A new gift edition of the classic guide to meditation and mindfulness, featuring archival photography and beautiful calligraphy by Thich Nhat Hanh. Since its publication in 1975, The Miracle of Mindfulness has been cherished by generations of readers for its eloquent and useful introduction to the practice of meditation. Readers interested in an introduction to Buddhist thought, as well as those seeking to learn about mindfulness and stress reduction, continue to look to Thich Nhat Hanh's classic work for guidance and (...) inspiration. This new hardcover gift edition features elegant calligraphic illustrations by Thich Nhat Hanh, as well as a dozen photographs spanning his early days as a peace activist to his life in Plum Village, a spiritual community that he founded in France. Also included in this edition is a historical chronology of Thich Nhat Hanh's life and work, and a revised afterword by Jim Forest. (shrink)

We all need to Chop Wood and Carry Water". In Thich Nhat Hanh's latest teachings on how to use applied Buddhism in daily life, he looks at how we deal with workplace scenarios, handle home and family responsibilities, and endure traffic jams and other challenges of modern life. By carefully examining our everyday choices he encourages us to become a lotus in a muddy world by building mindful communities, learning about compassionate living, and come to an understanding of our inert (...) "Buddha nature." Part-time Buddha aims at contributing to new models of leadership and doing business, but is also full of life-coaching advise and finding our true happiness. (shrink)

In Good Citizens: Creating Enlightened Society, Thich Nhat Hanh lays out the foundation for an international solidarity movement based on a shared sense of compassion, mindful consumption, and right action. Following these principles, he believes, is the path to world peace. The book is based on our increased global interconnectedness and subsequent need for harmonious communication and a shared ethic to make our increasingly globalized world a more peaceful place. The book will be appreciated by people of all faiths and (...) cultural backgrounds. While based on the basic Buddhist teachings of the Four Noble Truths and the Eight-Fold Path, Thich Nhat Hanh boldly leaves Buddhist terms behind as he offers his contribution to the creation of a truly global and nondenominational blueprint to overcoming deep-seated divisions and a vision of a world in harmony and the preservation of the planet. Key topics include the true root causes of discrimination; the exploration of the various forms of violence; economic, social, and sexual violence. He encourages the reader to practice nonviolence in all daily interactions, elaborates on the practice of generosity, and teaches the art of deep listening and loving speech to help reach a compromise and reestablish communication after misunderstandings have escalated into conflicts. Good Citizens also contains a new wording of the Five Mindfulness Trainings (traditionally called "precepts") for lay practitioners, bringing them in line with modern-day needs and realities. In their new form they are concrete and practical guidelines of ethical conduct that can be accepted by all traditions. Good Citizens also includes the complete text of the UN Manifesto 2000, a declaration of transforming violence and creating a culture of peace for the benefit of the children of the world. It was drafted by numerous Peace Nobel Prize recipients and signed by over 100 million people worldwide. Coinciding with a US presidential election year, Good Citizens reaches across all political backgrounds and faith traditions. It shows that dualistic thinking--Republican/Democrat, Christian/Muslim--creates tension and a false sense of separateness. When we realize that we share a common ethic and moral code, we can create a community that can change the world. (shrink)

An introduction to mindful walking, which can be done anywhere, at any time—even on a commute to work or school. The fourth book in the bestselling Mindfulness Essentials series, a back-to-basics collection from world-renowned Zen Master Thich Nhat Hanh that introduces everyone to the essentials of mindfulness practice. Slow, concentrated walking while focusing on in- and out-breaths allows for a unique opportunity to be in the present. There is no need to arrive somewhere—each step is the arrival to concentration, joy, (...) insight, and the momentary enlightenment of aliveness. When your foot touches the Earth with awareness, you make yourself alive and the Earth real, and you forget for one minute the searching, rushing, and longing that rob our daily lives of awareness and cause us to "sleepwalk" through life. Thich Nhat Hanh shares amusing stories of the impact mindful walking has on both the walker and those who notice him, and shows how mindful walking can be a technique for diminishing depression, recapturing wonder, and expressing gratitude. Pocket-sized, with original two color illustrations by Jason DeAntonis, How to Walk is a unique gift for all ages, sharing a simple practice that can have a profound effect on practitioners. (shrink)

Over the last quarter of a century, English medical law has taken an increasingly firm stand against medical paternalism. This is exemplified by cases such as Bolitho v City and Hackney Health Authority, Chester v Afshar, and Montgomery v Lanarkshire Health Board. In relation to decision-making on behalf of incapacitous adults, the actuating principle of the Mental Capacity Act 2005 is respect for patient autonomy. The only lawful acts in relation to an incapacitous person are acts which are in the (...) best interests of that person. The 2005 Act requires a holistic assessment of best interests. Best interests are wider than ‘medical best interests’. The 2018 judgment of the Supreme Court in An NHS Trust v Y from patients in prolonged disorders of consciousness ) risks reviving medical paternalism. The judgment, in its uncritical endorsement of guidelines from various medical organisations, may lend inappropriate authority to medical judgments of best interests and silence or render impotent non-medical contributions to the debate about best interests—so frustrating the 2005 Act. To minimise these dangers, a system of meditation should be instituted whenever it is proposed to withdraw life-sustaining CANH from patients with PDOC, and there needs to be a guarantee of access to the courts for families, carers and others who wish to challenge medical conclusions about withdrawal. This would entail proper public funding for such challenges. (shrink)

Professor Charles Foster1 argues that the recent decision by the Supreme Court2 on the process of making decisions about medical treatment in people who lack capacity due to a prolonged disorder of consciousness is fostering medical paternalism. He considers that the judgment shows ‘ deference to the guidelines of various organisations ’ and then that ‘ The guidance has effectively become a definitive statement of the relevant obligations,’ concluding that ‘ This usurps the function of the law.’ Healthcare teams make (...) all decisions concerning medical care provided; no-one else can. Both the clinicians themselves, and any guidance provided to them, must comply with the Mental Capacity Act 2005.3 Lady Black’s judgment makes clear that ‘ The basic protective structure is established by the MCA 2005 ’ and that the associated Code of Practice4 ‘ contains valuable guidance ’. She specifically highlights that the decision-maker must ensure that ‘ account has been taken of the patient’s previously expressed wishes and those of people close to him, as well as the opinions of other medical personnel. The MCA 2005 requires this to happen, and is reinforced by the professional guidance available to doctors.’ The Act says: ‘ He must consider, so far as is reasonably ascertainable— 1. the person’s past and present wishes and feelings (and, in …. (shrink)

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further ‘market-style’ reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English (...) NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. (shrink)

Evidence exists that the UK National Health Service has had, over many years, persistent problems of negative and intimidating behaviour towards staff from other employees. The evidence also suggests the organisational responses to negative behaviour can be inadequate. A conceptual model of organisational dysfunction was proposed to assist in explaining those responses and the overall culture in the NHS. Through research this model has been tested. Based upon the findings, an extended and developed model of organisational dysfunction is presented. A (...) qualitative approach was taken to research the organisational responses to negative behaviour, and the reasons and motivations for those responses. Forty-three interviews and six focus groups were conducted. There seem to be “islands” and “pockets” with a positive culture; however, the generalised evidence suggests the NHS is systemically and institutionally deaf, bullying, defensive and dishonest, exhibiting a resistance to ‘knowing’, denial and “wilful blindness”; a dysfunctional, perverse and troubled organisation. Totalitarian and Kafkaesque characteristics are identified. The NHS could also be described as a coercive bureaucracy and under certain definitions, a corrupt entity. The NHS appears to be an organisation with a heart of darkness; a “self perpetuating dysfunctional system”. There may be widespread “learned helplessness”. It seems to be a “good news factory”, rejecting and hiding any “bad news”; retreating from reality. The NHS appears to have “lost its way” and its focus/purpose as an institution. The dysfunctional organisational behaviours manifest in the NHS need to be addressed urgently as there is a detrimental, sometimes devastating, impact on the wellbeing of both staff and patients. The NHS needs to embrace an identity of being a listening, learning and honest organisation, with a culture of respect. (shrink)

On 8th August 2019, Secretary of State for Health and Social Care, Matt Hancock, announced the creation of a £250 million NHS AI Lab. This significant investment is justified on the belief that transforming the UK’s National Health Service (NHS) into a more informationally mature and heterogeneous organisation, reliant on data-based and algorithmically-driven interactions, will offer significant benefit to patients, clinicians, and the overall system. These opportunities are realistic and should not be wasted. However, they may be missed (one may (...) recall the troubled Care.data programme) if the ethical challenges posed by this transformation are not carefully considered from the start, and then addressed thoroughly, systematically, and in a socially participatory way. To deal with this serious risk, the NHS AI Lab should create an Ethics Advisory Board and monitor, analyse, and address the normative and overarching ethical issues that arise at the individual, interpersonal, group, institutional and societal levels in AI for healthcare. (shrink)

The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making (...) and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward. In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised. (shrink)

The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making (...) and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward.In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised. (shrink)

This paper draws on findings from interviews with people donating blood for a large epidemiological study of psoriatic arthritis concerned with identifying the genetic component in the aetiology of this disease. The 27 qualitative research interviews addressed peoples' reasons for agreeing to be involved in the biomedical research project, their hopes and expectations in relation to the study, and their views about the donation of a blood sample for the genetic element of the research. The involvement of these research subjects (...) can be characterized in terms of an investment in the future health of an imagined community, in which the NHS featured prominently. (shrink)

The recently published Report of theAHAG on the Operation of NHS Research Ethics Committees advocates major reforms of the NHS research ethics committees system. The main implications of the proposed changes and their probable effects on the major stakeholders are described.The Ad Hoc Advisory Group on the operation of NHS research ethics committees, set up in November 2004 by Lord Warner on behalf of the Department of Health, submitted its report in June 2005.1 The report advocates major reforms of the (...) research ethics committee system. The primary aim of the report is to streamline the processes around the approval of research projects and to pursue conformity of governance across Europe. Implicit in the report is the contention that failure to achieve this objective would be harmful to everyone with vested interests in improving health and social care. Moreover, it is stated that the reforms will enhance the mechanisms that protect the interests of all parties concerned.1Being mindful of two published critiques of the Warner Report, we suggest that its alleged benefits should not be taken at face value.2,3 In fact, the reformed system will give rise to moral failings akin to those of the existing system, but will differ from the existing system in its effect on the stakeholders. Thus, whereas the outgoing system has given each stakeholder a unique mixture of benefit and harm, the incoming system offers benefit only to sponsors and researchers and nothing but detriment to participants in research and consumers of its products.In the light of this conclusion, we finally suggest that the Warner Report be construed not merely as an ill-considered document, but rather as an ideological reflection of a long-established hegemonic contract fine-tuning itself to contemporary global challenges.To avoid …. (shrink)

At first glance, this case might give the impression that a resolution would have been straightforward. A 17-year-old young man with moderate to severe learning disabilities and other conditions discussed below required a kidney transplant–the Court of Protection was tasked with determining whether this was in his best interests. However, the case of WV was in fact far more technical and required nuanced discussion and expert medical evidence from a range of specialists to objectively balance the needs of WV and (...) the risks to WV, and to ultimately determine his fate of life or death based on receiving a kidney transplant.Manchester University NHS Foundation Trust applied for a declaration in relation to the capacity of William Verdon and for the court to consider whether an order should be made that it was not in his best interests to have a kidney transplant with sedation and ventilation post-operatively. (shrink)

Migrant nurses form an increasing proportion of the nursing workforce, with the United Kingdom (UK) being the third most popular destination for overseas nurses in the world. The migrant nurse workforce is highly susceptible to policy changes at the macro or professional level of the donor and recipient countries. Freedom of information requests were issued to 19 National Health Service [NHS] Trusts in England to determine their involvement in overseas nurse recruitment activity from 1998 onwards. These indicate a notable shift (...) away from active European Union (EU) recruitment and towards overseas countries particularly the Philippines and India. Reasons given were as follows: diminishing returns from EU sources, high attrition among EU nurses and the introduction of English language tests for EU nurses in July 2016. This led to Trusts revisiting their recruitment strategies by increasing more direct/less resource‐intensive methods and expanding their focus outside of the EU. Trusts frequently utilised private recruitment companies for their recruitment drives, including consulting and influencing the Trusts’ workforce strategies. Policy adjustments have numerous influences on the composition of the overseas nursing workforce. While the NHS continues its efforts in expanding its international nursing workforce, this should not be at the expense of ethical and sustainable recruitment practices, which may be compromised indirectly as a result. (shrink)

BackgroundPublication and outcome reporting bias is often caused by researchers selectively choosing which scientific results and outcomes to publish. This behaviour is ethically significant as it distorts the literature used for future scientific or clinical decision-making. This study investigates the practicalities of using ethics applications submitted to a UK National Health Service research ethics committee to monitor both types of reporting bias.MethodsAs part of an internal audit we accessed research ethics database records for studies submitting an end of study declaration (...) to the Hampshire A research ethics committee between 1st January 2010 and 31st December 2011. A literature search was used to establish the publication status of studies. Primary and secondary outcomes stated in application forms were compared with outcomes reported in publications.ResultsOut of 116 studies the literature search identified 57 publications for 37 studies giving a publication rate of 32 %. Original Research Ethics Committee applications could be obtained for 28 of the published studies. Outcome inconsistencies were found in 16 of the published studies.ConclusionsThis study showed that the problem of publication and outcome reporting bias is still significant in the UK. The method described here demonstrates that UK NHS research ethics committees are in a good position to detect such bias due to their unique access to original research protocols. Data gathered in this way could be used by the Health Research Authority to encourage higher levels of transparency in UK research. (shrink)

This article examines the discourses that are used by the British press to represent obesity in its coverage of coronavirus disease 2019 (COVID-19). Obesity is understood to be a risk factor for COVID-19, with people with obesity being more likely to die from the virus. This study adopts a corpus-based approach to Critical Discourse Studies and utilises a novel approach to keyword analysis, based on comparing analysis corpora against two reference corpora in order to yield keywords that are, in this (...) case, characteristic compared to general coverage of both COVID-19 and obesity. It is argued that the context of the pandemic has produced a range of discourses around obesity that are more stigmatising than usual in both the tabloids and the broadsheets, with people with obesity being construed, for example, in especially fatalistic terms and as being responsible for the problems facing the country’s healthcare system. At the same time, the pandemic context also seems to have given rise to some more positive changes to press coverage of obesity, with race-related health disparities receiving more focus than usual and the right-leaning press being more likely to critique the Conservative Government than it usually is, resulting in an arguably more balanced style of reporting. (shrink)

Whistleblowing in the NHS engages the fundamental right to free speech and as the paper makes clear is a means of ensuring individual patient safety. The discourse around the whistleblower is not simply about individuals being safeguarded if they blow the whistle on poor standards of patient care but that they may indeed be obliged as healthcare professionals to positively make the decision to blow the whistle to raise concerns. As noted in the paper, the NHS is an organisation in (...) which many—though not all—individuals who work there are bound by their own professional codes of practice in addition to broader employment requirements in relation to ethical and safety issues. But having an obligation to raise concerns and actually doing so are very different things. Individuals who blow the whistle have often found that following their conscience comes with consequences. They may ultimately be vindicated, as, for example in the 1990s, Stephen Bolsin the anaesthetist who blew the whistle in relation to Bristol Royal Infirmary in the 1990s.1 But getting such vindication can in many instances be over a long and very painful period of time and be exceedingly costly in both financial and emotional terms. Does …. (shrink)

The UK NHS National Programme for IT has been criticized for a lack of clinical engagement. This paper uses a soft systems methodology analysis of a case study from the use of electronic systems within a National Health Service Mental Health Trust in the United Kingdom to explore the legal and ethical implications of the failure to develop clinical systems which are fit for purpose.Soft systems methodology was used as a theoretical model both to derive deeper insights into the survey (...) data and suggest how communication between those producing information and those using it, could be improved. Multiple methods were employed which included a postal survey and participant interviews to triangulate the data.The use of SSM reinforced the concept that the national IT programme is based on a ‘hard' systems view and does not take local factors into account. The study found administrative staff to be a crucial link between clinicians and information departments and highlighted the need for a joint-up information strategy and integrated systems.The article concludes with a discussion of the legal and ethical implications of the findings and the lessons for the broader UK national programme. It argues that the failure to deliver systems that are fit for purpose is not value neutral but an ethical issue. (shrink)

Implementing The new NHS and the 1997 NHS (Primary Care) Act will gradually extend cash-limiting into primary health care, especially general practice. UK policy-makers have avoided providing clear, unambivalent direction about how to 'ration' NHS resources. The 'Child B' case became an epitome of public debate about NHS rationing. Among many other decision-making processes which occurred, Cambridge and Huntingdon Health Authority applied an ethical code to this rationing decision. Using new data this paper analyses the rationing criteria NHS managers and (...) clinicians used at local level in the Child B case; and the organisational structures which confronted them with such decisions. Primary Care Groups are likely to confront similar rationing decisions in respect of 'gate-kept' NHS services. However, such rationing processes are not so easily transposed to open-access services such as general practice. NHS rationing decisions, especially in PCGs, will require a much more specific ethical code than hitherto used. (shrink)

The inaugural southwest medical debate, between Exeter and Plymouth medical schools and respective health services, was held on the 3rd December 2014. Plymouth proposed the motion “This house believes the NHS should be privatised?” In an increasingly political climate, the National Health Service has become a constant topic for discussion in the media. On this occasion, all those debating were involved in the medical profession with roles encompassing clinical medicine, education, ethics, economics and policy. By allowing those with knowledge of (...) the NHS to speak, we hoped to spark novel discussions based on evidence and experience. (shrink)

This paper considers the way in which English law safeguards fundamental rights to respect for faith and belief in relation to the delivery of health care. It explores the implications of the Human Rights Act 1998 and the Equality Act 2010. It explores some of the challenges in attempting to reconcile fundamental rights to faith and belief and the delivery of health care, both now and in the future and whether this is a realistic aspiration in a state funded health (...) care service. (shrink)

This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis (...) of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested. (shrink)

How do cultures of self-quantification intersect with the modern state, particularly in relation to medical provision and health promotion? Here I explore the ways in which British practices and representations of body weight and weight management ignored or interacted with the National Health Service between 1948 and 2004. Through the lens of overweight, I examine health citizenship in the context of universal health provision funded from general taxation, and track attitudes toward “overweight” once its health implications and medical costs affected (...) a public service as well as individual bodies and households. Looking at professional and popular discourses of overweight and obesity, I map the persistence of a highly individual culture of dietary and weight self-management in postwar Britain, and assess the degree to which it was challenged by a new measure of “obesity” – the body mass index – and by visions of an NHS burdened and even threatened by the increasing overweight of the citizens it was created to serve. (shrink)

How could we better use public inquiries to stem the recurrence of healthcare failures? The question seems ever relevant, prompted this time by the inquiry into how former nurse Letby was able to murder newborns under National Health Service care. While criminality, like Letby’s, can be readily condemned, other factors like poor leadership and culture seem more often regretted than reformed. I would argue this is where inquiries struggle, in the space between ethics and law—with what is awful but lawful. (...) In response, we should learn from progress with informed consent. Inquiries and civil litigation have seen uninformed ‘consent’ shift from being undesirable to unlawful. If better leadership and culture were sole drivers here, we would likely be doing far better in many other areas of healthcare too. Instead, one could argue that progress on consent has been made by reducingepistemic injustice—by naming and addressingepistemicissues in ways that enhancesocial powerfor patients. If this is an ingredient that transforms clinician–patient working, might it also shift conduct within other key relationships, by showing up what else should become unlawful and why? Namingmedical paternalismmay have helped with consent reform, so I continue this approach, first naming two areas of epistemic injustice:management feudalismandlegal chokeholds. Remedies are then considered, including the democratisation of management and reforms to legal ethics, legislation and litigation. In brief, public inquiries may improve if they also target epistemic injustices that should become unlawful. Focus on informed consent and epistemic relationships has improved the medical profession. Likewise, it could help healthcare leaders shift from fiat towards consent, and their lawyers from a stifling professional secrecy towards the kind of candour a prudent public expects. (shrink)

Changes in technological and economic aspects of society have impacted on how we understand professional and client relationships. These relationships are constructed in terms of patients/users requiring care, and customers whose complaints have become a yardstick of satisfaction. A consequence of these changes is an interest in the related concepts of emotional labour and emotion work. For nurses, caring for people in illness and in health is central to their work, and it is this aspect of emotion at work that (...) distinguishes nursing from other occupational groups. This paper is concerned with emotion work in a National Health Service Direct (NHS Direct) call centre in the United Kingdom. Drawing upon theoretical perspectives from organizational psychology and sociology it focuses upon the social processes that narrate emotion events in a specific context. It is based on a qualitative study exploring the experience and emotion work of nurses working in a call centre. Issues in caring without the face‐to‐face contact using communication technology were crucial to the way nurses perceived their work. These factors contributed to nurses’ orientation to work and to the way that conflict and dissonance with expectations of callers and managers impacted on nurses’ emotion work. (shrink)

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient (...) and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)

It has long been the position in law that, subject to some minor but important exceptions, property cannot be held in the human body, whether living or dead. In the recent case of Yearworth and Others v North Bristol NHS Trust, however, the Court of Appeal for England and Wales revisited the property debate and threw into doubt a number of doctrines with respect to property and the body. This brief article analyses Yearworth, (1) reviewing the facts and the Court’s (...) decision with respect to the originators’ proprietary and contractual interests in their body and bodily products, (2) considering the significance of relying on property and its use a legal metaphor, (3) questioning the scope of the property right created, and (4) querying whether an alternate conceptual approach to extending rights and a remedy was warranted. It concludes that, while Yearworth engages with, and impacts on, important theoretical and practical issues—from legal, healthcare and research perspectives—it does not offer a great deal of guidance and, for that reason, its precedential significance is in doubt. (shrink)

The NHS is an institution of great importance to everybody in the UK - not only doctors, nurses and other health professionals, but also to patients, carers and their families. However, problems within the NHS are regularly reported in the media and we are all anxious about waiting lists, about whether potential illnesses will be identified treated in time, about bleeding to death on trollies in corridors or being struck down by antibiotic-resistant superbugs. This engaging book aims to explore and (...) simplify the issues from both sides of the NHS - professionals and patients - and to improve mutual understanding of the problems, which will hopefully spark an open debate about the future of health service provision. The book uses an innovative fictionalized account of the experiences of 'case study' individuals in the healthcare system, including a GP with depression, a woman with MS and a hospital manager whose wife has cancer. This book will be essential and enjoyable reading for anyone workingwithin the healthcare system, as well as patients and their families and anyone interested in the workings of the NHS. (shrink)

In April 2020, close to the start of the first U.K. COVID-19 lockdown, the U.K. government announced the development of a COVID-19 contact tracing app, which was later trialled on the U.K. island, the Isle of Wight, in May/June 2020. United Kingdom surveys found general support for the development of such an app, which seemed strongly influenced by public trust. Institutions developing the app were called upon to fulfil the commitment to public trust by acting with trustworthiness. Such calls presuppose (...) that public trust associated with the app can emerge if the conditions for trustworthiness are met and that public trust is simplistic, i.e., linearly the sum of each member of the publics’ individual – U.K. government trust relationship. Drawing on a synthesis of the trust literature and fifteen interviews with members of the public trialling the app on the Isle of Wight, this paper aims to explore what trust mechanisms and relationships are at play when thinking about public trust in the context of the U.K. COVID-19 app. We argue that public trust is a complex social phenomenon and not linearly correlated with institutional trustworthiness. As such, attention needs to widen from calls for trustworthy infrastructures as a way to build public trust, to a deeper understanding of those doing the trusting; in particular, what or whom do people place their trust in when considering whether using the app and why. An understanding of this will help when trying to secure public trust during the implementation of necessary public health measures. (shrink)

We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls’ principles – using his ‘veil of ignorance’ and both the ‘difference’ and ‘just savings’ principles which it generates – provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making (...) them did not know if one was patient, doctor, nurse or manager – in this generation or the next. We first offer a brief summary of Rawls’ approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls’ approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls’ thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil. (shrink)

Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new ‘managerialism’ has developed in the National Health Service (the NHS). This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the (...) view of the patient as an individual person. (shrink)

Zen Master Thích Nhá̂t Hạnh's commentary on Nāgārjuna's Treatise on the Middle Way, one of the most famous Buddhist texts in existence. Nāgārjuna is a giant in the Buddhist canon, thought to be the greatest Buddhist philosopher after the Buddha. He lived in southern India in the 2nd century CE. Cracking the Walnut contains the text of Nāgārjuna's Treatise on the Middle Way (Mulamadhyamakakarika), defending the essential premise that all things have the nature of emptiness, they have no self-nature, but (...) are in a constant process of change and interrelationship with one another. Weaving Nāgārjuna's text with commentary by Thích Nhá̂t Hạnh', taken from talks given at two 3-month-long retreats, helps us bring these teachings into our daily life. They are strong teachings, designed to break through all metaphysical speculation. To a greater or lesser extent, we all have notions and ideas about life. Sometimes our ideas can contribute to the advancement of humanity, but the problem comes when we are caught in our ideas and believe them to be the absolute truth. When people believe that something is the absolute truth, they may be ready to fight, kill, or die for it. This brings about polarization, deep division, and suffering in ourselves, our society, community, and family. This is not the way ahead for humanity. This book helps us let go of our ideas and go in the direction of understanding and compassion. (shrink)

From unlocking the connection to our inner self, forging deeper and more meaningful bonds with those around us to discovering a true sense of oneness with our natural world, this is the essential guide to help you master the art of connection." -- goodreads.com.

The BMA’s recent discussion paper A rational way forward for the NHS in England, while wishing to free the English NHS from day-to-day politics, merely shifts the locus of the political conflict.In May this year, the British Medical Association published a discussion paper entitled “A rational way forward for the NHS in England”, outlining the association’s suggestions for reform of the English NHS.1The paper is worth reading for its insightful dissection and analysis of the current problems of the English NHS, (...) as well as for its interesting but not totally unexpected conflation of professional and clinical with medical in most of the report. Many of the recommendations are eminently sensible, but some of the suggestions for reconfiguration of the highest-level structures of the English NHS are problematic and unrealistic. What the BMA wants is to free the English NHS from the influence of day-to-day politics by the establishment of a constitution and an independent board of governors, while keeping it free at the point of delivery and paid by general taxation. This is expressed in the first five of the total of 24 recommendations that outline the BMA proposals …. (shrink)

The UK Government’s Code of Conduct for data-driven health and care technologies, specifically artificial intelligence -driven technologies, comprises 10 principles that outline a gold-standard of ethical conduct for AI developers and implementers within the National Health Service. Considering the importance of trust in medicine, in this essay I aim to evaluate the conceptualisation of trust within this piece of ethical governance. I examine the Code of Conduct, specifically Principle 7, and extract two positions: a principle of rationally justified trust that (...) posits trust should be made on sound epistemological bases and a principle of value-based trust that views trust in an all-things-considered manner. I argue rationally justified trust is largely infeasible in trusting AI due to AI’s complexity and inexplicability. Contrarily, I show how value-based trust is more feasible as it is intuitively used by individuals. Furthermore, it better complies with Principle 1. I therefore conclude this essay by suggesting the Code of Conduct to hold the principle of value-based trust more explicitly. (shrink)

The UK Government’s Code of Conduct for data-driven health and care technologies, specifically artificial intelligence -driven technologies, comprises 10 principles that outline a gold-standard of ethical conduct for AI developers and implementers within the National Health Service. Considering the importance of trust in medicine, in this essay I aim to evaluate the conceptualisation of trust within this piece of ethical governance. I examine the Code of Conduct, specifically Principle 7, and extract two positions: a principle of rationally justified trust that (...) posits trust should be made on sound epistemological bases and a principle of value-based trust that views trust in an all-things-considered manner. I argue rationally justified trust is largely infeasible in trusting AI due to AI’s complexity and inexplicability. Contrarily, I show how value-based trust is more feasible as it is intuitively used by individuals. Furthermore, it better complies with Principle 1. I therefore conclude this essay by suggesting the Code of Conduct to hold the principle of value-based trust more explicitly. (shrink)

There is currently a clarion call for the NHS to be more creative and innovative, as it moves into an increasingly quality focused agenda. But exactly how easy is it to do this when the NHS performance regime for the last 10 years has been more about delivering centrally driven, specific and detailed targets for improvement, such as reduction of waiting times, than promoting a culture that speaks of experimentation and possibilities rather than certainties. Can a workforce that may not (...) have been all that prepared for creativity, be creative? And what does being prepared for creativity look like? This paper explores, briefly, the relationship the NHS has with creativity and the new agendas that are creating more fertile ground but then, drawing on practices and information from leading innovators and researchers in the business sector, it looks at the conditions the NHS might need to create in order foster creativity in its workforce. More specifically it looks at the role that a more personal approach to creativity might play in cultivating a workforce that is more comfortable entering into creative thinking and behaviour. (shrink)

This article examines recent developments in the regulation of the medical profession in England, with particular reference to doctors working in the National Health Service (NHS). It is argued that the Health Act 1999 and associated government policies are bringing about a shift from a «light touch», self-regulatory paradigm to a government-driven, interventionist approach. It is suggested that the reason for the change is not simply a governmental concern with the quality and nature of care provided by doctors, but more (...) significantly, a concern with the cost of that care. The article offers a critique of the new regime, drawing on the socio-legal literature on regulation. Some aspects of the reforms ignore the need to persuade doctors to comply, and may therefore result in cheating or «creative compliance»; other aspects of the reforms provide doctors with opportunities to «neutralize» their impact. It concludes with an examination of the wider significance of the change in regulatory paradigm, and of the agenda for future research in this field. (shrink)

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for.

One of the pressures placed upon researchers is the process of ethics review. This frequently provides considerable conflict. The process of review of student projects of little inherent risk is identical to that of their more senior colleagues. In this article I propose that we should be more tolerant of design problems within student research if the overall risk is minimal in order that the student can learn about the process of carrying out research.The frequency and content of papers discussing (...) research ethics review in specialist,1 professional2 3 and lay4 press suggests that many senior researchers find the process challenging. The opinion most frequently expressed is that research ethics committees work to an imprecise set of rules and represent a barrier to significant pieces of clinical research. In particular, specific criticism has been aimed at the review of student research5–8 and the difficulties that students and their supervisors face.In ethics committees we usually police research very carefully, monitoring the detail of projects, including how participants will be selected, what data will be collected, how it will be handled and how the research is funded in addition to the adequacy of the consent process and information that underlies it. My experience as a member of NHS REC and governance committees and, more particularly, coordinator of student research, is that National Research Ethics Service REC usually apply the same standards to student research with little inherent risk as to complex phase 1 studies with significant risk. Guidance in the standard operating procedures for NHS REC is at best unhelpful and at worst supportive of this view. …. (shrink)

For the first time Thich Nhat Hanh shares his inspiration and experience of living in stillness and timelessness. Written to pull you into the moment as he sees it, Inside the Now offers teachings inspired by the spirit of poetry. More personal than the majority of his writing, Inside the Now shares the Zen Master's experience using poetry and meditation to endure and move beyond violence and oppression. Inspired by Being Time by Zen Master Dogen, Thich Nhat Hanh shares short (...) meditations along with revelations from his past to give the reader a sense of entering a space of timelessness. In these meditations, he reveals his own doubts and his own searching. (shrink)