Context The attitudes of medical professionals towards physician assisted dying have been widely discussed. Less explored is the level of agreement among physicians on the possibility of ‘rational suicide’—a considered suicide act made by a sound mind and a precondition of assisted dying legislation. Objective To assess attitudes towards rational suicide in a representative sample of senior doctors in England and Wales. Methods A postal survey was conducted of 1000 consultants and general practitioners randomly selected from a commercially available database. (...) The main outcome of interest was level of agreement with a statement about rational suicide. Results The corrected participation rate was 50%; 363 questionnaires were analysed. Overall 72% of doctors agreed with the possibility of rational suicide, 17% disagreed, and 11% were neutral. Doctors who identified themselves as being more religious were more likely to disagree. Some doctors who disagreed with legalisation of physician assisted suicide nevertheless agreed with the concept of rational suicide. Conclusions Most senior doctors in England and Wales feel that rational suicide is possible. There was no association with specialty. Strong religious belief was associated with disagreement, although levels of agreement were still high in people reporting the strongest religious belief. Most doctors who were opposed to physician assisted suicide believed that rational suicide was possible, suggesting that some medical opposition is best explained by other factors such as concerns of assessment and protection of vulnerable patients. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing (...) the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm. (shrink)

Abstract This paper explores gender and mental health with particular reference to the emerging philosophical field of critical realism. This philosophy suggests a shared ontology and epistemology for the natural and social sciences. Until recently, most of the debate surrounding gender and mental health has been guided either implicitly or explicitly within a positivist or constructivist philosophy. With this in mind, key areas of critical realism are explored in relation to gender and mental health, and contrasted with the positions of (...) positivism and constructivism. It is argued that critical realism offers an alternative philosophical framework for the exploration of gender issues within mental health care. (shrink)

Some have objected to human enhancement on the grounds that it violates the autonomy of the enhanced. These objections, however, overlook the interesting possibility that autonomy itself could be enhanced. How, exactly, to enhance autonomy is a difficult problem due to the numerous and diverse accounts of autonomy in the literature. Existing accounts of autonomy enhancement rely on narrow and controversial conceptions of autonomy. However, we identify one feature of autonomy common to many mainstream accounts: reasoning ability. Autonomy can then (...) be enhanced by improving people’s reasoning ability, in particular through cognitive enhancement; given how valuable autonomy is usually taken to be, this gives us extra reason to pursue such cognitive enhancements. Moreover, autonomy-based objections will be especially weak against such enhancements. As we will argue, those who are worried that enhancements will inhibit people’s autonomy should actually embrace those enhancements that will improve autonomy. (shrink)

Moral enhancement is an ostensibly laudable project. Who wouldn’t want people to become more moral? Still, the project’s approach is crucial. We can distinguish between two approaches for moral enhancement: direct and indirect. Direct moral enhancements aim at bringing about particular ideas, motives or behaviors. Indirect moral enhancements, by contrast, aim at making people more reliably produce the morally correct ideas, motives or behaviors without committing to the content of those ideas, motives and/or actions. I will argue, on Millian grounds, (...) that the value of disagreement puts serious pressure on proposals for relatively widespread direct moral enhancement. A more acceptable path would be to focus instead on indirect moral enhancements while staying neutral, for the most part, on a wide range of substantive moral claims. I will outline what such indirect moral enhancement might look like, and why we should expect it to lead to general moral improvement. (shrink)

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

In spite of the labours of Sedlmayer,1 Ehwald2 and Palmer,3 it cannot be said that there exists a completely satisfactory edition of Ovid's Heroides. One or all of these editors sometimes leave a corrupted text, sometimes adhere too closely to a manuscript reading, and sometimes introduce untenable emendations. A new edition is called for, with revised collati ons of the known manuscripts, and an augmented apparatus criticus, exhibiting the large class of what I may term the ‘Vulgate’ manuscripts, which represents (...) a tradition different from, and probably later than that of our chief authority, the excellent but unfortunately incomplete eleventh-century Parisinus , which, like all primary manuscripts of this type, contains many readings or corruptions which should not on account of its mere authority be accepted slavishly. Light is often thrown on the text from less important sources, and the truth may be recovered from manuscripts of the ‘Vulgate’ family, where our better authority fails. In this connexion the study of my own manuscript has led me to some conclusions in certain passages which I venture to set forth as suggestions towards an improved constitution of the text of the Heroides. Though it is clear from the preceding investigation into its nature that O is no primary manuscript, but belongs rather to that large class which has passed through various stages of reproduction involving alterations due either to carelessness of copyists or, more rarely, to deliberate alteration, it presents at the same time a phenomenon not unusual with such manuscripts, inasmuch as it often supports the best tradition, and in some cases preserves a reading which yields the truth, or from which the truth can be elucidated. I have used the following symbols: P = Parisinus 8242 s. xi. E = Etonensis s. xi. G = Gueferbytanus s. xii. V = Schedae Vindobonenses s xii. O = my manuscript s. xiv. D = Dresdensis s. xiii. ω = all or the majonly of the ‘Vulgate’ manuscripts. ζ = some of these manuscripts. (shrink)

In spite of the labours of Sedlmayer,1 Ehwald2 and Palmer,3 it cannot be said that there exists a completely satisfactory edition of Ovid's Heroides. One or all of these editors sometimes leave a corrupted text, sometimes adhere too closely to a manuscript reading, and sometimes introduce untenable emendations. A new edition is called for, with revised collati ons of the known manuscripts, and an augmented apparatus criticus, exhibiting the large class of what I may term the ‘Vulgate’ manuscripts, which represents (...) a tradition different from, and probably later than that of our chief authority, the excellent but unfortunately incomplete eleventh-century Parisinus, which, like all primary manuscripts of this type, contains many readings or corruptions which should not on account of its mere authority be accepted slavishly. Light is often thrown on the text from less important sources, and the truth may be recovered from manuscripts of the ‘Vulgate’ family, where our better authority fails. In this connexion the study of my own manuscript has led me to some conclusions in certain passages which I venture to set forth as suggestions towards an improved constitution of the text of the Heroides. Though it is clear from the preceding investigation into its nature that O is no primary manuscript, but belongs rather to that large class which has passed through various stages of reproduction involving alterations due either to carelessness of copyists or, more rarely, to deliberate alteration, it presents at the same time a phenomenon not unusual with such manuscripts, inasmuch as it often supports the best tradition, and in some cases preserves a reading which yields the truth, or from which the truth can be elucidated. I have used the following symbols:P = Parisinus 8242 s. xi.E = Etonensis s. xi.G = Gueferbytanus s. xii.V = Schedae Vindobonenses s xii.O = my manuscript s. xiv.D = Dresdensis s. xiii.ω = all or the majonly of the ‘Vulgate’ manuscripts.ζ = some of these manuscripts. (shrink)

quam dolor hie umquam spatio euanescere possit,leniat aut odium tempus et hora meum.Here “spatio” means “lapse of time” : it is illustrated by A. A. II. 113forma bonum fragile est, quantumque accedit ad annos,fit minor et spatio carpitur ipsa suo.As regards the whole couplet, besides at this place, it is found also after line 40 in all the MSS. except the Galeanus Vaticanus and Phillipps MS. There, though it fits in with the context, it is not required: here it is (...) indispensable. It should therefore be omitted from the text after line 40, where its presence is due to that species of interpolation which consisted in the insertion of other portions of a writer's work kindred in meaning, on which see Mr. Hall's Companion to Classical Texts, p. 198. (shrink)

Since the publication of my critical edition in 1889 the Tristia of Ovid has received some attention. A paper in Hermathena, vol. vii. by Professor R. Ellis contains several conjectural emendations, and in a public lecture on The Second Book of Ovid's ‘Tristia’ , this veteran scholar analysed the intricate contents of Book II. Two learned pamphlets by Dr. R. Ehwald, Ad historiam carminum Ouidianorum recensionemque symbolae deal with the history of the text, and the textual criticism and interpretation generally. (...) Dr. Paul Vogel's Kritische und exegetische Bemerkungen zu Ovid ‘Tristien’ is a valuable contribution to the understanding of the text and its interpretation. (shrink)

Since the publication of my critical edition in 1889 the Tristia of Ovid has received some attention. A paper in Hermathena, vol. vii. by Professor R. Ellis contains several conjectural emendations, and in a public lecture on The Second Book of Ovid's ‘Tristia’, this veteran scholar analysed the intricate contents of Book II. Two learned pamphlets by Dr. R. Ehwald, Ad historiam carminum Ouidianorum recensionemque symbolae deal with the history of the text, and the textual criticism and interpretation generally. Dr. (...) Paul Vogel's Kritische und exegetische Bemerkungen zu Ovid ‘Tristien’ is a valuable contribution to the understanding of the text and its interpretation. (shrink)

While philosophers are often concerned with the conditions for moral knowledge or justification, in practice something arguably less demanding is just as, if not more, important – reliably making correct moral judgments. Judges and juries should hand down fair sentences, government officials should decide on just laws, members of ethics committees should make sound recommendations, and so on. We want such agents, more often than not and as often as possible, to make the right decisions. The purpose of this paper (...) is to propose a method of enhancing the moral reliability of such agents. In particular, we advocate for a procedural approach; certain internal processes generally contribute to people’s moral reliability. Building on the early work of Rawls, we identify several particular factors related to moral reasoning that are specific enough to be the target of practical intervention: logical competence, conceptual understanding, empirical competence, openness, empathy and bias. Improving on these processes can in turn make people more morally reliable in a variety of contexts and has implications for recent debates over moral enhancement. (shrink)

It has recently been argued that reproductive genetic manipulation technologies like mitochondrial replacement and germline CRISPR modifications cannot be said to save anyone’s life because, counterfactually, no one would suffer more or die sooner absent the intervention. The present article argues that, on the contrary, reproductive genetic manipulations may be life-saving (and, from this, have therapeutic value) under an appropriate population health perspective. As such, popular reports of reproductive genetic manipulations potentially saving lives or preventing disease are not necessarily mistaken, (...) though such terminology still requires further empirical validation. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating to (...) the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

By the courtesy of the editors I have been allowed to see Mr. A. Y. Campbell's “observations on two emendations of Ausonius suggested by me in C.Q. XXVII. 178 ff. Meanwhile I have learned from Mr. E. Harrison, of Trinity College, Cambridge, that, in the Cambridge Philological Society's Proceedings, 1924, p. 27, since Alcestis is meant, cp. Juv. 6, 652 spectant subeuntem fata mariti / Alcestim et, similis si permutatio detur, morte viri cupiant animam servare catellae, he had already proposed (...) to ‘read pro nece functa viri,’ thus anticipating my pro nece and Mr. Campbell's funere. As the Cambridge Phil. Soc. Proc. are inaccessible to me and are not to be discovered in theBodleian Library, I was ignorant of Mr. Harrison's proposal. I am glad that we concur. (shrink)

Before proceeding to consider certain passages of Silius in detail I should like to enter a protest against the undue disparagement which has been meted out to this poet. The letter of Pliny , containing reflexions suggested by the voluntary death by which with stoical fortitude he sought release from the agony of an incurable tumour, presents to us a character which if not great was attractive; the character of a wealthy and kindly noble, who had made no enemies; one (...) whose house was the resort of men of letters; a devotee of poetry, who worshipped Vergil with almost religious veneration; a lover of the beautiful, who found his pleasure according to the accepted Roman fashion in amassing works of art and tasteful country mansions. Pliny's terse criticism of his poem ‘scribebat carmina maiore cura quam ingenio’ is more just than that of modern critics. Though Silius is not a great poet, a poet he is, with merits distinctly his own. His Punica is hardly an epic proper, but is rather a chronicle in verse: as such its author displays considerable skill in the clearness with which he marshals the mass of events, and in the realistic force of his descriptions, especially that of the plague , and those of the numerous battles, and particularly of the sea-fights ; and in the elaboration of geographical detail, where the vividness of the topographical presentation shows a well-trained eye and no common literary power The numerous episodes which enliven the poem, such as the legend of Pyrene , the killing of the monster serpent , the pretty description of Pan , are executed with much imaginative fancy which recalls the manner of Ovid's Metamorphoses. Again there is a dignity and sustained elevation of language which results not unfrequently in vigorous, well-turned phrases of no ordinary merit. Such are the expression for an echo xiv. 365 ‘clamat scopulis clamoris imago,’ or for breaking through the ranks of the treacherous Greeks xvii. 425 ‘periuria Graia resignat,’ or again the fine line describing the sobbing sound made by water rushing into a wrecked ship's hull and out again xiv. 550 ‘mox sua ponto | singultante anima propulsa refunditur unda.’. (shrink)

In his elegiacs Ovid did not permit the elision of the final syllable of an iambic word ‘in an arsis , i.e. first syllable of dactyl or spondee.’ See L. Müller, De re metrica, ed. 2, p. 341. These two are the only lines in which this rule is transgressed, for in Trist. II. 296, which used to appear asstat Venus Vltori iuncta, uir ante foreswas brilliantly restored conjecturally by Bentley, and has since been found to be the actual reading (...) of our best manuscript, the Marcianus. The soundness of the text in the two lines obelized above is still open to question. (shrink)

The MS. 410 of the Bibliotheque publique of Valenciennes consists of 70 leaves of vellum, written in Caroline minuscules in the 11th century. The titles Ivvenalis liber primvs incipit and Explicit Ivvenalis. Incipit Persivs are in small rustic capitals. The MS. contains Juvenal and Persius in that order. The last leaf but one has been cut out, that containing Pers. vi. 8 dant–vi. 71 exits. Juvenal, Sat. xvi, follows at the end of Sat. xiv, fol. 56v: then Sat. xv follows (...) on Sat. xvi, fol. 57v, after which comes Persius, fol. 60v, beginning with the Choliambi, which precede Sat. i. The MS. has usually 32, occasionally 34, lines on a page. There are interlinear glosses, but no scholia, and no titles to the Satires, with three exceptions: Pers. iv. ‘In hac satira reprehendit illos qui honores cupiebant’ Juv. v. ‘Ad trebium loquitur’ xi. ‘De uictus comparatione.’. (shrink)

The Oxford Classical Texts, or Scriptorum Classicorum Bibliotheca Oxoniensis, are renowned for their reliability and presentation. The series consists of a text without commentary but with a brief apparatus criticus at the front of each page. There are now over 100 volumes, representing the greater part of classical Greek and Latin literature. The aim of the series remains that of including the works of all the principal classical authors. Although this has been largely accomplished, new volumes are still being published (...) to fill the remaining gaps, and old editions are being revised in the light of recent research or replaced. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

It is generally unquestioned that human subjects research review boards should assess the ethical acceptability of protocols. It says so right on the tin, after all: they are explicitly called research ethics committees in the UK. But it is precisely those sorts of unchallenged assumptions that should, from time to time, be assessed and critiqued, in case they are in fact unfounded. John Stuart Mill's objection to suppressers of dissent is instructive here: “If the opinion is right, they are deprived (...) of the opportunity of exchanging error for truth: if wrong, they lose, what is almost as great a benefit, the clearer perception and livelier impression of truth, produced by its collision with error”.1 Andrew Moore and Andrew Donnelly's compelling article, “The job of ‘ethics committees’”, is just this sort of challenge to conventional wisdom, a rejection of the notion that review boards should be considering ethical matters at all.2 If true, we should be substantially reforming our research ethics policies. And if false, rebuttals would help strengthen and ground the otherwise unquestioned assumption of the role of ethics committees. As it happens, I will argue that their critiques fall into the second category. While mistaken, they present a valuable opportunity to clarify the role of ethics committees and their relationship to relevant codes. In particular, I will defend a hybrid account where codes have strict primacy, but leave significant room for review boards …. (shrink)

With the recent report of a live birth after use of Mitochondrial replacement therapy, sometimes called ‘Three-parent IVF’, the clinical application of the technique is fast becoming a reality. While the United Kingdom allows the procedure under regulatory scrutiny, it remains effectively outlawed in many other countries. We argue that such prohibitions may violate individuals’ procreative rights, grounded in individuals’ interest in genetic affinity. The interest in genetic affinity was recently endorsed by Singapore’s highest court, reflecting an emphasis on the (...) importance of biological ties found across the globe. We apply that reasoning to make the case for a right to ‘Three-parent IVF’. (shrink)

The Symposia Aristotelica were inaugurated at Oxford in 1957. They are conferences of select groups of Aristotelian scholars from the UK, USA and Europe, and are held every three years. In 1975 the meeting was held in Cambridge and was devoted to Aristotle's psychological treatises, the De anima and the Parva uaturalia. The members of the conference discussed some of the much debated problems of Aristotle's psychology and broached important new topics such as his ideas on imagination. Dr Lloyd and (...) Professor Owen have collected and edited the papers presented to the Symposium and provided an analytical index. (shrink)

Monitored Emergency Use of Unregistered and Experimental Interventions (MEURI) is an ethical framework developed by the WHO for using unproven interventions in public health emergencies outside the context of medical research. It is mainly intended for use when medical research would be impracticable, but there is still a need to systematically gather data about unproven interventions. As such, it is designed as something of a middle ground between clinical and research ethical frameworks.However, I argue that MEURI does not truly lie (...) at the intersection of clinical care and research. Due to its intent, structure and oversight requirements, it takes on most of the crucial features of research, to the point that it is best understood as a form of research. As a result, cases where MEURI could practicably be applied should instead make use of existing research frameworks. For those circumstances where research is truly impracticable, a more straightforward oversight system than MEURI is needed. While existing practices of compassionate use have some applicability, proposals to make use of clinical ethics committees to oversee unproven interventions may help achieve the right balance in acting in a patient’s best interests when the relevant evidence base is weak. (shrink)

The Symposia Aristotelica were inaugurated at Oxford in 1957. They are conferences of select groups of Aristotelian scholars from the UK, USA and Europe, and are held every three years. In 1975 the meeting was held in Cambridge and was devoted to Aristotle's psychological treatises, the De anima and the Parva uaturalia. The members of the conference discussed some of the much debated problems of Aristotle's psychology and broached important new topics such as his ideas on imagination. Dr Lloyd and (...) Professor Owen have collected and edited the papers presented to the Symposium and provided an analytical index. (shrink)