Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to make a valid (...) refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Judges, perhaps inadvertently, have been able to take advantage of the equivocal nature of the concept to come tacitly to decisions that reflect their own moral judgments of patients or decisions made in particular cases. The result is the inconsistent application of principle. I ask whether this is an unforeseen outcome or if it reflects a wilful disregard for equal treatment in favour of silent moral judgments in legal cases. Whatever the cause, I suggest that once this practice is seen to occur, acceptable justification of it in some cases is difficult to find. (shrink)
The question of if, and under what conditions transsexuals should be allowed to participate in sports in their acquired sex is becoming increasingly relevant partly because the number of transsexuals is increasing partly because many countries now provide mechanisms for achieving legal recognition as belonging to the new acquired sex. This paper develops (1) an analysis of the justification for maintaining sex segregation in some sports and (2) an account of the rights of transsexuals to be recognised in their new (...) sex. On the basis of these two analyses it critically evaluates two set of rules for the participation of transsexuals in elite sports: the UK guidelines issued in pursuance of the Gender Recognition Act 2004 and the International Olympic Committee's guidelines. It is argued that these guidelines are conflicting and that a modified set of criteria is more justifiable. (shrink)
It was only a matter of time before the portmanteau term “genethics” would be coined and a whole field within bioethics delineated. The term can be dated back at least to 1984 and the work of James Nagle, who claims credit for inventing the word, which he takes “to incorporate the various ethical implications and dilemmas generated by genetic engineering with the technologies and applications that directly or indirectly affect the human species.” In Nagle’s phrase, “Genethic issues are instances where (...) medical genetics and biotechnology generate ethical problems that warrant societal deliberation.” The great promises and terrific threats of developments in scientific understanding of genetics, and the power to enhance, modify, or profit from the knowledge science breeds, naturally offer a huge range of issues to vex moral philosophers and social theorists. Issues as diverse as embryo selection and the quest for immortality continue to tax analysts, who offer reasons as varied as the matters that might be dubbed “genethical” for or against the morality of things that are actually possible, logically possible, and even just tenuously probable science fiction. (shrink)
In the previous issue of Health Care Analysis, Dr. Andrew Edgar wrote an editorial to round off his 8 years as editor of the journal. His commitment to the journal has provided a remarkable contribution to a range of fields of inquiry that focus on the relationships between health care, policy, practice, and philosophy. As Dr. Edgar indicates, under his stewardship, the journal has published papers addressing both long-standing and novel debates. As he notes, furthermore, his editorial approach has afforded (...) a platform not only for established scholars, but also scholars at the start of their careers. Indeed, when I was amongst that latter category, I was a fortunate and grateful beneficiary of Dr. Edgar’s thoughtful, patient, and generous editorial guidance, and can attest first hand to the important influence he has had in mentoring many of us working in the field, as well as on our scholarship itself.As I now move to the position of editor, I would like here to reflect on my own out. (shrink)
A large tranche of contemporary bioethical inquiry is self-consciously focused on purpose and methodology. Bioethics is a field of disparate disciplines, and it is not always clear what role the philosopher plays in the wider scheme. Even when philosophical reflections can, in principle, find application in the real world , there can be difficulty in finding sound resolution between the competing perspectives. Where fundamentals differ, we face apparent deadlock, with theorists seemingly able only to talk across each other. Perspectives on (...) this vary. For example, some will argue that the philosopher’s role is purely reflective and need have no practical resonance whatsoever. Others may say that philosophers are not equipped to engage with empirical questions or, when they do, they do so on flawed understandings of “the real world”; bad science or science fiction replaces brute fact and emotional, social, and empirical reality. Some may seek to strike a balance by trying to engage the questions within a political framing, allowing both for normative and real-world concerns. (shrink)
Recent Developments Content Type Journal Article DOI 10.1007/s11673-010-9235-5 Authors John Coggon, University of Manchester Centre for Social Ethics and Policy, Institute for Science, Ethics, and Innovation, School of Law Manchester UK Cameron Stewart, University of Sydney Centre for Health Governance, Law and Ethics, Sydney Law School Sydney NSW 2006 Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 7 Journal Issue Volume 7, Number 2.
This article provides an understanding and defence of ‘best interests’. The analysis is performed in the context of, and is informed by, English law. The understanding that develops allows for differences in values, and is thus argued to be appropriate in a pluralist liberal system. When understood properly, it is argued, best interests provides the best means of decision-making for people deemed incompetent to decide for themselves. It is accepted that some commentators are cynical of best interests in practice. Following (...) an assessment of some of their principal concerns, it is suggested that best interests in fact provides a construct that is both defensible and desirable. (shrink)
In their book Debating Euthanasia, Emily Jackson and John Keown present respectively arguments in favour of and against the legalization of (some instances of) euthanasia and assisted suicide. Jackson advances a case based on a principled commitment to a secular, liberal legal system, arguing that obligations rooted in compassion require the careful development of laws to permit assisted dying. Keown defends the status quo, arguing that the law ought to sustain a prohibition against assisted dying, both out of a principled (...) commitment to the inviolability of life doctrine, and because satisfactory regulation will be impossible to draft. I question the strength of each author’s essay. Jackson, I argue, does not take sufficiently seriously the plausibility of secular moral objections to assisted dying. Keown, meanwhile, overstates the inviolability principle’s place in English law. Focusing particularly on Keown’s essay, I go on to consider the approach taken to ‘debating euthanasia’, and suggest that it betrays more about the direction of the public debate, and the fragility of ‘the case against’, than he would perhaps wish. (shrink)
John Coggon argues that the important question for analysts in the fields of public health law and ethics is 'what makes health public?' He offers a conceptual and analytic scrutiny of the salient issues raised by this question, outlines the concepts entailed in, or denoted by, the term 'public health' and argues why and how normative analyses in public health are inquiries in political theory. The arguments expose and explain the political claims inherent in key works in public health ethics. (...) Coggon then develops and defends a particular understanding of political liberalism, describing its implications for critical study of public health policies and practices. Covering important works from legal, moral, and political theory, public health, public health law and ethics, and bioethics, this is a foundational text for scholars, practitioners and policy bodies interested in freedoms, rights and responsibilities relating to health. (shrink)
