This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it from three different kinds of hope, or ‘hopes for’, and then relate (...) these distinctions back to differing accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make. (shrink)

The concept of need is often proposed as providing an additional or alternative criterion to cost-effectiveness in making allocation decisions in health care. If it is to be of practical value it must be sufficiently precisely characterized to be useful to decision makers. This will require both an account of how degree of need for an intervention is to be determined and a prioritization rule that clarifies how degree of need and the cost of the intervention interact in determining the (...) relative priority of the intervention. Three common features of health care interventions must be accommodated in a comprehensive theory of need: the probabilistic nature of prognosis (with and without the intervention); the time course of effects; and the fact that the most effective treatments often combine more than one intervention. These common features are problematic for the concept of need. We outline various approaches to prioritization on the basis of need and argue that some approaches are more promising than others. (shrink)

Les inscriptions en linéaire Β des nodules de Thèbes (1982) : la fouille, les documents, les possibilités d'interprétation. P. 103-184 Les inscriptions en linéaire Β portées par les 56 nodules en argile — lesquels présentent également une empreinte de sceau — qui ont été trouvés en 1982 à Thèbes avaient déjà été glosées ici ou là mais jamais véritablement éditées. On trouvera ici photographie, dessin et transcription des faces portant les groupes de signes, le tout accompagné d'un apparat critique et (...) d'index. L'édition est précédée d'une introduction archéologique et suivie de commentaires épigraphiques, paléographiques et philologiques. Enfin, l'on s'interrogera sur l'interprétation qu'il convient de donner de ce groupe homogène de documents, lesquels avaient été réunis dans un but bien précis : la solution est sans doute fournie par une tablette en linéaire Β de Pylos qui présente des similitudes chiffrées étonnantes avec notre ensemble de nodules inscrits. (shrink)

The intent of this book focuses on Australia’s First Nations truth, voice, recognition, diversity, and respect. Hope O’Chin explains that knowledge about Australian First Nations culture and learning can be seen through new conceptual lens, which she refers to as an Ontology of Dreaming Hope for Australians. The book proposes to move from ontological propositions embedded in pedagogies and methodologies that center on the relevance of Indigenous epistemes and ways of doing. O’Chin offers a conceptual framing for engaging (...) with Indigenous peoples, and forming communities of belongingness and relationality. She offers suggestions for ways in which art and education can act as ‘healing’ and a way forward towards a more inclusive civil society. Reflexive practice, ethnographic principles, and action research is described in a way that methodologies provide an understanding of a sense of Belonging. O'Chin argues that theoretical research, art, and educational practice can add to the value of determining a strategy of Indigenous art investment within Australia, and to address how art and education can be used to validate contemporary expression of Aboriginality within contemporary Australian society. Ultimately, the book is about Indigenous strengths and what Indigenous ways of being, knowing and doing can offer, and how one might go about honouring and working in this way respectfully. (shrink)

The non-identity problem arises when an intervention or behavior changes the identity of those affected. Delaying pregnancy is an example of such a behavior. The problem is whether and in what ways such changes in identity affect moral considerations. While a great deal has been written about the non-identity problem, relatively little has been written about the implications for physicians and how they should understand their duties. We argue that the non-identity problem can make a crucial moral difference in some (...) circumstances, and that it has some interesting implications for when it is or is not right for a physician to refuse to accede to a patient's request. If a physician is asked to provide an intervention (identity preserving) that makes a person worse off, then such harm provides a good reason for the physician to refuse to provide the intervention. However, in cases where different (identity-altering) interventions result in different people having a better or worse life, physicians should normally respect patient choice. (shrink)

Health care systems across the world are unable to afford the best treatment for all patients in all situations. Choices have to be made. One key ethical issue that arises for health authorities is whether the principle of the “rule of rescue” should be adopted or rejected. According to this principle more funding should be available in order to save lives of identifiable, compared with unidentifiable, individuals. Six reasons for giving such priority to identifiable individuals are considered. All are rejected. (...) It is concluded that the principle of the rule of rescue should not be used in determining the allocation of health resources. (shrink)

Some of the most important achievements in the field of empiricist ethics were made by the School of Moral Sentiment, comprising Francis Hutcheson, David Hume, and Adam Smith. This book throws new light on their consensus theory of virtue. Hope works some of their ideas into a merit theory of rights applicable to conventional rights, defends ethical cognitivism, and analyzes pleasure.

Aristotle's Nicomachean Ethics is devoted to the topic of human happiness. Yet, although Aristotle's conception of happiness is central to his whole philosophical project, there is much controversy surrounding it. Hope May offers a new interpretation of Aristotle's account of happiness - one which incorporates Aristotle's views about the biological development of human beings. May argues that the relationship amongst the moral virtues, the intellectual virtues, and happiness, is best understood through the lens of developmentalism. On this view, happiness (...) emerges from the cultivation of a number of virtues that are developmentally related. May goes on to show how contemporary scholarship in psychology, ethical theory and legal philosophy signals a return to Aristotelian ethics. Specifically, May shows how a theory of motivation known as Self-Determination Theory and recent research on goal attainment have deep affinities to Aristotle's ethical theory. May argues that this recent work can ground a contemporary virtue theory that acknowledges the centrality of autonomy in a way that captures the fundamental tenets of Aristotle's ethics. (shrink)

Ethics, communication skills, and the law ('practice skills') are important in all aspects of modern health care. Doctors and nurses must be sensitive to the ethical aspects of their work and understand the legal framework within which clinical decisions are made. Well developed skills of communication, with patients, their relatives and other members of the clinical team, are a key feature of good clinical practice Until recently, the important of practice skills has been relatively neglected in health care education. This (...) situation is changing. The UK General Medical Council, for example, has recently identified three aspects as part of the core of the medical course, and the move to degree courses in nursing has led to an increasing focus of practice skills in nurse education. The Oxford Practice Skills Project (OPSP) team have developed a course, within the University of Oxford Clinical School, which covers the teaching of practice skills in an integrated manner. This course is widely recognized as one of the most systematic developments of education in these areas. This manual describes the OPSP course in detail and provides teaching materials. Although developed initially for medical students, it should be helpful to all those involved in teaching ethics, communication skills, and law in health care. Each Seminar is described in detail Tutors' guides are provided Student handouts are included Contains guidelines for introducing 'practice skills' into a busy clinical curriculum Includes over forty case histories for teaching and examination Gives details of many useful sources and resources Details a variety of teaching methods together with their advantages and disadvantages Provides an ethics teaching toolkit for clinical teachers new to this area Readers are welcome to photocopy any part of this manual for their own teaching. (shrink)

A lesson from cognitive behavior therapy (CBT) is that it is possible for people to change their beliefs and attitudes in ways that enhance mood. This chapter discusses mainly how the ideas from positive psychology combined with the therapeutic methods developed in CBT might provide ways of helping individuals to enhance their mood and increase happiness. The best single perspective from which to gain an understanding of positive psychology is that of evolutionary psychology, even though it is underdeveloped and contentious. (...) Evolutionary psychology bridges the gap between individual history and the general features of the human condition that helps to explain both our capacity for happiness and some of the barriers to achieving it. The modern general evolutionary view of emotions is that they help animals in regulating their effort: how they behave at any one time and how they apportion their time and energy between different types of behavior. (shrink)

It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...) concept of authenticity belatedly, one might say. We had been talking to people who had a diagnosis of anorexia nervosa about their experiences of living with their condition, and though we had not raised issues of authenticity or identity ourselves, they often did. They struggled with questions of .. (shrink)

Abstract:Human and animal research both operate within established standards. In the United States, criticism of the human research environment and recorded abuses of human research subjects served as the impetus for the establishment of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, and the resulting Belmont Report. The Belmont Report established key ethical principles to which human research should adhere: respect for autonomy, obligations to beneficence and justice, and special protections for vulnerable individuals and (...) populations. While current guidelines appropriately aim to protect the individual interests of human participants in research, no similar, comprehensive, and principled effort has addressed the use of (nonhuman) animals in research. Although published policies regarding animal research provide relevant regulatory guidance, the lack of a fundamental effort to explore the ethical issues and principles that should guide decisions about the potential use of animals in research has led to unclear and disparate policies. Here, we explore how the ethical principles outlined in the Belmont Report could be applied consistently to animals. We describe how concepts such as respect for autonomy and obligations to beneficence and justice could be applied to animals, as well as how animals are entitled to special protections as a result of their vulnerability. (shrink)

This reflection on the social and political role of revenge in the Mongol empire, with a focus on the Īl-Khānate, uses revenge as a means of analyzing the relationship between the khān, his commanders, local officials, the ulema, and the subject population of the Īl-Khānate. It documents the limitations on royal authority and begins a new conversation about the way that juridical power was conceived and practiced in the thirteenth and fourteenth centuries. This study will contribute to the current debate (...) about the role of the Jasaq in the Mongol empire and the Middle East, with particular reference to how it was enacted by the Mongol nobility. It is hoped that this paper will be the start of a more detailed investigation into the role of blood-feud and vengeance across Central Asia. (shrink)

Abstract:Current debates about ideal theory and idealization in modern moral and political philosophy do not typically scrutinize the form of reflection itself. This is an unfortunate oversight: assumptions about the form of reflection shape the positions defended in those debates. I argue that the appropriate form of reflection on the nature and justification of standards of justice and morality is the form of practical reason. I further argue that the form of practical reason cannot support many of the idealizations typically (...) deployed in modern moral and political philosophy. (shrink)

There are some ideas that at first seem simple, but which become more complex and profound the more they are explored. Great art, of course, is like that. When I first saw Vermeer's Girl with a Pearl Earring I was excited by its fresh simplicity. I thought, however, it a painting I would soon understand. I was wrong. It becomes increasingly mysterious with increasing familiarity. It has recently inspired a novel.1The distinction between acts and omissions is one of these simple, (...) complex, ideas. When I first studied philosophy I thought I would rapidly be able to decide once and for all whether the distinction is of moral importance or not. I did in fact come to a decision. The problem is that I have kept revising that decision ever since. The issues raised by the arguments over acts and omissions continue to inspire philosophical discussion. They also continue to haunt doctors and relatives at the bedsides of those near the end of their lives.Donna Dickenson, in this issue of the journal,2 reports the results of a survey of opinions from those taking part in an Open University course on death and dying. She believes that for many bioethicists the acts/omissions distinction has been shown to be wrong as a distinction of moral worth. Her survey suggests, however, that for many health professionals this distinction is seen as morally important. She asks whether the bioethical consensus, as she sees it, against the distinction is a result of clear thinking, or whether the views of practitioners result from their taking into account, in a way bioethicists do not, the richness of reality.There is I believe, less consensus amongst bioethicists than Dickenson suggests. In this issue of the journal, Marc Stauch3 argues in favour of the acts/omissions …. (shrink)

In this paper I assess the possibility of advancing a modern conception of social justice under neo-Aristotelian lights, focussing primarily on conceptions that assert a fundamental connection between social justice and eudaimonia. After some preliminary remarks on the extent to which a neo-Aristotelian account must stay close to Aristotle’s own, I focus on Martha Nussbaum’s sophisticated neo-Aristotelian approach, which I argue implausibly overworks the aspects of Aristotle’s thought it appeals to. I then outline the shape of a deeper and more (...) general, and as yet unanswered, problem facing neo-Aristotelian accounts: how to justify the claim that the point of a just society is to assist or enable its members to flourish. (shrink)

Alternative proteins, including plant-based and cell-based meat and dairy analogues, are discursively positioned as a new form of meat and dairy and as a solution to the myriad of issues associated with conventional animal agriculture. Animal agricultural industries across various nations have resisted this positioning in regulatory spaces by advocating for laws that restrict the use of meat and dairy terms on the labels of alternative proteins products. Underlying this contestation are differing understandings of, and vested interests in, desirable futures (...) for animal agriculture. In Australia, this broader contestation led to a national-level inquiry by a Senate parliamentary committee entitled _Definitions of meat and other animal products_ (the Inquiry). This paper reports findings from a study of the problematizations developed through the Inquiry using a framework for policy discourse analysis referred to as Bacchi’s ‘What’s the Problem Represented to be’ methodology. It shows how the dominant discourse throughout the Inquiry moved away from the initial problematization of alternative proteins as a threat to animal agriculture. Instead, both industries were ultimately positioned as not in competition and only labelling laws were problematized with the solution being amendments to ensure ‘consumer clarity’. This outcome ignored a range of alternative problematizations related to the ethical, environmental, health, social and economic issues raised by animal agriculture and by alternative proteins. This lack of scrutiny benefits both industries, by closing off the policy discourse to consideration of a range of alternative interests, voices, and potential solutions, such as stricter health and welfare regulation. (shrink)

There is a long history of medical research that involves intentionally infecting healthy people in order to study diseases and their treatments. Such research—what might be called “human challenge studies”—are an important strand of much current research—for example, in the development of vaccinations. The many international and national guidelines about the proper conduct of medical research do not specifically address human challenge studies. In this paper we review the guidelines on the risk of harm that healthy volunteers may be exposed (...) to in the course of medical research. We examine the ethical arguments that are implicit or explicit in these guidelines. We then ask whether there is reason for limiting such studies on grounds independent of risk of harm. We conclude that the major ethical concern with challenge studies is that of risk of harm and that the fact that a study is a challenge study is not a wrong in itself. (shrink)

The article reviews the book Intercivilizational Dialogue on Peace, by Madhuri Santanam Sondhi.

Focusing on the barriers between social work intervention in education and government funded programs that impact African American students, this book approaches these issues from a child-centered perspective. Interviews with ten African American students were conducted to discuss their perspectives on education, family life, and social work intervention.

The risks of harm to nonhuman primates, and the absence of benefits for them, are critically important to decisions about nonhuman primate research. Current guidelines for review and practice tend to be permissive for nonhuman primate research as long as minimal welfare requirements are fulfilled and human medical advances are anticipated. This situation is substantially different from human research, in which risks of harms to the individual subject are typically reduced to the extent feasible. A risk threshold is needed for (...) the justification of research on nonhuman primates, comparable to the way risk thresholds are set for vulnerable human subjects who cannot provide informed consent. Much of the laboratory research conducted today has inadequate standards, leading to common physical, psychological, and social harms. (shrink)

This article conceptualizes the evolution of the German political economy as the codevelopment of technological and institutional change. The notion of skill-biased liberalization is introduced to capture this process and contrasted with the two dominant theoretical frameworks employed in contemporary comparative political economy scholarship—dualization and liberalization. Integrating theories from labor economics, the article argues that the increasing centrality of high skills complementary in production to information and communications technology has weakened the traditional complementarity among specific skills, regulated industrial relations, and (...) generous social protection in core sectors. The liberalization of industrial relations and social protection is shown in fact to be instrumental for high-end exporting firms to concentrate wages and benefits on increasingly important high-skilled workers. Strong evidence based on descriptive statistics, union and industry documents, and twenty-one elite interviews is found in support of the article’s alternative perspective. (shrink)