This new edition of Law and Medical Ethics continues to chart the ever-widening field that the topics cover. The interplay between the health caring professions and the public during the period intervening since the last edition has, perhaps, been mainly dominated by wide-ranging changes in the administration of the National Health Service and of the professions themselves but these have been paralleled by important developments in medical jurisprudence.

This article revisits long-standing questions about consent, membership and emigration in Locke’s thought. Commentators such as A John Simmons have argued that Locke opens political membership to both express consenters and some kind of tacit consenters, and not just to the former, as some have suggested. Simmons’s reading seems to render Locke more sensible in that it does not exclude large numbers of people from membership or burden the few members with all the civic duties, and also in that it (...) allows at least tacit-consenting members the right to relocate, while this right is denied to express-consenting members. Against this reading, the article shows, by resolving seemingly conflicting claims in the text, that people become members only by express consent. It also responds to the criticism that the express-consent-only reading would limit membership to a few and so would render Locke’s account implausible from a practical point of view. The article then addresses the purported restriction Locke imposes on express consenters’ right to emigrate, arguing that the restriction concerns the change of membership and not the right to relocate. (shrink)

Mason and McCall Smith's classic textbook discusses the relationship of medical practice and ethics with the operation of the law. The subjects covered include natural and assisted reproduction, the impact of modern genetics on medicine, medical confidentiality, consent to medical treatment, the use of resources and problems surrounding death in the new medical era. It is of significance to anyone with an interest in the ethical and legal practice of medicine.

In lieu of an abstract, here is a brief excerpt of the content:MACINTYRE'S REPUBLIC J. K. SWINDLER Westminster College Fulton, Missouri CONTRARY TO HIS own evident intentions and perceptions, in After Virtue A'lasdair Macinty!l.·e is much more of a Ptlatonist 1than the A1 ristotelian he aims to be. I hase this judgment both on the positive evidence that Macintyre and Plato (in the Republic) m1gue for and against the same crucial theses and on the negative evidence that Plato has read (...) answers to the very issues which Macintyre finds 1 intractable from an AristoteHan point of viiew. My thesis can be made out in terms of a half dozen issues which Maclntyire takes as crucial to his case: (1) Can there he a science of government? (2) Is there an answer to the sophist's chaillenge to morality? (3) How oan the fragmentation of the modern self he theoretically overcome? (4) What are the hi1stocical and social determinants of morality? (5) Is there a unity of virtue in addition to individual virtues? (6) Can we reconcile ourselves to teleofogy, the absence of the polis, and the tragedy of human 1:ife? I will consider each of these in turn. I. Wisdom Plato defines wisdom as knowledge of how to rule, and Aristotle (in the Nichomachean Ethics) distinguishes between theoretical and practical wisdom, 1suggesting thereby an interesting ambiguity in Plato's view, an ambiguity of which Macintyre makes a great deal. One may rule eithecr hy law or by judgment. In his attack on the Enlightenment, MacIntyre showis quite clearly tha;t the idea of a social science that would p11ovide laws of human behavior, which could in 343 344 J. K. SWINDLER turn be used by il"ulers and managers to predict and therefore manipulate!human action, was an invention of the eighteenth century. He offers an extensive 1oritique o.f this conception of socirul science, grounded primarily in the claim that human.behavior is essentially unlawful, at least if we judge it by the standards of the physical sciences. There is in human affairs a farge 1and uneliminwble element of fortiuna which makes it impossrible rto.formulate laws of human nature or behavior that would he exceptionless and therefore underwrite predictions of behavior. For there is nothing to be done about the unpredictability of innovations or, from one's own point of view, of one's own future actions; nor can the uncertainties of gametheoretie decisions and 1 the general contingency of the outcomes of ruction,be remedied. There is therefore no possibility of a social science in the sense in which Hume tried to imitate Newton. So much for Marx and Weber and the horde of modern.social scientists. This is not to say that life is completely uncertain; on the contrary, there are genuine and general regularities in society, some natural, some social, ·some statistical, some causal, wihich make life bearable. But these provide a,ground for the Aristotelian idea, endorsed by MacIntyre, that the principles of conduct, such as they might be, hold only for the most part and not universa1ly. There is therefore in Maclntyre's view no justification for 1a mora;l oode in the modern sense, nor ev;en of moral principles of the kind we are used to from Kant ·and Mill, Rawls and Nozick, which purport to istand as a sufficient criterion of right in all cases. But, importantly, we do not find any such rules or codes in Pla.to either. For Plato, too, insists on the mixed reign of chaos and logos in the materia;l world and in our Jives and concludes that judgment is essential to· determining right conduct. He tellrs us that wise rule comes only &om good oharructer and good institutions, that legislating in such detaii1 as to eliminate judgment is "cut:ting off the heads of a hy:dra." One cannot help hut think that tMs (essentially Hemclitean) point is something Aristotle ~earned at his MACINTYRE'S REPUBLIC 345 master's knee. And both aspects of Plato's :point ~e ipresent in Aristotle, viz., that s~nce the:ve is chance in nature, there is luck (good 'and had) in life, and since no rule can capture the particularity of conorete situations right... (shrink)

Recent scholarship on technology-induced ‘conceptual disruption’ has spotlighted the notion of a conceptual gap. Conceptual gaps have also been discussed in scholarship on epistemic injustice, yet up until now these bodies of work have remained disconnected. This article shows that ‘gaps’ of interest to both bodies of literature are closely related, and argues that a joint examination of conceptual disruption and epistemic injustice is fruitful for both fields. I argue that hermeneutical marginalization—a skewed division of hermeneutical resources, which serves to (...) diminish the experiences of marginalized folk—does not only transpire because of conceptual gaps, but also because of two other kinds of conceptual disruption: conceptual overlaps and conceptual misalignments. Hence, there are multiple kinds of conceptual disruption that can be usefully studied through the normative lens of epistemic injustice. Technology can play different roles vis-a-vis epistemic injustices, both as a causal trigger of conceptual disruption, but also as a mediator of hermeneutical resources. Its role is normatively significant, in particular because socially disruptive technologies can have different epistemic implications for different groups: they may amplify the epistemic resources of some groups, while diminishing those of others. (shrink)

Originally published in 1926, this book attempts to state 'what has been believed with regard to God's incapacity for suffering'. Mozley charts the development of the doctrine from the Apostolic Fathers through the Reformation to the modern influence of metaphysical philosophy and concludes with six questions intended to prompt further theological discussion on this point. This book will be of value to anyone with an interest in the history of Christian theology.

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues. Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians (including three women), (...) aged 33–66 years, residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner. Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position. Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues.Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians , aged 33–66 years, (...) residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner.Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position.Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

Summary Coursework is an integral part of the GCSE framework, valued for its motivational qualities and its curricular validity. It is a common perception, widely reported in the national press and educational media, that coursework can be held at least partly accountable for differential performances at GCSE; coursework, it is argued, advantages girls. This article reports on an analysis of data arising from a project which offered an opportunity to study current and post-GCSE students’ perceptions of coursework. The outcomes indicate (...) that, when categorised by their relative levels of attainment, girls’ and boys’ perceptions show limited evidence of homogeneity. In other words, to suggest that girls’ and boys’ perceptions of coursework are a function of gender is a gross over-simplification. Other factors are at play and further, more specific and tailored research is essential if we are to understand how best to optimise the benefits that are claimed for coursework. (shrink)

Medical ethics and medical practice -- Public health and the state-patient relationship -- Health rights and obligations in the European Union -- Consent to treatment -- Liability for medical injury -- Medical confidentiality -- Genetic information and the law -- The management of infertility and childlessness -- The control of fertility -- Civil and criminal liability in reproductive medicine -- Health resources and dilemmas in treatment -- Treatment of the aged -- Mental health and human rights -- The body as (...) property -- Medical futility -- The diagnosis of death -- The donation of organs and transplantation -- Euthanasia and assistance in dying -- Biomedical human research and experimentation -- Research on children, fetuses and embryos. (shrink)

Technology has expanded genomic research and the complexity of extracted gene-related information. Health-related genomic incidental findings pose new dilemmas for nurse researchers regarding the ethical application of disclosure to participants. Consequently, informed consent specific to incidental findings is recommended. Critical Social Theory is used as a guide in recognition of the changing meaning of informed consent and to serve as a framework to inform nursing of the ethical application of disclosure consent in genomic nursing research practices.

In two important articles, Thomas Hurka applies his recursive account of value to virtue. Hurka’s contention is that being virtuous is merely a matter of having the proper pro-attitude toward what is objectively good. Hurka argues that the recursive framework honors much of our traditional conception of virtue, and even if it does not capture everything involved in virtue, it “describes at least part of what virtue involves.” I argue that the recursive account of virtue is not a partial description (...) of traditional virtue, however, but a reconception of virtue. Accepting the recursive account would require abandoning the most distinctive elements of traditional virtue ethics. (shrink)

The central question of Aeschylus' Supplices has usually been taken to be the reason for the flight of the Danaids. The most exhaustive guide to the many theories, of varying plausibility, which have been developed to account for this flight is provided by A. F. Garvie's book on the Supplices. For present purposes, therefore, it is unnecessary to examine any but the two most acceptable theories in detail. Nevertheless, a brief summary, prior to this examination, of two other, initially attractive, (...) views might be helpful to students of this problem, the first simply because it is so attractive to so many eminent scholars, the second because, while it fails to provide an acceptable solution, it suggests a useful approach to the problem. (shrink)

_Practical Bioethics_ offers a mix of theory and readings, presented in a format that is succinct and approachable. Each chapter begins and ends with a case study, illustrating the core issues at play and emphasizing the practical nature of the dilemmas arising in medicine. Primary source texts are provided to flesh out the issues, and each of these is carefully edited and presented with interwoven explanatory comments to assist student readers. Throughout, J.K. Miles shows the importance of health-care ethics to (...) us all, whether we be medical providers, patients, or both. (shrink)

This chapter contains sections titled: Why a Philosophy of Fatherhood? Role Responsibilities Autonomy Autonomy and Fatherhood Conclusion Notes.

It is shown that all the countable superatomic boolean algebras of finite rank have the small index property.

Why do we persist in the relentless pursuit of artificial nourishment and other treatments to maintain a permanently unconscious existence? In facing the future, if not the present world-wide reality of a huge number of persistent vegetative state (PVS) patients, will they be treated because of our ethical commitment to their humanity, or because of an ethical paralysis in the face of biotechnical progress? The PVS patient is cut off from the normal patterns of human connection and communication, with a (...) life unlike other forms of human existence. Why the struggle to justify ending a life which, it is said, has suffered an irreversible loss of the content of consciousness? Elsewhere, the authors have addressed the ethical controversies and confusion engendered by ambiguous terminology, misuse of medical facts and the differing interpretations of what constitutes 'effective' treatment: in particular, the issue of whether in fact artificial nutrition and hydration is a medical treatment, or simply part of the obligatory care owed to all patients, permanently unconscious or not. In this paper, we intend to argue that recent analyses of medical futility, its meaning and ethical implications, despite an absence of public consensus, permit some tentative re-evaluation of our ethical obligations to the PVS patient. (shrink)

In this paper an attempt is made to establish that the parties on both sides of the disputes concerning whether reasons are causes have mischaracterized or misdescribed what is involved in acting from a reason. A characterization of acting from a reason is provided, and, as a result, it is shown why contradictory positions have been and still are maintained by opposing parties. As a consequence of this account, an attempt is made to show why all parties have missed the (...) nature and significance of empathetic understanding. (shrink)