter Heiner Klemme Hume's letter to the well-known physician and sometime President of the Edinburgh Royal College of Physicians, Sir Alexander Dick (formerlyCunningham)(1703-1785),1 belongs toa series ofinteresting letters written by philosophers and historians of the Scottish Enlightenment to be found in the autograph-collection of the German chemist and historian of science Ludwig Darmstaedter (1846-1927). Although a catalogue has been (...) published which lists the items ofhis collection in 1909, some of its autographs have not been noticed by scholars. The only hitherto known letter from Hume to Dick was written in August 1760. However, Hume mentions Dick once in a letter of 1762. Although the letter of 1771 listed below does not contribute in any specific way to our knowledge of their relationship, it might be of general interest to students ofHume.?. Staatsbibliothek Preußischer Kulturbesitz Berlin (West) Signature: Sammlung Darmstaedter, 2a 1748 (1) [Address:] To Sir Alexander Dick Bar1 Dear Sir This will be deliverdtoyoubyMrPanton,5 whogoes offthe Endof this Week, to New York. I have us'd the Freedom ofintroducing him to you, both as he is a young Man of Merit, and as I thought it probable you might take the Oppertunity of writing to your Friend, Mr Smith, by so good ahand. Ifyou do, I shoudbegofyou to recommend the young Gentlemen to his Acquaintance; and you may safely mention him as a Man of Letters and a Man of Character. He is to settle in New York, and it is impossible but he must get acquainted with Mr Smith; but a Recommendation from so good an Authority as Yours, wou'd serve to Volume XVI Number 2 87 HEINER KLEMME [crossedout: probably]forwardtheirgood Correspondence, andconnect them much sooner with each other. I am Dear Sir Your most obedient and most humble EdinburghServant 18 of March 1771David Hume Philipps-Universität Marburg, F.R.G. 1.For details ofhis life and work see Leslie Stephen, ed., Dictionary ofNational Biography, Vol. 15 (London, 1888), 14a-14b. 2.Ludwig Darmstaedter, Verzeichnis der Autographensammlung (Berlin, 1909), esp. 167. The collection includes the very firstletter Hume wrote in March 1755 to Andrew Strahan, his printer. See my "'And Time does Justice to All the World': Ein unveröffentlichter Brief von David Hume an William Strahan," Journal of the History of Philosophy, forthcoming. Two further letters of Adam Smith to Thomas Cadell are to be published in Archiv für Geschichte derPhilosophie. 3.See R. Klibansky and E. C. Mossner, eds., New letters ofDavid Hume (Oxford, 1954; reprint, New York, 1983), 58-64. 4.See New Letters (above,?. 3), 68. 5.I have not been able to verify the identity ofthis person nor ofthe Mr. Smith mentioned below. 88Hume Studies... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:David Hume to Alexander Dick: A New Letter Heiner Klemme Hume's letter to the well-known physician and sometime President of the Edinburgh Royal College of Physicians, Sir Alexander Dick (formerlyCunningham)(1703-1785),1 belongs toa series ofinteresting letters written by philosophers and historians of the Scottish Enlightenment to be found in the autograph-collection of the German chemist and historian of science Ludwig Darmstaedter (1846-1927). Although a catalogue has been (...) published which lists the items ofhis collection in 1909, some of its autographs have not been noticed by scholars. The only hitherto known letter from Hume to Dick was written in August 1760. However, Hume mentions Dick once in a letter of 1762. Although the letter of 1771 listed below does not contribute in any specific way to our knowledge of their relationship, it might be of general interest to students ofHume.?. Staatsbibliothek Preußischer Kulturbesitz Berlin (West) Signature: Sammlung Darmstaedter, 2a 1748 (1) [Address:] To Sir Alexander Dick Bar1 Dear Sir This will be deliverdtoyoubyMrPanton,5 whogoes offthe Endof this Week, to New York. I have us'd the Freedom ofintroducing him to you, both as he is a young Man of Merit, and as I thought it probable you might take the Oppertunity of writing to your Friend, Mr Smith, by so good ahand. Ifyou do, I shoudbegofyou to recommend the young Gentlemen to his Acquaintance; and you may safely mention him as a Man of Letters and a Man of Character. He is to settle in New York, and it is impossible but he must get acquainted with Mr Smith; but a Recommendation from so good an Authority as Yours, wou'd serve to Volume XVI Number 2 87 HEINER KLEMME [crossedout: probably]forwardtheirgood Correspondence, andconnect them much sooner with each other. I am Dear Sir Your most obedient and most humble EdinburghServant 18 of March 1771David Hume Philipps-Universität Marburg, F.R.G. 1.For details ofhis life and work see Leslie Stephen, ed., Dictionary ofNational Biography, Vol. 15 (London, 1888), 14a-14b. 2.Ludwig Darmstaedter, Verzeichnis der Autographensammlung (Berlin, 1909), esp. 167. The collection includes the very firstletter Hume wrote in March 1755 to Andrew Strahan, his printer. See my "'And Time does Justice to All the World': Ein unveröffentlichter Brief von David Hume an William Strahan," Journal of the History of Philosophy, forthcoming. Two further letters of Adam Smith to Thomas Cadell are to be published in Archiv für Geschichte derPhilosophie. 3.See R. Klibansky and E. C. Mossner, eds., New letters ofDavid Hume (Oxford, 1954; reprint, New York, 1983), 58-64. 4.See New Letters (above,?. 3), 68. 5.I have not been able to verify the identity ofthis person nor ofthe Mr. Smith mentioned below. 88Hume Studies... (shrink)

This article argues that lingering uncertainty about the normative foundations of research ethics is perpetuated by two unfounded dogmas of research ethics. The first dogma is that clinical research, as a social activity, is an inherently utilitarian endeavor. The second dogma is that an acceptable framework for research ethics must impose constraints on this endeavor whose moral force is grounded in role-related obligations of either physicians or researchers. This article argues that these dogmas are common to traditional articulations of (...) the equipoise requirement and to recently articulated alternatives, such as the non-exploitation approach. Moreover, important shortcomings of these approaches can be traced to their acceptance of these dogmas. After highlighting these shortcomings, this article illustrates the benefits of rejecting these dogmas by sketching the broad outlines of an alternative called the "integrative approach" to clinical research. (shrink)

Wars must be won if our country … is to be protected from unthinkable outcomes, as the events on September 11th most recently illustrated…. This best protection unequivocally requires armed forces having military physicians committed to doing what is required to secure victory…. As opposed to needing neutral physicians, we need military physicians who can and do identify as closely as possible with the military so that they, too, can carry out the vital part they play in (...) meeting the needs of the mission.Counterpoint:We believe the role of the “physician–soldier” to be an inherent moral impossibility because the military physician, in an environment of military control, is faced with the difficult problems of mixed agency that include obligations to the “fighting strength” and … “national security.”. (shrink)

While another von Hagens style public autopsy should not be encouraged, the public should nevertheless be able to experience such events as a public autopsy.During 2002 and 2003 there was considerable discussion about the work of Gunter von Hagens, famed for his Body Worlds exhibition,1 which was publicised extensively and with considerable success. The exhibition is a tribute to, and celebration of, his method of preserving organic life through the process of plastination, developed by von Hagens in the 1980s. The (...) process entails a form of preservation, whereby body parts are dehydrated and filled with polymer resin, making them more robust than conventional formaldehyde does.While it was in the United Kingdom, the exhibit was housed at a back street gallery in Brick Lane, London, though the exhibition has toured throughout the world. Despite many millions having flocked to see the exhibition, the reasons for its success are open to interpretation and have provoked strong opinions from the medical community as to whether this physician ought to be entitled to create exhibits from real bodies. Von Hagens would argue that these works are justifiable because they have artistic merit. Others would claim that viewers are being brought to the gallery by the immense publicity. Alternatively, one might suppose that those who attend the exhibition do so mainly because of a fascination with the extraordinary and with the grotesque. Indeed, such fascination with death, and human remains specifically, was the focus of a meeting hosted by the Institute of Ideas and the Royal College of Physicians in May 2003, which was entitled Morbid Fascinations: the Body and Death in Contemporary Culture.The controversy arising from the Body Worlds exhibition pales in comparison, however, to von Hagens’s most recent performance—the first “public autopsy” in Britain …. (shrink)

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to (...) caring for the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. (shrink)

Renowned neurologist and author Dr Oliver Sacks is a visiting professor at the University of Warwick as part of the Institute of Advanced Study. Dr Sacks was born in London. He earned his medical degree at the University of Oxford (Queen’s College) and the Middlesex Hospital (now UCL), followed by residencies and fellowships at Mt. Zion Hospital in San Francisco and at University of California Los Angeles (UCLA). As well as authoring best-selling books such as Awakenings and The (...) Man Who Mistook His Wife for a Hat, he is clinical professor of neurology at NYU Langone Medical Center in New York. Warwick is part of a consortium led by New York University which is building an applied science research institute, the Center for Urban Science and Progress (CUSP). Dr Sacks recently completed a five-year residency at Columbia University in New York, where he was professor of neurology and psychiatry. He also held the title of Columbia University Artist, in recognition of his contributions to the arts as well as to medicine. He is a fellow of the Royal College of Physicians and the Association of British Neurologists, the American Academy of Arts and Sciences, and the American Academy of Arts and Letters, and has been a fellow of the New York Institute for the Humanities at NYU for more than 25 years. In 2008, he was appointed CBE. (shrink)

"While it is true that Yves R. Simon did not intend this to be a history book, __The Ethiopian Campaign and French Political Thought __is an important historical work well deserving of a close reading by students of twentieth-century European history and international relations. This book, which finds a worthy English translation after too many years, was Simon's first serious foray into the public square on the side of justice and the common good. Simon's analysis is wide-ranging, incisive, and brimming (...) with far-sighted political acumen." --_Robert Ventresca, King's University College_ "The Italian invasion of Ethiopia in 1935 led to the memorable plea of Emperor Haile Selassie before the League of Nations as his country's freedom died. Easier to forget is that it also sparked a surprisingly familiar intellectual dispute over the legitimacy of the bombing and the relevance of international law, as depressingly many European intellectuals rallied behind Benito Mussolini's campaign as a defense of the West and the cause of 'civilization.' The unsparing critique leveled against these frequently religious apologists for imperialism by Yves Simon, French Catholic thinker and later American university professor, is an eye-opening reminder of the terms of debate, and the larger constellation of forces of the turbulent era. Anthony Simon and his colleagues deserve thanks for making this precious and moving document available, since its ethical kernel, like its model of Catholic intellectualism, remain highly relevant." --_Samuel Moyn, Columbia University_ "__The Ethiopian Campaign and French Political Thought_ _offers a very important discussion grounded in traditional metaphysics and in a sound sense of historical circumstances. This little book is a gem. --_George Anastaplo, Loyola University of Chicago_ Yves Simon was one of the preeminent Thomistic philosophers and political theorists of the twentieth century. He saw it as a moral duty to understand human reality and to use philosophical analysis to examine contemporary politics when they embodied philosophical errors or vicious ideologies. In __The Ethiopian Campaign and French Political Thought__, Simon extracts principles from the 1894 Dreyfus Affair in France and applies them to Italy's 1935 invasion of Ethopia. As Simon's analysis shows, the relatively obscure events leading up to the Italian invasion had larger implications for Europe and the world, perhaps even paving the way for Vichy France's collaboration with Hitler's German New Order. This book, available for the first time in English, offers an interesting case study of such ethical concerns as just war theory and pre-emptive war, and is of particular relevance in our modern political climate. (shrink)

The story of the end of the Philosophical Society of Edinburgh in 1783, is linked with that of the founding of the Society of Antiquaries of Scotland and the Royal Society of Edinburgh , both of which were given Royal Charters sealed on 6 May 1783. It is a story which has been admirably told by Steven Shapin. He persuasively argued that the P.S.E. was a casualty of bitter quarrels rooted in local Edinburgh politics, in personal animosities and (...) in disputes about the control of cultural property and intellectual leadership. In all this he was surely correct just as he was in finding the principal actors in this controversy to be: David Erskine, 11th Earl of Buchan; the Reverend Dr John Walker, Professor of Natural History in Edinburgh University; Dr William Cullen, Professor of the Theory and Practice of Medicine and Vice-President of the P.S.E.; Mr William Smellie, Printer to the Society of Antiquaries; Henry Home, Lord Kames, S.C.J. and President of the P.S.E.; Sir George Clerk-Maxwell, Vice-President of the P.S.E.; John Robison, Professor of Natural Philosophy and Secretary to the P.S.E.; Edinburgh University's Principal, William Robertson; the Curators of the Advocates Library: Ilay Campbell, Robert Blair, Alexander Abercromby, Alexander Fraser Tytler, Professor of Public Law; Henry Dundas, Lord Advocate and M.P. for Midlothian. In a peripheral way, the Royal Colleges of Physicians and Surgeons were probably also involved; so too were Lord Buchan's brothers, Henry and Thomas Erskine, Foxite Whigs who opposed Dundas politically. Henry Erskine displaced Dundas as Lord Advocate in August 1783. After the change of ministry on 18 December 1783 he was ousted, but became Dean of the Faculty of Advocates in 1785. National as well as burgh politics touched these disputes and gave the parties of the Erskines and Dundas and his friends some leverage in London. (shrink)

This paper shows that in late seventeenth-century Scotland there existed a sizeable virtuoso community whose leaders were abreast of European developments in philosophy, history and science. Moreover, by c. 1700, Sir Robert Sibbald was attempting to organize a learned society modelled upon those he knew in Europe and upon London's Royal Society. The interests of the virtuosi and their attempts to institutionalize their pursuits laid much of the ground work for the Scottish Enlightenment. The Royal Society of (...) Scotland which Sir Robert hoped to found never became a reality, but the academic ideals which he propounded came to fruition in the Philosophical Society of Edinburgh and later bodies such as the Royal Society of Edinburgh and the Society of Antiquaries of Scotland. The intellectual inquiries and achievements of Sir Robert and his friends, particularly those in medicine and natural history, continued to be of interest to later Scots. They, thanks in part to the influence of the Newtonian physician Archibald Pitcaire, improved upon Sibbald's naïve Baconianism, but to a surprising degree their concerns had also been his. (shrink)

Sickle cell disease is a debilitating illness that affects quality of life and life expectancy for patients. In Cameroon, it is now possible to opt for termination of an affected pregnancy where the fetus is found to be affected by SCD. Our earlier studies found that, contrary to the views of Cameroonian physicians, a majority of parents with their children suffering from SCD would choose to abort if the fetuses were found to be affected. What have not yet been (...) investigated are the views of people suffering from/living with SCD. We used a quantitative sociological method, with administered structured questionnaires, to study the attitudes of adult patients suffering from SCD on prenatal genetic diagnosis and possible TAP. The majority of the 89 participants were urban dwellers , women , Christian and single , with a secondary/tertiary education . The majority would consider PND for SCD; almost half would reject TAP while 40.9% would consider it. Respondents who rejected TAP claimed mostly ethical reasons while those who found TAP acceptable cited fear of having an affected child and the poor quality of the affected child's health . Cameroonian patients with SCD are generally supportive of PND and a remarkably high number of patients living with SCD reported that they would consider terminating a pregnancy based on their assessment of the future well-being of the child. Research is required to investigate the burden of SCD on families and their quality of life. (shrink)

In the face of a perceived lack of widespread understanding of the theoretical issues underlying the development, dissemination and implementation of clinical guidelines, the Royal College of General Practitioners Guidelines Group developed a 2-day course aimed at teaching the theory in these areas. The course was targeted at potential opinion formers and ran on six occasions. Postal questionnaire assessment of the course revealed high levels of satisfaction with all aspects of the course and high levels of reported use (...) of the knowledge gained. Further developments of the course are discussed. (shrink)

Taking the Royal College of Barcelona (1760–1843) as a case study, this paper shows the development of modern surgery in Spain initiated by the Bourbon Monarchy when they founded new kinds of institutions as academic activities to spread scientific knowledge. Antoni Gimbernat was the most famous internationally recognised Spanish surgeon. He was trained as a surgeon at the Royal College of Surgery in Cadiz and was later appointed Professor of Anatomy at the College of Barcelona. (...) He then became Royal Surgeon of King Carlos IV, and with that esteemed position in Madrid, he worked relentlessly to improve the quality of the Royal Colleges in Spain. Learning human body structure by performing hands-on dissections in the anatomical theatre has become a fundamental element of modern medical education. Gimbernat favoured the study of natural sciences, the new chemistry of Lavoisier and experimental physics in the academic programmes of surgery. According to the study of a very relevant set of documents preserved in the library, the so-called “juntas literarias”, among the main subjects debated in the clinical sessions was the concept of human beings and diseases in relation to the development of the new experimental sciences. These documents showed that chemistry and experimental physics were considered crucial tools to understand the unexplained processes that occurred in the diseased and healthy human body and in a medico-surgical context. It is important to stress that through these manuscripts, we can examine the role and the reception of the new sciences as they were applied to the healing arts. (shrink)

Philosophers and Buddhist scholars have noted the affinities between David Hume's empiricism and the Buddhist philosophical tradition. I show that it was possible for Hume to have had contact with Buddhist philosophical views. The link to Buddhism comes through the Jesuit scholars at the Royal College of La Fleche. Charles Francois Dolu was a Jesuit missionary who lived at the Royal College from 1723-1740, overlapping with Hume's stay. He had extensive knowledge both of other religions and (...) cultures and of scientific ideas. Dolu had had first-hand experience with Theravada Buddhism as part of the second French embassy to Siam in 1687-1688. In 1727, Dolu also had talked with Ippolito Desideri, a Jesuit missionary who visited Tibet and made an extensive study of Tibetan Buddhism from 1716-1721. It is at least possible that Hume heard about Buddhist ideas through Dolu. (shrink)

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

A model policy for conscientious objection in medicine.