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.

Recently, new developments took place in the Dutch debate on the legislation of euthanasia. After a brief account of that debate, the article discusses a new government proposal for legislation in this field, which was submitted to the Dutch parliament in November 1991. This proposal relates not only to euthanasia but also to some other medical decisions concerning the end of life. The author concludes that, for several reasons, it is unsatisfactory.

Republicans consider freedom as non-domination an attractive political ideal for a modern pluralistic society that cannot be found in liberalism. This book shows how this view is untenable. By analysing freedom as non-domination as it is understood by contemporary republicans, the book rejects the widely held view that this freedom concept is superior to liberal understandings of freedom as non-interference. In fact, setting up institutions to promote non-domination is shown to also promote non-interference. The book demonstrates how it is the (...) focus on making an ideal suitable for a modern society that leads republicans to a view of freedom with no normative insight that cannot also be found in liberalism. However, the book also shows how republicans can adjust their freedom ideal so that it actually offers a distinctly republican contribution to political philosophy. By understanding freedom to require that citizens commit to an especially high level of political participation to deny powerholders opportunities to act against the common good, republicans can reject liberalism and freedom as non-interference. But this freedom ideal does not respect the many citizens in a modern society whose conceptions of a good life do not involve such a high level of political engagement. Republicans therefore face a dilemma: They can promote a freedom ideal suited for modern conditions, but they then end up endorsing a liberal theory promoting freedom as non-interference. Alternatively, they can promote a distinct freedom ideal, but this ideal will be unsuited for a modern society. (shrink)

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)

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.

A set is said to be amorphous if it is infinite, but is not the disjoint union of two infinite subsets. Thus amorphous sets can exist only if the axiom of choice is false. We give a general study of the structure which an amorphous set can carry, with the object of eventually obtaining a complete classification. The principal types of amorphous set we distinguish are the following: amorphous sets not of projective type, either bounded or unbounded size of members (...) of partitions of the set into finite pieces), and amorphous sets of projective type, meaning that the set admits a non-degenerate pregeometry, over finite fields either of bounded cardinality or of unbounded cardinality. The hope is that all amorphous sets will be of one of these types. Examples of each sort are constructed, and a reconstruction result for bounded amorphous sets is presented, indicating that the amorphous sets of this kind constructed in the paper are the only possible ones. The final section examines some questions concerned with the resulting cardinal arithmetic. (shrink)

Despite a growing body of literature focused on understanding experiences of workplace dignity, attention has centered almost exclusively on employees with lower-level jobs. As a result, little is known about how workplace dignity and indignity are experienced by employees with middle- and upper-level jobs and how their experiences differ from those with lower-level jobs. We address these absences by interviewing employees from a diversity of lower-, middle-, and upper-level jobs about their experiences of indignity at work. We outline common dignity (...) threats, along with typical emotional responses and recourses employees use at each level. We find lower-level employees experience chronic dignity threats from being disrespected, devalued, demeaned, and dehumanized, to which their most typical response is endurance. Middle-level employees experience periodic dignity threats due to undermining of their work, confidence, and reputation. For them, the typical response is strategizing. Finally, on the rare occasions upper-level employees experience dignity threats, it usually is due to a disregard of their special expertise or denial of special rights, to which they respond by rising above. (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)

The literature on collective action largely ignores the constraints that moral principle places on action-prompting intentions. Here I suggest that neither individualism nor holism can account for the generality of intentional contents demanded by universalizability principles, respect for persons, or proactive altruism. Utilitarian and communitarian ethics are criticized for nominalism with respect to social intentions. The failure of individualism and holism as grounds for moral theory is confirmed by comparing Tuomela's reductivist analysis of we-intentions with Gilbert's analysis of social facts. (...) Tuomela's account founders over intentions to cooperate, and Gilbert's cannot accommodate legitimate authority, vicarious agency, or group structure. (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.

This manuscript reports on a landmark symposium on the ethical, legal and technical challenges of xenotransplantation in the UK. King’s College London, with endorsement from the British Transplantation Society (BTS), and the European Society of Organ Transplantation (ESOT), brought together a group of experts in xenotransplantation science, ethics and law to discuss the ethical, regulatory and technical challenges surrounding translating xenotransplantation into the clinical setting. The symposium was the first of its kind in the UK for 20 years. This paper (...) summarises the content of the expert lectures showcasing the progress which has been made in xenotransplantation including—the history of xenotransplantation, advances in gene edited animals and progress towards clinical xenotransplantation. We then set out the ethical and legal issues still to be resolved. Finally, we report the themes of the roundtable discussion highlighting areas of consensus and controversy. While the detail of the legal discussion was directed towards the UK, the principles and summary reported here are intended to be applicable to any jurisdiction seeking to implement clinical xenotransplantation. (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)

In this moderate realist account of the whole range of issues facing contemporary analytic philosophy, J. K. Swindler aims to fill the gap in the literature between extreme realism and extreme nominalism. He discusses such fundamental concepts as existence, property, universality, individual, and necessity; analyzes the paradoxes of negative existentials and the substitutivity of co-referential terms; and defends objectivity in philosophy. The study moves through three phases: first, an argument that objective philosophical truth is attainable; second, an extended realist analysis (...) of fundamental ontological concepts; and finally, a demonstration of advantages of this ontology over leading alternatives. Weaving: An Analysis of the Constitution of Objects will be of interest to all philosophers working in contemporary philosophy, philosophy of language, logic, and metaphysics, and will serve as an excellent text for advanced undergraduate and graduate courses in metaphysics. (shrink)

The advent of personal genomics companies offering direct translation of scientific data into personal health information, calls into question traditional policies to refuse disclosure of such scientific data to research participants. This seems especially true for population biobanks, as they collect not only genotype information but also associated phenotype information, and thus may be in a unique position to translate their scientific findings into personal health information for their participants. Disclosure of such information seems mandated by the expectations raised by (...) biobanks and their participants' rights to know health information, to know clinical research results, to life and health and particularly their right to benefit. Refusals to disclose such information can be grounded in the lack of analytical validity and/or clinical utility of most findings, the need to avoid the therapeutic misconception, the complexity and costs involved in translation and disclosure and the disproportionate burden resulting from the obligation to respect participants' right not to know before any disclosure can be made. Currently, any demands by participants in population biobanks for full disclosure of all pertinent personal health information potentially resulting from the biobank's scientific findings are unlikely to be granted by a Dutch court under Dutch and international law. As the law stands now, a population biobank is neither a doctor nor a personal genomics company. However, in view of the rapid scientific, medical, technological, commercial and social developments, population biobanks must prepare to take more care of their participants' legitimate interest in receiving as much validated personal health information as reasonably possible, in a timely fashion, by developing appropriate translation and disclosure mechanisms. This paper examines whether population biobank participants have the right, under Dutch civil law and international law, to full disclosure, i.e. to all information generated by the biobank that is pertinent to their present and future health. It pioneers the format of a hypothetical court case to elucidate the legal and policy arguments" for and against full disclosure. (shrink)

Most discussions of medical futility try to answer the Futility Question: when is a medical procedure futile? No answer enjoys universal support. Some futility policies say that the health care provider will answer this question when the provider and patient cannot agree. This raises the Decision Question: who has the moral authority to decide what to do in cases where futility is disputed? I look for a procedural answer to this question, an answer that does not turn on whether a (...) given party happens to answer the Futility Question correctly. I argue that these policies get it right; the provider should decide because providers have a right of conscientious refusal that extends to refusing procedures on grounds of futility. This is a procedural answer because providers have this right even if they are sincerely mistaken about whether a procedure is futile. (shrink)

This paper traces the development of parental rights to accept or to refuse treatment for a defective newborn infant in the United Kingdom and in the United States of America; its main purpose is to explore the common trends from which an acceptable policy may be derived. It is probable that the British law on parental decision-making in respect of infants suffering from Down's syndrome is to be found in the civil case of In Re B rather than in the (...) criminal case of R v Arthur. United States court decisions are strongly influenced by constitutional law and reflect the right to personal privacy. The position on each side of the Atlantic seems very similar but this similarity includes a sense of uncertainty as to legal responsibility. There is a case for agreed guidelines and a suggested format is offered for consideration. (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)

Background: The American Medical Association, the British Medical Association and the Canadian Medical Association have guidelines that specifically discourage physicians from self-prescribing or prescribing to family members, but only the BMA addresses informal prescription requests between colleagues. Objective: To examine the practices of paediatric providers regarding self-prescribing, curbsiding colleagues, and prescribing and refusing to prescribe to friends and family. Methods: 1086 paediatricians listed from the American Academy of Paediatrics 2007 web-based directory were surveyed. Results: 44% of eligible survey respondents returned (...) usable surveys. Almost half of respondents had prescribed for themselves. An equal number had informally requested a prescription from a colleague. Three-quarters stated they had been asked to prescribe a prescription drug for a first-degree or second-degree relative, and 51% had been asked by their spouse. Eighty-six per cent stated that they had refused to write a prescription on at least one occasion for a friend or family member. The following reasons “strongly influenced” their decision to refuse a prescription request: outside of provider’s expertise ; patient’s need for his or her own physician ; not medically indicated ; need for a physical examination. Conclusion: These data confirm that most physicians have engaged in self-prescribing or curbside requests for prescriptions. It can be argued that curbsiding is more morally problematic than self-prescribing because it implicates a third party, and should be discouraged regardless of whether the requester is a colleague, family member or friend. (shrink)

Over the last two decades, Dutch courts have left room for euthanasia. Although a crime under the Penal Code, euthanasia will usually not result in prosecution and conviction if it is committed by a physician according to rules of careful medical practice ; if the patient's request is voluntary, well-considered, and enduring; and if there is unacceptable and hopeless suffering and there are no other solutions to the patient's situation.

This article aims to show that Locke’s discussion of tacit consent and the right to punish aliens in the Second Treatise of Government has important bearings on the moral status of undocumented immigrants. It argues that Locke conceptualized both friendly and hostile aliens, counting the former as tacit consenters to whom host states owed rights and protection. Moreover, it highlights how his approach, unlike theorists before and after him, was one that saw individuals as capable of shaping their own relationship (...) with the host. The article also examines Locke’s discussion of the federative power of the state, which includes the power to vet aliens within the country. Seen through this Lockean lens, the article argues that the vast majority of undocumented immigrants can be understood as tacit consenters or potential citizens who should be judged by how they choose to relate to the host, and not by their country of origin. While noting that the Lockean approach is not incompatible with border control, the article also shows how it puts the onus on the host to justify the power it exercises and to engage in dialogue with undocumented immigrants about what their status should be in the country. (shrink)

Emotional stimuli (e.g. words, images) are often remembered better than neutral stimuli. However, little is known about how memory is affected by an environmentally induced emotional state (without any overtly emotional occurrences) – the focus of this study. Participants were randomly assigned to discovery (n = 305) and replication (n = 306) subsamples and viewed a desktop virtual environment before rating their emotions and completing objective (i.e. item, temporal-order, duration) and subjective (e.g. vividness, sensory detail, coherence) memory measures. In both (...) samples, a Partial Least Squares Correlation analysis showed that an emotional state characterised by high negative emotion (i.e. threat, fear, anxiety) and arousal was reliably associated with better memory in both objective (i.e. item) and subjective (i.e. vividness and sensory detail) domains. No reliable associations were observed for any temporal memory measures (objective or subjective). Thus, an environmentally induced state of negative emotion corresponds with enhanced memory for indices of episodic memory pertaining to “what” happened, but not necessarily “when” it happened. (shrink)

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)

This chapter contains sections titled: “I'm shocked, I tell you, shocked!” The Preacher and the Porn Star Picnic Sex and the Prudes “Don't look, Ethel!” Tease Me, Whip Me, Persuade Me Biting the Bullet Hard Cases If Porn Isn't Free Speech, What Is It? Notes.

Ongoing serious breaches in medical professionalism can only be avoided if UK doctors rethink their approach to law. UK medical education has a role in creating a climate of change by re-examining how law is taught to medical students. Adopting a more insightful approach in the UK to the impact of The Human Rights Act and learning to manipulate legal concepts, such as conflict of interest, need to be taught to medical students now if UK doctors are to manage complex (...) decision-making in the NHS of the future. The literature is reviewed from a unique personal perspective of a doctor and lawyer, and practical proposals for developing medical education in law in the UK are suggested. (shrink)

IN THE beginning Parmenides sought to deny the void. But he found himself trapped by his language and his thought into admitting what he sought to deny. Wisely, he counseled others to avoid the whole region in which the problem arises, lest they too be unwarily ensnared. Plato, being less easily intimidated and grasping for the first time the urgency of the paradox, unearthed each snare in turn until he felt he had found a safe path through the forbidden terrain (...) in a new conception of being and the derivation of its linguistic consequences in the Sophist. Aristotle evidently took Parmenides’ advice; and save for a few groping scholastics, perhaps Leibniz, Brentano, and Meinong, and Frege only in passing, no one else attempted the crossing before Russell made his spectacular dash through the posted ground from the completely new direction of linguistic reference. Again the problem lay dormant for half a century until Strawson constructed a new low road through ordinary language and Quine improved Russell’s high algebraic pass. Refinements of these routes have been forthcoming, especially from Searle and Kripke, until today it might appear that there are two super highways through Parmenides’ forbidden country of nonbeing. In this essay I will first argue that these new linguistic highways are no more than flimsy camouflage hiding but not resolving the old paradoxes. I will then show how Plato’s ontological way out, though more difficult, is the straight and narrow path. (shrink)

Libertarians have long been divided over how best to interpret the Lockean proviso, which requires that one leave “enough and as good” in common for others after one’s appropriation. This article sheds light on this exegetical question in relation to its qualitative part through a contextual analysis of Locke’s often neglected writings on ….

The current UN policy regarding free speech presents a philosophical dilemma between accepting the free speech provisions in the Universal Declaration of Human Rights and exceptions carved out for hatred, hostility, and religious defamation. The Declaration should be understood to imply viewpoint neutrality and the exceptions for defamation are not viewpoint neutral. If the UN were to adopt J. S. Mill’s crucial distinctions between expression and performative speech, content and context, and mental states and the acts motivated by them, it (...) would be clear that hatred, hostility, and defamation cannot be exceptions to viewpoint neutral free speech. If the heart of free speech is freedom especially for the thought we hate, then the UN should abandon its exceptions or abandon appeals to free speech. However, I will offer a strong reason that it should not do the latter. (shrink)

In this article, we present results from a literature review of intrinsic, instrumental, and relational values of nature conducted for the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, as part of the Methodological Assessment of the Diverse Values and Valuations of Nature. We identify the most frequently recurring meanings in the heterogeneous use of different value types and their association with worldviews and other key concepts. From frequent uses, we determine a core meaning for each value type, which is (...) sufficiently inclusive to serve as an umbrella over different understandings in the literature and specific enough to help highlight its difference from the other types of values. Finally, we discuss convergences, overlapping areas, and fuzzy boundaries between different value types to facilitate dialogue, reduce misunderstandings, and improve the methods for valuation of nature's contributions to people, including ecosystem services, to inform policy and direct future research. © 2023 The Author(s). Published by Oxford University Press on behalf of the American Institute of Biological Sciences. (shrink)

_Despite advances in standard of living of the population, the condition of widows and divorced women remains deplorable in society. The situation is worse in developing nations with their unique social, cultural and economic milieu, which at times ignores the basic human rights of this vulnerable section of society. A gap exists in life expectancies of men and women in both developing and developed nations. This, coupled with greater remarriage rates in men, ensures that the number of widows continues to (...) exceed that of widowers. Moreover, with women becoming more educated, economically independent and aware of their rights, divorce rates are increasing along with associated psychological ramifications. The fact that widowed/divorced women suffer from varying psychological stressors is often ignored. It has been concluded in various studies that such stressors could be harbingers of psychiatric illnesses (e.g., depression, anxiety, substance dependence), and hence should be taken into account by treating physicians, social workers and others who come to the aid of such women. A change in mindset of the society is required before these women get their rightful place, for which a strong will is needed in the minds of the people, and in law-governing bodies._. (shrink)