'The law imposes the duty of care: but the standard of care is a matter of medical judgment'. So says Lord Scarman, outlining the hitherto accepted 'Bolam' standard, in his recent speech in the House of Lords decision of Sidaway v Bethlem Royal Hospital, reflecting earlier judicial dicta suggesting that it is for the medical profession rather than the courts to determine whether or not a medical practitioner has achieved the required standard of care (1). It is suggested here that (...) this concept is bad in principle, and that the weight of judicial authority is against it. (shrink)

Narrative ethics taps into an inherent human need to tell our own stories centred on our own moral values and to have those stories heard and acknowledged. However, not everyone’s words are afforded equal power. The use of narrative ethics in bioethical decision-making is problematized by a disparity in whose stories are told, whose stories are heard, and whose stories are believed. Here, I conduct an analysis of narrative ethics through a critical theory lens to show how entrenched patterns of (...) narrative neglect in medicine are harming not only our capacity to make use of narrative ethics but also our capacity to deliver effective healthcare. To illustrate this point, I use three examples where the patient’s gender affects how their stories unfold: autism, weight, and pain management. From these, I argue that the use of narrative ethics without the application of a critical theory lens risks the exacerbation of what Miranda Fricker refers to as “testimonial injustice,” the prima facie harm experienced by individuals whose credibility is undermined by others’ prejudices. Finally, I suggest that narrative ethics can be a powerful tool for mitigating oppressive practices in medicine if we couple it with critical analysis that enables us to understand the power dynamics at play in storytelling. (shrink)

This essay discusses an alternative interpretation of the term “Dasein” as Heidegger uses it in Being and Time and, in particular, the possibility that Dasein is meant to contain an inherent form of intersubjectivity to which we must “return” in order to achieve authenticity. In doing so, I build on the work of John Haugeland and his interpretation of Dasein as a mass term, while exploring the implications such an interpretation has on Heidegger’s conception of “authenticity”. Ultimately, this paper aims (...) to take seriously Heidegger’s claim to be moving past the isolated Cartesian subject and towards a view of authentic human existence that is cognizant of the way our identities are always formed within a pre-existing community. In addition, since many interpretations of Heidegger have argued that “the Anyone” is representative of all possible forms of community, I consider how this alternative understanding of Dasein as intersubjective can shed new light on critical remarks Heidegger makes about “the Anyone”. Thus, I argue that by reinterpreting Dasein as community, we can find more coherence between Heidegger’s otherwise conflicting conceptions of authenticity and “the Anyone”. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

In Nicolaus Cusanus on Faith and the Intellect: A Case Study in 15th-Century Fides-Ratio Controversy, K.M. Ziebart presents an account of the Cusan epistemology as a fascinating late-medieval attempt to definitively harmonize faith and reason.

Medical ethics, principles, persons, and perspectives is discussed under three headings: History, Theory, and Practice. Under Theory, the author will say something about some different approaches to the study and discussion of ethical issues in medicine—especially those based on principles, persons, or perspectives. Under Practice, the author will discuss how one perspectives based approach, hermeneutics, might help in relation first to everyday ethical issues and then to public controversies. In that context some possible advantages of moving from controversy to conversation (...) will be explored; and that will then be illustrated with reference to a current controversy about the use of human embryos in stem cell therapy research. The paper begins with history, and it begins in the author’s home city of Edinburgh. (shrink)

Abortion is forbidden under normal circumstances by nearly all the major world religions. Traditionally, abortion was not deemed permissible by Muslim scholars. Shiite scholars considered it forbidden after implantation of the fertilised ovum. However, Sunni scholars have held various opinions on the matter, but all agreed that after 4 months gestation abortion was not permitted. In addition, classical Islamic scholarship had only considered threats to maternal health as a reason for therapeutic abortion. Recently, scholars have begun to consider the effect (...) of severe fetal deformities on the mother, the families and society. This has led some scholars to reconsider the prohibition on abortion in limited circumstances. This article reviews the Islamic basis for the prohibition of abortion and the reasons for its justification. Contemporary rulings from leading Shiite scholars and from the Sunni school of thought are presented and reviewed. The status of abortion in Muslim countries is reviewed, with special emphasis on the therapeutic abortion law passed by the Iranian Parliament in 2003. This law approved therapeutic abortion before 16 weeks of gestation under limited circumstances, including medical conditions related to fetal and maternal health. Recent measures in Iran provide an opportunity for the Muslim scholars in other countries to review their traditional stance on abortion. (shrink)

Many of our most important goals require months or even years of effort to achieve, and some never get achieved at all. As social psychologists have lately emphasized, success in pursuing such goals requires the capacity for perseverance, or "grit." Philosophers have had little to say about grit, however, insofar as it differs from more familiar notions of willpower or continence. This leaves us ill-equipped to assess the social and moral implications of promoting grit. We propose that grit has an (...) important epistemic component, in that failures of perseverance are often caused by a significant loss of confidence that one will succeed if one continues to try. Correspondingly, successful exercises of grit often involve a kind of epistemic resilience in the face of failure, injury, rejection, and other setbacks that constitute genuine evidence that success is not forthcoming. Given this, we discuss whether and to what extent displays of grit can be epistemically as well as practically rational. We conclude that they can be (although many are not), and that the rationality of grit will depend partly on features of the context the agent normally finds herself in. In particular, grit-friendly norms of deliberation might be irrational to use in contexts of severe material scarcity or oppression. (shrink)

This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this (...) is to ask practising nurses about the real ethical problems they encounter. (shrink)

Although science supplies medicine's “gold standard,” knowledge exercised in the care of patients is, like moral knowing, a matter of narrative, practical reason. Physicians draw on case narrative to store experience and to apply and qualify the general rules of medical science. Literature aids in this activity by stimulating moral imagination and by requiring its readers to engage in the retrospective construction of a situated, subjective account of events. Narrative truths are provisional, uncertain, derived from narrators whose standpoints are always (...) situated, particular, and uncertain, but open to comparison and reinterpretation. Reading is thus a model for knowing in both morality and clinical medicine. While principles remain essential to bioethics and science must always inform good clinical practice, the tendency to collapse morality into principles and medicine into science impoverishes both practices. Moral knowing is not separable from clinical judgment. While ethics must be open to discussion and interpretation by patients, families, and society, it is nevertheless substantively and epistemologically an inextricable part of a physician's clinical practice. (shrink)

Suppose some person 'A' sets out to accomplish a difficult, long-term goal such as writing a passable Ph.D. thesis. What should you believe about whether A will succeed? The default answer is that you should believe whatever the total accessible evidence concerning A's abilities, circumstances, capacity for self-discipline, and so forth supports. But could it be that what you should believe depends in part on the relationship you have with A? We argue that it does, in the case where A (...) is yourself. The capacity for "grit" involves a kind of epistemic resilience in the face of evidence suggesting that one might fail, and this makes it rational to respond to the relevant evidence differently when you are the agent in question. We then explore whether similar arguments extend to the case of "believing in" our significant others -- our friends, lovers, family members, colleagues, patients, and students. (shrink)

For much of human history the idea of a right to life has not seemed self-evident. The credibility of the idea appears to depend on a particular kind of intuition concerning the nature of the world. In this paper, the kind of intuition involved is related to the idea of a covenant, illustrated by that of marriage. The paper concludes by suggesting that talk about responsibilities may be more fruitful than talk about rights.

Aphantasia is a recently discovered disorder characterised by the total incapacity to generate visual forms of mental imagery. This paper proposes that aphantasia raises important theoretical concerns for the ongoing debate in the philosophy and science of consciousness over the nature of dreams. Recent studies of aphantasia and its neurobehavioral correlates reveal that the majority of aphantasics, whilst unable to produce visual imagery while awake, nevertheless retain the capacity to experience rich visual dreams. This finding constitutes a novel explanandum for (...) theories of dreaming. Specifically, I argue that the recent dream reports of aphantasics constitute an empirical challenge to the emerging family of views which claim that dreams are essentially imaginative experiences, constitutively involving the kinds of mental imagery which aphantasics, ex-hypothesi, lack. After presenting this challenge in the context of Jonathan Ichikawa’s recent arguments for this view, I argue that this empirical challenge may be overcome if the imagination theorist abandons Ichikawa’s account of dreaming in favour of a modified version. This involves the claim that dreams are essentially inactive and constitutively involve non voluntary forms of imagination. I conclude with a suggestion for further research which can test the viability of this alternative hypothesis, and move the debate forward. (shrink)

Was society’s response adequate in the cases of Mrs Pretty and Ms B?On the 11th of May, less than two weeks after losing her final legal appeal, Mrs Diane Pretty died, under sedation and in the care of a hospice. It was not the end she had pursued through the English High Court, the Court of Appeal, the House of Lords, and the European Court of Human Rights. Paralysed by motor neurone disease and unable to take her own life, Mrs (...) Pretty wanted her husband to be allowed to help her to die when they decided the time had come. But in England, assisting suicide is a crime, although suicide itself no longer is, and the English courts refused Mrs Pretty’s request to grant her husband legal immunity. In turning to the European Court of Human Rights, Mrs Pretty argued that the English courts’ refusal had violated the European Convention on Human Rights.The European court, however, judged that there had been no violation. The right to life could not be construed as conferring a “right to die”, and consequently the state could not be required to “sanction actions intended to terminate life” in order to protect Mrs Pretty from the “inhuman or degrading treatment” to which she claimed the law on assisted suicide subjected her. The right to respect for private life , moreover, had to be exercised “in accordance with the law” of the state concerned. “States were entitled to regulate through the operation of the general criminal law activities which were detrimental to the life and safety of other individuals”; and such activities were what the English law against assisting suicide was designed to prevent. Exceptions to this law could not be allowed without undermining the …. (shrink)

Investigation into the reality of time can be pursued within the ontological domain or it can also span human thought and natural language. I propose to approach time by correlating three domains of inquiry: metaphysical time, the human concept of time, and temporal reference in natural language, entertaining the possibility of what I call a ‘horizontal reduction’ and ‘vertical reduction’. I present a view of temporalityL/E as epistemic modality, drawing on evidence from the L domain and its correlates in the (...) E and M domains. On this view, the human concept of time is a complex, ‘molecular’ concept and can be broken down into primitive concepts that are modal in nature, featuring as degrees of epistemic commitment to representations of states of affairs. I present evidence from tensed and tenseless languages and point out its compatibility with the view of real time as metaphysical modality. (shrink)

Haydar el-Herevî Horasan’dan Osmanlı topraklarına gelen önemli âlimlerdendir. Teftâzânî’nin şeçkin bir talebesi olan bu âlim I. Mehmed’ten büyük saygı görerek onun tarafından himaye edilmiştir. Herevî, Zemahşerî’nin el-Keşşâf’ı üzerine yazdığı şerhi büyük övgü ifadeleriyle I. Mehmed’e ithaf etmiş, ithafın yer aldığı mukaddimede hayat hikayesiyle ilgili önemli ayrıntılar vermiştir. Osmanlı topraklarında geçirdiği uzun yıllar sonra Timur’un oğlu Şahruh ile irtibat kuran Herevî, el-Keşşâf şerhi mukaddimesini tekrardan kaleme alarak aynı eseri bu sefer Şahruh’a ithaf etmiştir. Herevî’nin bu yeni patronaj ilişkisi mukaddimenin ikinci versiyonundan (...) öğrenilmektedir. İkinci versiyonda sadece ithaf kısmı değiştirilmemiş, yeni haminin kimliğiyle irtibatlı olarak muhteva da yeni- den kurgulanmıştır. İlk versiyonda bulunmayan önemli biyografik ayrıntılar ikinci versiyonda yer almaktadır. Mukaddimenin iki versiyonu Herevî biyografisinin neredeyse yegâne kaynağıdır. Bu makalede mukaddimenin ikinci versiyonu ilk defa gün yüzüne çıkarılmış ve her iki versiyonda verilen bilgiler bir araya getirilerek Herevî’nin biyografisi inşa edilmiştir. İki versiyonda herhangi bir tarih verilmemiş, sadece bazı şehirlerdeki ikamet süreleri belirtilmiştir. Biyografi inşa edilirken anlatıda oluşan boşluklar tarihi olaylardan hareketle doldurulmuş ve tarihlendirme yapılmıştır. Bahsedilen olaylar, yapılan nitelemeler ve verilen ikamet süreleri itibara alınarak Herevî’nin hayatının yaklaşık kırk yıllık bölümü tam olarak tarihlendirilmiş, Serahs’tan başlayarak sırasıyla Şîraz, Tebriz, Şirvan, Bursa, Edirne ve tekrar Horasan’a uzanan yıllara dair bütünlüklü bir tablo ortaya konulmuştur. Bu hayat hikayesi ulema-sultan ilişkileri, siyasî gelişmelerin ilim hayatına yansımaları ve hayatını ilim yolculuklarında geçiren bir âlimin zihin dünyası hakkında eşsiz bilgiler sunmaktadır. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Dogs and MonstersObservations on the Evacuation of Afghanistan and the Intersection of Human Rights and the AnthropoceneK. M. Ferebee (bio)On August 28, 2021, former Royal Marine and charity worker Pen Farthing was evacuated from Afghanistan with almost two hundred dogs and cats that his Kabul animal charity, Nowzad Dogs, had rescued. The role of the British government in this evacuation remains hotly contested: At the time, the British Ministry (...) of Defence tweeted (Fig. 1) that Farthing's escape had been assisted by the British military, but Farthing later disputed this claim and argued that his rescue was not the result of high-level intervention in the British government. In January 2022 controversy erupted around the emergence of documents suggesting that Prime Minister Boris Johnson had lied to Parliament about the personal role that he played in just such an intervention. Notably, Nowzad's Afghan staff members were not evacuated alongside Farthing and the animals, though they would eventually escape to Pakistan. Following Farthing's escape, the British government failed to evacuate hundreds of British citizens and residents (Merriman and Ghouri), as well as many more Afghans who had worked on behalf of British forces. The Nowzad Dogs evacuation became a site of symbolic struggle over Britain's respect (or lack thereof) for human rights. "What a story to tell the world: Britain values dogs more than Afghan people," the headline of an opinion piece in the Guardian (Hinsliff) read.The story of Nowzad Dogs is interesting to me not only as a tale of human-nonhuman relations, but also because I was, at the time it occurred, volunteering within the Afghan aid community to assist relatives of a friend, British Afghans who had been visiting Kabul when the government [End Page 52] collapsed. The family repeatedly asked for assistance from the British Foreign, Commonwealth and Development Office—assistance that never appeared. Ultimately, due to the generosity of donors and the coordination of a volunteer team, the family was able to flee to Pakistan, where they boarded a commercial flight to London. This case was a particularly stark and powerful illustration of the negotiations of rights and value that took place during and following the evacuation. It seemed nonsensical, in August 2021, to suppose that British citizens, including British children (the family I worked with included a six- and an eleven-year-old who were British citizens), would be abandoned while Afghan dogs had their rights prioritized. As I hope to demonstrate here, however, such an incident becomes comprehensible and even logical when it is understood as part of a specifically Anthropocene manifestation of subjectivity.Upendra Baxi suggests that 1948's Universal Declaration of Human Rights (UDHR) marks a broad shift from the era of "modern" (42) human rights (which began with the American and French Revolutions) to the era of "contemporary" (42) human rights. His periodization links these eras in human rights to shifts in the ideology of capitalism and empire. The "modern" era of human rights, he writes, "signals a whole variety of ideological 'justifications' for colonization and world domination" and "provides a register of major development in industrial capitalism" (42), while the "contemporary" era of human rights "is based on the premise of radical self-determination" (46). Such a periodization also brings human rights into close alignment with the Anthropocene, which is rooted in the capitalist-colonial Enlightenment and Industrial Revolution, yet often dated most concretely to the circa-1950 shift that some (such as J. R. McNeill and Peter Engelke) label the "Great Acceleration." Indeed, one could reasonably appropriate Baxi's terms and speak of "modern" and "contemporary" Anthropocenes mapped identically onto the global timeline.I propose to use the 2021 Afghan evacuation as a site from which to explore how human rights and the Anthropocene have together coproduced certain forms of subjectivity that are essential for the continued smooth functioning of world-ecological capitalism. These new forms of subjectivity are necessary to sustain the important fiction of individual [End Page 53] agency and value and conceal the ways in which the Anthropocene moment renders this fiction meaningless. Ultimately, I paint a picture of an Anthropocene without any human agency at all. I want... (shrink)