In this paper, we reflect upon shame and humiliation as threats to personal and professional integrity and moral agency within contemporary health care. A personal narrative, written by a nurse about a particular shift in a British National Health Service Accident and Emergency Department, is provided as a case study. This is critically reflected and commented upon in dialogue with insights into the nature of shame and humiliation. It is suggested that Accident and Emergency is a locus that is latently (...) prone to dynamics of shame and humiliation, a potential exacerbated within a culture subject to externally‐determined time targets that are enforced by a top‐down system of surveillance and management. The result is that nurses may lose their sense of professional competence and responsibility, moral agency, and integrity, to their own personal detriment, as well as to the detriment of patients with whom they work. Insofar as examining a small part of a whole may suggest insights into the operation and ethos of a very large system, this very particular case study narrative/reflection has some important implications and lessons for the wider organization and provision of health care in Britain and beyond. (shrink)

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of (...) the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term ‘spirituality’ is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service. (shrink)

In 2008 the United Kingdom Nursing and Midwifery Council (NMC) published the latest version of its code of conduct (The code: standards of conduct, performance and ethics for nurses and midwives). The new version marked a significant change of style in the Code compared with previous versions. There has been considerable controversy and the accrual of an extensive body of literature over the years in the UK and Europe criticizing nursing codes of ethics and questioning their ethical standing and their (...) usefulness. In this article we review the current NMC Code. We argue that the NMC has been misguided in labelling the Code as a code of ethics, and suggest that the new document falls short in many respects. (shrink)

The paper offers an account of integrity as the capacity to deliberate and reflect usefully in the light of context, knowledge, experience, and information (that of self and others) on complex and conflicting factors bearing on action or potential action. Such an account of integrity seeks to encompass the moral complexity and conflict of the professional environment, and the need for compromises in professional practice. In addition, it accepts that humans are social beings who must respect and engage with the (...) moral position of others. This account is contrasted with a more traditional view of integrity as the rigid maintenance of consistency between professional practice and deeply held, but inflexible, moral principles. While this strong sense of moral conviction may be valuable as a source of moral motivation, e.g. in the case of whistle‐blowers, it is equally likely to lead to dogmatism and hubris. Professionals and their organizations are encouraged to foster the more complex and reflective form of integrity. (shrink)

This special issue of Health Care Analysis originated in an conference, held in Birmingham in 2014, and organised by the group Think about Health. We introduce the issue by briefly reviewing the understandings of the concept of ‘flourishing’, and introducing the contributory papers, before offering some reflections on the remaining issues that reflection on flourishing poses for health care provision.

The whole subject of values is surrounded by partiality, ignorance, confusion and ambiguity from the conceptual level down to the nitty gritty level of everyday practice. Some of these problems have been exposed in a preliminary way in this paper. A great deal more, and more detailed, work at conceptual and practical levels needs to be undertaken before we can really start to talk intelligibly and in a non-confusing way about value and values. One thing is clear. We will never (...) completely escape from the relativity and conceptual slipperiness that inheres in the very nature of valuing some things over others. Values are created in an ongoing dynamic process, not revealed. In the short-term, however, this knowledge will not convince politicians and other ideologues that values may not be in and of themselves a wholly desirable thing! (shrink)

ConclusionThe whole subject of values is surrounded by partiality, ignorance, confusion and ambiguity from the conceptual level down to the nitty gritty level of everyday practice. Some of these problems have been exposed in a preliminary way in this paper. A great deal more, and more detailed, work at conceptual and practical levels needs to be undertaken before we can really start to talk intelligibly and in a non-confusing way about value and values. One thing is clear. We will never (...) completely escape from the relativity and conceptual slipperiness that inheres in the very nature of valuing some things over others. Values are created in an ongoing dynamic process, not revealed. In the short-term, however, this knowledge will not convince politicians and other ideologues that values may not be in and of themselves a wholly desirable thing! (shrink)

ConclusionThe whole subject of values is surrounded by partiality, ignorance, confusion and ambiguity from the conceptual level down to the nitty gritty level of everyday practice. Some of these problems have been exposed in a preliminary way in this paper. A great deal more, and more detailed, work at conceptual and practical levels needs to be undertaken before we can really start to talk intelligibly and in a non-confusing way about value and values. One thing is clear. We will never (...) completely escape from the relativity and conceptual slipperiness that inheres in the very nature of valuing some things over others. Values are created in an ongoing dynamic process, not revealed. In the short-term, however, this knowledge will not convince politicians and other ideologues that values may not be in and of themselves a wholly desirable thing! (shrink)

The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is (...) argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one’s life as a narrative. To flourish, it is argued, is to tell a story of one’s life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one’s life. (shrink)

The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is (...) argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one’s life as a narrative. To flourish, it is argued, is to tell a story of one’s life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one’s life. (shrink)

The paper offers an account of integrity as the capacity to deliberate and reflect usefully in the light of context, knowledge, experience, and information (that of self and others) on complex and conflicting factors bearing on action or potential action. Such an account of integrity seeks to encompass the moral complexity and conflict of the professional environment, and the need for compromises in professional practice. In addition, it accepts that humans are social beings who must respect and engage with the (...) moral position of others. This account is contrasted with a more traditional view of integrity as the rigid maintenance of consistency between professional practice and deeply held, but inflexible, moral principles. While this strong sense of moral conviction may be valuable as a source of moral motivation, e.g. in the case of whistle‐blowers, it is equally likely to lead to dogmatism and hubris. Professionals and their organizations are encouraged to foster the more complex and reflective form of integrity. (shrink)

This article aims to challenge and expand notions of health, health care and health promotion, particularly in relation to smoking, via a consideration of the autobiographical literary work of the English playwright, Simon Gray. Gray died in 2008, having written a series of reflective autobiographical books, The Smoking Diaries. Gray was a lifelong smoker, perpetually trying to give up his habit. This article introduces Gray’s diaries and their reflections on life, death, health care and smoking. It then enquires what can (...) be learned about contemporary health care practices and assumptions from Gray’s work. Finally, it reflects on the limits of views of health and health promotion when considered in the light of a fully lived life. In the life under consideration, health care risks are very differently understood to those prevalent in the medical community. Literary approaches to thinking about smoking are thus seen to place health and health care in broader, richer, and less instrumental perspectives than those that are common amongst contemporary health professionals and institutions. (shrink)

This paper raises some issues about understanding religion, religions and spirituality in health care to enable a more critical mutual engagement and dialogue to take place between health care institutions and religious communities and believers. Understanding religions and religious people is a complex, interesting matter. Taking into account the whole reality of religion and spirituality is not just about meeting specific needs, nor of trying to ensure that religious people abandon their distinctive beliefs and insights when they engage with health (...) care institutions and policies. Members of religious groups and communities form an integral part of the structure and fabric of health care delivery, whether as users or in delivery capacities. Religion is both facilitator and resistor, friend and critic, for health care institutions, providers and workers. (shrink)

This study shows how Kierkegaard's mature theological writings reflect his engagement with the wide range of theological positions which he encountered as a student, including German and Danish Romanticism, Hegelianism and the writings of Fichte and Schleiermacher. George Pattison draws on both major and lesser-known works to show the complexity and nuances of Kierkegaard's theological position, which remained closer to Schleiermacher's affirmation of religion as a 'feeling of absolute dependence' than to the Barthian denial of any 'point of contact', (...) with which he is often associated. Pattison also explores ways in which Kierkegaard's theological thought can be related to thinkers such as Heidegger and John Henry Newman, and its continuing relevance to present-day debates about secular faith. His volume will be of great interest to scholars and students of philosophy and theology. (shrink)

Hume viewed religion as a way to relieve the anxiety caused by our fate, but as he saw it, the natural development of different monotheisms and religions often resulted in persecution and war. Hume on Religion introduces his major work, Dialogues Concerning Natural Religion, and assesses Hume's life and the background to the work. The ideas and text of the work are also considered along with Hume's continuing importance to philosophy today.

Undergraduate students with no prior classroom instruction in mathematical logic will benefit from this evenhanded multipart text by one of the centuries greatest authorities on the subject. Part I offers an elementary but thorough overview of mathematical logic of first order. The treatment does not stop with a single method of formulating logic; students receive instruction in a variety of techniques, first learning model theory (truth tables), then Hilbert-type proof theory, and proof theory handled through derived rules. Part II supplements (...) the material covered in Part I and introduces some of the newer ideas and the more profound results of logical research in the twentieth century. Subsequent chapters introduce the study of formal number theory, with surveys of the famous incompleteness and undecidability results of Godel, Church, Turing, and others. The emphasis in the final chapter reverts to logic, with examinations of Godel's completeness theorem, Gentzen's theorem, Skolem's paradox and nonstandard models of arithmetic, and other theorems. Unabridged republication of the edition published by John Wiley & Sons, Inc. New York, 1967. Preface. Bibliography. Theorem and Lemma Numbers: Pages. List of Postulates. Symbols and Notations. Index. (shrink)

The International Commission on Intervention and State Sovereignty's report, The Responsibility to Protect, argues that when a state is unable or unwilling to uphold its citizens? basic human rights, such as in cases of genocide, ethnic cleansing, and crimes against humanity, the international community has a responsibility to protect these citizens by undertaking humanitarian intervention. An essential issue, however, remains unresolved: which particular agent in the international community has the duty to intervene? In this article, I critically examine four ways (...) of assigning this duty. Although I highlight the benefits of institutionalising the responsibility to protect, I argue that we should adopt, in the short term at least, a consequentialist solution: humanitarian intervention should be the responsibility of the intervener that will be the most effective. (shrink)

In Return to Reason, Stephen Toulmin argues that the potential for reason to improve our lives has been hampered by a serious imbalance in our pursuit of ...

Stephen Toulmin argues that the potential for reason to improve our lives has been hampered by a serious imbalance in our pursuit of knowledge. The centuries-old dominance of rationality has diminished the value of reasonableness. Toulmin issues a powerful call to redress the balance between rationality and reasonableness.

The Hedgehog, the Fox, and the Magister's Pox is a controversial discourse, rich with facts and observations gathered by one of the most erudite minds of our ...

"Biophilia" is the term coined by Edward O. Wilson to describe what he believes is humanity's innate affinity for the natural world. In his landmark book Biophilia, he examined how our tendency to focus on life and lifelike processes might be a biologically based need, integral to our development as individuals and as a species. That idea has caught the imagination of diverse thinkers. The Biophilia Hypothesis brings together the views of some of the most creative scientists of our time, (...) each attempting to amplify and refine the concept of biophilia. The variety of perspectives -- psychological, biological, cultural, symbolic, and aesthetic -- frame the theoretical issues by presenting empirical evidence that supports or refutes the hypothesis. Numerous examples illustrate the idea that biophilia and its converse, biophobia, have a genetic component: fear, and even full-blown phobias of snakes and spiders are quick to develop with very little negative reinforcement, while more threatening modern artifacts -- knives, guns, automobiles -- rarely elicit such a response people find trees that are climbable and have a broad, umbrella-like canopy more attractive than trees without these characteristics people would rather look at water, green vegetation, or flowers than built structures of glass and concrete The biophilia hypothesis, if substantiated, provides a powerful argument for the conservation of biological diversity. More important, it implies serious consequences for our well-being as society becomes further estranged from the natural world. Relentless environmental destruction could have a significant impact on our quality of life, not just materially but psychologically and even spiritually. (shrink)

In this article, from the 2009 Oxford University Press collection Epistemic Value, I criticize existing accounts of epistemic normativity by Alston, Goldman, and Sosa, and then offer a new view.

What does it mean to think of philosophy in the condition of modernism, in which its relation to its past and future has become a relevant problem? This book argues that the writings of Wittgenstein, Heidegger, and Kierkegaard are best understood as responsive (each in their own way) to such questions. Through detailed analysis of these authors' most influential texts, Stephen Mulhall reorients our sense of the philosophical work each text aims to accomplish, engendering a critical dialogue between them (...) from which the elements of a new conception of philosophy might emerge. (shrink)

Transnational corporations have become actors with significant political power and authority which should entail responsibility and liability, specifically direct liability for complicity in human rights violations. Holding TNCs liable for human rights violations is complicated by the discontinuity between the fragmented legal/political structure of the TNC and its integrated strategic reality and the international state system which privileges sovereignty and non-intervention over the protection of individual rights. However, the post-Westphalian transition—the emergence of multiple authorities, increasing ambiguity of borders and jurisdiction (...) and blurring of the line between the public and private spheres—should facilitate imposing direct responsibility on transnational firms. Mechanisms for imposing direct responsibility on TNCs are considered including voluntary agreements and international law. However, I conclude that a hybrid public-private regime which relies on non-hierarchical compliance mechanisms is likely to be both more effective and consistent with the structure of the emerging transnational order. (shrink)

Organizational aesthetics, both as a body of theory and a method of inquiry, is a rapidly expanding area of the organizational sciences. The Aesthetics of Organization accessibly draws key contributions delineating the emerging parameters of the field. It explains the significance of concepts devised by postmodern thinkers, through which emerge meaning and order in organizations. Methodological problems associated with investigations of the aesthetic are also highlighted so the reader can identify and understand the importance of recent ideas on vision, perspective (...) and periphery for learning in organizations. Through the contributions of leading international theorists, organizational aesthetics is defined in greater historical and theoretical depth, with a broad conceptual and practical range which academics will find invaluable. (shrink)

Hume's Enlightenment Tract is the first full study for forty years of David Hume's Enquiry concerning Human Understanding. The Enquiry has, contrary to its author's expressed wishes, long lived in the shadow of its predecessor, A Treatise of Human Nature. Stephen Buckle presents the Enquiry in a fresh light, and aims to raise it to its rightful position in Hume's work and in the history of philosophy.

In his second book, Tierney argues that the purpose of education must move to the heart of the educational debate. Purpose will significantly influence what schools and the education system as a whole will do next.

The norms of simplicity, convenience, unfussiness, and self-control guide Diogenes the Cynic, Zeno of Citium, Chrysippus, Seneca, Musonius Rufus, Epictetus, and Marcus Aurelius in approaching food. These norms generate the precept that meat and dainties are luxuries, so Stoics should eschew them. Considerations of justice, environmental harm, anthropogenic global climate change, sustainability, food security, feminism, harm to animals, personal health, and public health lead contemporary Stoics to condemn the meat industrial complex, debunk carnism, and select low input, plant-based foods.

In the UK, many fundamentally important policy decisions that are likely to affect the relationship between citizens and care services are now made at the sublegislative level and without adequate ethical consideration and scrutiny. This is well exemplified in the proposed guidance on the disclosure of information on children. A recent consultation paper by the UK government on the subject proposes an approach that seeks a simple technical solution to a complex problem, emphasising control and surveillance. This reflects pressure to (...) be seen to act. The document fails with regard to ethical reflection appropriate to the complexity of the issue, an appreciation of complex relationships of trust, and a proper sense of the richness and complexity of the public interest. Such policies would, if implemented, fundamentally change the relationships between citizens and their carers, and among carers and the law and the state. This and similar proposals require far more ethical scrutiny and consideration of the public interest in the widest sense. (shrink)