The World Medical Association (WMA), the global representation of the medical profession, first adopted the International Code of Medical Ethics (ICoME) in 1949 to outline the professional duties of physicians to patients, other physicians and health professionals, themselves and society as a whole. The ICoME recently underwent a major 4-year revision process, culminating in its unanimous adoption by the WMA General Assembly in October 2022 in Berlin. This article describes and discusses the ICoME, its revision process, the controversial and uncontroversial (...) issues, and the broad consensus achieved among WMA constituent members, representing over 10 million physicians worldwide. The authors analyse the ICoME, including its response to contemporary changes and challenges like ethical plurality and globalisation, in light of ethical theories and approaches, reaching the conclusion that the document is a good example of international ethical professional self-regulation. (shrink)

We thank our commentators for their thoughtful responses to our paper1 covering among other issues the relationships of ethics law and professional codes, the tensions between ethical universalism and cultural relativism and the phenomenon of moral judgement required when ethical norms conflict, including the norms of patient care versus obligations to others both now and in the future. Although the comments deserve more extensive discussion, in what follows we respond briefly to specific aspects of each commentary and remind readers that (...) professional codes of ethics are necessarily brief and that the International Code of Medical Ethics (ICoME) explicitly refers to the World Medical Association’s (WMA) mutually concordant and far more extensive ‘body of policies’.2 Sarela raises a fundamental and, as stated in the commentary, unresolved debate: ‘should ethics shape law or is it the converse’?3 We understand the ‘global medical ethos’ represented in the WMA’s revised ICoME to be firmly embedded in the assumption that ethics should shape law and that only where laws are so shaped do people governed by them have an ethical obligation to obey them. For the medical profession, laws permitting participation in torture or other cruel, inhuman or degrading practices and punishments are categorically unethical, and therefore, doctors must not facilitate or participate in them—difficult as it may be for some doctors in some regions or environments to act accordingly. Schantz and Mansoori claim that ‘if a code of ethics is an act of professional self-regulation and professional self-regulation is community-dependent, then a code of ethics cannot be …. (shrink)

The Declaration of Geneva is one of the core documents of medical ethics. A revision process was started by the World Medical Association in 2016. The WMA has also used this occasion to examine how the Declaration of Geneva is used in countries throughout the world by conducting a survey of all WMA constituent members. The findings are highly important and raise urgent questions for the World Medical Association and its National Medical Associations : The Declaration of Geneva is only (...) rarely used as an oath text despite the fact that physicians’ oaths are generally widespread. This is not consistent with the intention and claim of the Declaration of Geneva. The article then discusses three questions. Should there be one single binding oath? Which organization should be responsible for such an oath? Which oath is the most obvious candidate? In a globalized world and despite all cultural diversity, the medical profession should have one core moral basis which is binding for physicians all over the world. The most obvious candidate for an oath incorporating this moral basis is the Declaration of Geneva. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 19 Heft: 1 Seiten: 253-276.

Parsa-Parsi et al systematically discuss and elucidate contentious and non-controversial ethical issues that emerged during the ICoME (International Code of Medical Ethics) revision process and the consensus they achieved. The ethical issues discussed include the physician’s duty to act in the best interests of patients and to ensure they are protected from the unjustifiable risk of harm, respect for patient autonomy and the duties of physicians during emergencies, among others. This paper examines paragraph 26, which requires doctors to (...) provide only medically justified remote treatment, ensure patients offer informed consent and adequately protect their confidentiality.1 At the peak of the COVID-19 pandemic, many countries in Europe and America implemented remote-by-default healthcare policies. At that time, the policy aimed to ensure that patients enjoyed continued access to care while protecting healthcare professionals’ health and well-being. After the COVID-19 pandemic, this policy remained in place. Regardless of the nature of their ailment, patients have consistently preferred in-person care out of concern that their health issues might not be accurately diagnosed and that they may not receive quality care …. (shrink)

Parsa-Parsi et al assert that the International Code of Medical Ethics (ICoME) provides a professional standard that overrides conflicting national legal norms.1 While this claim is made in the context of laws that require doctors to participate in ‘acts of torture, or other cruel, inhuman, or degrading practices and punishments’ (para10 of ICoME), the underlying premise that medical ethics supersedes law requires scrutiny. It is clear that medical ethics and law are linked inextricably, but there is unresolved debate (...) about the sequence of this interaction: should ethics shape law; or is it the converse? Important principles, notably respect for patients’ autonomy, have arisen from case law and subsequently been adopted into medical ethics. As pointed out by Beauchamp and Childress, it is only ‘since the mid-1970s (that) the primary justification advanced for requirements of informed consent has been to protect autonomous choice’ (pg.118).2 Whereas, the legal obligation to respect autonomy can be traced to the early 1900s, in the landmark US case of Schloendorff v Society of New York Hospital : ‘Every human being of adult years and sound mind has a right to determine what shall be done with his own body’.1 Moreover, the term informed consent was born in law: it was coined …. (shrink)

Parsa-Parsi et al bring attention to the World Medical Association (WMA) and transparency to its International Code of Medical Ethics (ICoME) revisions.1 We value their report and the revised ICoME but explain here that the ICoME cannot reflect consensus among all WMA members, or the wider medical profession, given structural and epistemic injustices that restrain low-income and middle-income country (LMIC) physicians from participating in activities such as WMA revisions. Such injustices overlook experiences and contributions of those from LMICs (...) and marginalised groups, hindering their access to and influence within medicine.2 They also undermine access to information about, and from, the WMA. Recruiting new members from, and better engaging members in, LMICs would strengthen the WMA and its influence across the medical profession, and better elevate environmental sustainability as a biomedical and bioethical concern. This would be beneficial because there is controversy among physicians, bioethicists and other stakeholders about the relevance of environmental sustainability to medicine.3 4 That its addition to the ICoME was ‘uncontentious’ hints at structural and epistemic injustices in the revision process and homogeneity of those most involved in the revisions. Based on our observations as medical educators, it appears that few medical students and physicians at our institution, and few across the Caribbean and …. (shrink)

After an intensive 4-year process, the World Medical Association (WMA) has revised its International Code of Medical Ethics (ICoME). In their report outlining this process, Parsa-Parsi et al not only describe how the WMA sought to ‘cultivat[e] international agreement’ on a ‘global medical ethos’, but also outline the philosophical framework of the ICoME: how the WMA, as the ‘global representation of the medical profession’, created and revised the ICoME through the process of international professional self-regulation.1 However, there is (...) a significant tension to be found in this framework—one which contrasts the international scope of the ICoME with the supposed source of its legitimacy. Here, we seek to characterise this tension and the doubt which it casts on the legitimacy of the ICoME. (shrink)

Paragraph 12 of the revised International Code of Medical Ethics (ICoME) states that ‘the physician should strive to practise medicine in ways that are environmentally sustainable with a view to minimising environmental health risks to current and future generations.’1 This emphasis on environmental sustainability is in line with popular discourse as well growing scholarly attention in medical ethics for healthcare’s contribution to climate change. Recent research analyses, for instance, the ‘greening’ of informed consent and related bioethical principles.2 3 It is (...) unclear what the duty of practising sustainable healthcare means at the level of doctor–patient interaction. Parsa-Parsi et al flag the potential conflict in the ICoME’s provisions if ‘the actions of physicians are influenced by environmental considerations to the detriment of patients’ (p. 2), noting that the ICoME does not provide a handhold to improve understanding of such tensions. The code ‘does not go into extensive detail, does not include comprehensive explanations nor any rules or guidance on how to reconcile its principles when they conflict’ (p. 4). For Parsa-Parsi et al, not codes, but textbooks have a crucial role to play in resolving this conflict. It is rife that professional codes can lead to internal inconsistencies and …. (shrink)

Contribución de eruditos autores sobre aspectos trascendentales de la teoría pura del derecho. Esta obra debe verse como una expresión de esa renovada ocupación con los problemas de la doctrina de Kelsen.

Based on a comparison of various sources, such as different editions, correspondence, reviews, and lecture transcripts, it is shown that Ludwig Heinrich Jakob’s Outline of the General Logic and Critical Elements of Metaphysics in General uses one or more transcripts of Kant’s Logic Lectures as a source. In addition to the thus far known texts by Kiesewetter and Hippel, Jakob’s textbook should therefore also be added to the list of secondary transmissions of Kant’s Logic Lectures.

Since Boorse [Philos Sci 44(4):542–573, 1977] published his paper “Health as a theoretical concept” one of the most lively debates within philosophy of medicine has been on the question of whether health and disease are in some sense ‘objective’ and ‘value-free’ or ‘subjective’ and ‘value-laden’. Due to the apparent ‘failure’ of pure naturalist, constructivist, or normativist accounts, much in the recent literature has appealed to more conciliatory approaches or so-called ‘hybrid accounts’ of health and disease. A recent paper by Matthewson (...) and Griffiths [J Med Philos 42(4):447–466, 2017], however, may bear the seeds for the revival of purely naturalist approach to health and disease. In this paper, I defend their idea of Biological Normativity against recent criticism by Schwartz [J Med Philos Forum Bioethics Philos Med 42(4):485–502, 2017] and hope to help it flower into a revival of naturalist approaches in the philosophy of medicine. (shrink)

Climate change mitigation has become a paradigm case both for externalities in general and for the game-theoretic model of the Tragedy of the Commons (ToC) in particular. This situation is worrying, as we have reasons to suspect that some models in the social sciences are apt to be performative to the extent that they can become self-fulfilling prophecies. Framing climate change mitigation as a hardly solvable coordination problem may force us into a worse situation, by changing real-world behaviour to fit (...) our model, rather than the other way around. But while this problem of the performativity of the ToC has been noted in a recent paper in this journal by Matthew Kopec, his proposed strategies for dealing with their self-fulfilling nature fall short of providing an adequate solution. Instead of relying on the idea that modelling assumptions are always strictly speaking false, this paper shows that the problem may be better framed as a problem of underdetermination between competing explanations. Our goal here is to provide a framework for choosing between this set of competing models that allows us to avoid a ‘Russian Roulette’-like situation in which we gamble with existential risk. (shrink)

In his 2009 monograph, Darwinian Populations and Natural Selection, Peter Godfrey-Smith accuses biologists of demonstrating ‘Darwinian Paranoia’ when they engage in what he dubs ‘agential thinking’. But as Daniel Dennett points out, he offers neither an illuminating set of examples nor an extended argument for this assertion, deeming it to be a brilliant propaganda stroke against what is actually a useful way of thinking. Compared to the dangers of teleological thinking in biology, the dangers of agential thinking have unfortunately rarely (...) been discussed. Drawing on recent work by Samir Okasha, I attempt to remedy this omission, through analyzing the nature of agential thinking, and providing a philosophical treatment of the unexamined dangers in this peculiar, yet tempting way of thinking. (shrink)

The post-classical (or post-Avicennan, post-Rāzian) genre of the “protocols for dialectical inquiry and disputation” (ādāb al-baḥth wa-l-munāẓara) has its more proximate origins in the famed Risāla of Shams al-Dīn al-Samarqandī (d. 722/1322). The greater part of his conceptions and methodology, however, consists in a streamlining and universalizing of the more strictly juristic dialectic (jadal / khilāf) of his teacher Burhān al-Dīn al-Nasafī (d. 687/1288); and this in turn draws on the highly logicized dialectic of Rukn al-Dīn al-ʿAmīdī (d. 615/1218) and (...) his teacher Raḍī al-Dīn al-Nīsābūrī (d. 617/1220). At the heart of methods in this lineage, and carried forward by al-Samarqandī into the universal ādāb al-baḥth, are three truth-preserving logical relationships critical to the truth-seeking enterprise of dialectic: entailment (talāzum / mulāzama), mutual negation or exclusion (tanāfin / munāfā), and causal concomitance (dawarān). The practical elaboration of these relations reveals a logic in action—a premodern dialogical logic for living disputation praxis. In fact, so critical were these to the dialectical enterprise that al-Samarqandī devoted a specialized treatise entirely to summarizing their defining features and rules, aptly naming it the ʿAyn al-Naẓar, or “Wellspring of Rational Investigation.” In this article, and drawing upon a recently published digital critical edition, I will present an analytical outline of these core logical relations as presented in the ʿAyn al-Naẓar. Then I will address a number of points of interest in this text, grouped under six themes: the potential for cross-disciplinary advancement; notions in discursive development; significant or uniquely contributive formulations; peculiarities of content; signs of an evolving, universalist agenda; and evidence that the ʿAyn al-Naẓar was designed as an aide-mémoire for the active disputant. (shrink)

Proponents of situated affectivity hold that “tools for feeling” are just as characteristic of the human condition as are “tools for thinking” or tools for carpentry. An agent’s affective life, they argue, is dependent upon both physical characteristics of the agent and the agent’s reciprocal relationship to an appropriately structured natural, technological, or social environment. One important achievement has been the distinction between two fundamentally different ways in which affectivity might be intertwined with the environment: the “user-resource-model” and the “mind-invasion-model.” (...) The twofold purpose of this paper is to complement the debate about situated affectivity in general and about “mind invasion” in particular by, firstly, connecting it to situationist research in social psychology and, secondly, broadening the perspective to not only accommodate decidedly detrimental “invasions” but also potentially beneficial forms of “mind shaping” that include the manipulation of an agent’s experiential life and behaviour through the moulding of both the agent’s environment and the agent’s body. (shrink)

Proponents of situated affectivity hold that “tools for feeling” are just as characteristic of the human condition as are “tools for thinking” or tools for carpentry. An agent’s affective life, they argue, is dependent upon both physical characteristics of the agent and the agent’s reciprocal relationship to an appropriately structured natural, technological, or social environment. One important achievement has been the distinction between two fundamentally different ways in which affectivity might be intertwined with the environment: the “user-resource-model” and the “mind-invasion-model.” (...) The twofold purpose of this paper is to complement the debate about situated affectivity in general and about “mind invasion” in particular by, firstly, connecting it to situationist research in social psychology and, secondly, broadening the perspective to not only accommodate decidedly detrimental “invasions” but also potentially beneficial forms of “mind shaping” that include the manipulation of an agent’s experiential life and behaviour through the moulding of both the agent’s environment and the agent’s body. (shrink)

The workshop will discuss new insights in the interaction between logic and law, and more precisely the study of different answers to the question: What role does logic play in legal reasoning? It will present both current challenges and historical perspectives in the relation between logic and law. The perspectives to be discussed involve the interface of the following studies.

It has now become a realistic prospect for smart care to be provided at home for those living with long-term conditions such as dementia. In the contemporary smart care scenario, homes are fitted with an array of sensors for remote monitoring providing data that feed into intelligent systems developed to highlight concerning patterns of behaviour or physiological measurements and to alert healthcare professionals to the need for action. This paper explores some ethical issues that may arise within such smart care (...) systems, focusing on the extent to which ethical issues can be addressed at the system design stage. Artificial intelligence has been widely portrayed as an ethically risky technology, posing challenges for privacy and human autonomy and with the potential to introduce and exacerbate bias and inequality. While broad principles for ethical artificial intelligence have become established, the mechanisms for governing ethical artificial intelligence are still evolving. In healthcare settings the implementation of smart technologies falls within the existing frameworks for ethical review and governance. Feeding into this ethical review there are many practical steps that designers can take to build ethical considerations into the technology. After exploring the pre-emptive steps that can be taken in design and governance to provide for an ethical smart care system, the paper reviews the potential for further ethical challenges to arise within the everyday implementation of smart care systems in the context of dementia, despite the best efforts of all concerned to pre-empt them. The paper concludes with an exploration of the dilemmas that may thus face healthcare professionals involved in implementing this kind of smart care and with a call for further research to explore ethical dimensions of smart care both in terms of general principles and lived experience. (shrink)

In their thoughtful article, Malm and Navin (2020) raise concerns about a potentially unjust generational welfare tradeoff between children and adults when it comes to chicken pox. We share their c...

There are two foundational, but not fully developed, ideas in paraconsistency, namely, the duality between paraconsistent and intuitionistic paradigms, and the introduction of logical operators that express metalogical notions in the object language. The aim of this paper is to show how these two ideas can be adequately accomplished by the logics of formal inconsistency and by the logics of formal undeterminedness. LFIs recover the validity of the principle of explosion in a paraconsistent scenario, while LFUs recover the validity of (...) the principle of excluded middle in a paracomplete scenario. We introduce definitions of duality between inference rules and connectives that allow comparing rules and connectives that belong to different logics. Two formal systems are studied, the logics mbC and mbD, that display the duality between paraconsistency and paracompleteness as a duality between inference rules added to a common core—in the case studied here, this common core is classical positive propositional logic. The logics mbC and mbD are equipped with recovery operators that restore classical logic for, respectively, consistent and determined propositions. These two logics are then combined obtaining a pair of LFI and undeterminedness, namely, mbCD and mbCDE. The logic mbCDE exhibits some nice duality properties. Besides, it is simultaneously paraconsistent and paracomplete, and able to recover the principles of excluded middle and explosion one at a time. The last sections offer an algebraic account for such logics by adapting the swap structures semantics framework of the LFIs the LFUs. This semantics highlights some subtle aspects of these logics, and allows us to prove decidability by means of finite nondeterministic matrices. (shrink)

This book brings the idea of a public—defined in part as the quality of communication among strangers—back into focus. The benefits of doing this are many, but perhaps the most important are to adjust our understanding of what is good teaching and to widen our understanding of what counts as central to the educational process.

The DSM–5 characterizes mental disorders as significant disturbances in cognition, emotion, or behavior. But what might unite the disturbances on this list? We hypothesize that mental disorders can all be meaningfully characterized as failures of attention. We understand these as failures to distribute attention in the way one has most reason to, and we include both failures of tendency and of ability. We discuss six examples of mental disorders and offer a preliminary gloss of how to recast each as centrally (...) involving a failure of attention. We close by highlighting theoretical and practical upshots of our proposal. (shrink)