On 24 July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion. Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. Life support was subsequently withdrawn and Charlie died on 28 July 2017.Box 1 ### Case summary and timeline21–23 Charlie Gard was born at full term, apparently healthy, in August 2016. At a few weeks of age his parents (...) noticed early signs of muscle weakness. At 2 months of age, he was admitted to Great Ormond Street Hospital with poor feeding, failure to thrive and respiratory failure. He was admitted to intensive care, where investigations led to the diagnosis of a rare severe mitochondrial disorder – infantile onset encephalomyopathic mitochondrial DNA depletion syndrome. The specific genetic form of MDDS in Charlie Gard had previously been reported in approximately 15 infants, with typical clinical features including early onset, rapid progression and death in infancy.24 By that point, Charlie was paralysed and unable to breathe without respiratory support. He was found to have congenital deafness, and his heart, liver and kidneys were affected by the disorder. Doctors felt that Charlie’s prognosis was extremely poor. In early 2017, Charlie’s parents identified an experimental treatment, previously used in a different form of MDDS, which they hoped might benefit Charlie. In mouse models of a myopathic form of MDDS, early supplementation with deoxypryrimidine nucleosides apparently bypasses the genetic defect and leads to a reduction in the biochemical defect and in the severity of the clinical phenotype.25 26 Doctors at GOSH initially planned to use nucleoside treatment in Charlie, but in January he developed evidence of electrical seizures, and clinicians became convinced that treatment, both continued intensive care and the requested …. (shrink)

We have a reason to use information which is available about such genes in our reproductive decision-making; (3) couples should selec.

Autonomy is a vital principle in medical law and ethics. It occupies a prominent place in all medico-legal and ethical debate. But there is a dangerous presumption that it should have the only vote, or at least the casting vote. This book is an assault on that presumption, and an audit of autonomy's extraordinary status. This book surveys the main issues in medical law, noting in relation to each issue the power wielded by autonomy, asking whether that power can be (...) justified, and suggesting how other principles can and should contribute to the law. It concludes that autonomy's status cannot be intellectually or ethically justified, and that positive discrimination in favour of the other balancing principles is urgently needed in order to avoid some sinister results. 'This book is a sustained attack on the hegemony of the idea of autonomy in medical ethics and law. Charles Foster is no respecter of authority, whether of university professors or of law Lords. He grabs his readers by their lapels and shakes sense into them through a combination of no-nonsense rhetoric and subtle argument that is difficult to resist.' Tony Hope, Professor of Medical Ethics, Oxford University 'This book is unlikely to be in pristine state by the time you have finished reading it. Whether that is because you have thrown it in the air in celebration or thrown it across the room in frustration will depend on your perspective. But this book cannot leave you cold. It is a powerful polemic on the dominance of autonomy in medical law, which demands a reaction. Charles Foster sets out a powerful case that academic medical lawyers have elevated autonomy to a status it does not deserve in either ethical or legal terms. In a highly engaging, accessible account, he challenges many of the views which have become orthodox within the academic community. This will be a book which demands and will attract considerable debate.' Jonathan Herring, Exeter College, Oxford University 'This is a learned, lively and thought-provoking discussion of problems central to the courts' approach to ethical issues in medical law. What principles are involved? More significantly, which really underlie and inform the process of seeking justice in difficult cases? Charles Foster persuasively argues, and demonstrates, that respect for autonomy is but one of a number of ethical principles which interact and may conflict. He also addresses the sensitive issue of the extent to which thoughts and factors which go to influence legal decisions may not appear in the judgments.' Adrian Whitfield QC. 'Introducing the Jake La Motta of medical ethics. Foster is an academic street-fighter who has bloodied his hands in the court room. He provides a stinging, relentless, ground attack on the Goliath of medical ethics: the central place of autonomy in liberal medical ethics. This is now the first port of call for those who feel that medical ethics has become autonomized.' Julian Savulescu, Uehiro Chair in Practical Ethics, University of Oxford. "This important book offers a robust challenge to anyone, whether lawyer or 'ethicist', who sees respect for autonomy as the only game in town. It argues eloquently and effectively that, on the one hand, despite the reverence paid to it by judges, in practice the law, even in the context of consent, weaves together a number of moral threads of which autonomy is merely one, in the pursuit of a good decision. It argues on the other hand, that were the day-to-day practice of law to be guided primarily by respect for autonomy, this would be wrong. Foster concludes that whilst, 'any society that does not have laws robustly protecting autonomy is an unsafe and unhappy one', so too would be a society in which too much emphasis was placed on respect for autonomy at the expense of other important moral principles. This is essential reading for anyone interested in the role of autonomy and indeed of medical ethics, in the law." Michael Parker, Professor of Bioethics, University of Oxford. (shrink)

Principles of distributive justice are normative principles designed to guide the allocation of the benefits and burdens of economic activity.

This impressive volume of essays that includes contributions from Herbert Dreyfus, Sean Kelly, Mike Wheeler, Dan Zahavi, and Shaun Gallagher reflects an emerging trend in cognitive science, and explores this new approach to cognitive science informed by Heidegger's thoughts on human existence.

Economic environmental valuation remains a much debated and contested issue. Concerns have been voiced that it is unable to capture the manifold immaterial values of ecosystems due to conceptual and methodological issues. Thus, additional value categories (social values) as well as novel valuation approaches like deliberative (monetary) valuation are areas of growing interest, yet the theoretical foundations are rather weak. Against this background, this article aims to develop a consistent conceptual framework for making sense of social values in economic environmental (...) valuation. Based on a holistic view of society and individuals, the role of institutions, the social environment, culture and transcendental values is emphasised. To synthesise diverging concepts of value into an economic concept and to account for the multidimensionality of social values, the framework consists of three spheres: social, natural and contextual. The novel framework demonstrates that social values may be integrated into a preference-based utility framework when denoting a holistic understanding of social preferences and human embeddedness in nature and society. (shrink)

We develop and test a model of pseudo-transformational leadership. Pseudo-transformational leadership is manifested by a particular combination of transformational leadership behaviors, and is differentiated from both transformational leadership and laissez-faire -leadership. Survey data from senior managers show differential outcomes of transformational, pseudo-transformational, and laissez-faire leadership. Possible extensions of the theoretical model and directions for future research are offered.

Drawing on a wide range of Kant's recorded thought beyond his Groundwork for the Metaphysics of Morals, this essay presents an overview of Kant's account of practical agency as embodied practical agency and argues against the intellectualized interpretations of Kant's account of practical agency presented by Christine Korsgaard and Henry Sidgwick. In both Kant's empirical-psychological and metaphysical descriptions of practical agency, he presents a recognizably human practical agent that is broader and deeper than the faculty of reason alone. This agent (...) chooses action from a reflective distance, but not from the complete affective distance of reason. We choose neither as reason alone, nor even as the sum of all of our ‘higher’ faculties, of cognition (including reason), feeling, and desire, in Kant's view. Instead, we choose as an agent that also has ‘lower’, ‘sensible’ faculties, of cognition (including sense), feeling, and desire, which together comprise our ‘sensibility’. These mental states of sensibility are not merely confused versions of our higher cognitions, feelings, or desires, and so different from them in degree only, but are instead distinct from our higher states in kind also; and these distinct sensible states are not dependent on our higher states and so on a commitment to the value of humanity, for example. For this reason, a choice in favour of sensible states and in opposition to the moral law need in no way undermine its own foundations and thus be incoherent, as Korsgaard and Sidgwick argue, but instead only immoral. Because Kant does not reduce the problem of immoral choice to one of insufficient reflection and ensuing confusion, he does not view moral progress in cognitive terms alone, whether in the form of a clearer understanding of the moral law, improved judgment in applying it, or deeper insight into our own nature as practical agents. Kant instead recognizes the crucial importance of cultivating our feelings and desires over the course of a lifetime both as a way to make ourselves worthy of the humanity within us directly and also as a way to facilitate future moral choices. (shrink)

Simplifying somewhat, sonicists believe that works of music are individuated purely in terms of how they sound. For them, exact sound-alikes are identical. Stephen Davies, in his ‘Musical Works and Orchestral Colour’ ( BJA 48 (2008), pp. 363–375) took me to task for defending a version of sonicism. In this paper I seek to explain why Davies's objections miss their mark. In the course of the discussion, I make some methodological remarks about the ontology of music.

Un conocimiento profundo de la historia y la experiencia de una vida bastante larga han llevado al autor a revisar lo que ha sido la obra y a meditar sobre el estado actual de una de las dimensiones decisivas de la vida humana, uno de los núcleos en torno a los cuales se organiza la vida, y precisamente en sus estratos más profundos, donde se encuentran las raíces de casi todos los demás. Las deficiencias en este aspecto contrastan con el (...) nivel de otros aspectos de nuestro tiempo, en el que se ha llegado a matices de una finura e intensidad que nunca habían sido posibles. Al estudiar esta faceta de la vida humana se comprende la historia de una manera inesperada, y a la vez se siente temor por las posibilidades que se pueden perder. El peligro está en que se pueda decir, con Antonio Machado: "tengo en moneda de cobre el oro de ayer cambiado". Pero siempre se puede hacer la operación inversa y trocar el cobre por una resplandeciente moneda de oro. En esto consiste la educación sentimental. (shrink)

Two topics figure prominently in recent discussions of mathematical structuralism: challenges to the purported metaphysical insight provided by sui generis structuralism and the significance of category theory for understanding and articulating mathematical structuralism. This article presents an overview of central themes related to these topics.

Pasiones del alma y sentimientos, el sentido íntimo y la condición carnal, la intrahistoria, las relaciones entre dependencia y dominio, la maternidad, la belleza, los deseos y pretensiones, la amistad, la interpretación de la mujer por la palabra, la amistad y el amor entre hombre y mujer, la sombra que afecta a la imagen de la mujer, ese 'continente misterioso', son algunos de los aspectos investigados en La mujer y su sombra.

This paper is a response to John Harris’ provocative ‘Justice and Equal Opportunities in Health Care’. The aim of this short response is to locate the difference between Harris and me within a broader debate about the nature of reasons for action. I argue that Harris is appealing to a desire‐based conception of normative reasons. I highlight some of the deficiencies of a desire‐based conception of reasons, and contrast it with a value‐based account.

En el artículo se analizan los pasajes más relevantes donde Wittgenstein emplea la expresión‘forma de vida’, estableciendo conexiones entre sus diferentes sentidos. Acontinuación se exponen dos interpretaciones de esta noción –la orgánica y la cultural–, quealgunos autores consideran excluyentes entre sí, y se discute críticamente la unilateralidadde ambas interpretaciones y su status teórico. Finalmente, se propone una interpretaciónque permite compatibilizar trascendentalismo y naturalismo, habida cuenta de la funciónmetodológica que Wittgenstein atribuyó a la noción de ‘forma de vida’ en su análisisconceptual (...) de las condiciones de la comprensión del lenguaje. (shrink)

El objetivo principal del artículo es mostrar que, en aspectos significativos, la obra artística de Franz Kafka, Samuel Beckett y Francis Bacon se hace cargo de ciertas aporías de la subjetividad moderna y puede entenderse como una respuesta crítica a las mismas dentro del horizonte de la modernidad. La especificidad de este arte crítico se analiza a través de una red de conexiones: en primer lugar, trazando contrastes entre la lógica de la acción presente en la tragedia moderna, y la (...) lógica del acontecimiento propia de la epopeya griega arcaica y la tragedia antigua; luego, estableciendo diferencias entre el sujeto de la tragedia moderna y el del arte crítico del siglo XX; y, por último, mostrando la existencia en éste de tensiones entre la lógica de la acción y la lógica del acontecimiento. (shrink)

La lectura que ha recibido Spinoza ha variado de acuerdo con la época y los intereses propios de sus intérpretes. Algunas lecturas, como las de sus contemporáneos, han encontrado en él una fuente de ateísmo radical, mientras el romanticismo lo llamará “el ebrio de Dios”. Estas interpretaciones también permiten hacer juicios sobre las religiones reveladas, es decir, sobre aquellas religiones positivas tales como el cristianismo, el judaísmo o el islam. Una lectura clásica de Spinoza ha denigrado totalmente la religión. En (...) este artículo, sin embargo, propongo mostrar que aquella interpretación es errada, pues Spinoza entiende la religión como una visión de mundo imaginativa que permite, por medio de los afectos, la tradición y la obediencia, la cohesión de la comunidad. La teología, distinta de la religión, será el verdadero adversario de Spinoza. Para cumplir con lo planteado, se analizarán las dos figuras que expresan cada campo social: el profeta y el teólogo. La hipótesis es que el profeta expresa una relación de inmanencia frente a su comunidad, mientras el teólogo se establece sobre la base de una representación trascendente, ejecutando un dominio político de servidumbre y superstición sobre sus fieles. (shrink)