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.

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)

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)

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)

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)

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)

Research involving human subjects is much more stringently regulated than many other nonresearch activities that appear to be at least as risky. A number of prominent figures now argue that research is overregulated. We argue that the reasons typically offered to justify the present system of research regulation fail to show that research should be subject to more stringent regulation than other equally risky activities. However, there are three often overlooked reasons for thinking that research should be treated as a (...) special case. First, research typically involves the imposition of risk on people who do not benefit from this risk imposition. Second, research depends on public trust. Third, the complexity of the moral decision making required favors ethics committees as a regulative solution for research. (shrink)

Philosophy & Public Affairs, Volume 50, Issue 2, Page 169-201, Spring 2022.

Geographic definitions of constituency—the set of voters eligible to vote for a representative—have been criticized by theorists and reformers as undermining democratic values. I argue, in response, that there is no categorical (or even generally applicable) reason sounding in political equality to reject geographic districts. Geographic districting systems are typically flexible enough that, when properly designed, and matched with an appropriate electoral system, they can satisfy the requirements of political equality. More generally, I argue that it is a mistake to (...) evaluate the egalitarian character of constituency definitions in isolation from the political decision-making process as a whole. While it is conceptually important that we can detach constituency definition from other features of electoral systems, when it comes to normative and evaluative judgment, we ought to judge holistically. When we do so, we will rarely find general reasons to prefer one type of constituency definition to another. Geographic districts may offer benefits of logistical convenience and information circulation, even given the existence of advanced information technology. The best reason to reject geographic districts is their liability to anti-democratic abuse. Their defensibility in any given polity thus depends on how feasible it is to protect against such abuses while retaining a geographic districting system. (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)

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.

The infant mortality rate in Liberia is 50 times higher than it is in Sweden, whilst a child born in Japan has a life expectancy at birth of more than double that of one born in Zambia. 1 And within countries, we see differences which are nearly as great. For example, if you were in the USA and travelled the short journey from the poorer parts of Washington to Montgomery County Maryland, you would find that ‘for each mile travelled life (...) expectancy rises about a year and a half. There is a twenty-year gap between poor blacks at one end of the journey and rich whites at the other’. (Marmot, 2004, p.2). There are two types of questions which it is important to ask about inequalities in health such as these. The first are social scientific questions about the extent of inequalities in health and the factors which are causally responsible for these inequalities. Examples of social scientific questions to ask might be: how do infant mortality rates in the UK differ according to social class? What is the difference in life expectancy between Japanese who emigrate to the US and those who remain in Japan? Why do civil servants in higher ranked jobs tend to live longer than civil servants in lower ranked jobs? The second type are normative questions about the reasons we have to care about inequalities in health. Important normative questions to answer are: which inequalities in health should we care about (all inequalities or merely some of them)? When is an inequality in health unjust? How should we weigh our concern for equality in health against other factors such as maximising the.. (shrink)

Intellectual property typically involves claims of ownership of types, rather than particulars. In this article I argue that this difference in ontology makes an important moral difference. In particular I argue that there cannot be an intrinsic moral right to own intellectual property. I begin by establishing a necessary condition for the justification of intrinsic moral rights claims, which I call the Rights Justification Principle. Briefly, this holds that if we want to claim that there is an intrinsic moral right (...) to φ, we must be able to show that (a) violating this right would typically result in either a wrongful harm or other significant wrong to the holder of the right, and (b) the wrongful harm or other wrong in question is independent of the existence of the intrinsic right we are trying to justify. I then argue that merely creating a new instance of a type is not the kind of action which can wrongfully harm the creator of that type. Insofar as there do seem to be wrongs involved in copying a published poem or computer program, these wrongs presuppose the existence of an intrinsic right to own intellectual property, and so cannot be used to justify it. I conclude that there cannot be an intrinsic right to own intellectual property. (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.

This comment encourages normative democratic theorists to attend to the agenda for democratic theory that Steffen Ganghof sets in Beyond Parliamentarism and Presidentialism. I discuss Ganghof’s distinction between ‘procedural’ and ‘process’ equality. I conclude with a meta-theoretical question about how theorists should think about advocacy for large-scale constitutional systems.

This paper reflects on the relationship between theory and practice in bioethics, by using various concepts drawn from debates on innovation in healthcare research—in particular debates around how best to connect up blue skies ‘basic’ research with practical innovations that can improve human lives. It argues that it is a mistake to assume that the most difficult and important questions in bioethics are the most abstract ones, and also a mistake to assume that getting clear about abstract cases will automatically (...) be of much help in getting clear about more complex cases. It replaces this implicitly linear model with a more complex one that draws on the idea of translational research in healthcare. On the translational model, there is a continuum of cases from the most simple and abstract to the most concrete and complex. Insights need to travel in both directions along this continuum—from the more abstract to the more concrete and from the more concrete to the more abstract. The paper maps out some difficulties in moving from simpler to more complex cases, and in doing so makes recommendations about the future of bioethics. (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)

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)

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)

Although Leibniz characterised himself in the “New Essays” as a “Platonic” as opposed to a “Democritean” philosopher, his intellectual relationship with the most famous of the Renaissance Neoplatonists, Marsilio Ficino, has received little attention. Here we review what can be thus far established regarding Leibniz’s acquaintance with portions of Ficino’s Opera omnia of 1576. We compare Ficino’s disenchantment with the atomistic materialism of Lucretius, which he had favoured in his youth, and his turn to Platonism for inspiration, with Leibniz’s own (...) reported disenchantment with Gassendi’s Epicurean atomism and his invention of a vitalistic monadology that, despite Leibniz’s reservations regarding Ficinian magic, resembles Ficinian nature philosophy in number of striking respects. (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)

Three main claims are made in this paper. First, it is argued that Onora O’Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O’Neill convincingly argues that we should abandon both these thoughts. Second, it is argued that (...) O’Neill’s proposed solution to this problem is inadequate. O’Neill’s approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O’Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. Respect for autonomy is in trouble. In recent work in this journal1 and elsewhere,2 O’Neill has forcefully argued that respect for autonomy, as it has come to be used in medical ethics, is philosophically indefensible. If her arguments are sound, then, contrary to the standard view, respect for autonomy cannot be the source of the ethical requirement to seek informed consent before treating a patient or enrolling a participant in a trial. So her critique goes to the heart of contemporary medical ethics: if O’Neill is right, medical ethicists have systematically misunderstood two of the most fundamental concepts they deal with—respect for autonomy and informed consent. This paper has four sections. Section 1 distinguishes between three different ways of talking about respect for autonomy, and looks in more detail at the one that has come to be central to bioethical writing on informed consent—namely, the idea that we should respect autonomous choices. Section 2 argues, following O’Neill, that it is implausible to think that the purpose of informed consent requirements is to respect autonomous choices. Section 3 argues that O’Neill’s proposed reworking of autonomy and informed consent is inadequate. O’Neill’s approach requires us to adopt a more modest view of the purpose of informed consent procedures. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. I argue that contrary to what O’Neill claims, we cannot derive the wrongness of coercion from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Section 4 argues that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. (shrink)

In this essay, I make the interpretive claim that we cannot properly understand the Federalist without appreciating the extent to which the papers mount a sustained rejection of extra-constitutional democracy—practices in which people aim to assert authority over the terms of common life in ways that are not sanctioned by existing laws. I survey such practices, which were common in America before and after the Revolution. I argue that there is continuity between Publius’s justification for rejecting extra-constitutional democracy and his (...) justification for his preferred system against constitutional alternatives. Adequate analysis and evaluation of the Federalist’s arguments about faction, representation, and institutional design require attention to the double duty the arguments play against constitutional and extra-constitutional opposition. This interpretive argument supports several analytic and evaluative conclusions. First, we must distinguish a new form of “non-hierarchical dualist” constitutionalism, according to which irregular democratic activity need not be limited to extraordinary “constitutional moments” or revolutions. Second, the politically egalitarian character of procedures depends not on the procedures alone, but how the maintenance of such procedures limits other forms of democratic practice. Third, the argument suggests a novel defense of “uncivil” disobedient politics: one grounded not in contributions to democratic deliberation, but in the entitlements of citizens to direct assertions of authority over common life. (shrink)

There is a need to better understand how individuals in different religious groups construct and maintain their worldviews. This study explores how religious practices, beliefs, and relationships create and sustain the worldviews of five British Muslims. Semi-structured interviews were inductively analyzed using interpretative phenomenological analysis (IPA) to idiographically explore the participants’ lived experiences. This analysis developed multiple subordinate themes that formed two superordinate themes: “Submitting to Allah” and “Being a British Muslim.” The participants’ experiences of being raised in Muslim families (...) strongly shaped their beliefs and they each strongly identify themselves as both Muslim and British. These important relationships taught them to follow the teachings of the Qur’an and to live their lives in submission to God. The analysis suggests the belief that the Qur’an is the authoritative and enduring revelation of God to mankind provided the core of their worldview and that this belief had far-reaching implications for every aspect of their lives. Their social relationships and religious practices both continually affirmed this fundamental belief in their sacred text and created a social reality in which the participants experienced God and submitted to the will of Allah. The combination of many different religious practices, social relationships, and personal experiences imbued the Qur’an with the power and authority to shape the participants’ lives and sustained their religious community. The participants’ intratextually fundamentalist approach to the Qur’an helped them create coherent worldviews that were filled with meaning and purpose. (shrink)

This article introduces a symposium on Daniel Hausman’s Valuing Health: Well-Being, Suffering and Freedom. The symposium contains papers by Elselijn Kingma, Adam Oliver, Anna Alexandrova, Erik Nord, Alex Voorhoeve and James Wilson, with replies by Daniel Hausman. In Valuing Health, Hausman argues that, despite apparently measuring health, projects such as the Global Burden of Disease Study in fact measure judgments about the value of health. Once this has been clarified, the key question is how the value of health (...) should be measured. Hausman argues that existing instruments measure the private value of health, that is, health’s ‘contribution to whatever the individual cares about or should care about’, whereas what should be measured for resource allocation purposes is the public value of health, that is, the value health should be accorded from the perspective of the liberal state. Hausman argues that the public value of health should be measured by the extent to which suffering and activity limitations are relieved. Each commentator engages with a different aspect of Hausman’s argument. (shrink)