“In the UK a so‐called internal market has been operating within the government‐run National Health Service since 1991.” Analysing the ethical tensions to which this gives rise is Tom Sorell, Editor of this FOCUS, author with John Hendry of Business Ethics , Professor of Philosophy at the University of Essex and Fellow in the Ethics and the Professions Program at Harvard for 1996/97.

Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new ‘managerialism’ has developed in the National Health Service (the NHS). This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the (...) view of the patient as an individual person. (shrink)

This article examines recent developments in the regulation of the medical profession in England, with particular reference to doctors working in the National Health Service (NHS). It is argued that the Health Act 1999 and associated government policies are bringing about a shift from a «light touch», self-regulatory paradigm to a government-driven, interventionist approach. It is suggested that the reason for the change is not simply a governmental concern with the quality and nature of care provided by doctors, but more (...) significantly, a concern with the cost of that care. The article offers a critique of the new regime, drawing on the socio-legal literature on regulation. Some aspects of the reforms ignore the need to persuade doctors to comply, and may therefore result in cheating or «creative compliance»; other aspects of the reforms provide doctors with opportunities to «neutralize» their impact. It concludes with an examination of the wider significance of the change in regulatory paradigm, and of the agenda for future research in this field. (shrink)

This paper uses the recent history of marketization and privatization in the UK National Health Service as a case study through which to explore the relationship between health-care organization and health-care goods. Phases and processes of marketization are briefly reviewed in order to show that, although the scope of both marketization and privatization reforms have, until recently, been very heavily circumscribed (and can only be understood in the context of the rise of managerialism), they have nonetheless had a major (...) impact on the “value field” of UK health services. The second half of the paper draws upon the concerns of the critics of market-style reforms to set out and explore the ways in which organizational reform and the shifts in institutional norms consequent upon it construct health-care goods and argues that the investigation of this organization-goods axis ought to have a central place in health-care ethics. (shrink)

Significant changes are proposed for the research ethics system governing the review of the conduct of medical research in the UK. This paper examines these changes and whether they will meet the aimed-for goal of improving the efficiency of the research ethics system. The author concludes that, unfortunately, they will not and thus should be rejected.

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further ‘market-style’ reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in (...) the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. (shrink)

The recently published Report of theAHAG on the Operation of NHS Research Ethics Committees advocates major reforms of the NHS research ethics committees system. The main implications of the proposed changes and their probable effects on the major stakeholders are described.The Ad Hoc Advisory Group on the operation of NHS research ethics committees, set up in November 2004 by Lord Warner on behalf of the Department of Health, submitted its report in June 2005.1 The report advocates major reforms (...) of the research ethics committee system. The primary aim of the report is to streamline the processes around the approval of research projects and to pursue conformity of governance across Europe. Implicit in the report is the contention that failure to achieve this objective would be harmful to everyone with vested interests in improving health and social care. Moreover, it is stated that the reforms will enhance the mechanisms that protect the interests of all parties concerned.1Being mindful of two published critiques of the Warner Report, we suggest that its alleged benefits should not be taken at face value.2,3 In fact, the reformed system will give rise to moral failings akin to those of the existing system, but will differ from the existing system in its effect on the stakeholders. Thus, whereas the outgoing system has given each stakeholder a unique mixture of benefit and harm, the incoming system offers benefit only to sponsors and researchers and nothing but detriment to participants in research and consumers of its products.In the light of this conclusion, we finally suggest that the Warner Report be construed not merely as an ill-considered document, but rather as an ideological reflection of a long-established hegemonic contract fine-tuning itself to contemporary global challenges.To avoid …. (shrink)

Researchers have frequently complained that the NHS ethical review system stifles good research. At last measures are being put in place to address this criticism, but will they undermine the protection of research participants? The Declaration of Helsinki recognizes that medicine will not progress without good quality research, but also demands that the well-being of research participants takes precedence over the interests of science and society. This article examines the implications of the ongoing reform of the NHS research ethics review (...) system for researchers, ethics committees and research participants. (shrink)

It has been claimed that beneath the government rhetoric of patient choice, no real choice exists either in law or in National Health Service policy. Thus, choice is considered to be a fallacy in that patients are not able to demand specific treatment, but are only able to express preferences amongst the available options. This article argues that, rather than considering choice only in terms of patient autonomy or consumer rights, choice ought to be seen as serving other functions: Choice (...) serves as a mechanism of destabilisation, i.e., as a lever for change. This is apparent at the level of patient and doctor, and at the level of patient and health authority, but even more so, at the level of government. Patient choice, rather than benefiting the individual, can have effects on a wider scale. It encourages change and reform in healthcare practices and in the NHS institutions. (shrink)

How could we better use public inquiries to stem the recurrence of healthcare failures? The question seems ever relevant, prompted this time by the inquiry into how former nurse Letby was able to murder newborns under National Health Service care. While criminality, like Letby’s, can be readily condemned, other factors like poor leadership and culture seem more often regretted than reformed. I would argue this is where inquiries struggle, in the space between ethics and law—with what is awful but lawful. (...) In response, we should learn from progress with informed consent. Inquiries and civil litigation have seen uninformed ‘consent’ shift from being undesirable to unlawful. If better leadership and culture were sole drivers here, we would likely be doing far better in many other areas of healthcare too. Instead, one could argue that progress on consent has been made by reducing _epistemic injustice_—by naming and addressing _epistemic_ issues in ways that enhance _social power_ for patients. If this is an ingredient that transforms clinician–patient working, might it also shift conduct within other key relationships, by showing up what else should become unlawful and why? Naming _medical paternalism_ may have helped with consent reform, so I continue this approach, first naming two areas of epistemic injustice: _management feudalism_ and _legal chokeholds_. Remedies are then considered, including the democratisation of management and reforms to legal ethics, legislation and litigation. In brief, public inquiries may improve if they also target epistemic injustices that should become unlawful. Focus on informed consent and epistemic relationships has improved the medical profession. Likewise, it could help healthcare leaders shift from fiat towards consent, and their lawyers from a stifling professional secrecy towards the kind of candour a prudent public expects. (shrink)

The BMA’s recent discussion paper A rational way forward for the NHS in England, while wishing to free the English NHS from day-to-day politics, merely shifts the locus of the political conflict.In May this year, the British Medical Association published a discussion paper entitled “A rational way forward for the NHS in England”, outlining the association’s suggestions for reform of the English NHS.1The paper is worth reading for its insightful dissection and analysis of the current problems of the English NHS, (...) as well as for its interesting but not totally unexpected conflation of professional and clinical with medical in most of the report. Many of the recommendations are eminently sensible, but some of the suggestions for reconfiguration of the highest-level structures of the English NHS are problematic and unrealistic. What the BMA wants is to free the English NHS from the influence of day-to-day politics by the establishment of a constitution and an independent board of governors, while keeping it free at the point of delivery and paid by general taxation. This is expressed in the first five of the total of 24 recommendations that outline the BMA proposals …. (shrink)

Using the conceptual lenses offered by the ideational and cultural path taken in the health care arena, this article attempts to explain the trajectory of recent major health care reforms in Italy and the reasons for their failure, as well as providing some directions for successful intervention. A diachronic analysis of the relatively under-investigated phenomenon of health care reforms in Italy is carried out, drawing on a systematic review of the Italian and international literature combined with the research (...) work carried out by the Author. For all the three major health reforms examined, a significant gap between the authoritative policy choices taken and the overall implementation, in terms of process and system changes, can be observed, determining a growing distance between the theoretical efficiency and the practical effectiveness of the Italian National Health Service (NHS) as well as its detachment from the social system. The main obstacle to effective reform seems to be the cultural hegemony of the administrative-managerial and the biomedical paradigms, which, by reinforcing one another, yielded infertile ground for renewing in a post-modern sense the Italian NHS. The various Reforms have not been conceived to break such a positivistic monopoly in that they did not promote cultural or educational intervention. In this context, intervention that acts at a cultural level, such as reforming university education for physicians and managers or devising immigration policies to attract adequately acculturated people to the Italian NHS, seems to be the most promising. (shrink)

The United Kingdom's coalition government has just begun the most sweeping overhaul of the National Health Service since its inception.1 Under the reforms, 80 percent of the NHS budget will be handed over to about five hundred local consortia of primary care physicians, who will be empowered to make medical spending and allocation decisions for their patients. The 152 existing Primary Care Trusts (PCTs), which purchase hospital and community care for patients and oversee primary care physicians in their regions, (...) will close their doors, leaving local doctors with the power to decide which interventions are appropriate, and which too expensive.2 Hospitals and community service providers will have greater freedom .. (shrink)

It has recently been pointed out that the 1989 White PaperWorking for Patients, which provides the basis for the current reforms of the British National Health Service, has some common features with the 1944 White PaperA National Health Service, which was the unadopted model for the service produced by the Wartime Coalition Government. Moreover, it is likely that the Conservatives, if elected in the 1945 General Election, would have introduced a service based on a modified version of the 1944 (...) document. We can compare these two blueprints to shed some light on Conservative thinking on health care over a period of nearly 50 years. There are some similarities in terms of the notions of purchaser and provider, contracts and pluralism. However, there are striking contrasts, notably in their attitude towards planning versus competition and local democracy versus patronage. It is claimed that the profound differences outweigh the apparent similarities and consequently the two blueprints show the discontinuity rather than the continuity of Conservative thinking on health care. (shrink)

Unlike the managerially oriented reforms that have brought auditing and accounting into such prominence in the UK National Health Service (NHS), and which seem alien to the culture of the caring professions, consumerist reforms may seem to complement moves towards the acceptance of wide definitions of health, and towards increasing patient autonomy. The empowerment favoured by those who support patient autonomy sounds like the sort of empowerment that is sometimes associated with the patient's charter. For this reason moral (...) criticism of recent NHS reforms may stop short of calling consumerism into question. This, however, would be a mistake: consumerism can be objectionable both within and beyond the health care market. (shrink)

Priorities in Medical Research was published in 1988 by a select committee of the House of Lords. The report ushered in an era of NHS research and development that lasted from 2001 to 2006. The inquiry's origins lay in concerns about academic medicine in the United Kingdom, yet PMR gave relatively little attention to this subject. Instead the report focused critically on the disconnect between the Department of Health and the NHS in R & D. This, the committee argued, had (...) led to the neglect of research into health services and public health. To sidestep the report's unwelcome proposal for a National Health Research Agency, the department eventually grafted R & D management onto structures created as part of wider NHS reforms. The Medical Research Council successfully pursued a strategy of keeping the committee's attention away from sensitive aspects of its own programme. The final focus of PMR was shaped by an alignment between committee members with an industrial view of research and champions of health services research. The actions of the various actors involved are interpreted using elite models of the state, and the applicability of these models is critically examined. (shrink)

Several bioethical topics received a great deal of news coverage here in Scotland in 2009. Three important issues with transatlantic connections are the swine flu outbreak, which was handled very differently in Scotland, England and America; the US debate over healthcare reform, which drew the British NHS into the controversy; and the release to Libya of the Lockerbie bomber, which at first glance might not seem particularly bioethical, but which actually hinged on the very public discussion of the prisoner’s medical (...) records. On a national level, there have been attempts in both Scotland and England to change the law on assisted suicide, where success looks more likely than ever. This paper will discuss each of these issues, and hopefully raise awareness of how these issues were dealt with in the UK and its component countries. (shrink)

‘Organisational failure’ is central to medical ethics. In the National Health Service (NHS), we usually examine failures at hospital level. We have had around 100 hospital inquiries since the first in 1969, into Ely Hospital, Cardiff. This year, we had the Ockenden Report into Shrewsbury and Telford Hospital. Last year, we had the Outram Inquiry into West Suffolk Hospital. In 2020, the James Inquiry into Ian Paterson. And, before that, Morecombe Bay, Gosport War Memorial, Mid Staffordshire, Liverpool Community Health, Winterbourne (...) View, Anthony Ledward, Stoke Mandeville, Bristol Royal Infirmary and so on. As Taylor says, these reports teach us clinical failure usually has an institutional setting and that blaming individuals overlooks working ‘culture’. They have also led to: (a) new regulatory bodies to manage, investigate and improve NHS standards, (b) new codes of conduct to mandate reporting of serious accidents—backed up by the Whistle-blower’s Act and explicit statutory duties of disclosure, (c) root cause analysis to encourage consistent investigations so we can learn from reliable data and (d) new ‘Speaking Up Guardians’ and a Patient Safety Commissioner to encourage informal discussion about patient safety. What is so surprising is how little these inquiries and reforms have achieved on the larger scale. Of course, we must …. (shrink)

This paper examines the UK’s response to a recent European Clinical Trials Directive, namely the Department of Health, Central Office for Research Ethics Committee guidance, Governance Arrangements for NHS Research Ethics Committees. The revisions have been long awaited by researchers and research ethics committee members alike. They substantially reform the ethical review system in the UK. We examine the new arrangements and argue that though they go a long way toward addressing the uncertainty surrounding ethics committee function, the system favours (...) the facilitation of research over the protection of the dignity and welfare of research participants. (shrink)

The UK’s National Institute for Health and Care Excellence is responsible for conducting health technology assessment on behalf of the National Health Service. In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness —and one substantive—an ‘ethics of opportunity costs’ that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE’s approach and to analyse (...) whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE’s approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE’s recommendations. These changes also weaken NICE’s commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE’s approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE’s practice of HTA and to better understand how and why they have come about. (shrink)

This article examines the consequences of the politicization of health care in the United Kingdom following the creation of the National Health Service (NHS) in 1948. The NHS is founded on the principle of universal access to health care free at the point of use but in reality charges exist for some services and other services are rationed. Not to charge and/or ration would create a common-pool resource with no means of conserving scarce resources. Taking rationing decisions in the political (...) realm means that the values and priorities of individual patients are marginalized and the preferences of powerful organized groups able to capture the political process dominate. The key lesson for international health care reform is that the politicization of health care via the NHS has not led to the realization of egalitarian ends but rather has empowered vested and organized interests at the expense of individual patients. (shrink)

Psychoanalysis was introduced to Greece in 1915 by the progressive educator Manolis Triantafyllidis and was further elaborated by Marie Bonaparte, Freud’s friend and member of the Greek royal family, and her psychoanalytic group in the aftermath of the Second World War. However, the accumulated traumas of the Nazi occupation (1941–1944), the Greek Civil War (1946–1949), the post-Civil-War tension between the Left and the Right, the military junta (1967–1974) and the social and political conditions of post-war Greece led this project and (...) all attempts to establish psychoanalysis in Greece, to failure and dissolution. The restoration of democracy in 1974 and the rapid social changes it brought was a turning point in the history of Greek psychoanalysis: numerous psychoanalysts, who had trained abroad and returned after the fall of the dictatorship, were hired in the newly established Greek National Health Service (NHS), and contributed to the reform of Greek psychiatry by offering the option of psychoanalytic psychotherapy to the non-privileged. This article draws on a range of unexplored primary sources and oral history interview material, in order to provide the first systematic historical account in the English language of the complex relationship between psychoanalysis and Greek society, and the contribution of psychoanalytic psychotherapy to the creation of the Greek welfare state. In so doing, it not only attempts to fill a lacuna in the history of contemporary Greece, but also contributes to the broader historiography of psychotherapy and of Europe. (shrink)

The main aim of this paper is to investigate the micro and macro predictors of Portuguese willingness to pay (WTP) more taxes to bolster funds channelled to the National Health Service (NHS). An online questionnaire was used to collect data from 584 Portuguese citizens. The statistical analysis was performed through the application of logistic regressions. The research shows that willingness to support increasing taxes depended on socioeconomic, behavioural, and psychological factors. The WTP more taxes to finance the NHS were associated (...) with younger ages, life satisfaction and dispositional optimism, satisfaction with the NHS performance, current perceived risk exposure, and risk orientation. Identifying and understanding the main influencing factors associated with WTP more taxes for NHS is essential to assist policy-makers in developing healthcare reforms. Decision-makers may take this opportunity to improve the NHS since those who ultimately benefit from the measures can provide an additional source of health financing. (shrink)

This paper discusses the current initiatives on error and adverse events within healthcare, with a particular focus on the NHS, within the context of health policy. One of the key features of the paper is the proposal for an emergent taxonomy of the medical error literature, developed from the ideologies and rationales that underpin their approaches. This taxonomy provides details of three categories—empiricists, organisational rationalists and reformers of professional culture—and these act as an organising framework for the exploration of the (...) potential consequences of current policy on errors and adverse events. This discussion highlights the tension between optimising health outcomes for patients and managing the health system as effectively as possible. In particular, the inherent tension between explicit managerial formulations of risk and implicit risk management strategies associated with medical professionalism are considered. (shrink)

Collaboration of tradition and modern from the East and Western on the humanity and cultural view in Vietnam.

Business ethics in the socialist-oriented market economy in Vietnam.

This new translation of the Buddha's most important, most studied teaching offers a radical new interpretation. In September, 2014 Thich Nhat Hanh completed a profound and beautiful new English translation of the Prajñaparamita Heart Sutra, one of the most important and well-known sutras in Buddhism. The Heart Sutra is recited daily in Mahayana temples and practice centers throughout the world. This new translation came about because Thich Nhat Hanh believes that the patriarch who originally compiled the Heart Sutra was not (...) sufficiently skillful with his use of language to capture the intention of the Buddha's teachings--and has resulted in fundamental misunderstandings of the central tenets of Buddhism for almost 2,000 years. In The Other Shore: A New Translation of the Heart Sutra with Commentaries, Thich Nhat Hanh provides the new translation with commentaries based on his interpretation. Revealing the Buddha's original intention and insight makes clear what it means to transcend duality and pairs of opposites, such as birth and death, and to touch the ultimate reality and the wisdom of nondiscrimination. By helping to demystify the term "emptiness," the Heart Sutra is made more accessible and understandable. Prior to the publication of The Other Shore, Thich Nhat Hanh's translation and commentaries of the Heart Sutra, called The Heart of Understanding, sold more than 120,000 copies in various editions and is one of the most beloved commentaries of this critical teaching. This new book, The Other Shore, supersedes all prior translations. (shrink)

In Good Citizens: Creating Enlightened Society, Thich Nhat Hanh lays out the foundation for an international solidarity movement based on a shared sense of compassion, mindful consumption, and right action. Following these principles, he believes, is the path to world peace. The book is based on our increased global interconnectedness and subsequent need for harmonious communication and a shared ethic to make our increasingly globalized world a more peaceful place. The book will be appreciated by people of all faiths and (...) cultural backgrounds. While based on the basic Buddhist teachings of the Four Noble Truths and the Eight-Fold Path, Thich Nhat Hanh boldly leaves Buddhist terms behind as he offers his contribution to the creation of a truly global and nondenominational blueprint to overcoming deep-seated divisions and a vision of a world in harmony and the preservation of the planet. Key topics include the true root causes of discrimination; the exploration of the various forms of violence; economic, social, and sexual violence. He encourages the reader to practice nonviolence in all daily interactions, elaborates on the practice of generosity, and teaches the art of deep listening and loving speech to help reach a compromise and reestablish communication after misunderstandings have escalated into conflicts. Good Citizens also contains a new wording of the Five Mindfulness Trainings (traditionally called "precepts") for lay practitioners, bringing them in line with modern-day needs and realities. In their new form they are concrete and practical guidelines of ethical conduct that can be accepted by all traditions. Good Citizens also includes the complete text of the UN Manifesto 2000, a declaration of transforming violence and creating a culture of peace for the benefit of the children of the world. It was drafted by numerous Peace Nobel Prize recipients and signed by over 100 million people worldwide. Coinciding with a US presidential election year, Good Citizens reaches across all political backgrounds and faith traditions. It shows that dualistic thinking--Republican/Democrat, Christian/Muslim--creates tension and a false sense of separateness. When we realize that we share a common ethic and moral code, we can create a community that can change the world. (shrink)

365 days of practical, powerful teachings from the beloved Zen teacher Inspiring, joyful, and deeply insightful, this book offers daily contemplations and words of wisdom from one of today's most important spiritual teachers. Thich Nhat Hanh is, with His Holiness the Dalai Lama, the best-known Buddhist teacher in the world, and his teachings have touched millions. These powerful and transformative words of wisdom, drawn from the works of this best-selling and prolific author, touch all apsects of our lives, from the (...) personal to the global, and reflect the great themes of Thich Nhat Hanh's teachings: how the practice of mindfulness brings joy and insight into every moment of our lives; how to transcend fear and other negative emotions; how we can heal our inner wounds with gentleness and awareness; how to transform our relationships through love, presence, and deep listening; and how to practice peace for our world and caring for the earth. Through Thich Nhat Hanh's great brilliance, this book presents these profound themes in short teachings that are practical yet powerful, and will uplift and inspire your day. (shrink)

On the influence of Confucianism to the social and politics in Vietnam.

How to Eat is the second in a Parallax's series of how-to titles by Zen Master Thich Nhat Hanh that introduce beginners to and remind seasoned practitioners of the essentials of mindfulness practice. Pocket-sized, with bold black-and-white illustrations by Jason DeAntonis, How to Eat explains what it means to eat as a meditative practice and why eating mindfully is important. Specific instructions are followed by a collection of verses written for secular practitioners that help set a mindful intention for each (...) activity connected with preparing, serving, eating, and cleaning up after meals. The results of mindful eating are both global and personal. Eating a meal in mindfulness shows practitioners that the whole universe is supporting them. This awareness helps develop compassion and understanding, reminding practitioners that there are things they can do to help nourish people who are hungry and lonely. Encouraging moderation, mindful eating can lead to optimum health and body weight, while diminishing waste, and contributing to a more healthy society. Scientific studies indicate that meditation contributes tremendously to well-being, general health, and longevity. How to Eat is perfect for those who want a comprehensive yet simple guide to eating as a meditative practice. (shrink)

In Is Nothing Something? Zen Master Thich Nhat Hanh answers heartfelt, difficult, and funny questions from children of all ages. Illustrated with original full-color artwork by Jessica McClure, Is Nothing Something? will help adults plant the seeds of mindfulness in the young children in their lives. Beginning with the most basic questions, "What is important in life?" and "Why is my brother mean to me?" and progressing through issues that we all wrestle with, such as "How do I know if (...) I really love somebody?", "How long am I going to live?", and "What does God look like?", each page presents a question with a short answer from Thich Nhat Hanh, appropriate for beginning readers to work with on their own. The back of the book has the first complete children's biography of Thich Nhat Hanh, along with basic, kid-friendly instructions for mindful breathing and mindful walking. Both humorous and profound, Is Nothing Something? is the perfect resource for kids with questions, adults looking to answer them, and anyone with questions of their own. (shrink)

Festschrifts of Vietnamese philosopher Trà̂n Đức Thảo, 1917-1993.

Zen Master Thích Nhá̂t Hạnh's commentary on Nāgārjuna's Treatise on the Middle Way, one of the most famous Buddhist texts in existence. Nāgārjuna is a giant in the Buddhist canon, thought to be the greatest Buddhist philosopher after the Buddha. He lived in southern India in the 2nd century CE. Cracking the Walnut contains the text of Nāgārjuna's Treatise on the Middle Way (Mulamadhyamakakarika), defending the essential premise that all things have the nature of emptiness, they have no self-nature, but (...) are in a constant process of change and interrelationship with one another. Weaving Nāgārjuna's text with commentary by Thích Nhá̂t Hạnh', taken from talks given at two 3-month-long retreats, helps us bring these teachings into our daily life. They are strong teachings, designed to break through all metaphysical speculation. To a greater or lesser extent, we all have notions and ideas about life. Sometimes our ideas can contribute to the advancement of humanity, but the problem comes when we are caught in our ideas and believe them to be the absolute truth. When people believe that something is the absolute truth, they may be ready to fight, kill, or die for it. This brings about polarization, deep division, and suffering in ourselves, our society, community, and family. This is not the way ahead for humanity. This book helps us let go of our ideas and go in the direction of understanding and compassion. (shrink)