Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not (...) only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

While there is considerable disagreement on the precise nature of material objecthood, it is standardly assumed that material objects must be spatial. In this paper, I provide two arguments against this assumption. The first argument is made from largely a priori considerations about modal plenitude. The possibility of non-spatial material objects follows from commitment to certain plausible principles governing material objecthood and plausible principles regarding modal plenitude. The second argument draws from current philosophical discussions regarding theories of quantum gravity and (...) the emergence of spacetime. When it is appreciated what possible worlds these current theories commit us to, the possibility of non-spatial material objects will follow. Thus, either route will lead us to the possibility of non-spatial material objects. The significance of this result is that we need to revise our accounts of material objecthood to both accommodate these possibilities and the theories that lead to them. (shrink)

According to contemporary ‘process ontology’, organisms are best conceptualised as spatio-temporally extended entities whose mereological composition is fundamentally contingent and whose essence consists in changeability. In contrast to the Aristotelian precepts of classical ‘substance ontology’, from the four-dimensional perspective of this framework, the identity of an organism is grounded not in certain collections of privileged properties, or features which it could not fail to possess, but in the succession of diachronic relations by which it persists, or ‘perdures’ as one entity (...) over time. In this paper, I offer a novel defence of substance ontology by arguing that the coherency and plausibility of the radical reconceptualisation of organisms proffered by process ontology ultimately depends upon its making use of the ‘substantial’ principles it purports to replace. (shrink)

Based on the Zen philosophy about focusing away from the self, a guide to "neural Zen" meditative practices draws on recent findings in brain research to outline recommendations for various methods of pursuing a balanced, selfless state of ...

Justice requires that public policy improve the lives of disadvantaged members of society. Dementia is a source of disadvantage, and a growing global public health challenge. This article examines the theoretical and ethical connections between theories of justice and public dementia policy. Disability in general, and dementia in particular, poses important challenges for theories of justice, especially social contract theories. First, the article argues that non-contractarian accounts of justice such as the Capabilities and Disadvantage approaches are better equipped than their (...) contractarian counterparts to analyse issues of justice and dementia. Secondly, using a capabilities framework, I analyse original empirical data from qualitative interviews and discussion groups with health and social care professionals. The article concludes that social connection is a ‘fertile functioning’—a multiplier of advantage that enables people to live well with dementia together—and should therefore be a priority for public dementia policy. (shrink)

Essay one: Parmenidean dialectic -- Essay two: Parmenidean metaphysics -- Essay three: Parmenides and the history of dialectic.

This paper offers a new framework for thinking about the relationship between the common law of property and the rule of law. The standard way of framing this relationship is within the terms of the form/substance debate within the literature on the rule of law: Does the rule of law include only formal and procedural aspects or does it also encompass and support substantive rights such as private property rights and civil liberties? By focusing on the nature of common-law reasoning, (...) I wish to question the form/substance dichotomy that frames this debate and to show that the formal aspects of the rule of law are in fact principles widely adopted within the practice of common-law reasoning and as such play a large role in shaping the substantive content of common-law property rights. Understanding this has implications beyond the relationship between property law and the rule of law. (shrink)

abstract In this paper, I first develop a neo-Aristotelian account of the virtue of magnanimity. I then apply this virtue to ethical issues that arise in sport, and argue that the magnanimous athlete will rightly use sport to foster her own moral development. I also address how the magnanimous athlete responds to the moral challenges present in sport by focusing on the issue of performance-enhancing drugs, and conclude that athletic excellence as it is conventionally understood, without moral excellence, has very (...) little value. (shrink)

I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for (...) understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. I defend this proposal against three objections. (shrink)

A twenty-three-year-old atheist man was admitted to the intensive care unit after a motor vehicle accident left him terminally unconscious. He was not expected to survive long, so his religious mother asked the attending physician to ask someone from the hospital's spiritual care team to perform an emergent baptism. The physician consulted ethical and spiritual services to determine the best course of action. This essay, which, together with “The Case for Baptizing a Dying, Unconscious Atheist,” by Abram Brummett and Nelson (...) Jones, forms a two-essay case study, argues that the ethicist should recommend against baptism in such a scenario. Without consent, baptism would contradict the patient's self-determined identity and inflict significant dignitary harm. The emotional benefit provided to the mother or other family members, while potentially significant, is insufficient to justify this dignitary harm. (shrink)

First published in 1962, contains the William James Lectures delivered at Harvard University in 1955. It sets out Austin's conclusions in the field to which he directed his main efforts for at least the last ten years of his life. Starting from an exhaustive examination of his already well- known distinction of performative utterances from statements, Austin here finally abandons that distinction, replacing it by a more general theory of 'illocutionary forces' of utterances which has important bearings on (...) a wide variety of philosophical problems. (shrink)

Eric C. Ip has recently argued that seriously anorexic service users ought to be assumed to be legally incapacitous to refuse life‐saving artificial nutrition unless they can demonstrate otherwise, reversing the ordinary legal presumption in place to protect patients’ liberty and values. In this response, I argue against this proposal on two grounds. Firstly, the proposal is wrongfully discriminatory; it would expose service users to serious harm, and wrong them in numerous ways, on the basis of their diagnosis alone, without (...) significantly benefitting them in any way relative to the status quo. Secondly, he is unable to show that a large majority of such service users actually are incapacitous to refuse life‐saving artificial nutrition. This means that his proposal would likely involve declaring a large number of actually capacitous patients to be incapacitous, without even the requirement of a formal assessment, and burdening them with the responsibility of proving their clinical team wrong if they wish to avoid deprivation of liberty and/or compelled treatment. Given this, his proposal is indefensible. (shrink)

Murray N. Rothbard’s _Toward a Reconstruction of Utility and Welfare Economics_ is the defining contribution outlining the Austrian school’s approach to welfare theory. A recent attack on this approach is by Wysocki and Dominiak (2023), who argue, contra Rothbard, that whether an exchange is welfare-enhancing is not necessarily related to whether that exchange is just, and therefore the Rothbardian framework is wrong. This paper shows that their argument misconceives how Austrians treat the concept of welfare. They also misunderstand the crucial (...) role of the principle of demonstrated preference. Properly conceived, Rothbard’s reconstruction remains intact. (shrink)

The standard microeconomic analysis of taxation suggests that excise taxes on goods with a price-inelastic demand are more efficient in that they lead to a lower deadweight loss than taxes on goods with price-elastic demand. This argument ignores secondary effects on the rest of the economy. By narrowly focusing on the primary effects on the market where the tax is raised, the overall deadweight loss is underestimated when demand is price-inelastic. Moreover, it is overestimated when demand is price-elastic. This puts (...) into question the validity of the standard textbook argument. In this paper we address this issue by considering how taxes affect consumer behavior in other markets. From this we can clearly see how the impact of an excise tax is not limited to one market in isolation, but is spread over all markets and affects the demand for cash balances. We suggest a simple way to incorporate this important insight into a standard textbook exposition. (shrink)

Mixed lineage leukemia (MLL) fusion protein (FP)‐induced acute leukemia is highly aggressive and often refractory to therapy. Recent progress in the field has unraveled novel mechanisms and targets to combat this disease. Menin, a nuclear protein, interacts with wild‐type (WT) MLL, MLL‐FPs, and other partners such as the chromatin‐associated protein LEDGF and the transcription factor C‐Myb to promote leukemogenesis. The newly solved co‐crystal structure illustrating the menin–MLL interaction, coupled with the role of menin in recruiting both WT MLL and MLL‐FPs (...) to target genes, highlights menin as a scaffold protein and a central hub controlling this type of leukemia. The menin/WT MLL/MLL‐FP hub may also cooperate with several signaling pathways, including Wnt, GSK3, and bromodomain‐containing Brd4‐related pathways to sustain MLL‐FP‐induced leukemogenesis, revealing new therapeutic targets to improve the treatment of MLL‐FP leukemias. (shrink)

I argue that Schmidtet al, while correctly diagnosing the serious racial inequity in current ventilator rationing procedures, misidentify a corresponding racial inequity issue in alternative ‘unweighted lottery’ procedures. Unweighted lottery procedures do not ‘compound’ (in the relevant sense) prior structural injustices. However, Schmidtet aldo gesture towards a real problem with unweighted lotteries that previous advocates of lottery-based allocation procedures, myself included, have previously overlooked. On the basis that there are independent reasons to prefer lottery-based allocation of scarce lifesaving healthcare resources, (...) I develop this idea, arguing that unweighted lottery procedures fail to satisfy healthcare providers’ duty to prevent unjust population-level health outcomes, and thus that lotteries weighted in favour of Black individuals (and others who experience serious health injustice) are to be preferred. (shrink)

For this second edition, the editors have returned to Austin's original lecture notes, amending the printed text where it seemed necessary.

The author responds to a letter by D. Brendan Johnson in the July‐August 2023 issue of the Hastings Center Report concerning his and Joseph Clair's article “Love Your Patient as Yourself: On Reviving the Broken Heart of American Medical Ethics.”.

How accurate is Kevin Carson’s characterization of “freed” markets? Carson, a left-libertarian “free market anti-capitalist,” portrays free markets as so radically different from actually-existing markets that they are almost unrecognizable. In The Homebrew Industrial Revolution: A Low Overhead Manifesto, he provides an alternative history of industrialization that argues that large-scale industrial organization and production are largely creatures of state intervention and that truly free markets would be characterized mainly by small-scale production for local markets. This paper evaluates Carson’s narrative in (...) order to determine whether his vision of the freed market is credible. I find that Carson fails to provide sufficient evidence to demonstrate that, but for government intervention, national markets would only exist for a few goods. Furthermore, many of the features he believes freed markets would possess are based on fallacious views of competition, knowledge, capital, and entrepreneurship. (shrink)

Cooper, Austin Review(s) of: The Bloomsbury guide to Christian spirituality, by Richard Woods and Peter Tyler, eds. (London: Bloomsbury, 2012), pp. viii + 422, $65.00.

A recent development in biology has been the growing acceptance that holobionts, entities comprised of symbiotic microbes and their host organisms, are widespread in nature. There is agreement that holobionts are evolved outcomes, but disagreement on how to characterize the operation of natural selection on them. The aim of this paper is to articulate the contours of the disagreement. I explain how two distinct foundational accounts of the process of natural selection give rise to competing views about evolutionary individuality.