Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm (...) in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)
According to Bayesian epistemology, the epistemically rational agent updates her beliefs by conditionalization: that is, her posterior subjective probability after taking account of evidence X, pnew, is to be set equal to her prior conditional probability pold(·|X). Bayesians can be challenged to provide a justification for their claim that conditionalization is recommended by rationality—whence the normative force of the injunction to conditionalize? There are several existing justifications for conditionalization, but none directly addresses the idea that conditionalization will be epistemically rational (...) if and only if it can reasonably be expected to lead to epistemically good outcomes. We apply the approach of cognitive decision theory to provide a justification for conditionalization using precisely that idea. We assign epistemic utility functions to epistemically rational agents; an agent’s epistemic utility is to depend both upon the actual state of the world and on the agent’s credence distribution over possible states. We prove that, under independently motivated conditions, conditionalization is the unique updating rule that maximizes expected epistemic utility. (shrink)
Difficulties over probability have often been considered fatal to the Everett interpretation of quantum mechanics. Here I argue that the Everettian can have everything she needs from `probability' without recourse to indeterminism, ignorance, primitive identity over time or subjective uncertainty: all she needs is a particular *rationality principle*. The decision-theoretic approach recently developed by Deutsch and Wallace claims to provide just such a principle. But, according to Wallace, decision theory is itself applicable only if the correct attitude to a future (...) Everettian measurement outcome is subjective uncertainty. I argue that subjective uncertainty is not to be had, but I offer an alternative interpretation that enables the Everettian to live without uncertainty: we can justify Everettian decision theory on the basis that an Everettian should *care about* all her future branches. The probabilities appearing in the decision-theoretic representation theorem can then be interpreted as the degrees to which the rational agent cares about each future branch. This reinterpretation, however, reduces the intuitive plausibility of one of the Deutsch -Wallace axioms. (shrink)
The Everett (many-worlds) interpretation of quantum mechanics faces a prima facie problem concerning quantum probabilities. Research in this area has been fast-paced over the last few years, following a controversial suggestion by David Deutsch that decision theory can solve the problem. This article provides a non-technical introduction to the decision-theoretic program, and a sketch of the current state of the debate.
Much of the evidence for quantum mechanics is statistical in nature. The Everett interpretation, if it is to be a candidate for serious consideration, must be capable of doing justice to reasoning on which statistical evidence in which observed relative frequencies that closely match calculated probabilities counts as evidence in favour of a theory from which the probabilities are calculated. Since, on the Everett interpretation, all outcomes with nonzero amplitude are actualized on diﬀerent branches, it is not obvious that sense (...) can be made of ascribing probabilities to outcomes of experiments, and this poses a prima facie problem for statistical inference. It is incumbent on the Everettian either to make sense of ascribing probabilities to outcomes of experiments in the Everett interpretation, or to ﬁnd a substitute on which the usual statistical analysis of experimental results continues to count as evidence for quantum mechanics, and, since it is the very evidence for quantum mechanics that is at stake, this must be done in a way that does not presuppose the correctness of Everettian quantum mechanics. This requires an account of theory conﬁrmation that applies to branching-universe theories but does not presuppose the correctness of any such theory. In this paper, we supply and defend such an account. The account has the consequence that statistical evidence can conﬁrm a branching-universe theory such as Everettian quantum mechanics in the same way in which it can conﬁrm a probabilistic theory. (shrink)
Recent work in the Everett interpretation has suggested that the problem of probability can be solved by understanding probability in terms of rationality. However, there are *two* problems relating to probability in Everett --- one practical, the other epistemic --- and the rationality-based program *directly* addresses only the practical problem. One might therefore worry that the problem of probability is only `half solved' by this approach. This paper aims to dispel that worry: a solution to the epistemic problem follows from (...) the rationality-based solution to the practical problem. (shrink)
Richard Feynman has claimed that anti-particles are nothing but particles `propagating backwards in time'; that time reversing a particle state always turns it into the corresponding anti-particle state. According to standard quantum field theory textbooks this is not so: time reversal does not turn particles into anti-particles. Feynman's view is interesting because, in particular, it suggests a nonstandard, and possibly illuminating, interpretation of the CPT theorem. In this paper, we explore a classical analog of Feynman's view, in the context of (...) the recent debate between David Albert and David Malament over time reversal in classical electromagnetism. (shrink)
The CPT theorem of quantum field theory states that any relativistic (Lorentz-invariant) quantum field theory must also be invariant under CPT, the composition of charge conjugation, parity reversal and time reversal. This paper sketches a puzzle that seems to arise when one puts the existence of this sort of theorem alongside a standard way of thinking about symmetries, according to which spacetime symmetries (at any rate) are associated with features of the spacetime structure. The puzzle is, roughly, that the existence (...) of a CPT theorem seems to show that it is not possible for a well-formulated theory that does not make use of a preferred frame or foliation to make use of a temporal orientation. Since a manifold with only a Lorentzian metric can be temporally orientable—capable of admitting a temporal orientation—this seems to be an odd sort of necessary connection between distinct existences. The paper then suggests a solution to the puzzle: it is suggested that the CPT theorem arises because temporal orientation is unlike other pieces of spacetime structure, in that one cannot represent it by a tensor field. To avoid irrelevant technical details, the discussion is carried out in the setting of classical field theory, using a little-known classical analog of the CPT theorem. (shrink)
During the past thirty years a high proportion of all long stay hospital beds have been closed. The responsibility for those who would have occupied those beds previously has to a large extent been transferred from health to social services departments, or to family, voluntary and private care. The overall effect has been to prioritize acute medical care, and to expose the public provision and funding of long term residential care, whether medical or social, to the direct determination of political (...) and economic forces. These policy changes have been introduced under the banner of community care, but are dependent on complex concepts which are morally contentious and often obscure. The purpose of this paper is to analyse these processes as a prerequisite to devising better policies in future. (shrink)
Since the nineteenth century the theory and practice of mainstream Western medicine has been grounded in the biomedical model. In the later years of the twentieth century, however, it has faced a range of serious problems, which when viewed collectively, remain unresolved despite a variety of responses. The question we now face is whether these problems can be dealt with by modifying and extending the principles underlying the biomedical model, or whether a more radical solution is required. Recent critiques of (...) Western medicine have focused mainly on the biopsychosocial model in relation to the former approach, but it will be contended that this cannot deal adequately with the challenges that medicine currently faces, because although it addresses both the scientific and humanistic aspects of medicine it fails to harmonise them. I shall therefore argue for the necessity of a more radical approach, and suggest that what is required to accomplish this is the development of a new medical cosmology, rooted in an older and more global framework. Such a fundamental change would inevitably involve a long term process which it is not yet possible to fully comprehend let alone specify in detail. Some of the necessary features of such a new medical cosmology can, however, already be distinguished and the outline of these is described. (shrink)
The debate between substantivalists and relationists about spacetime was given a new lease of life approximately twenty years ago, when John Earman and John Norton published an argument for the conclusion that, in the light of general relativity, substantivalism is untenable. Responses to Earman and Norton’s argument generated a proliferation of ‘substantivalisms’, and a debate between them that was, to the ears of at least some, distinctively metaphysical in character.
Section 47 of the National Assistance Act is controversial in that it makes provision for the compulsory removal and care of mentally competent adults in certain limited circumstances. A case is described in which it is argued that compulsory management could be justified. This is because the diversity and potentially conflicting nature of the relevant considerations involved in this and a restricted range of other cases, defies their being captured in any wholly rational moral scheme. It follows that if the (...) law is to be both sensitive and just it cannot always provide definitive guidance as to how the community doctor, as the designated decision-maker, should act. The acceptance of his or her judgement is therefore necessary and depends for its proper working on trust, which can only be gained through compassion and respect for the patients concerned. (shrink)
The failure of Western medicine to deal with many of the problems it is currently facing has led to an awareness of the need for a fundamental reappraisal. The way in which medical concepts derived from the nineteenth century have brought technical medical advances in this century and the alliances that medicine has made with statistics and more recently the social sciences, have prevented a questioning of medicine's underlying assumptions. Thus, despite a number of critical initiatives from both within and (...) outside medicine, there has been no coherent development to seriously confront the question 'what is medicine?'. It is suggested that the basis for such a development depends on the return to a philosophical questioning of our conceptual understanding of disease, a subject which has largely been ignored during the past hundred years. (shrink)
There has been a modern epidemic of heart attacks in the western world, and this paper is concerned with this ânewâ medical condition and how it arose. Two competing theories are commonly proposed, relating either to conventional accounts of medical science, or to social construction. Whilst recognising that aspects of both theories have some validity, it is claimed that neither is wholly adequate. This issue has particular relevance for heart attacks and is explored in some detail, but it also points (...) to some more general conclusions. First that medical knowledge cannot be separated into âscientificâ and âsocialâ compartments but is united by its human aspect; and second that although medical knowledge has a special dimension, when understood in this way, it may also resonate with a more general re-examination of the relationship between scientific and human knowledge. (shrink)
(a) How to design a nuclear power plant 3. Deutsch/Wallace solution to the practical problem (a) Argue that the rational Everettian agent makes decisions by maximizing expected utility, where the expectation value is an average over branches 4. The semantics of branching - two options..
Armstrong describes the rise of a new mode of medical practice that he calls in the following terms: Surveillance medicine gives rise to a novel and underexplored aspect of the long-standing tension between the different goals of clinical medicine and public health.
A postgraduate Diploma in Medical Ethics and Law was started in October 1984 by the Centre of Medical Law and Ethics at King's College. It is a part-time one year course designed so as to enable students to continue with full-time employment if they wish. It is multidiscipinary and is open to all who have a first degree in a relevant discipline, for example law, philosophy, theology, medicine and nursing studies. It is unique in combining medical law and medical ethics (...) and has attracted students of high calibre from a variety of backgrounds during its first three years. Building on the experience of the diploma the course is being upgraded to an MA in 1987-88. It will be available either full-time for one year or part-time for two years. (shrink)
In this well-known passage of his Antiquitates Romanae, Dionysius of Halicarnassus describes how Romulus and his companions seized and married the Sabine virgins. Romulus justifies his actions by stating that this method of acquiring wives was a Greek custom:Dionysius' report of a Greek tradition adopted by Romulus is rather enigmatic. It has previously been noted that this passage bears similarity to passages of Plutarch and in particular his description of the Spartan marriage ceremony. This Spartan marriage ceremony does bear some (...) relation to the situation being described by Dionysius in that the women are captured before being married, but other elements of the ceremony—the bride having her hair cut off and being taken in a darkened room—are quite out of place here and would appear to be a peculiarly Spartan tradition. As Plutarch was writing some time after Dionysius, it is not possible for Dionysius to be making a parallel with the ceremony as decribed by Plutarch, but he may have had access to a common source about that ceremony, now lost. However, I would like to suggest that there is another well-known source which may have been the source of the Greek tradition referred to in Dionysius 2.30 that is connected to neither Plutarch nor marriage. (shrink)
Following the first enactment of living will legislation in California in 1976 the majority of the states of the USA have now passed similar laws. However, flaws have been identified in the way they work in practice and many states are considering reviewing their legislation. In Britain there is no legislation but the subject is currently commanding considerable interest. This paper assesses the future prospects for living wills in both the USA and Britain, analysing the different options available and comparing (...) the two countries. If patients who become permanently incompetent are to have their previous autonomous decision-making respected, there is general agreement that advance directives for health care must be introduced. The difficulty is in deciding how to implement them, and especially whether this should be by statutory or non-statutory means, the traditions in the two countries being very different in this respect. It is concluded that whichever route is taken, promoting respect for patient autonomy is as much a matter for education and persuasion of doctors as of the adoption of particular instruments. Doctors should therefore be trained in what constitutes good medical practice in this area and, to ensure that it can be carried out properly, the general level of medical facilities for these patients must also be protected and promoted. (shrink)
Introduction -- Phenomenology : the logic of appearance -- Phenomenology without attitude -- The root of sense and sensibility -- Concrete sketches of experience -- The self-evidence and elusiveness of phenomena -- Dasein : a living question -- Interrogating ourselves -- Hermeneutics, philosophy, and ontological difference -- The facts of life -- More or less human -- World : the event of meaning -- Tackling the world around us -- Environmental breakdown and recovery -- Our world owns itself -- Anyone (...) and everyone -- Already with others -- The dictatorship of the one -- The real and the authentic self -- Language bears the one -- Between our selves -- Finding oneself in a mood -- Where do moods belong? -- The fundamental tone of attunement -- Nothing to be anxious about -- The depths of boredom and love -- Meaning and truth -- Laying out understanding -- Disclosing and enclosing an horizon -- Decisive truths -- Excavating and sheltering the truth -- Time and space -- Extending our reach and making room -- Exploding, stretching and punctuating time -- Measuring out the dimension -- Ways of life and death -- The whole of life in death -- A call to indebted freedom -- Philosophy sacralised -- Origin and originality -- Original destruction -- History repeats itself -- Beginning again with the first beginning -- Arts and science : poetry and thought -- Undermining the academic divide -- Returning the arts and sciences to themselves -- The cult(ure) of technology -- Two cultures in one. (shrink)
This paper examines the concept of liberty at the heart of Sarah Chapone’s 1735 work, The Hardships of the English Laws in Relation to Wives. In this work, Chapone (1699-1764) advocates an ideal of freedom from domination that closely resembles the republican ideal in seventeenth and eighteenth- century England. This is the idea that an agent is free provided that no-one else has the power to dispose of that agent’s property—her “life, liberty, and limb” and her material possessions—according to (...) his arbitrary will and pleasure, without being accountable to the law. This paper shows how Chapone uses this ideal to ground her arguments against those laws that put married women in a worse condition than slavery, and to call for the establishment of reasonable and just safeguards for a woman’s personal property and property in her children. More than this, it is argued, in this text Chapone articulates a feminist ideal that is both negative freedom from domination and positive freedom to be one’s own master or arbiter. Her work thus occupies a unique—and hitherto unrecognized—place in the history of feminist philosophy. (shrink)
Sarah Grand was one of the most prominent New Women of the 1890s and a notable social purity feminist and suffragist. This collection offers important insights into the full range of her journalistic output and lesser-known fictional writings. It also makes available biographical and autobiographical material, and previously unpublished manuscript sources. The first volume reproduces Grand's articles and the contemporary critical reception of her work. The letters in volume two, written mostly in the 1920s and 1930s, shed light on (...) Grand's genesis as a writer and her interaction with 1890s artistic and feminist circles. The third and fourth volumes contain a selection of short stories from three collections published at and after the turn of the century. These comment on some of the explosive issues of that time: feminism, decadence, eugenics, class, race and war. They also reflect Grand's exploration of the interplay between gender and genre. (shrink)