In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have demonstrated (...) many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features. (shrink)

The purpose of this paper is to explore the work of John Macmurray as a philosophical resource for Christianswhose theological framework presumes an epistemological shift, toward a new starting point in the way we understand our knowledge of God. After a brief introduction to both contextual theology and John Macmurray, the paper will concern itself with an exploration of Macmurray’s critique of idealist epistemology and the relationship this critique has to the assumptions of contextual theology. Next we will consider the (...) implications of this shift for both philosophy and theology. Thirdly, we will offer support for the claim that Macmurray’s work represents a positive future resource for those who are struggling to make sense of the practical demands of a living faith. In closing, some criticisms of Macmurray from the perspective of contextual theology will be anticipated. (shrink)