There is a long history of medical research that involves intentionally infecting healthy people in order to study diseases and their treatments. Such research—what might be called “human challenge studies”—are an important strand of much current research—for example, in the development of vaccinations. The many international and national guidelines about the proper conduct of medical research do not specifically address human challenge studies. In this paper we review the guidelines on the risk of harm that healthy volunteers may be exposed (...) to in the course of medical research. We examine the ethical arguments that are implicit or explicit in these guidelines. We then ask whether there is reason for limiting such studies on grounds independent of risk of harm. We conclude that the major ethical concern with challenge studies is that of risk of harm and that the fact that a study is a challenge study is not a wrong in itself. (shrink)

We describe the teaching programme in ethics, law and communication skills for clinical medical students which is being developed as part of the Oxford Practice Skills Project. These three elements of practice are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centred health care in guiding the teaching is described. Although the final aim of the teaching is to improve actual practice, we have found three 'sub-aims' helpful in (...) the development of the programme. These sub-aims are: increasing students' awareness of ethical issues; enhancing their analytical thinking skills, and teaching specific knowledge. (shrink)

There are some ideas that at first seem simple, but which become more complex and profound the more they are explored. Great art, of course, is like that. When I first saw Vermeer's Girl with a Pearl Earring I was excited by its fresh simplicity. I thought, however, it a painting I would soon understand. I was wrong. It becomes increasingly mysterious with increasing familiarity. It has recently inspired a novel.1The distinction between acts and omissions is one of these simple, (...) complex, ideas. When I first studied philosophy I thought I would rapidly be able to decide once and for all whether the distinction is of moral importance or not. I did in fact come to a decision. The problem is that I have kept revising that decision ever since. The issues raised by the arguments over acts and omissions continue to inspire philosophical discussion. They also continue to haunt doctors and relatives at the bedsides of those near the end of their lives.Donna Dickenson, in this issue of the journal,2 reports the results of a survey of opinions from those taking part in an Open University course on death and dying. She believes that for many bioethicists the acts/omissions distinction has been shown to be wrong as a distinction of moral worth. Her survey suggests, however, that for many health professionals this distinction is seen as morally important. She asks whether the bioethical consensus, as she sees it, against the distinction is a result of clear thinking, or whether the views of practitioners result from their taking into account, in a way bioethicists do not, the richness of reality.There is I believe, less consensus amongst bioethicists than Dickenson suggests. In this issue of the journal, Marc Stauch3 argues in favour of the acts/omissions …. (shrink)

The Mental Capacity Act is an impressive piece of legislation that deserves serious ethical attention, but much of the commentary on the Act has focussed on its legal and practical implications rather than the underlying ethical concepts. This paper examines the approach that the Act takes to best interests. The Act does not provide an account of the underlying concept of best interests. Instead it lists factors that must be considered in determining best interests, and the Code of Practice to (...) the Act states that this list is incomplete. This paper argues that this general approach is correct, contrary to some accounts of best interests. The checklist includes items that are unhelpful. Furthermore, neither the Act nor its Code of Practice provides sufficient guidance to carers faced with difficult decisions concerning best interests. This paper suggests ways in which the checklist can be developed and discusses cases that could be used in an updated Code of Practice. (shrink)

The “best interests” of the patient are widely seen as a cornerstone of medical practice. They are the explicit legal standard for medical care in the case of patients who lack capacity to consent to treatment.The best interests of the individual patient have, of course, long been compromised for the sake of other potential patients—in infectious disease control for example. The question of the ethics of such compromise became a hot issue, for UK doctors, about fifteen years ago in the (...) context of health care rationing. At that time the fact that there are insufficient resources to provide all patients, in all circumstances, with the best possible treatment became explicit. Faced with this uncomfortable truth, doctors tended to divide into two camps. Some wanted to play no role in decisions about resource allocation. They continued to be guided by the single ethic of each individual patient's best interests. However, “best interests” could be interpreted as “best” given the treatments that were made available by those who determined the allocation of resources. Others took the opposite approach: since choices had to be made as to the best use of available resources, doctors ought to be playing a significant role in making these choices.This polarisation has softened over time. Doctors have become more at ease with the idea that some treatments are not, given the overall resources, cost-effective, even if they are the best available. Clinical guidelines increasingly are influenced by cost-effectiveness. To provide the best health care overall, within the available resources, doctors aim to provide good care for each individual patient, but they do not always provide the best care. (shrink)

Propositional attitude generics such as “Experts think early humans ate grass” report an epistemic state (e.g., think, believe, say) that is generalised to a wider community (e.g., Experts, Scientists, Academics). These generics are often used in place of quantified claims (e.g., “Some experts think…”) but three pre-registered experiments (N = 4891) indicate that this lexical choice risks misrepresenting the true degree of scientific consensus. Relative to “Some experts think…” the generic “Experts think…” was more likely to be understood as “All (...) Experts” or “Possibly all Experts” and less likely to invite the scalar inference “Not all Experts.” Consistent with this, the choice to use generic language became increasingly likely as expert consensus approached unanimity. Propositional attitude generics can imply a high degree of consensus and keep open the possibility of universal agreement. To avoid overgeneralisation, they should be used with caution where the objective degree of consensus is unknown. (shrink)

Background: Priority setting is necessary in current healthcare services. Discussion of fair process has highlighted the value of developing reasons for allocation decisions on the basis of experience gained from real cases.Aim: To identify the reasons that those with experience of real decision-making concerning resource allocation think relevant in deciding on the priority of a new but expensive drug treatment.Methods: Semistructured interviews with members of committees with responsibility for making resource allocation decisions at a local level in the British National (...) Health Service, analysed using modified grounded theory.Results: 22 interviews were carried out. 14 reasons were identified. Four reasons were almost universally considered most important: cost effectiveness; clinical effectiveness; equality and gross cost. No one reason was considered dominant. Some considerations, such as political directives and fear of litigation, were thought by many participants to distort decision-making. There was a substantial lack of agreement over the relevance of some reasons, such as the absence of alternative treatment for the condition.Conclusions: There is a clear consensus on the importance and role of a limited number of reasons in allocation decisions among participants. A focus on the process of decision-making, however, does not obviate the need for those involved in the process to engage with problematical ethical issues, nor for the importance of further ethical analysis. (shrink)

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions.

Alternative proteins, including plant-based and cell-based meat and dairy analogues, are discursively positioned as a new form of meat and dairy and as a solution to the myriad of issues associated with conventional animal agriculture. Animal agricultural industries across various nations have resisted this positioning in regulatory spaces by advocating for laws that restrict the use of meat and dairy terms on the labels of alternative proteins products. Underlying this contestation are differing understandings of, and vested interests in, desirable futures (...) for animal agriculture. In Australia, this broader contestation led to a national-level inquiry by a Senate parliamentary committee entitled _Definitions of meat and other animal products_ (the Inquiry). This paper reports findings from a study of the problematizations developed through the Inquiry using a framework for policy discourse analysis referred to as Bacchi’s ‘What’s the Problem Represented to be’ methodology. It shows how the dominant discourse throughout the Inquiry moved away from the initial problematization of alternative proteins as a threat to animal agriculture. Instead, both industries were ultimately positioned as not in competition and only labelling laws were problematized with the solution being amendments to ensure ‘consumer clarity’. This outcome ignored a range of alternative problematizations related to the ethical, environmental, health, social and economic issues raised by animal agriculture and by alternative proteins. This lack of scrutiny benefits both industries, by closing off the policy discourse to consideration of a range of alternative interests, voices, and potential solutions, such as stricter health and welfare regulation. (shrink)

We bear witness to a sweeping social movement for change—fostered and driven by a powerful group of Black nurses and nursing students determined to call out and dismantle anti‐Black racism and discrimination within the profession of nursing. The Black Nurses Task Force, launched by the Registered Nurses' Association of Ontario (RNAO) in July 2020, is building momentum for long‐standing change in the profession by critically examining the racist and discriminatory history of nursing, listening to and learning from the lived experiences (...) of the Black nursing community, and shaping concrete, actionable steps to confront anti‐Black racism and discrimination in academic settings, workplaces, and nursing organizations. The Black Nurses Task Force and the RNAO are standing up and speaking out in acknowledgment of the magnitude of anti‐Black racism and discrimination that exist in our profession, health system, justice system, and economic system. This social movement is demonstrating, in actions, how individuals and a collective act as change agents to drive meaningful and widespread change for our present and future Black nurses. We also acknowledge the Black nurses who have gone before us. (shrink)

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology (...) were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs. (shrink)

This volume brings together essays written at the cutting edge of an emerging sub-field of environmental philosophy, relating to the nature and role of hope.

Two protechnology arguments, the “hopeful principle” and the “automatic escalator”, often used in bioethics, are identified and critically analysed in this paper. It is shown that the hopeful principle is closely related to the problematic precautionary principle, and the automatic escalator argument has close affinities to the often criticised empirical slippery slope argument. The hopeful principle is shown to be really hopeless as an argument, and automatic escalator arguments often lead nowhere when critically analysed. These arguments should therefore only be (...) used with great caution. (shrink)

A new ethics of human finitude developed through three experimental essays. As ethical beings, we strive for lives that are meaningful and praiseworthy. But we are finite. We do not know, so we hope. We need, so we trust. We err, so we forgive. In this book, philosopher John T. Lysaker draws our attention to the ways in which these three capacities—hope, trust, and forgiveness—contend with human limits. Each experience is vital to human flourishing, yet each also poses (...) significant personal and institutional challenges as well as opportunities for growth. Hope, Trust, and Forgiveness explores these challenges and opportunities and proposes ways to best meet them. In so doing, Lysaker experiments with the essay as a form and advances an improvisational perfectionism to deepen and expand our ethical horizons. (shrink)

The word “forgiveness” and its verbal form, “forgiving,” may appear to have one and the same meaning whenever it is used. But the first thesis of this essay is that several distinct kinds of human activity are denominated by this word, and their differences are philosophically important. The second thesis of this essay is that some of the human activities denominated by this word have a close connection with hope, more specifically with hoping-in-a-person. The third thesis of this essay (...) is that, because of this connection, some kinds of forgiving have important communal aspects that are often overlooked. The essay develops its three theses through discussions of the expression “forgive and forgot,” a theme from Charles Bosk’s study, Forgive and Remember, a scene from Jane Austen’s, Emma, and a description of forgiving by theologian and spiritual writer, Louis Every. (shrink)

The article considers Richard Rorty’s thought on pragmatic religion and meliorism. It begins with Rorty’s critique of theism and Platonism, and his attempt to rehabilitate religion using a pragmatist framework. The article then offers an analysis of Rorty’s “unjustifiable hope”. Here, the author distinguishes the differentsenses of unjustifiable hope. With a tension between the “romantic” and “utilitarian” aspects of this outlook, the paper concludes with the advent of Rorty’s pragmatic religion.

In lieu of an abstract, here is a brief excerpt of the content:UNDERSTANDING THE DIFFERENCE OF BEING: ON THE RELATIONSHIP BETWEEN METAPHYSICS AND THEOLOGY HELMUT HOPING University of Tubingen, Germany Introduction T:HE PHILOSOPHY of the twentieth century has been o no small extent a critique of metaphysics. Admittedly, philosophical programs have been developed in which the tradition of metaphysics survives. Yet the position of metaphysics in the modern age is disputed even today-as is demonstrated by the recent controversy between Jiirgen (...) Habermas and Dieter Henrich about the possibility of metaphysics after Kant.1 Since 1 See J. Habermas, "Ruckkehr zur Metaphysik: Eine Tendenz in der deutschen Philosophie?" Merkur 439/440, 39 (1985): 898-905; "Metaphysik nach Kant," in K. Cramer et al., eds., Theorie der Subjektivitiit: Dieter Henrich zum 60. Geburtstag (Frankfurt am Main: Suhrkamp, 1978), 425-443. (Both articles are reprinted in J. Habermas, Nachmetaphysisches Denken: Philosophische Aufsiitze [Frankfurt am Main: Suhrkamp, 1988], 18-34; 267-279.) Henrich replied to Habermas's critique in the article "Was ist Metaphysik, was Moderne?: Thesen gegen Jurgen Habermas," Merkur 440, 40 (1986): 495-508 (reprinted in D. Henrich, Konzepte: Essays zur Philosophie der Zeit [Frankfurt am Main: Suhrkamp, 1987], 11-43). On the controversy between Habermas and Henrich, see V. Gerhardt, " Metaphysik und ihre Kritik: Zur Metaphysikdebatte zwischen Jurgen Habermas und Dieter Henrich," Zeitschrift fur philosophische Forschung 42 (1988) : 45-70. Habermas's notion of a " return to metaphysics " undoubtedly has a certain diagnostic value; after all, there has indeed been a recent " discovery " of metaphysics. But Habermas 's criticism of the concept and content of metaphysics-i.e., his thesis that after Kant metaphysics is impossible-not only contradicts the self-understanding of modern philosophy for which metaphysics is essential; it also fails to recognize the metaphysical implications of his own theory of communicative action. See W. C. Zimmerli, "Kommunikation und Metaphysik: Zu den Anfangsgrunden von Habermas ' ' Theorie des kommunikativen Handelns,' " in W. Oelmuller, ed., Metaphysik heute? Kolloquien zur Gegenwartsphilosophie, vol. 10 (Paderborn: SchOningh, 1987), 97-111. 189 190 HELMUT HOPING metaphysics has been indispensable for the self-understanding of philosophy in the modern age up until Hegel, this controversy cannot be reduced to the simple disjunction: either the "end of metaphysics" or the "return to metaphysics "-as Habermas has suggested. The task of philosophy today lies in a metaphysical form of thinking that remains possible even after the critique of metaphysics in Kant and Heidegger. Until recently, the current debate about metaphysics has not been adequately addressed by theology. That is surprising because metaphysics is also indispensable for theology.2 But in the light of the modern critique of metaphysics, the self-understanding of theology and its relationship to metaphysics cannot remain unchanged -just as the self-understanding of metaphysics itself cannot remain unchanged. Yet at least in the realm of Catholic theology, the traditional doctrine of the praeambula fidei has not been abandoned. The aim of the following reflections is to show that the determination of the relationship between metaphysics and theology depends upon how metaphysics understands the " difference of Being" that is given with the manifold of beings. I will introduce four different understandings of the " difference of Being": that which is found in Aquinas's metaphysics; that in Kant's transcendental philosophy; that in Heidegger's thinking of Being; and that in the metaphysics of the absolute projected by Henrich. In some concluding reflections, I will then try to draw out some implications of these understandings of the " difference of Being " for the determination of the relationship between metaphysics and theology. I. Metaphysics of God and Creation : Theological Difference (Aquinas) It is well-known that Thomas Aquinas defines metaphysics as the science of being qua being. The subject-matter that dis2 See W. Kasper, " Zustimmung zum Denken: Von der Unerlasslichkeit der Metaphysik fiir die Sache der Theologie," Tiibinger Theologische Quartalschrift 169 (1989) : 257-271. RELATIONSHIP BETWEEN METAPHYSICS & THEOLOGY 191 tinguishes metaphysics from all other sciences is the ens inquantum est ens 3 or the ens commune.4 Contrary to later concepts of metaphysics, this is not an abstract-universal, for " the term ' a being' [ens], which is applied to a thing by reason of its being [esse], designates the same thing as the term which is applied... (shrink)

ABSTRACT Hope is a complex social-psychological phenomenon. It combines cognitive and affective dimensions, and it is temporally extended, drawing upon the past in order to orient the present toward the future. In conversation with various texts, ranging from Ernst Bloch to Cornel West to Patrick Shade, the article offers a multidimensional account of hope, arguing that it is integral to human action and possibility.

The word “forgiveness” and its verbal form, “forgiving,” may appear to have one and the same meaning whenever it is used. But the first thesis of this essay is that several distinct kinds of human activity are denominated by this word, and their differences are philosophically important. The second thesis of this essay is that some of the human activities denominated by this word have a close connection with hope, more specifically with hoping-in-a-person. The third thesis of this essay (...) is that, because of this connection, some kinds of forgiving have important communal aspects that are often overlooked. The essay develops its three theses through discussions of the expression “forgive and forgot,” a theme from Charles Bosk’s study, Forgive and Remember, a scene from Jane Austen’s, Emma, and a description of forgiving by theologian and spiritual writer, Louis Every. (shrink)

Low opportunity cost, weak influence of quality of life in the face of death, the social value of life extension to others, shifting psychological reference points, and hope have been proposed as factors to explain why people apparently perceive marginal life extension at the end of life to have disproportionately greater value than its length. Such value may help to explain why medical spending to extend life at the end of life is as high as it is, and the (...) various factors behind this value might provide normative rationale for that spending. Upon critical analysis, however, most of these factors turn out to be questionable or incompletely conceived; this includes hope, which is examined here in special detail. These factors help to explain complexity and nuance in the normative issues, but they do not provide adequate justification for spending as high as it often is. In any case, two additional factors must be added to the descriptive explanation of high spending, and they throw its normative justification into further doubt: the “insurance effect” and provider-created demand. Overall, the perception of especially high value of life at the end of life provides some normative justification for high spending, but seldom strong justification, and not for spending as high as it often is. (shrink)

Having considered the role of ethics in Indian mystical teachings in a previous, related, essay I would like to consider the same question in its western religious contexts in the present paper, beginning with the Christian mystical tradition. As is the case with Asian traditions charges of moral unconcern are widely directed at Christian mystics, but they are false. Christian mystics are not indifferent to morality nor do they disconnect morality from an intrinsic relationship to their mystical quest. Augustine would (...) already teach that the story of Leah and Rachel was an instructive allegory in which the active life represented by Leah was intrinsic to the contemplative life represented by Rachel while Gregory the Great would unambiguously assert: ‘We ascend to the heights of contemplation by the steps of the active life’, defining the active life as: ‘to dispense to all what they need and to provide those entrusted to us with the means of subsistence’. These representative early samples of the salience of ethical behaviour to the life of contemplation could be multiplied at great length, and almost without exception in the teaching of the major Christian mystics. This historical exegetical exercise, however, is in the present circumstances, both out of place and I hope unnecessary. Instead, the more general, more enigmatic, more repercussive, issues raised by the place and significance of morality within the Christian mystical tradition need attending to. (shrink)

The so called "Knowledge Argument" of Frank Jackson 1 claims to show that there is something about the human mind that must inevitably escape the grasp of physical science: "There are truths about . . . people which escape the physicalist story" . In effect, materialism is false, and science, as opposed to metaphysics, cannot hope to attain to an understanding of consciousness.

Set in 2029, The Education of Sam Sanders tells the story of an 8th grader searching for meaning in his school experiences. In a public school system beset by the finality and rigidity of standardized tests and curriculums, Sam Sanders, with the help of his teacher and mother, defies the system and creates something new: a curriculum that enlightens rather than categorizes students. In this hopeful yet frightening look at an educational future not too far from our own, we encounter (...) the high cost of inquiry-oriented learning and the even higher cost of a system that suppresses it. (shrink)

Against the background of a disenfranchised and hopeless exilic Israel, Ezekiel received the vision of ‘Dry Bones’, predicting an eschatological resuscitation and resurrection to life and restoration to the land of Yahweh’s covenant people. This article previews the political, social, economic and moral conditions of many African societies as being in a disenfranchised, hopeless exilic state. It nonetheless argues that the theological essence of Ezekiel’s visionary imagery of ‘Dry Bones’ resonates well with such deteriorating and hopeless African societies. It envisages (...) the semblances, relatedness and relevance of Ezekiel’s hope principle of a restorative eschatological theology as a possible reality for Africa’s hopeless present ‘Dry Bones’ state. Upon this hope principle, the article proposes a theological framework of faith against despondency and despair for the realisation of such eschatological reality for Africa. It holds that God is equally capable of displaying his restorative power and sovereignty to reverse the hopeless conditions of African nations in demonstration of his love, compassion and care as he did for the apparently irreparable condition of exilic Israel. (shrink)

Open peer commentary on the article “Second-Order Cybernetics as a Fundamental Revolution in Science” by Stuart A. Umpleby. Upshot: The process of writing a discussion case study requires that a researcher become embedded in the domain being studied; it entails constructing a reality as it is perceived by the participants; it demands a high level of humility, since complex environments have a tendency to thwart rational reasoning processes. Unfortunately, these very characteristics lead conventional researchers to disparage case writing, even questioning (...) whether it warrants the label of “research.” The propositions of second-order cybernetics offer a glimmer of hope to those of us who continue to write cases, as they inform us that what we are doing is science, just a different flavor of science. (shrink)

Will democracy figure prominently in China's future? If so, what kind of democracy? In this insightful and thought-provoking book, David Hall and Roger Ames explore such questions and, in the course of answering them, look to the ideas of John Dewey and Confucius.