SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

Medical Humanities the journal started life in 2000 as a special edition of the JME. However, the intellectual taproots of the medical humanities as a field of enquiry can be traced to two developments: calls made in the 1920s for the development of multidisciplinary perspectives on the sciences that shed historical light on their assumptions, methods and practices; refusals to assimilate all medical phenomena to a biomedical worldview. Medical humanities the term stems from a desire to situate the significance of (...) medicine as a product of culture. But despite growing usage over half a century the term defies a unifying encapsulation and continues to conjure up a multitude of discourse communities, including scholars working at the interfaces of health and humanities, arts and health, and medical education and bioethics. The field is intellectually capacious and polymorphous, forming and reforming around critical new research questions and teaching tasks spanning disciplines. (shrink)

Bioethics case reports generally treat aspects of moral fathomability, characterised and addressed in different ways. This paper reads the case as a textual model of scenarios and draws attention to its structure, narrative shape, linguistic register, and the effects of tone and temporality on reader expectation and responsiveness. Such textual elements of case composition reflect authorial purpose and influence the interpretation, including moral and ethical interpretation, of bioethics cases.

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)

Volume 20, Issue 7, July 2020, Page W17-W19.

The first part of the book, dedicated to 'Rhetorical and Epistemological Aspects of Science Writing', addresses how scientific pursuits and methods feed into multi-level texts that generate responses within science, society, and culture.

This collection arose out of a conference on intuitions at the University of Notre Dame in April 1996. The papers in it mainly address two related questions: (a) How much evidential weight should be assigned to intuitions? and (b) Are concepts governed by necessary and sufficient conditions, or are they governed by ‘family resemblance’ conditions, as Wittgenstein suggested? The book includes four papers by psychologists relating and analyzing some empirical findings concerning intuitions and eleven papers by philosophers endorsing various answers (...) to these questions. (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)

Volume 34, Issue 2-3, June - September 2024.

“Love hurts”—as the saying goes—and a certain amount of pain and difficulty in intimate relationships is unavoidable. Sometimes it may even be beneficial, since adversity can lead to personal growth, self-discovery, and a range of other components of a life well-lived. But other times, love can be downright dangerous. It may bind a spouse to her domestic abuser, draw an unscrupulous adult toward sexual involvement with a child, put someone under the insidious spell of a cult leader, and even inspire (...) jealousy-fueled homicide. How might these perilous devotions be diminished? The ancients thought that treatments such as phlebotomy, exercise, or bloodletting could “cure” an individual of love. But modern neuroscience and emerging developments in psychopharmacology open up a range of possible interventions that might actually work. These developments raise profound moral questions about the potential uses—and misuses—of such anti-love biotechnology. In this article, we describe a number of prospective love-diminishing interventions, and offer a preliminary ethical framework for dealing with them responsibly should they arise. (shrink)

Assisted Reproductive Technologies (ARTs) have been practiced in Islamic societies within married couples since their introduction. However, there are divergent views over the issue of third-party donation among Sunni and Shia scholars. This paper illustrates the different perspectives of Shia Muslims surrounding, sperm, egg, and embryo donation and ethical aspects thereof. The study reveals that there are different views regarding sperm, egg, and embryo donation among the Shia religious leaders around the world. Many Shia religious scholars, including the Iranian supreme (...) religious leader Ali Hussein Khamenei allow sperm, egg, and embryo donation with certain conditions. However, the conditions stipulated by Shia religious scholars contradict the ethical and legal practices of sperm, egg, and embryo donation. Regarding sperm and egg donation, they declared that the donor child would inherit from a third-party donor and the commissioning parents would be adoptive parents. Thus, according to them, donor anonymity is impossible. Moreover, the Iranian act on embryo donation did not stipulate the right and responsibilities of the donor child and recipient couples and did not clarify the nature and number of embryos that can be donated and implanted. The paper argues that the lack of laws and guidelines on sperm, egg, and embryo donation raises many ethical problems. Based only on religious rulings, third-party donation has been practiced without foreseeing the well-being and safety of donor children, donors, and recipient couples. (shrink)

The stipulation of living organ transplantation policy and practice in Bangladesh is family-oriented, with relatives being the only people legally eligible to donate organs. There have been very few transplantations of bone marrows, liver lobes, and kidneys from related-living donors in Bangladesh. The major question addressed in this study is why Bangladesh is not getting adequate organs for transplantation. In this study, I examin the stipulations of the policy and practice of living organ donation through the lens of 32 key (...) stakeholders including physicians and nurses, a health administrator, organ donors and recipients, and their family members, as they can shed light on the realities and problems of organ donation for transplantation in Bangladesh. My ethnography reveals that the family members are always encouraged to donate organs for transplantation, and saving the lives of relatives through organ donation is seen as a moral obligation. Many view saving the life of a relative by donating one’s organs as equivalent to saving one’s own life. An assessment of the dynamics of biomedicine, religion, and culture leads to the conclusion that the family-oriented organ donation policy and practice have been widely endorsed and accepted in Bangladesh, and Islamic ethical principles and collective family ethos undergird that policy and practice. However, the unavailability of medical resources, lack of post-operative coverage for organ donors, religious misconceptions and unawareness of the general public, and the absence of posthumously donated vital organs for transplantation are perceived to be the most common barriers to a successful living donor-recipient pair organ transplantation. By overcoming these obstacles, Bangladesh can develop a successful living donor-recipient pair organ transplantation program that will ensure improved healthcare outcomes, promote altruism and solidarity among Bangladeshi families, and protect the poor from having their organs sold to wealthy patients. (shrink)

Brian Leftow offers a theist theory of necessity and possibility, and a new sort of argument for God's existence. He argues that necessities of logic and mathematics are determined by God's nature, but that it is events in God's mind - his imagination and choice - that account for necessary truths about concrete creatures.

We live in a world of crowds and corporations, artworks and artifacts, legislatures and languages, money and markets. These are all social objects — they are made, at least in part, by people and by communities. But what exactly are these things? How are they made, and what is the role of people in making them? In The Ant Trap, Brian Epstein rewrites our understanding of the nature of the social world and the foundations of the social sciences. Epstein (...) explains and challenges the three prevailing traditions about how the social world is made. One tradition takes the social world to be built out of people, much as traffic is built out of cars. A second tradition also takes people to be the building blocks of the social world, but focuses on thoughts and attitudes we have toward one another. And a third tradition takes the social world to be a collective projection onto the physical world. Epstein shows that these share critical flaws. Most fundamentally, all three traditions overestimate the role of people in building the social world: they are overly anthropocentric. Epstein starts from scratch, bringing the resources of contemporary metaphysics to bear. In the place of traditional theories, he introduces a model based on a new distinction between the grounds and the anchors of social facts. Epstein illustrates the model with a study of the nature of law, and shows how to interpret the prevailing traditions about the social world. Then he turns to social groups, and to what it means for a group to take an action or have an intention. Contrary to the overwhelming consensus, these often depend on more than the actions and intentions of group members. (shrink)

When we say that what two people feel for each other is 'true love,' we seem to be doing more than simply clarifying that it is in fact love they feel, as opposed to something else. That is, an experience or relationship might be a genuine or actual instance of love without necessarily being an instance of true love. But what criteria do people use to determine whether something counts as true love? This chapter explores three hypotheses. The first holds (...) that the ordinary concept of true love picks out love that is highly prototypical. The second, that it picks out love that is especially good or valuable. The third, that people distinguish between psychological states that are 'real' or not, and that it picks out love that is real. Two experiments provide evidence against the first hypothesis and in favor of the second and third. Implications for real-life disagreements about love are also discussed. (shrink)

Almost every country today contains adherents of different religions and different secular conceptions of the good life. Is there any alternative to a power struggle among them, leading most probably to either civil war or repression? The argument of this book is that justice as impartiality offers a solution. According to the theory of justice as impartiality, principles of justice are those principles that provide a reasonable basis for the unforced assent of those subject to them. The object of this (...) book is to set the theory out, explain its rationale, and respond to a variety of criticism that have been made of it. As the second volume of his work-in-progress, A Treatise on Social Justice, this work lies at the heart of a thriving academic debate which the author has played a key role in shaping. (shrink)

This introduction to legal theory provides a broad overview of the main topics and theories and covers the central issues. Written in a straightforward style, the author conveys academically challenging and often controversial ideas in a lucid manner.

Value pluralists believe in multiple dimensions of value. What does betterness along a dimension have to do with being better overall? Any systematic answer begins with the Strong Pareto principle: one thing is overall better than another if it is better along one dimension and at least as good along all others. We defend Strong Pareto from recent counterexamples and use our discussion to develop a novel view of dimensions of value, one which puts Strong Pareto on firmer footing. We (...) conclude by defending Dimensionalism, the hypothesis that overall value relations are determined solely by how things compare along value dimensions. These are first steps towards a more systematic value pluralism. (shrink)

Brian Hedden defends a radical view about the relationship between rationality, personal identity, and time. On the standard view, personal identity over time plays a central role in thinking about rationality, because there are rational norms for how a person's attitudes and actions at one time should fit with her attitudes and actions at other times. But these norms are problematic. They make what you rationally ought to believe or do depend on facts about your past that aren't part (...) of your current perspective on the world, and they make rationality depend on controversial, murky metaphysical facts about what binds different instantaneous snapshots into a single person extended in time. Hedden takes a different approach, treating the relationship between different time-slices of the same person as no different from the relationship between different people. On his account, the locus of rationality is the time-slice rather than the temporally extended agent. This impersonal, time-slice-centric approach to rationality yields a unified approach to the rationality of beliefs, preferences, and actions where what rationality demands of you is solely determined by your evidence, with no special weight given to your past beliefs or actions. (shrink)

A textbook on modal logic, intended for readers already acquainted with the elements of formal logic, containing nearly 500 exercises. Brian F. Chellas provides a systematic introduction to the principal ideas and results in contemporary treatments of modality, including theorems on completeness and decidability. Illustrative chapters focus on deontic logic and conditionality. Modality is a rapidly expanding branch of logic, and familiarity with the subject is now regarded as a necessary part of every philosopher's technical equipment. Chellas here offers (...) an up-to-date and reliable guide essential for the student. (shrink)

I advocate Time-Slice Rationality, the thesis that the relationship between two time-slices of the same person is not importantly different, for purposes of rational evaluation, from the relationship between time-slices of distinct persons. The locus of rationality, so to speak, is the time-slice rather than the temporally extended agent. This claim is motivated by consideration of puzzle cases for personal identity over time and by a very moderate form of internalism about rationality. Time-Slice Rationality conflicts with two proposed principles of (...) rationality, Conditionalization and Reflection. Conditionalization is a diachronic norm saying how your current degrees of belief should fit with your old ones, while Reflection is a norm enjoining you to defer to the degrees of belief that you expect to have in the future. But they are independently problematic and should be replaced by improved, time-slice-centric principles. Conditionalization should be replaced by a synchronic norm saying what degrees of belief you ought to have given your current evidence and Reflection should be replaced by a norm which instructs you to defer to the degrees of belief of agents you take to be experts. These replacement principles do all the work that the old principles were supposed to do while avoiding their problems. In this way, Time-Slice Rationality puts the theory of rationality on firmer foundations and yields better norms than alternative, non-time-slice-centric approaches. (shrink)

"Brian Orend's The Morality of War promises to become the single most comprehensive and important book on just war for this generation. It moves far beyond the review of the standard just war categories to deal comprehensively with the new challenges of the conflict with terrorism. It thoughtfully reviews every major military conflict of the past few decades, mining them for implications of the evolving tradition of just war thinking. It concludes with a critical engagement with the major alternatives (...) to just war thinking: pacifism and 'realism.' It is, in short, the most comprehensive and thoughtful assessment of all aspects of just war since Michael Walzer's classic Just and Unjust Wars." - Martin L. Cook, United States Air Force Academy. (shrink)