Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)
First paragraph: This paper seeks to understand various paradoxes as cases of conflicting rules. In particular, the ambition is to outline a new perspective on and response to the Liar -- though it will take us a while to get that far. We begin in Section 1 with an account of simple rule confliction. Section 2 then brings this account to bear on a paradox, the Secretary Liberation Paradox, which is readily seen to involve conflicting rules. Finally in Section 3 (...) I suggest that the Liar can also be seen as a case of rule confliction, and outline briefly how that perspective provides for Liar arguments to be blocked. (shrink)
It is not immediately clear from Wittgenstein’s Tractatus how to connect his idea there of an object with the logical ontologies of Frege and Russell. Toward clarification on this matter, this paper compares Russell’s and Wittgenstein’s versions of the thesis of an atomic fact that it is a complex composition. The claim arrived at is that whilst Russell (at times at least) has one particular of the elements of a fact – the relation – responsible for the unity of the (...) whole, for Wittgenstein the unity of a fact is the product of copulative powers inherent in all its elements. All kinds of constituents of Tractarian facts – all kinds (forms) of object – are, to use Fregean terminology, unsaturated. (shrink)
The identity theory of truth takes on different forms depending on whether it is combined with a dual relation or a multiple relation theory of judgment. This paper argues that there are two significant problems for the dual relation identity theorist regarding thought’s answerability to reality, neither of which takes a grip on the multiple relation identity theory.
It has been much debated whether Tractarian objects are what Russell would have called particulars or whether they include also properties and relations. This paper claims that the debate is misguided: there is no logical category such that Wittgenstein intended the reader of the Tractatus to understand his objects either as providing examples of or as not providing examples of that category. This is not to say that Wittgenstein set himself against the very idea of a logical category: quite the (...) contrary. However, where Russell presents his logical variety of particulars and the various types of universal, and Frege presents his of objects and the various types of function, Wittgenstein denies the propriety of such a priori expositions. Wittgenstein envisages a variety of logical types of entity but insists that the nature of these types is something to be discovered only through analysis. (shrink)
This article examines the standard of disclosure, set by law, of risks of treatment and alternative procedures that should normally be disclosed to patients. Therapeutic privilege has been recognized by the courts as an exception to this standard of disclosure. It provides a justification for withholding such information from competent patients in the interests of patient welfare. The article explores whether this justification is either legally or ethically defensible. In assessing patient welfare, the health care professional is required to consider (...) the patient's overall best interests - but this is not limited to an assessment of medical best interests. It is contended that the health care professional is neither qualified nor justified in making such a judgement, as the law recognizes that a competent adult patient determines her own best interests. This is not possible without sufficient information of risks to inform the decision. (shrink)
In W v M and Others (Re M) the Court of Protection considered whether withdrawal of artificial nutrition and hydration was in the best interests of a person in minimally conscious state. The Mental Capacity Act 2005 states that in determining best interests the decision-maker must consider, so far as is reasonably ascertainable, the patient's wishes, feelings, beliefs and values. Baker J. indicated that a high level of specificity is required in order to attribute significant weight to these factors. It (...) is preservation of life which carries substantial weight in the best interests' balance sheet. Could the (prior) values of a patient ever meet the probative standard necessary to offset the weight accorded to preservation of life? Rather than referencing the patient's values to specific circumstances and treatments they could be more effectively considered as part of the patient narrative, how the patient would want her life story to continue/cease. (shrink)
Wittgenstein responds in his Notes on Logic to a discussion of Russell's Principles of Mathematics concerning assertion. Russell writes: "It is plain that, if I may be allowed to use the word assertion in a non-psychological sense, the proposition "p implies q" asserts an implication, though it does not assert p or q. The p and the q which enter into this proposition are not strictly the same as the p or the q which are separate propositions." (PoM p35) Wittgenstein (...) replies: "Assertion is merely psychological. In not-p, p is exactly the same as if it stands alone; this point is absolutely fundamental." (NB p95) Wittgenstein's response is intriguing, not least because of the centrality to his Tractatus of the idea that a proposition says something. This paper will examine that idea, distinguishing it from 'merely psychological' assertion, and explore in this context how we should understand the occurrence of a Tractarian proposition within another. (shrink)
This paper is concerned with the status of a symbol in Wittgenstein’s Tractatus. It is claimed in the first section that a Tractarian symbol, whilst essentially a syntactic entity to be distinguished from the mark or sound that is its sign, bears its semantic significance only inessentially. In the second and third sections I pursue this point of exegesis through the Tractarian discussions of nonsense and the context principle respectively. The final section of the paper places the forgoing work in (...) a secondary context, addressing in particular a debate regarding the realism of the Tractatus. (shrink)
The Mental Capacity Act received Royal Assent on 7 April 2005, and it will be implemented in 2007. The Act defines when someone lacks capacity and it supports people with limited decision-making ability to make as many decisions as possible for themselves. The Act lays down rules for substitute decision making. Someone taking decisions on behalf of the person lacking capacity must act in the best interests of the person concerned and choose the options least restrictive of his or her (...) rights and freedoms. Decision making will be allowed without any formal procedure unless specific provisions apply, such as a written advance decision, lasting powers of attorney or a decision by the court of protection. (shrink)
This paper develops a model for understanding the Tractarian doctrine that a sign insyntactic use determines a form. This doctrine is found to be in tension withWittgenstein's agnosticism with regard to forms of reality.
The teaching of ethics in UK medical schools has recently been reviewed, from the perspective of the teachers themselves. A questionnaire survey of medical undergraduates at King’s College London School of Medicine provides useful insight into the students’ perception of ethics education, what they consider to be the value of learning ethics and law, and how engaged they feel with the subject.
Wittgenstein held that Russell’s multiple relation theory of judgment fails to explain an atomic judgment’s representation of entities as combined. He demonstrated this failure as follows. Under the multiple relation theory, an atomic judgment is a complex whose relating relation is judgment, the universal, and whose terms include the entities the judgment represents as combined. Taking such a complex we may arrive through the substitution of constituents at a complex whose relating relation is again judgment but whose terms do not (...) include entities which are logically suited for combination. This second judgment complex will not represent any of its terms as combined, for entities that are logically uncombinable are unrepresentable as combined. Russell’s theory does not, however, explain how the original judgment differs from the complex arrived at by the substitution of constituents such that the former but not the latter represents certain of its terms as combined. (shrink)
In this paper. we attempt to view a long-held assumption in nursing as mistaken. That is, that patient suffering is something to be overcome. Utilizing Nietzsche’s statements on Amor Fati, we carefully examine the cultural assumptions behind our denigration of suffering, look at specific nursing examples of this situation, and attempt the beginnings of a discourse on what it would take for nurses to overcome their own predetermined views of suffering in order to better help their patients “own” their own (...) suffering. (shrink)
This article considers the provisions of the Mental Capacity Act 2005 in respect of advance decisions. It considers the new statutory regulation of advance directives (termed 'advance decisions' in the Act) and the formalities necessary to effect an advance decision purporting to refuse life-sustaining treatment. The validity and applicability of advance decisions is discussed with analogy to case law and the clinician's reasonable belief in following an advance decision is considered. The article assesses the new personal welfare Lasting Powers of (...) Attorney, the situation where an attorney purports to refuse life-sustaining treatment on behalf of the donor, and the contrast between best interests and substituted judgment. (shrink)
This article explores the attitudes of consultants in a large UK teaching hospital to the need for formal clinical ethics support. Data obtained through an anonymous online questionnaire illustrate the ways in which consultants deal with clinical ethical dilemmas and their confidence in such decision-making. In the absence of formal ethics support a large proportion of consultants who took part in the survey said that they would consult with colleagues when faced with a clinical ethical dilemma and the majority considered (...) that this satisfactorily resolved the issue. However, 80% of respondents stated that they would find a form of ethics support within the Trust to be useful. Consultants also noted the reasons for, and barriers to, using ethics support. The response rate to the survey was low, perhaps indicating a lack of interest in the topic or that clinical ethics discussion is of low priority. (shrink)