A report by the Nuffield Council on Bioethics, contrary to the Declaration of Helsinki, permits most important research initiatives in developing countries.The Ethics of Research Related to Health Care in Developing Countries by the Nuffield Council on Bioethics makes a number of innovative recommendations that depart from codes such as the Declaration of Helsinki. It recommends that standards of care might be relativised to the standard of that nation. It recommends that very good reasons need to be given for not (...) giving post-trial access to medications but recognises that there may be justifiable instances of this. It is the view of the authors that these and other recommendations of the report are sensible pieces of advice given the complexities of the developing world. (shrink)

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

NICE, the draft fertility guideline and dodging the big question: should fertility treatment be provided by the NHS?In August of this year the National Institute for Clinical Excellence made its draft guideline on fertility treatment available for consultation.1 As has been widely reported in the media the draft guideline recommends that the National Health Service should provide publicly funded fertility treatment in a consistent way across England and Wales. The guideline recommends that three cycles of IVF should be available when (...) “The woman is within the optimal range for in vitro fertilisation and there is an appropriately diagnosed cause of infertility of any duration, or unexplained infertility of at least three years’ duration .Those who need fertility treatment will celebrate the guideline, as will many fertility clinics. The guideline does not, however, address key questions that will be obvious to many. Is fertility treatment the kind of thing that ought to be available on the NHS? Will the inevitable increase in demand mean that resources are directed away from other services? Is fertility treatment really the same kind of intervention as heart or hip replacement surgery?My view is that there are good reasons for doing what we can to help people access fertility services. Most of us will start a family and for those of us who do it is probably the most important of all of our life projects. Given that social status and wealth can be significant obstacles to many of the things that people would like to do with their lives, the fact that most of us are able to pursue this important life project is good from an egalitarian …. (shrink)

Access to a deep pool of talent is essential to the success of every professional services firm. The supply of that talent is contingent upon the available rewards for the exercise of that talent, and both the existence of the potential rewards and the beliefs that individuals hold about the existence of the rewards affect the decision to remain in the field. One structural factor that may affect the judgment about whether to remain in a profession concerns promotions based on (...) the gender of the employee. In this study, we examine the “glass ceiling” within the context of the accounting profession. While advances have been made within the accounting profession to address the glass ceiling, the continued existence—and perceptions about the continued existence—of the issue exert adverse effects upon the available talent pool and may create long-term problems for the profession. In this study, we investigate glass ceiling perceptions among a large sample of female accounting professionals employed in accounting; the sample includes both public accountants, and those employed in industry accounting. Our study yields the finding of beliefs in bias-driven effects, structural effects, and cultural effects among these accounting professionals. Glass ceiling perceptions are also influenced by several demographic factors. Furthermore, accounting professionals employed by industry are more likely to report a glass ceiling within their firms than accounting professionals employed by public accounting firms. The findings are of interest to researchers who explore gender-related issues in professional service firms such as the field of accounting, and to senior members of practice who are tasked with ensuring the integrity and quality of the talent pool and the equitable distribution of rewards to employees. (shrink)

The threat of malpractice litigation in the United States is encouraging physicians again to assume responsibility for their patients. The fundamental ethical problem, however, is that this approach denies the patient's moral agency. In this essay, responsibility to patients, rather than for them, is discussed as an alternative to the emerging neo-paternalism. Responsibility to avoids the ethical problems of assuming responsibility for moral agents and could reduce the threat of litigation as well.

The influence of historiography on aspects of political thought in France, Italy and Germany. In recent years the overlap between political thought and historiography has changed the boundaries of intellectual history. Donald Kelley, the longtime editor of The Journal of the History of Ideas has played a leading part in this process. These essays by his friends and former students follow in his footsteps. The collection is divided into three parts: France, England [six essays], and Italy and Germany [four essays]. (...) Anthony Grafton and John Salmon provide an introduction, and the volume concludes with a bibliography of Donald Kelley's many works. Historians and Ideologues is designed for those with an interest in the contribution of historiography to political thought, and will be a timely addition to the growing reaction against the postmodern scepticism in historiographical research in this field. Contributors include Ann Blair, Julian Franklin, Kathleen Parrow, David Harris Sacks, Sarah Hanley, Daniel Woolf, Gordon Schochet, Joseph Levine, John Pocock, Perez Zagorin, William Connell, Donald Phillip Verene, and Michael Carhart. Anthony Grafton is a Professor in the Department of History at Princeton University. John Salmon is the Marjorie Walter Goodheart Emeritus Professor of History at Bryn Mawr College. (shrink)

Clarifying the meaning of ethical concepts is fundamental for medical ethics. Many of the best papers in the Journal of Medical Ethics have advanced our understanding of the limits and implications of ethical concepts. This issue includes a number of papers that give us reason to reflect on the use, implications and grounding of some important ethical concepts. The concepts we use are rarely neutral. For example, those arguing against assisted dying are more likely to use terms such as ‘euthanasia’ (...) or perhaps even ‘killing’, while those arguing in favour of it might opt for ‘aid in dying’ or ‘facilitated aid in dying’. Of course, these are different concepts and do not mean the same thing, but the different associations and implications of concepts can weaken or strengthen a position. Woollard analyses the way in which the terms used in public information and discussions about breastfeeding can be morally loaded and thereby cause guilt or detract from the effectiveness of public information.1 She argues that normative concepts such as ‘harm’ or ‘dangerous’ and slogans such as ‘breast is best’ can imply moral duties or criticism when it is unhelpful and inappropriate to do so. She does this by showing how concepts such as ‘harm’ and ‘risk’, …. (shrink)

The kind of expertise someone who specialises in ethics has, or indeed whether it makes sense to talk of moral expertise, is keenly debated and is a far from settled issue. It has been of interest to moral philosophers, partly because of the light it might shine on the nature of morality.1 2 It has also been debated within medical ethics, with some arguing against the idea that expertise in moral philosophy translates into ethical expertise and others arguing that skills (...) in ethical justification can be viewed as ethical expertise.3 4 This issue of the Journal of Medical Ethics includes a number of papers that demonstrate the importance of ethical expertise and some of the distinctive elements of it. Public involvement in research is seen in a number of countries as something valuable and in some, such as Australia, it can be a criterion for research grants. The UK National Standards for Public Involvement in Research are discussed in this issue of JME and McCoy et al provide a good illustration of why ethical expertise is important for framing public policy.5 The appeal of stakeholders having some say into research projects, particularly when they are funded via taxation is easy to understand, so who would not see public involvement as a good thing? However, McCoy et al claim that while there is a substantial and growing literature on public involvement in research that tends to emphasise the importance of public involvement, it doesn’t explain how or what this looks like when …. (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these pose interesting challenges for (...) the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

In this chapter we argue that Robert Hare's psychopathy checklist revised (PCL-R) offers a construct of psychopathy that is valid enough for philosophical investigations of the moral and legal responsibility of psychopathic offenders.

The key objectives of this book are to demonstrate the applicability of issues in the philosophy of science to problems in psychiatry and to show how the conceptual issues raised by psychiatry should be considered more closely by philosophers of science. These are worthy aims: the philosophy of psychiatry needs to draw more thoughtfully upon contemporary philosophical debates and stimulating interest within the philosophy of science is a good way to do this.Cooper's book succeeds for both of these desiderata. The (...) first five chapters discuss the central issues in the philosophy of psychiatry: whether mental illness is a disease/natural kind and what follows from this. There is a large literature on these questions, some of which …. (shrink)

The essays in this volume, with the exception of Gary Ferngren's, derive from ancestral versions originally presented at a symposium, 'Conflicts with Newborns: Saving Lives, Scarce Resources, and Euthanasia: held May 10-12,1984, at the Mercer University School of Medicine, Macon, Georgia. We wish to express our gratitude to the Georgia Endowment for the Humanities for a generous grant for the symposium and to Mercer University and the Medical Center of Central Georgia for additional financial support. The vit:ws expressed in this (...) volume do not necessarily represent those of the Georgia Endowment for the Humani ties, Mercer University, or the Medical Center of Central Georgia. We have endeavored to bring together a group of individuals with contrast ing viewpoints to display some of the range of approaches to a major problem in public policy: medical decisions regarding the treatment of defective newborns. So many persons contributed to the symposium that acknowledg ment of each would be impossible. Although unnamed, we express our sincere appreciation to each. Three individuals, however, must be recognized: R. Kirby Godsey, President, Mercer University; William P. Bristol, Dean, Mercer University School of Medicine; and Kenneth C. Henderson, Medical Director and Director of Medical Education, Medical Center of Central Georgia. Without their support, the symposium could not have succeeded and this volume would not have been possible. We wish also to express our gratitude to S. G. M. (shrink)

Psychopathy, as articulated in Hare’s PCL-R, appears to reliably pick out a forensic category of troubled people. This chapter considers the use and utility of PCL-R by focussing upon two interrelated questions. Does philosophical investigation direct attention toward the issues that should interest us about psychopathy? Is being diagnosed as psychopathic or having ASPD clinically useful, as well as for judicial and sentencing purposes? While the research programmes that developed following the attention paid to psychopathy are warranted, more attention could (...) be directed to the varied nature of psychopathy and the presentations of it that Cleckley described in the Mask of Sanity. It is important to understand psychopathy as it affects lives, as well as a forensic problem. (shrink)

McMillan et al. (2005) measured brain activity.

What is conscientious objection? -- Should conscientious objectors be accommodated? -- Assessing objectors' beliefs and reasons -- Accommodation and conscientious provision.

Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for an (...) ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills). (shrink)

Approximately 50 years have passed since Judith Jarvis Thomson wrote A Defense of Abortion (1971). Her article has significantly shaped the philosophical literature on abortion. In this paper, I will summarize some of the interesting and important work done on the topic since Thomson's article. I will highlight Thomson as a defender of the claim that abortion is morally permissible and Don Marquis as an influential opponent of that claim. I will start by articulating Thomson's case, focusing on the violinist (...) analogy. I will underscore key questions, concepts, and objections the analogy raises. I will then examine briefly how philosophers have addressed some of these issues. Next, I will outline Marquis’ work, provide a similar commentary on it, and discuss some of its main responses. I will then survey other philosophers who have addressed abortion beyond the scope of providing specific replies to Thomson or Marquis. I will close by highlighting significant points of agreement and disagreement in the literature, as well as crucial gaps in the current research. The paper is not an attempt to address every work on the topic over the last five decades, nor is it aimed at taking a position on the moral permissibility of abortion. My goal is to provide an overview of the dialectic. (shrink)

Medieval interpretations of hylomorphism, in which substances are conceived as metaphysical composites of prime matter and substantial form, are receiving attention in contemporary philosophy. It has even been suggested that a recovery of Aquinas's conception of prime matter as a ‘pure potentiality’, lacking any actuality apart from substantial form, may be expedient in hylomorphic interpretations of quantum mechanics. In this paper, we consider a recent hylomorphic interpretation of non-relativistic quantum mechanics, the theory of Cosmic Hylomorphism, which does not explicitly invoke (...) any notion of prime matter in its original formulation. We argue that prime matter does in fact play a role in constituting and individuating particles in this theory. However, we demonstrate that the notion of prime matter which features in the extended version of Cosmic Hylomorphism that we propose here is distinct from Aquinas's conception of prime matter, inasmuch as it has discrete metaphysical parts. (shrink)

In this article, we focus on a particular kind of emotional impact of the pandemic, namely the phenomenology of the experience of moral injury in healthcare professionals. Drawing on Weber's reflections in his lecture Politics as a Vocation and data from the Experiences of Social Distancing during the COVID-19 Pandemic Survey, we analyse responses from healthcare professionals which show the experiences of burnout, sense of frustration and impotence, and how these affect clinicians’ emotional state. We argue that this may relate (...) to the ethical conflicts they experience when they are forced to make clinical decisions where there are no optimal outcomes, and how in turn that impacts on their own emotional state. We then further examine the notion of ‘burnout’ and the phenomenology of ‘moral injury’. Our argument is that these experiences of moral injury across a range of clinicians during the pandemic may be more prevalent and long-standing in psychiatry and mental health than in other areas of healthcare, where ethically difficult decisions and resource constraints are common outside times of crisis. Hence, in these clinical arenas, moral injury and the phenomenology of emotional changes may be independent of the pandemic. The insights gained during the pandemic may provide wider insights into the challenges of developing services and training the workforce to provide appropriate mental health care. (shrink)

The first edition of The Scientific Background to Modern Philosophy took the dialogue of science and philosophy from Aristotle through to Newton. This second edition adds eight chapters, taking the dialogue through the Enlightenment and up to Darwin. This anthology is an attempt to help bridge the gap between the history of science and the history of philosophy.

Keisha Ray and Jane Falls Cooper’s article “Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments” seeks to give environmental concerns greater p...

Bio-heteronormative conceptions of the family have long reinforced a nuclear ideal of the family as a heterosexual marriage, with children who are the genetic progeny of that union. This ideal, however, has also long been resisted in light of recent social developments, exhibited through the increased incidence and acceptance of step-families, donor-conceived families, and so forth. Although to this end some might claim that the bio-heteronormative ideal is not necessary for a social unit to count as a family, a more (...) systematic conceptualization of the family—the kind of family that matters morally—is relatively underexplored in the philosophical literature. This paper makes a start at developing and defending an account of the family that is normatively attractive and in line with the growing prevalence of non-conventional families and methods of family-formation. Our account, which we call a constitutive-affirmative model of the family, takes the family to be constituted by an ongoing process of relevant affective and affirmative relations between the putative family members. (shrink)

Antimicrobial resistance (AMR) poses an increasing threat to patient care and population health and there is a growing need for novel therapies to tackle AMR. Bacteriophage (phage) therapy is a re-emerging antimicrobial strategy with the potential to transform how bacterial infections are treated in patients and populations. Currently, in the UK, phages can be used as unlicensed medicinal products on a ‘named-patient’ basis. We make an ethical case for why it is crucially important for the UK to invest in Good (...) Manufacturing Practice (GMP) for both ongoing unlicensed and future licensed phage therapy. Access to phages produced to GMP (GMP phages) will ensure effective patient care and better outcomes as well as health systems benefits. The UK also has the potential to become a global leader in the timely and cost-efficient manufacturing and supply of a therapy that meets internationally recognised standards. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Uttering the Unutterable: Aristotle, Religion, and Literature by Louis GroarkeJay R. ElliottGROARKE, Louis. Uttering the Unutterable: Aristotle, Religion, and Literature. Montreal: McGill-Queen’s University Press, 2023. 336 pp. Cloth, $120.00Louis Groarke’s Uttering the Unutterable is an extraordinarily ambitious book. Its aims include: to provide a definition of literature; to argue that literature must be morally good; to argue that literature is necessarily concerned with an “utterable” transcendent reality; to (...) advance a version of Aristotelian realism in metaphysics and epistemology; to defend the Western “tradition” in literature and philosophy; to criticize the entire enterprise of structuralist and poststructuralist literary theory; to criticize the entire enterprise of analytic philosophy of language; to resurrect the Chicago School of literary criticism associated with figures such as R. S. Crane and Richard McKeon; to relitigate the mid-twentieth-century battles between the Chicago School and “New Criticism”; and to offer an homage to Groarke’s former teacher, the Chicago-trained Bernard Suits.At the center of Groarke’s project is his aspiration to formulate an Aristotelian literary theory and to defend it against a wide variety of alternative perspectives. But as the above list of Groarke’s ambitions suggests, he carries out this aspiration in a highly unusual way. For Groarke, questions of literary theory are not to be debated exclusively— or even primarily—through discussion of literature. This book contains very few examples of literary works, and none of them is discussed in depth. Indeed, for Groarke, matters of literary theory are not even to be [End Page 719] discussed primarily in terms of literary theory. Rather, Groarke’s central conviction is that we can approach literature properly only by situating it within the context of certain fundamental questions in epistemology, metaphysics, ethics, and religion. Readers who pick up this work expecting a discussion of Aristotle’s Poetics will be sorely disappointed. Groarke barely mentions this seminal work of Aristotelian literary criticism. Rather, his project begins from a diagnosis of what ails contemporary literary criticism: that it suffers, not so much from a false view of literature, as from a false view of truth, goodness, and reality. He accordingly undertakes to provide a better view of those fundamental matters, one that he derives from aspects of Aristotle’s thought. According to Groarke, it is these aspects of Aristotle that have the most to offer literary theorists today.Groarke draws his most important Aristotelian inspiration from Aristotle’s discussion of theōria in Nicomachean Ethics 10.7–8. In Groarke’s view, Aristotelian theōria is a truthful vision of a supreme reality that transcends human life and pervades the universe. This vision, for Groarke, is what literature is (or should be) about. On this basis, he critiques forms of literary criticism that see literature as concerned only with politics, or with class distinctions, or with entertainment, or with language itself. As Groarke sums up his argument: “[L]iterature supplies opportunities for intelligence gathered up in an artful and superlative moment of beholding of what is fundamental, real, meaningful, and true. Literature provides an avenue for contemplation (theōria), facilitating a divine-like gaze upon the world.” For Groarke, Aristotelian theōria allows us to behold what is “fundamental, real, meaningful, and true.” It is especially valuable because it affirms the essential unity of these attributes. Like Aristotle’s god, Groarke’s transcendent reality is simultaneously the highest reality and the summation of all value. For Groarke, to engage in theōria is thus to affirm that the universe is suffused with moral significance. It is this stance that Groarke thinks literature should promote.I have a great deal of sympathy both for Groarke’s reading of Aristotle and for his sense that these aspects of his thought are relevant to fundamental questions about literature. But I found the experience of reading this book challenging. The bulk of Groarke’s work is not devoted to developing his Aristotelian conception, applying it to literary case studies, or considering any problems it might raise. Rather, Groarke applies most of his time and energy to attacking what he perceives to be the myriad enemies of his Aristotelian outlook in the... (shrink)