Medical Ethics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medical ethics and bioethics in the UK more centrally within its historical and human contex.

We wish to describe and acknowledge the exceptional contributions to medical ethics, both in the UK and internationally, made by Edward Shotter1 who died at home on 3 July 2019. He was founder of the London Medical Group2 3 and instigator of similar student-led medical ethics groups throughout the UK; founder of the Institute of Medical Ethics4 and founder of the Journal of Medical Ethics. Ted Shotter transformed the study of medical ethics in the UK in the interests of patients (...) and professionals alike. In 1963, he established the pioneering ‘Medical Group’ model, an innovative bottom-up method whereby students in the health professions could gain a grounding in ethics that had previously been denied to the profession.5 It was with these Medical Groups that many of the leading figures in contemporary UK medical ethics and law began their careers in the subject including Sir Kenneth Calman, Sir Ian Kennedy, Professor Margaret Brazier OBE, Professor John Harris and Professor Sir Jonathan Montgomery to name but …. (shrink)

In discussions of religious disagreement, some epistemologists have suggested that religious disagreement is distinctive. More specifically, they have argued that religious disagreement has certain features which make it possible for theists to resist conciliatory arguments that they must adjust their religious beliefs in response to finding that peers disagree with them. I consider what I take to be the two most prominent features which are claimed to make religious disagreement distinct: religious evidence and evaluative standards in religious contexts. I argue (...) that these two features fail to distinguish religious disagreement in the ways they have been taken to. However, I show that the view that religious disagreement is not a unique form of disagreement makes religious disagreement less, rather than more, worrisome to the theist who would prefer to rationally remain steadfast in her religious beliefs. (shrink)

Justice, one of the four Beauchamp and Childress prima facie basic principles of biomedical ethics, is explored in two excellent papers in the current issue of the journal. The papers stem from a British Medical Association essay competition on justice and fairness in medical practice and policy. Although the competition was open to all comers, of the 235 entries both the winning paper by Alistair Wardrope1 and the highly commended runner-up by Zoe Fritz and Caitríona Cox2 were written by practising (...) doctors—a welcome indication of the growing importance being accorded to philosophical reflection about medical practice and practices within medicine itself. Both papers are thoroughly thought provoking and represent two very different approaches to the topic. Each deserves a careful read. The competition was a component of a BMA 2019/2020 ‘Presidential project’ on fairness and justice and asked candidates to ‘use ethical reasoning and theory to tackle challenging, practical, contemporary, problems in health care and help provide a solution based on an explained and defended sense of fairness/justice’. In this guest editorial I’d like to explain why, in 2018 on becoming president-elect of the BMA, I chose the theme of justice and fairness in medical ethics for my 2019–2020 Presidential project—and why in a world of massive and ever-increasing and remediable health inequalities biomedical ethics requires greater international and interdisciplinary efforts to try to reach agreement on the need to achieve greater ‘health justice’ and to reach agreement on what that commitment actually means and on what in practice it requires. First, some background. As president I was offered the wonderful opportunity to pursue, with the organisation’s formidable assistance, a ‘project’ consistent with the BMA’s interests and values. As a hybrid of general medical practitioner and philosopher/medical ethicist, and as a firm defender of the Beauchamp …. (shrink)

Developing a boundary-crossing ethics by paying attention to our stories, myths, and moral intuition.

Martin highlights the degree to which H. L. A. Hart’s legal positivism relies on Hobbesian assumptions. Like Hart, Hobbes combines utilitarian and retributivist elements. The best way to make sense of Hobbes’s theory of punishment is to follow Quentin Skinner and view both the “sovereign” and the “state” as distinct legal fictions. Unlike Hobbes, Hart asserts these fictions as facts. As a result, Hart’s philosophy of criminal law in Punishment and Responsibility is in tension with his legal philosophy in The (...) Concept of Law. Martin worries that Hart’s mixed theory is untenable: the utilitarian element threatens to overtake his core retributivist thesis. Ultimately, however, neither Hart nor Hobbes has the resources to explain why the autonomous individual matters in the context of criminal law. (shrink)

Through the use of particular pedagogies and the adoption of new modes of thinking, physical literacy promises more realistic models of physical competence and ...

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a (...) wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

Margaret Whitford's study provides the ideal introduction to Irigaray's thought, offering a sustained interpretation of her whole corpus, including previously untranslated French texts. Whitford suggests that Irigaray's work should be seen as "philosophy in the feminine," actively opposing the complicity of philosophy with other social practices which exclude or marginalize women.

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)

Study of Nyayabindu of Dharmakirti, 7th cent. and its commentary Nyayabindutika of Dharmottara.

With advice that combines ancient spiritual traditions with the common sense of the 21st century, this book offers soothing and practical guidance to the frazzled decision-maker. Those concerned about making the best choices can find techniques for broadening their way of thinking and effectively solving problems that also make sense for them spiritually. From everyday choices to landmark decisions, this book will simplify problem-solving and guide readers through all stages of life.

History is useful when it is used properly: to understand why we and those we must deal with think and react in certain ways. It can offer examples to inform our decisions and guesses about the consequences of our actions. But we should be wary of looking to history for dogmatic lessons.We should distrust those who abuse history when they call on it to justify unreasonable claims to land, for example, or restitution. MacMillan illustrates how dangerous history can be in (...) the hands of nationalistic or religious or ethnic leaders who use it to foster a sense of grievance and a desire for revenge. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

Promoting respect for the four principles remains of great practical importance in ordinary medicineThe following are four “scenarios” with brief outlines of how Raanan Gillon has analysed them using the “four principles” approach. These are the four cases that the commentators were asked to analyse.Professor Gillon has for many years advocated the use of the Beauchamp and Childress four principles approach as a widely and interculturally acceptable method for medical ethics analysis . At present there seems to be (...) a backlash by some bioethicists against this approach, with among others, adherents of feminist ethics, narrative ethics, virtue ethics, and various varieties of regional ethics claiming to offer better approaches to medical ethics.At Raanan Gillon’s request this special issue of the Journal of Medical Ethics is intended to focus on this aspect of his work, with a view not only to discussing the issue of how different approaches to medical ethics are and/or are not compatible with the four principles approach but also to make clear to JME readers what alternative ethics analysis method is preferred and used by the various commentators.THE “STANDARD” JEHOVAH’S WITNESS CASEIn the first scenario, that of the “standard” Jehovah’s Witness case, a competent adult patient loses a massive amount of blood from a blood vessel bleeding in an acute duodenal ulcer. The best chance of …. (shrink)

The influence of European and especially German historiography on the formation of the modern academic discipline in Japan is undisputed, as is the importance of the German historian Ludwig Rieß. Undeniably, Rieß contributed to the organization of the academic discipline by teaching future historians and taking an active part in the establishment of the Historical Society, as well as by the example of his own research in the history of Japan. But how significant was his influence on the establishment and (...) maintenance of archives in Japan? Japanese scholars had been collecting and working with primary documents long before Rieß arrived; indeed, the earliest efforts predate even the measures introduced under the Meiji government in the 1870s. This article outlines the beginnings of komonjogaku (the study of primary documents), giving particular attention to the work of its pioneer, Kume Kunitake. The author argues that while European methods based on archival research inspired and served to justify Japanese activities, indigenous traditions were at least equally important. Moreover, parallels with western countries are not merely a result of western imports but reflect the common responses to global processes in the late 19th and early 20th centuries. (shrink)

This chapter sets out to distinguish the sorts of claims have been advanced under the rubric of “moral particularism,” and to sort through the insights and costs of each. In particular, it distinguishes those who are animated by suspicion of theory itself from those who aim to reconfigure — sometimes radically — the nature of theory. It defends as key the particularist insight that exceptions to substantive moral explanations are ubiquitous. It argues that the lesson of this insight is not (...) to abandon moral generalizations, but to change the picture of what they must look like to do their work. (shrink)

This paper argues that there is a distinctive vice of hypocrisy, which is Janus-faced. The vice of hypocrisy is the self-excepting avoidance of a particular pain, namely, the pain associated with being an object of blame one believes deserved. One can self-exceptingly avoid this pain attitudinally or behaviorally. With “attitudinal” hypocrisy, a person avoids it at the level of her beliefs: she avoids forming the belief that she is blameworthy for some act, while blaming others for their comparable acts. With (...) “behavioral” hypocrisy, by contrast, a person avoids it at the level of her behavior. She shields herself from the blame she believes her acts merit (e.g. by hiding what she has done), while blaming others for their comparable acts. The paper argues that both forms of hypocrisy are objectionable and explains how they are in tension, such that a given instance of the vice will typically involve only one or the other. Though both attitudinal and behavioral hypocrisy selectively spare the hypocrite the same pain, they require incongruous moral-psychological states: the attitudinal hypocrite avoids blaming herself, while the behavioral hypocrite proceeds on the assumption she is blameworthy. (shrink)

In this issue of the journal “Lee Elder”,1 a pseudonymous dissident Jehovah's Witness , previously an Elder of that faith and still a JW, joins the indefatigable Dr Muramoto2–5 in arguing that even by their own religious beliefs based on biblical scriptures JWs are not required to refuse potentially life-saving blood transfusions. Just as the “official” JW hierarchy has accepted that biblical scriptures do not forbid the transfusion or injection of blood fractions so too JW theology logically can and should (...) permit the transfusion of whole blood when this is medically required.Few doctors would argue that they should override the adequately autonomous decisions of Jehovah's Witnesses to refuse blood transfusions even if they are likely to die as a result of such transfusions. However, there is a case to be made for doctors asking such patients to reflect on their potentially fatal refusal of blood and for drawing to these patients' attention the reasoning of members of their own faith that justifies acceptance of potentially life-saving blood transfusions. What is that case? Simply that doctors' primary professional duty to try to benefit the health of their patients entails trying to save their patients' lives when and if doing so will benefit their patients' health. Of course this is not an absolute duty overriding all other duties; in particular if patients who are adequately autonomous to do so refuse such life-prolonging treatment doctors must generally accept such refusal, however sadly. This editorial endorses that view in the case of adequately autonomous legally competent JWs. (In another paper in this issue of the journal Professor Shimon Glick argues that ethics committees should be empowered—as they now are in Israel—to override even competent refusals of life-prolonging treatment where the committee judges that …. (shrink)

For those open to the possibility that philosophical thought can improve life, David Hume's Essays: Moral, Political, and Literary have something to say. In the first comprehensive study of the Essays, Margaret Watkins engages closely with these neglected texts and shows how they provide important insights into Hume's perspective on the breadth and depth of human life, arguing that the Essays reveal his continued commitment to philosophy as a discipline that can promote both social and individual progress. Addressing topics (...) such as politics, war, slavery, the priesthood, the development of industry, aesthetics, emotional disorders, egoism, friendship, sexuality, gender relations, and the nature of philosophy itself, the volume examines Hume's purposes and aims against the backdrop of the eighteenth century society in which he lived. It will be of interest to scholars of modern thought in philosophy, politics, history, and economics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt by Tim MilnesMargaret WatkinsTim Milnes. The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt. Oxford: Oxford University Press, 2019. Pp. viii + 278. Hardback. ISBN: 9780198812739. $91.00.In his brief autobiography, “My Own Life,” Hume reports that “almost all [his] life has been spent in literary pursuits and occupations” (E-MOL: xxxi). This is one (...) of at least ten places in this brief work in which he associates himself with “letters” or “literature”—as compared to at most four associations with philosophy. The moral to be inferred is not that Hume considered himself not to be a philosopher. Rather, he conceived of philosophy as a kind of literature. The Treatise was itself a “literary attempt.” Indeed, opposition between the “literary” and “philosophical” aspects of a text would have been foreign to Hume and his contemporaries—a notion for a later age, despite his occasional loose distinction between the relevant genres, as in his list of writings “historical, philosophical, or literary” in “My Own Life” (E-MOL: xxxvi).Yet despite Hume’s own understanding of the continuity between philosophy and literature, broadly conceived, it is still common for contemporary philosophers to ignore literary questions in their examination of Hume’s work, or to presume that one can easily distinguish the “philosophical” parts from the “literary” ones. Tim Milnes’s The Testimony of Sense is therefore a welcome addition to the Hume literature (pun intended). With a particular focus on the essay—a genre of great importance to Hume—Milnes contributes to the small set of engagements with Hume from the disciplinary perspective of English literature. With training in both philosophy and literature, as well as established expertise on Romanticism and its own essays, Milnes is well-qualified for the task. The Testimony of Sense includes sustained engagement with Hume’s contemporaries and successors, but for the purposes of this review, I engage the book primarily as a Hume scholar for Hume scholars.Milnes’s story plays out in three acts. The first establishes the need for public trust created by a skeptical crisis, itself a product of Hume’s criticism of the epistemic program of thinkers in the Cartesian and Lockean traditions. The second explains how the essays of the long eighteenth century constitute a response to that need in various ways. The third reveals in detail how the Romantic essayists, particularly William Hazlitt and Charles Lamb, both respond to and deviate from the “neoclassical” essayists, typified by Hume and Samuel Johnson.The first chapter, “Self and Intersubjectivity,” lays the groundwork by articulating how Hume, Adam Smith, Thomas Reid, and Dugald Stewart identify the need for what we now call intersubjectivity. Milnes describes the common thread as a kind of “natural transcendentalism.” In what sense are these thinkers properly understood as [End Page 175] transcendentalists? The central idea seems to be that all posit things other than reason as “conditions of meaningful thought” (72). For Hume, it is the social, linguistic experience of a community of virtuous judges. The intricate relations between self and other essential to such a community get “internalized within the specular drama of the impartial spectator” (72) in Smith’s writing, which itself takes part in the drama through his “halting, qualified syntax” that mimics “everyday speech” (44). Reid posits a “prescience” of trust, which grounds our reliance on both human testimony and the uniformity of nature, itself undergirded by the design of a benevolent God. Stewart, who posits axiomatic truths that help constitute the “stamina of intellect,” goes furthest, actually calling these truths transcendental (55). This chapter also puts these eighteenth-century thinkers in conversation with twentieth-century theorists, including Habermas, Davidson, and Rorty.Chapter 2, “The Subject of Trust,” deepens the analysis by situating these “natural transcendentalisms” in the broader enlightenment context. In contrast to Descartes, Bacon, and Locke, who were suspicious of our reliance on the opinions of others, the eighteenth-century thinkers understand trust as prior to reason in various ways—though not prior to solidarity. The particulars in each case depend on their responses to skepticism and their accounts of the relation between... (shrink)

Does one have special obligations to support the political institutions of one’s own country precisely because it is one’s own? In short, does one have political obligations? This book argues for an affirmative answer, construing one’s country as a political society of which one is a member, and a political society as a special type of social group. The obligations in question are not moral requirements derived from general moral principles. They come, rather, from one’s participation in a special kind (...) of commitment: a joint commitment. This theory is referred to as the plural subject theory of political obligation since, by the author’s definition, those who are party to any joint commitment constitute a plural subject of some action in a broad sense of the term. Several alternative theories are compared and contrasted with plural subject theory, with a particular focus on the most famous — actual contract theory — according to which membership in a political society is a matter of participation in an agreement. The book offers plural subject accounts of both social rules and everyday agreements, and includes discussion of political authority and punishment. (shrink)

Recognition of Hannah Arendt's contribution to the history of western philosophy is long overdue. Arendt was a 'political thinker', but this book highlights the importance of her ontological preoccupations for an understanding of her work.

In recent years, the free market position has been gaining strength. In this book, Radin provides a nuanced response to its sweeping generalization.

Late last year the English Court of Appeal confirmed a lower court's ruling that doctors could impose an operation to separate recently born conjoined twins, overriding the refusal of consent of their parents. The doctors believed the operation would probably save one of the babies at the cost of killing the other, while not operating would highly probably be followed by the death of both twins within months of their birth. The parents, said to be devout Roman Catholics, believed that (...) it was absolutely wrong to kill one of their babies, even to save the life of the other.Undoubtedly many people, the writer included, would agree with the English courts that the “least worst” option was to separate the twins and save one at the cost of killing the other. But surely many fewer people would have imposed their own resolution of this acute moral dilemma upon parents who conscientiously chose the other limb of the dilemma, refusing to kill one baby even in order to save the other. Were the English judges right, then, to take away the parents' normal right and duty to make health care decisions on behalf of their children and instead impose their own answer to what they admitted to be a terrible dilemma? Describing the two alternatives in terms of choosing between the lesser of two evils on the one hand, and the obligation not to kill on the other, Lord Justice Ward declared, according to The Times law report,1 that: “Parents who were placed on the horns of such a terrible dilemma simply had to choose the lesser of their inevitable loss [sic]”. But that surely is to beg the moral question in favour of the judges' preferred answer to this moral dilemma. The fact is that there are—as …. (shrink)

This title explores how human commitments, rooted in the story of God's love, are acts of free choice and love. Farley reflects on the concrete experiences of people who strive to be faithful to what they have claimed to love: 'My concern is to name something that I think is, after all, common to all of our lives - an experience, a reality, perhaps a problem, a challenge, something that is sometimes a source of joy, sometimes a cause of tragedy'. (...) Farley explores the nature nad meaning of commitment as it is played out in our lives, addressing love, fidelity, a sense of obligation, and covenant. (shrink)

Prepare for practice with the essential text dedicated to Canadian legal and ethical issues! Focused solely on the ever-changing, and often complex health care landscape in Canada, Ethical & Legal Issues in Canadian Nursing 4th, Edition expertly covers the often intertwined ethical and legal issues that health care professionals face today. This fourth edition includes discussion points at the end of every chapter along with tables and illustrations to help you fully comprehend the material. Plus, the clear and straightforward writing (...) style presents information just as you will encounter it in your day-to-day practice, ensuring you're even more prepared to make an impact from the start! -- From the publisher. (shrink)

As the_number of clinical trials continues to grow, there is an increasing need for education and training in the field. The clinical research climate is less forgiving of errors and oversights and therefore requires more knowledge of regulations and requirements. This brand new edition details new laws and regulations in protecting children participating in clinical trials and how a new focus on privacy of individual health information in the United States has changed how medical records are handled. Includes a manual (...) for investigators, research nurses and study coordinators with minimal experience or who are new to clinical research An easy-to-read and open text design using ‘sidebars’ of examples and information boxes related to the main text Includes a list of Frequently Asked Questions and Glossary Duke Clinical Research Institute is the world’s largest academic clinical research organisation and is well known and respected within the clinical research community. (shrink)