This is the first textbook of surgical ethics. It is a practical, clinically comprehenive, well-organized guide to ethical issues in surgical practice, research, and education written by leading figures in surgery and bioethics. The authors cover the surgeon-patient relationship, the full range of surgical patients, surgical education and research, and surgery and managed care. Their chapters are not abstract discussions of ethical principles; rather, they connect directly with the everyday concerns of practicing surgeons.

Moral psychology studies the features of cognition, judgement, perception and emotion that make human beings capable of moral action. Perspectives from feminist and race theory immensely enrich moral psychology. Writers who take these perspectives ask questions about mind, feeling, and action in contexts of social difference and unequal power and opportunity. These essays by a distinguished international cast of philosophers explore moral psychology as it connects to social life, scientific studies, and literature.

Just health: meeting health needs fairly is an ambitious book, in which Norman Daniels attempts to bring together in a single framework all his work on health and justice from the past 25 years. One major aim is to reconcile his earlier work on the special moral importance of healthcare with his later work on the social determinants of health. In his earlier work, Daniels argued that healthcare is of special moral importance because it protects opportunity. In this later work, (...) Daniels argues that the social determinants of health (which in fact tend to have a larger effect on health outcomes than healthcare does) should also be considered special. This paper argues that it is a mistake to base a theory of justice for health on the claim that health (or the social determinants of health) are "special", for three reasons. First, once we realise that health is to a large part socially determined by features such as distribution of income, which are also of independent importance for justice, we cannot talk about a theory of justice for health in isolation from an overall theory of justice. Second, when we are trying to work out the place of health in a general theory of justice, being told that health (or the social determinants of health) is special is unhelpful. The relevant starting point should rather be whether health matters in a fundamental way for justice, or whether it matters merely for the effects it has on those goods which are of fundamental importance for justice. Third, treating the social determinants of health as special would in fact be counterproductive in terms of the broad approach to justice Daniels favours. (shrink)

Following Jacques Hadamard, applied mathematicians typically investigate their models in the form of well-set problems, which actually consist of a family of applicational circumstances that vary in specific ways with respect to their initial and boundary values. The chief motive for investigating models in this wider manner is to avoid the improper behavioral conclusions one might reach from the consideration of a more restricted range of cases. Suitable specifications of the required initial and boundary variability typically appeal to previously established (...) experimental conclusions as to how the target system will behave under a range of eternally applied manipulations of the form “If the conditions pertaining to S were altered in manner M, internal features X would/would not alter”. In his investigations of causal reasoning within other parts of science, our first author has emphasized the conceptual importance of counterfactuals of this nature, for which he was been often criticized by authors of a self-styled “metaphysical” inclination. The purpose of this note is to argue, pace these objections, that closely analogous considerations have long been part of the practice of investigating differential equation models in a sensible way. (shrink)

The objective of the present text is to develop a reflection about the value of human life in today’s society bringing into focus the contrasting perspectives of the ordinary and the extraordinary of life. For that purpose, we emphasize the conception of the Catholic Church from the Second Vatican Council that suggests an attitude of a Pilgrim Church which longs for dialogue with human beings in their ordinary life (we intend to rescue the positive sense of the term "ordinary"), in (...) disadvantage of the triumphalist vision which gives priority to the great deeds of history. In that sense, we establish a dialogue with the literal work Crime and Punishment (1866) by Fyodor Dostoyevsky whose protagonist Raskolnikov reveals himself through the contemporary dilemma between being and not being extraordinary in the eyes of the society. His moral conscience is tested after a crime he committed. The apex of this revelation takes place after the reading of the Gospel relating to the resurrection of Lazarus shared with Sonia, a flagrant sinner, an ordinary in the eyes of the society represented in the work. In fact, how it happens in the painful passage of Raskolnikov, God makes himself known through the other in borderline situations and we take him into account through the experience which a man of faith realizes when discovering Him to be present. The presence of God in the world is surely not to be understood in the sphere of the extraordinary, what matters is the experience of refuge when we are seduced by the faith. (shrink)

Historian James H. Jones published the first edition of Bad Blood, the definitive history of the Tuskegee Syphilis Experiment, in 1981. Its clear-eyed examination of that research and its implications remains a bioethics classic, and the 30-year anniversary of its publication served as the impetus for the reexamination of research ethics that this symposium presents. Recent revelations about the United States Public Health Service study that infected mental patients and prisoners in Guatemala with syphilis in the late 1940s (...) in order to determine the efficacy of treatment represent only one of the many attestations to the persistence of ongoing, critical, and underaddressed issues in research ethics that Bad Blood first explored. Those issues include, but are not limited to: the complex and contested matters of the value of a given research question, the validity of the clinical trial designed to address it, and the priorities of science. (shrink)

The research project described in this report represents one of the most extensive studies of character education ever undertaken, including over 10,000 students and 255 teachers in schools across England, Scotland, Northern Ireland and Wales. Research techniques consisted of a mixture of surveys, moral dilemmas and semi-structured interviews. This report explores: - The current situation in character education, both in the UK and internationally - How developed British students are with respect to moral character and the extent to which they (...) are able to understand and apply moral virtues, especially those aged 14 and 15 - How teachers in the UK understand their role in terms of students’ moral and character development - What helps or hinders the development of children’s characters according to teachers in UK schools. (shrink)

Thomas Jefferson and Philosophy: Essays on the Philosophical Cast of Jefferson’s Writings is a collection of essays on topics that relate to philosophical aspects of Jefferson’s thinking over the years. Much historical insight is given to ground the various philosophical strands in Jefferson’s thought and writing on topics such as political philosophy, moral philosophy, slavery, republicanism, wall of separation, liberty, educational philosophy, and architecture.

Democracy establishes relationships of political equality, ones in which citizens equally share authority over what they do together and respect one another as equals. But in today's divided public square, democracy is challenged by political thinkers who disagree about how democratic institutions should be organized, and by antidemocratic politicians who exploit uncertainties about what democracy requires and why it matters. Democratic Equality mounts a bold and persuasive defense of democracy as a way of making collective decisions, showing how equality of (...) authority is essential to relating equally as citizens. James Lindley Wilson explains why the US Senate and Electoral College are urgently in need of reform, why proportional representation is not a universal requirement of democracy, how to identify racial vote dilution and gerrymandering in electoral districting, how to respond to threats to democracy posed by wealth inequality, and how judicial review could be more compatible with the democratic ideal. What emerges is an emphatic call to action to reinvigorate our ailing democracies, and a road map for widespread institutional reform. Democratic Equality highlights the importance of diverse forms of authority in democratic deliberation and electoral and representative processes—and demonstrates how that authority rests equally with each citizen in a democracy. (shrink)

The idea that there is something ethically corrupt or ethically corrupting about Nietzsche’s work is an anathema to Nietzsche scholars today. Although there are some serious moral philosophers, such as Philippa Foot, Jonathan Glover and Martha Nussbaum who write about Nietzsche whilst finding his position ethically deplorable, most Nietzsche scholars tend to focus rather more heavily on his positive aspects. This means that negative ethical assessments of Nietzsche now tend to be relatively few and far between, and given that they (...) tend to be composed by people who know the texts less well than the dedicated Nietzsche scholars, these criticisms can usually be swatted away quite easily. There are two halves to this paper. The first half sets up the problem for the Nietzsche interpreter: the moral equality of human beings is the basic idea through which we (now) think about morality; and Nietzsche’s views on the nature of human ethical life commit him to opposing the moral equality of human beings. The second half of the paper examines Nietzsche’s critique of moral egalitarianism in more detail. Nietzsche’s critique, I suggest, is composed of two parts: a negative and a positive. The negative part (the slave morality thesis) argues that (a) we should make a distinction between moralities of affirmation and moralities of denial; and (b) all moralities which have the equality of human beings as their fundamental value are moralities of denial. The positive part, which, following Nietzsche, I shall call the pathos of distance thesis claims that human greatness requires a feeling of great height from which the great person looks down in lofty contempt on others. I shall argue that it is false to claim that all moralities which have the equality of human beings as their fundamental value are moralities of denial, and that the pathos of distance thesis is either false or question begging or both. Hence there is no reason, even being as generous to Nietzsche as we can be, to think his critique should force us to give up moral egalitarianism. However, even if not all egalitarian moralities are moralities of denial, it is certainly true that some are, which leaves us with a very difficult question: how do we ensure that our belief in the moral equality of human beings forms part of a morality of affirmation rather than one of denial? (shrink)

Examines the perennial issues that keep science and religion at arm's length, clarifies those issues, and fits them into an historical framework—from Plato, to Aquinas, to today's thinkers.

Ours is an age full of desires but impoverished in its understanding of where those desires lead—an age that claims mastery over the world but also claims to find the world as a whole absurd or unintelligible. In The Vision of the Soul, James Matthew Wilson seeks to conserve the great insights of the western tradition by giving us a new account of them responsive to modern discontents. The western— or Christian Platonist—tradition, he argues, tells us that man (...) is an intellectual animal, born to pursue the good, to know the true, and to contemplate all things in beauty. Wilson begins by reconceiving the intellectual conservatism born of Edmund Burke’s jeremiad against the French Revolution as an effort to preserve the West’s vision of man and the cosmos as ordered by and to beauty. After defining the achievement of that vision and its tradition, Wilson offers an extended study of the nature of beauty and the role of the fine arts in shaping a culture but above all in opening the human intellect to the perception of the form of reality. Through close studies of Theodor W. Adorno and Jacques Maritain, he recovers the classical vision of beauty as a revelation of truth and being. Finally, he revisits the ancient distinction between reason and story-telling, between mythos and logos, in order to rejoin the two. Story-telling is foundational to the forms of the fine arts, but it is no less foundational to human reason. Human life in turn constitutes a specific kind of form—a story form. The ancient conception of human life as a pilgrimage to beauty itself is one that we can fully embrace only if we see the essential correlation between reason and story and the essential convertibility of truth, goodness and beauty in beauty. By turns a study in fundamental ontology, aesthetics, and political philosophy, Wilson’s book invites its readers to a renewal of the West’s intellectual tradition. (shrink)

Religion has been responsible for both horrific acts against humanity and some of humanity's most sublime teachings and experiences. How is this possible? From a contemporary psychoanalytic perspective, this book seeks to answer that question in terms of psychology dynamic of realism. At the heart of living religion is the idealization of everyday objects. Such idealizations provide much of the transforming power of religious experience, which is one of the positive contributions of religion to psychological life. However, idealization can also (...) lead to religious fanaticism, which can be very destructive. Drawing on the work of various contemporary relational theorists within psychoanalysis, this book develops a psychoanalytically informed theory of the transforming terror-producing effects of religious experience. It discusses the question of whether or not, if idealism is the cause of many of the destructive acts done in the name of religion, there can be vital religion without idealism. Thisis the first book to address the nature of religion and its capacity to sponsor both terrorism and transformation in terms of contemporary relational psychoanalytic theory. It will be invaluable to students and practitioners of psychoanalysis, psychotherapy, psychology and religious studies. (shrink)

Since the 1960s we have moved rapidly from a “doctor-knows-best” society which in which medical paternalism -- such as withholding information from patients “for their benefit” -- was common, towards a society which celebrates patients’ rights to make informed decisions about their care. In Choosing Life, Choosing Death, Charles Foster mounts a polemic against the current enthusiasm for respect for autonomy in medical ethics and law.

The pandemic significantly raised the stakes for the translation of bioethics insights into policy. The novelty, range and sheer quantity of the ethical problems that needed to be addressed urgently within public policy were unprecedented and required high‐bandwidth two‐way transfer of insights between academic bioethics and policy. Countries such as the United Kingdom, which do not have a National Ethics Committee, faced particular challenges in how to facilitate this. This paper takes as a case study the brief career of the (...) Ethics Advisory Board (EAB) for the NHS Covid‐19 App, which shows both the difficulty and the political complexity of policy‐relevant bioethics in a pandemic and how this was exacerbated by the transience and informality of the structures through which ethics advice was delivered. It analyses how and why, after EAB's demise, the Westminster government increasingly sought to either take its ethics advice in private or to evade ethical scrutiny of its policies altogether. In reflecting on EAB, and these later ethics advice contexts, the article provides a novel framework for analysing ethics advice within democracies, defining four idealised stances: the pure ethicist, the advocate, the ethics arbiter and the critical friend. (shrink)

This collection of essays focuses on the concepts of tolerance and intolerance as it commemorates the life of James Parkes - the man who pioneered the study of antisemitism and Jewish-non-Jewish relations. The essays analyse many different examples of antisemitism, ambivalence and philosemitism.

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. Ethics of service (...) provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

In preparing for a lecture on the ethics of surgical complications, it became apparent that confusion exists about the definition of a ‘‘surgical complication.’’ Is it, as one medical website states, ‘‘any undesirable result of surgery?’’ [1]. In the European Journal of Surgery, Veen et al. [2] provide a more elaborate definition: ‘‘every unwanted development in the illness of the patient or in the treatment of the patient’s illness that occurs in the clinic’’ [2]. An esteemed historian of science suggests (...) yet another definition in a recent volume on surgical complications: ‘‘a complication, in any sphere of endeavour, is something out of the norm, and the product of extraneous and unexpected factors’’ [3]. Such is the discrepancy in definitions that Rampersaud et al. [4] declared in 2006 that ‘‘presently, there is no clear or consistent definition of a complication in the surgical literature.’’ Much research in surgery aims to reduce the risk of surgical complications. However, until we have a stable and agreed definition of what counts as a surgical complication, we cannot reliably compare different studies to discover what best reduces the chance of surgical complications [5]. Therefore, the topic is more than mere pedantry; defining surgical complications will help us with the broader question of how to improve surgical practice. A basic PubMed search returned nearly 800 articles with the phrases ‘‘surgical complications’’ or ‘‘surgical complication’’ in the title. But unlike the sources above. (shrink)

This article explores the use of walking interviews as a research method. In spite of a wave of interest in methods which take interviewing out of the "safe," stationary environment, there has been limited work critically examining the techniques for undertaking such work. Curiously for a method which takes an explicitly spatial approach, few projects have attempted to rigorously connect what participants say with where they say it. The article reviews three case studies where the authors have used different techniques, (...) including GPS, for locating the interview in space. The article concludes by arguing that researchers considering using walking interviews need to think carefully about what kinds of data they wish to generate when deciding which approach to adopt. (shrink)

Virtue and the Moral Life brings together distinguished philosophers and theologians with younger scholars of consummate promise to produce ten essays that engage both academics and students of ethics. This collection explores the role virtues play in identifying the good life and the good society.

Fair allocation of scarce healthcare resources has been much studied within philosophy and bioethics, but analysis has focused on a narrow range of cases. The Covid-19 pandemic provided significant new challenges, making powerfully visible the extent to which health systems can be fragile, and how scarcities within crucial elements of interlinked care pathways can lead to cascading failures. Health system resilience, while previously a key topic in global health, can now be seen to be a vital concern in high-income countries (...) too. Unfortunately, mainstream philosophical approaches to the ethics of rationing and prioritisation provide little guidance for these new problems of scarcity. Indeed, the cascading failures were arguably exacerbated by earlier attempts to make health systems leaner and more efficient. This paper argues that health systems should move from simple and atomistic approaches to measuring effectiveness to approaches that are holistic both in focusing on performance at the level of the health system as a whole, and also in incorporating a wider range of ethical concerns in thinking about what makes a health system good. (shrink)

When we talk about intellectual property, it is often implicitly assumed that we are talking about private intellectual property. However, private property and the idea of private ownership do not exhaust the possibilities for accounts of ownership and of property. There are other ways that ownership can operate, such as common property. A resource is common property if its use is ‘governed by rules whose point is to make them available for use by all or any members of the society.’.

Book reviewed in this article: On Human Nature. By Edward O. Wilson.

We are all familiar with assertions of rights: we talk of the right to confi dentiality, the right to health care and, more controversially, the right to die. But beneath this surface familiarity lies a heap of diffi culties about what it is to have a right, how we should go about determining which assertions of rights are genuine and what role (if any) rights should play in our broader moral thinking. This chapter aims to offer a guide through these (...) perplexities. (shrink)