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)

An introduction to mindful walking, which can be done anywhere, at any time—even on a commute to work or school. The fourth book in the bestselling Mindfulness Essentials series, a back-to-basics collection from world-renowned Zen Master Thich Nhat Hanh that introduces everyone to the essentials of mindfulness practice. Slow, concentrated walking while focusing on in- and out-breaths allows for a unique opportunity to be in the present. There is no need to arrive somewhere—each step is the arrival to concentration, (...) joy, insight, and the momentary enlightenment of aliveness. When your foot touches the Earth with awareness, you make yourself alive and the Earth real, and you forget for one minute the searching, rushing, and longing that rob our daily lives of awareness and cause us to "sleepwalk" through life. Thich Nhat Hanh shares amusing stories of the impact mindful walking has on both the walker and those who notice him, and shows how mindful walking can be a technique for diminishing depression, recapturing wonder, and expressing gratitude. Pocket-sized, with original two color illustrations by Jason DeAntonis, How to Walk is a unique gift for all ages, sharing a simple practice that can have a profound effect on practitioners. (shrink)

We all need to Chop Wood and Carry Water". In Thich Nhat Hanh's latest teachings on how to use applied Buddhism in daily life, he looks at how we deal with workplace scenarios, handle home and family responsibilities, and endure traffic jams and other challenges of modern life. By carefully examining our everyday choices he encourages us to become a lotus in a muddy world by building mindful communities, learning about compassionate living, and come to an understanding of our (...) inert "Buddha nature." Part-time Buddha aims at contributing to new models of leadership and doing business, but is also full of life-coaching advise and finding our true happiness. (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)

A collection of powerful and inspiring teachings in a convenient pocket-size book. These writings provide a wonderful overview of mindfulness in our daily lives, Buddhism and enlightenment, working with emotions and relationships, and transforming society.

This paper examines the roles of indexicals in explicating speakers’ intentions and constructing common ground in the context of a continuum with two extreme endpoints, the intracultural at one end, and the intercultural at the other, within the framework of the socio-cognitive approach proposed and developed by Kecskes and Kecskes and Zhang. Thirteen participants from different linguistic and cultural backgrounds were recruited to represent varying degrees on the intra- and intercultural continuum. They were divided into three groups: American English speakers, (...) speakers from Asian countries, and a group of speakers, each of whom represents linguistically and culturally different countries. Eight extracts were drawn from the data of up to three hours of recordings, including discussions on one topic, and retrospective interviews retrieving the speakers’ intentions for using deixis. The results reveal that the closer the interlocutors were towards the intercultural communicative context endpoint on the continuum, the more they employed four types of indexicals as common ground construction strategies. Those strategies included the explicit manifestation of intentions, clarification, and confirmation of referent identification in actual situational context, elicitation of information, disambiguation and explanation of similar salient specifics in their home culture in an effort to sustain cooperative communication. This study enhances our understanding of different functions of indexicals in interactions on the intra- and intercultural continuum, which resulted from different levels of context interpretation and common ground. (shrink)

The secret to happiness is to acknowledge and transform suffering, not to run away from it. In No Mud, No Lotus, Thich Nhat Hanh offers practices and inspiration for transforming suffering and finding true joy. Thich Nhat Hanh acknowledges that because suffering can feel so bad, we try to run away from it or cover it up by consuming. We find something to eat or turn on the television. But unless we're able to face our suffering, we can't (...) be present and available to life, and happiness will continue to elude us. Nhat Hanh shares how the practices of stopping, mindful breathing, and deep concentration can generate the energy of mindfulness within our daily lives. With that energy, we can embrace pain and calm it down, instantly bringing a measure of freedom and a clearer mind. No Mud, No Lotus introduces ways to be in touch with suffering without being overwhelmed by it. With his signature clarity and sense of joy, Thich Nhat Hanh helps us recognize the wonders inside us and around us that we tend to take for granted and teaches us the art of happiness. (shrink)

One of the key tenets of the Zen school of Mahayana Buddhism is that each of us is already a Buddha -- our enlightenment is inherent within us and the practice of mindfulness is the tool to bring this truth to our awareness. While it can bring much relief, this simple statement does not preclude the need for practice. We must strive to be aware of our Buddha nature rather than waiting until times of emotional upheaval when it is more (...) difficult to practice. Thich Nhat Hanh uses the teachings of ninth century Zen Master Linji, founder of the Rinzai school, to elaborate on this simple truth and to give readers tools that can help awaken them to their true inner nature. One of the unique aspects of Linji's teaching, is the need to "wake ourselves up," not only by means of listening to enlightened teachings, but also through unique techniques such as the shout, the stick, and the empty fist. The teachings of Master Linji bring readers back to reality and to simply being. Powerful, direct, and uncompromising, Thich Nhat Hanh's reflections on the teachings of Master Lin Chi are destined to join the ranks of classic Buddhist writings. (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)

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)

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)

For the first time Thich Nhat Hanh shares his inspiration and experience of living in stillness and timelessness. Written to pull you into the moment as he sees it, Inside the Now offers teachings inspired by the spirit of poetry. More personal than the majority of his writing, Inside the Now shares the Zen Master's experience using poetry and meditation to endure and move beyond violence and oppression. Inspired by Being Time by Zen Master Dogen, Thich Nhat Hanh (...) shares short meditations along with revelations from his past to give the reader a sense of entering a space of timelessness. In these meditations, he reveals his own doubts and his own searching. (shrink)

A new gift edition of the classic guide to meditation and mindfulness, featuring archival photography and beautiful calligraphy by Thich Nhat Hanh. Since its publication in 1975, The Miracle of Mindfulness has been cherished by generations of readers for its eloquent and useful introduction to the practice of meditation. Readers interested in an introduction to Buddhist thought, as well as those seeking to learn about mindfulness and stress reduction, continue to look to Thich Nhat Hanh's classic work for (...) guidance and inspiration. This new hardcover gift edition features elegant calligraphic illustrations by Thich Nhat Hanh, as well as a dozen photographs spanning his early days as a peace activist to his life in Plum Village, a spiritual community that he founded in France. Also included in this edition is a historical chronology of Thich Nhat Hanh's life and work, and a revised afterword by Jim Forest. (shrink)

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)

This research employs the Bayesian network modeling approach, and the Markov chain Monte Carlo technique, to learn about the role of lies and violence in teachings of major religions, using a unique dataset extracted from long-standing Vietnamese folktales. The results indicate that, although lying and violent acts augur negative consequences for those who commit them, their associations with core religious values diverge in the final outcome for the folktale characters. Lying that serves a religious mission of either Confucianism or Taoism (...) (but not Buddhism) brings a positive outcome to a character (βT_and_Lie_O= 2.23; βC_and_Lie_O= 1.47; βT_and_Lie_O= 2.23). A violent act committed to serving Buddhist missions results in a happy ending for the committer (βB_and_Viol_O= 2.55). What is highlighted here is a glaring double standard in the interpretation and practice of the three teachings: the very virtuous outcomes being preached, whether that be compassion and meditation in Buddhism, societal order in Confucianism, or natural harmony in Taoism, appear to accommodate two universal vices—violence in Buddhism and lying in the latter two. These findings contribute to a host of studies aimed at making sense of contradictory human behaviors, adding the role of religious teachings in addition to cognition in belief maintenance and motivated reasoning in discounting counterargument. (shrink)

At first glance, this case might give the impression that a resolution would have been straightforward. A 17-year-old young man with moderate to severe learning disabilities and other conditions discussed below required a kidney transplant–the Court of Protection was tasked with determining whether this was in his best interests. However, the case of WV was in fact far more technical and required nuanced discussion and expert medical evidence from a range of specialists to objectively balance the needs of WV and (...) the risks to WV, and to ultimately determine his fate of life or death based on receiving a kidney transplant.Manchester University NHS Foundation Trust applied for a declaration in relation to the capacity of William Verdon and for the court to consider whether an order should be made that it was not in his best interests to have a kidney transplant with sedation and ventilation post-operatively. (shrink)

On 8th August 2019, Secretary of State for Health and Social Care, Matt Hancock, announced the creation of a £250 million NHS AI Lab. This significant investment is justified on the belief that transforming the UK’s National Health Service (NHS) into a more informationally mature and heterogeneous organisation, reliant on data-based and algorithmically-driven interactions, will offer significant benefit to patients, clinicians, and the overall system. These opportunities are realistic and should not be wasted. However, they may be missed (one may (...) recall the troubled Care.data programme) if the ethical challenges posed by this transformation are not carefully considered from the start, and then addressed thoroughly, systematically, and in a socially participatory way. To deal with this serious risk, the NHS AI Lab should create an Ethics Advisory Board and monitor, analyse, and address the normative and overarching ethical issues that arise at the individual, interpersonal, group, institutional and societal levels in AI for healthcare. (shrink)

The current practice for UK research ethics committees (RECs) is to invite researchers to attend meetings at which their applications are to be considered and for student-based research the National Research Ethics Service recommends supervisors to attend. This study aims to identify the extent to which students and their supervisors attend NHS REC meetings and whether attendance is associated with the initial outcomes of RECs.

The NHS differs from a private business in not aiming at profits and in being obliged to provide only the single product of health care. How radically does this affect the requirement to be “business‐like” and adopt business values? Dr Draper is Lecturer in Biomedical Ethics at The Medical School, The University of Birmingham, Birmingham B15 2TT. She wishes to thank Tom Sorell for his comments on the first draft of this article.

Many despair at trying to understand something’s meaning and express dissatisfaction with language wholesale. What if some things simply are not understandable? Thich Nhat Hanh coined interbeing to name the fundamental principle of interdependence defining Buddhist ontologies, and uses interbeing to dislodge despair resulting from rigid expectations of how things must be. Thich also criticized a standard view of language as generating those rigid expectations. Drawing upon classical humanist traditions, Hans-Georg Gadamer promoted a hermeneutics whereby interpreters overcome existential alienation. (...) In his theory of understanding meaning, Gadamer rehabilitated language as having its being in revealing aspects of truth. By situating Gadamer’s hermeneutics within Thich’s interbeing, I develop limits of understanding that facilitate freedom from despair about meaning and language. Thich and Gadamer both taught that the quest for stability within change is misguided. This requires rigorous attention to the limits of understanding. Attention to these limits serves to liberate people from clinging to the illusion that all things are understandable and despair accompanying the incapacity to understand some things. (shrink)

Văn khắ c Chămpa tại Ba̓ o tàng ̃ Điêu khắ c Chăm–Đà Nă ̃ ng. The Inscriptions of Campā at the Museum of Cham Sculpture in Đà Năng. By Arlo Griffiths, Amandine Lepoutre, William A. Southworth, and Thành Phn. Published in collaboration between École française d’Extrême-Orient, Hanoi, and Center for Vietnamese and Southeast Asian Studies, University of Social Sciences and Humanities, Vietnam National University H̀ô Chí Minh City. H̀ô Chí Minh: VNUHCM Publishing House, 2012. Pp. 288, 67 pl., 38 (...) photos. VND 170.000. (shrink)

Migrant nurses form an increasing proportion of the nursing workforce, with the United Kingdom (UK) being the third most popular destination for overseas nurses in the world. The migrant nurse workforce is highly susceptible to policy changes at the macro or professional level of the donor and recipient countries. Freedom of information requests were issued to 19 National Health Service [NHS] Trusts in England to determine their involvement in overseas nurse recruitment activity from 1998 onwards. These indicate a notable shift (...) away from active European Union (EU) recruitment and towards overseas countries particularly the Philippines and India. Reasons given were as follows: diminishing returns from EU sources, high attrition among EU nurses and the introduction of English language tests for EU nurses in July 2016. This led to Trusts revisiting their recruitment strategies by increasing more direct/less resource‐intensive methods and expanding their focus outside of the EU. Trusts frequently utilised private recruitment companies for their recruitment drives, including consulting and influencing the Trusts’ workforce strategies. Policy adjustments have numerous influences on the composition of the overseas nursing workforce. While the NHS continues its efforts in expanding its international nursing workforce, this should not be at the expense of ethical and sustainable recruitment practices, which may be compromised indirectly as a result. (shrink)

This article examines the discourses that are used by the British press to represent obesity in its coverage of coronavirus disease 2019 (COVID-19). Obesity is understood to be a risk factor for COVID-19, with people with obesity being more likely to die from the virus. This study adopts a corpus-based approach to Critical Discourse Studies and utilises a novel approach to keyword analysis, based on comparing analysis corpora against two reference corpora in order to yield keywords that are, in this (...) case, characteristic compared to general coverage of both COVID-19 and obesity. It is argued that the context of the pandemic has produced a range of discourses around obesity that are more stigmatising than usual in both the tabloids and the broadsheets, with people with obesity being construed, for example, in especially fatalistic terms and as being responsible for the problems facing the country’s healthcare system. At the same time, the pandemic context also seems to have given rise to some more positive changes to press coverage of obesity, with race-related health disparities receiving more focus than usual and the right-leaning press being more likely to critique the Conservative Government than it usually is, resulting in an arguably more balanced style of reporting. (shrink)

The institution of the proskynesis at the Roman imperial court seems to have its roots in the world of Iranian peoples, be it the Parthian Empire or Sassanid Persia. Many hints in our sources point eastwards when we consider the origin of this custom. The contacts between the Graeco-Roman and Persian world had a long tradition by the time of Diocletian. For several reasons, it is hard to imagine that the proskynesis, as an act of obeisance before the late antique (...) Emperors, evolved purely within the Empire and unaffected by Eastern influences. (shrink)

Changes in technological and economic aspects of society have impacted on how we understand professional and client relationships. These relationships are constructed in terms of patients/users requiring care, and customers whose complaints have become a yardstick of satisfaction. A consequence of these changes is an interest in the related concepts of emotional labour and emotion work. For nurses, caring for people in illness and in health is central to their work, and it is this aspect of emotion at work that (...) distinguishes nursing from other occupational groups. This paper is concerned with emotion work in a National Health Service Direct (NHS Direct) call centre in the United Kingdom. Drawing upon theoretical perspectives from organizational psychology and sociology it focuses upon the social processes that narrate emotion events in a specific context. It is based on a qualitative study exploring the experience and emotion work of nurses working in a call centre. Issues in caring without the face‐to‐face contact using communication technology were crucial to the way nurses perceived their work. These factors contributed to nurses’ orientation to work and to the way that conflict and dissonance with expectations of callers and managers impacted on nurses’ emotion work. (shrink)

The U.K.'s National Health Service (NHS) is critically reliant on staff from overseas, which means that a sizeable number of U.K. healthcare professionals have received their training at the cost of other states, whose populations are urgently in need of healthcare professionals. At the same time, while healthcare is widely seen as a primary good, many migrants are unable to access the NHS without charge, and anti‐immigration political trends are likely to further reduce that access. Both of these topics have (...) received close attention in the global health ethics literature. In this article, I make the novel move of suggesting that these two seemingly disparate issues should be folded into the same moral narrative. The ‘brain drain’ upon which the NHS and its users depend derives from the same gradient of wealth, security, and opportunity that produces migrants who require the NHS. I endorse moral cosmopolitanism as a lens for understanding patients' right to healthcare regardless of nationality or immigration status. I argue that the NHS in its current formulation effectively enacts a partial cosmopolitanism in its reliance on medical workers from abroad, but could more meaningfully instantiate that cosmopolitanism were it to offer the same healthcare to migrants as it does to citizens. (shrink)

Implementing The new NHS and the 1997 NHS (Primary Care) Act will gradually extend cash-limiting into primary health care, especially general practice. UK policy-makers have avoided providing clear, unambivalent direction about how to 'ration' NHS resources. The 'Child B' case became an epitome of public debate about NHS rationing. Among many other decision-making processes which occurred, Cambridge and Huntingdon Health Authority applied an ethical code to this rationing decision. Using new data this paper analyses the rationing criteria NHS managers and (...) clinicians used at local level in the Child B case; and the organisational structures which confronted them with such decisions. Primary Care Groups are likely to confront similar rationing decisions in respect of 'gate-kept' NHS services. However, such rationing processes are not so easily transposed to open-access services such as general practice. NHS rationing decisions, especially in PCGs, will require a much more specific ethical code than hitherto used. (shrink)

In this paper we want to briefly illustrate the ways in which technical, ethical and political judgements of various kinds are interwoven in the processes of healthcare decision-making in the UK. Drawing upon the research for the “Choices in Health Care” project we will borrow the notion of the hidden curriculum from education to illuminate the nature of resource allocation decision processes. In particular we will indicate some of the fundamental but largely hidden political factors in play in these processes (...) and the importance of the inchoate and implicit notion of “NHS values” in shaping UK resource allocation policies. We suggest that these more diffuse, holistic and system level value judgements are both central to understanding priority setting and at the same time difficult to reduce or abstract out into lists of single values/principles. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 115-125 [Access article in PDF] Pretending to Be Buddhist and Christian: Thich Nhat Hanh and the Two Truths of Religious Identity Jeffrey CarlsonDePaul University Nagarjuna replies: "The teaching by the Buddhas of the dharma has recourse to two truths: / The world-ensconced truth and the truth which is the highest sense. / Those who do not know the distribution (vibhagam) of the two kinds (...) of truth / Do not know the profound 'point' (tattva) in the teaching of the Buddha. / The highest sense [of the truth] is not taught apart from practical behavior, / And without having understood the highest sense one cannot understand nirvana. / Emptiness, having been dimly perceived, utterly destroys the slow-witted. / It is like a snake wrongly grasped or [magical] knowledge incorrectly applied." 1I would like to offer a response to Thich Nhat Hanh's book Living Buddha, Living Christ, a response which suggests that Nhat Hanh embodies and propounds this classical Buddhist notion of "two truths," in a way that sheds much light on the very notion of "religious identity."The fact that Buddhist teachings involve two kinds of truths is a familiar one in Buddhist studies. T.R.V. Murti describes worldly truth as "truth so called; truth as conventionally believed in common parlance.... It is the truth that does not do any violence to what obtains in our everyday world, being in close conformity with linguistic conventions and ideas." 2 Edward Conze notes that "... in some places the Buddhas have spoken of a 'self', in others they have taught a 'notself', and in addition they have also taught that there is neither a self nor a notself. Candrakirti convincingly explains this aphorism by pointing out that the Buddhas are physicians rather than teachers, that they always consider the mentality and spiritual maturity of their interlocutors, and vary their teachings accordingly." 3Ultimate truth, again characterized by Streng, is "the realization of dependent coorigination whereby there is no attachment to fabricated 'things'--not even to the formulation of dependent coorigination." 4 [End Page 115] 1. Thich Nhat Hanh on Conventional Truth and Religious Identity Thich Nhat Hanh writes: "We need roots to be able to stand straight and grow strong. When young people come to Plum Village, I always encourage them to practice in a way that will help them go back to their own tradition and get re-rooted. If they succeed at becoming reintegrated, they will be an important instrument in transforming and renewing their tradition." 5 An advocate of interreligious dialogue, he nonetheless maintains that "sharing does not mean wanting others to abandon their own spiritual roots and embrace your faith. That would be cruel. People are stable and happy only when they are firmly rooted in their own tradition and culture. To uproot them would make them suffer. There are already enough people uprooted from their tradition today, and they suffer greatly, wandering around like hungry ghosts, looking for something to fill their spiritual needs. We must help them return to their tradition." 6He cites the suffering caused by Christian missionaries who, he writes, "came to Vietnam several hundred years ago, [and] urged us to abandon the cult of ancestral worship and to abandon our Buddhist tradition. Later, when they offered to help us in refugee camps in Thailand and Hong Kong, they also urged us to give up our roots. The good will to help and to save us was there, but the correct understanding was not. People cannot be happy if they are rootless." 7Nhat Hanh tells a compelling story of six children he met in Sri Lanka. Coming upon them Nhat Hanh began chanting in Pali, "I take refuge in the Buddha. I take refuge in the Dharma. I take refuge in the Sangha." Nhat Hanh recounts that four of the children joined their palms and chanted, while the other two stood respectfully. "I motioned to the two children who were not chanting to join us. They smiled, placed their palms together and chanted in Pali, 'I... (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)

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)

There is currently a clarion call for the NHS to be more creative and innovative, as it moves into an increasingly quality focused agenda. But exactly how easy is it to do this when the NHS performance regime for the last 10 years has been more about delivering centrally driven, specific and detailed targets for improvement, such as reduction of waiting times, than promoting a culture that speaks of experimentation and possibilities rather than certainties. Can a workforce that may not (...) have been all that prepared for creativity, be creative? And what does being prepared for creativity look like? This paper explores, briefly, the relationship the NHS has with creativity and the new agendas that are creating more fertile ground but then, drawing on practices and information from leading innovators and researchers in the business sector, it looks at the conditions the NHS might need to create in order foster creativity in its workforce. More specifically it looks at the role that a more personal approach to creativity might play in cultivating a workforce that is more comfortable entering into creative thinking and behaviour. (shrink)

One of the pressures placed upon researchers is the process of ethics review. This frequently provides considerable conflict. The process of review of student projects of little inherent risk is identical to that of their more senior colleagues. In this article I propose that we should be more tolerant of design problems within student research if the overall risk is minimal in order that the student can learn about the process of carrying out research.The frequency and content of papers discussing (...) research ethics review in specialist,1 professional2 3 and lay4 press suggests that many senior researchers find the process challenging. The opinion most frequently expressed is that research ethics committees work to an imprecise set of rules and represent a barrier to significant pieces of clinical research. In particular, specific criticism has been aimed at the review of student research5–8 and the difficulties that students and their supervisors face.In ethics committees we usually police research very carefully, monitoring the detail of projects, including how participants will be selected, what data will be collected, how it will be handled and how the research is funded in addition to the adequacy of the consent process and information that underlies it. My experience as a member of NHS REC and governance committees and, more particularly, coordinator of student research, is that National Research Ethics Service REC usually apply the same standards to student research with little inherent risk as to complex phase 1 studies with significant risk. Guidance in the standard operating procedures for NHS REC is at best unhelpful and at worst supportive of this view. …. (shrink)

Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on ‘consent’, look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient (...) I argue for a semantic change that obviates the use of ‘choice’, focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations. (shrink)

The purpose of this contemporary history study is to analyse nursing strategy documents produced by NHS Trusts in England in the period 2009–2013, through a process of discourse analysis. In 2013 the Francis Report on the Mid-Staffordshire NHS Foundation Trust was published. The Report highlighted the full range of organisational failures in a Trust that valued financial efficiency over patient care. The analysis that followed, however, dwelt heavily on the failings of the nurses. Nursing strategy documents at that time served (...) to set the future direction for NHS Trusts, prescribing specific value frameworks for each nursing workforce. However, the values chosen frequently conflicted with each other pitting nursing values against a managerial trope. It is argued that documents provided a response to wider NHS concerns and high-profile failures in care, particularly the Francis Report, paying lip service to staff engagement whilst maintaining a corporate focus. Nursing values were placed firmly within a managerialist discourse, one that has needed to be re-evaluated in the current Covid-19 pandemic. Wider implications of the research suggest discussion of value conflict may be beneficial within nursing education and a truly local approach to strategy creation would potentially promote staff buy-in to strategy documents. (shrink)

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be ‘all changed, changed utterly’. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care (...) of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions? (shrink)

Care after research is for participants after they have finished the study. Often it is NHS-provided healthcare for the medical condition that the study addresses. Sometimes it includes the study intervention, whether funded and supplied by the study sponsor, NHS or other party. The NHS has the primary responsibility for care after research. However, researchers are responsible at least for explaining and justifying what will happen to participants once they have finished. RECs are responsible for considering the arrangements. There are (...) ethical and practical issues, in particular when participants may wish to continue on the study intervention after the study. There are also various guidelines and legislation. This document presents a framework of questions to help NHS RECs and their applicants. Information on this document’s development is here. (shrink)

The publication ‘Governance arrangements for NHS Research Ethics Committees’ is clear in its recommendations about the composition of National Health Service research ethics committees in the United Kingdom. It highlights the need for a sufficiently broad range of experience and expertise, balanced age and gender distribution and every effort to be made to recruit members from black and ethnic minority backgrounds, as well as people with disabilities. It was considered that this composition would make it possible for the scientific, clinical (...) and methodological aspects of a research proposal to be reconciled with the welfare of research participants, and with broader ethical implications. Black and other ethnic minorities constitute 7.9 per cent of the UK population. Ideally, in any research ethics committee with a maximum of 18 members, at least one would be a member of the black or other ethnic minority groups. However, this does not appear to be the case; some committees having more than one, while most do not have any. This paper looks at the present position and suggests ways of improving recruitment and retention of members of these groups. (shrink)

“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.

In April 2020, close to the start of the first U.K. COVID-19 lockdown, the U.K. government announced the development of a COVID-19 contact tracing app, which was later trialled on the U.K. island, the Isle of Wight, in May/June 2020. United Kingdom surveys found general support for the development of such an app, which seemed strongly influenced by public trust. Institutions developing the app were called upon to fulfil the commitment to public trust by acting with trustworthiness. Such calls presuppose (...) that public trust associated with the app can emerge if the conditions for trustworthiness are met and that public trust is simplistic, i.e., linearly the sum of each member of the publics’ individual – U.K. government trust relationship. Drawing on a synthesis of the trust literature and fifteen interviews with members of the public trialling the app on the Isle of Wight, this paper aims to explore what trust mechanisms and relationships are at play when thinking about public trust in the context of the U.K. COVID-19 app. We argue that public trust is a complex social phenomenon and not linearly correlated with institutional trustworthiness. As such, attention needs to widen from calls for trustworthy infrastructures as a way to build public trust, to a deeper understanding of those doing the trusting; in particular, what or whom do people place their trust in when considering whether using the app and why. An understanding of this will help when trying to secure public trust during the implementation of necessary public health measures. (shrink)

Resumen Ésta es la primera traducción al español de las guías “Atención después de la investigación: un marco para los comités de ética de investigación del National Health Service (NHS) (borrador versión 8.0)”. El documento afirma que existe una fuerte obligación moral de garantizar que los participantes enfermos de un estudio clínico hagan una transición después del estudio hacia una atención de la salud apropiada. Con “atención de la salud apropiada” se hace referencia al acceso para los participantes a la (...) atención de la salud, proporcionada principalmente por el National Health Service (en adelante NHS), el sistema de salud del Reino Unido, y/o a la intervención en estudio, también llamada producto o tratamiento en investigación. Las guías “Atención después de la investigación” están dirigidas principalmente a los miembros de los 79 comités de ética de investigación del NHS y a quienes presentan sus estudios de investigación ante estos comités. Se trata de un documento borrador muy avanzado, trabajado en numerosas reuniones, durante más de 3 años, que ha sido discutido por participantes de estudios y miembros de la comunidad, miembros y presidentes de comités de ética de investigación del Reino Unido, especialistas internacionales en ética de la investigación, representantes de la industria y otras partes interesadas. La redacción de las guías es producto de la colaboración de Neema Sofaer y Penney Lewis, ambas investigadoras del King’s College London, en el Centre of Medical Law and Ethics del Dickson Poon School of Law, y Hugh Davies, Asesor en Ética de la Investigación de la Health Research Authority (HRA) del NHS. El traductor del presente documento, Ignacio Mastroleo, participó del workshop en la Fundación Brocher (Ginebra, Suiza, diciembre de 2011) donde se revisó el borrador versión 7.0 y contribuyó en la revisión del borrador de la versión 8.0 durante el 2012. -/- Abstract This is the first Spanish translation of the guidelines “Care after research: a framework for NHS RECs (8th draft)”. The document states that there is a strong moral obligation to ensure that participants in a clinical study who are ill transition after the study to appropriate healthcare. The terms "appropriate healthcare" refer to participants’ access to health care, mainly provided by the National Health Service (NHS), the health system in the UK, and/or to the intervention study also named investigational treatment or product. The guides "Care after research" are mainly directed to members of the 79 NHS committees of research ethics (RECs) and to those who submit their research to these committees. This is a very advanced draft document, worked in several meetings, for more than three years, that has been discussed with study participants and community members, members and chairs of RECs in the UK, international specialists in research ethics, industry representatives and other stakeholders. The drafting of the guidelines is the result of the collaboration of Neema Sofaer and Penney Lewis, both researchers at King's College London, at the Centre of Medical Law and Ethics of Dickson Poon School of Law, and Hugh Davies, Research Ethics Advisor of the Health Research Authority (HRA) of the NHS. The translator of this document, Ignacio Mastroleo, attended the workshop at the Brocher Foundation (Geneva, Switzerland, December 2011) where draft version 7.0 was revised and contributed in the revision of draft version 8.0 during 2012. (shrink)

The Diamond Sutra is one of the earliest and most treasured of the Perfection of Wisdom Sutras and had a wide influence on the development of Zen Buddhism. There has been, in recent years, great interest in one particular form of sentences that repeatedly occur in the sutra, sentences of the form “A is not A, therefore it is A”. These sentences display what has been called the “logic of not” or the “logic of affirmation-in-negation”. They are of special interest (...) since they do not only encapsulate one of the central insights of Zen Buddhism, that of nonduality, but at the same time seem to go against one of the most orthodox laws of logic in Western philosophy, the law of identity. This paper discusses the interpretation of these “diamond sentences” by the Vietnamese Zen monk Thich Nhat Hanh. I present Thich Nhat Hanh’s interpretation of the diamond sentences in terms of interbeing and go on to argue that and explain how, on his interpretation, the validity of the law of identity is indeed rejected. Finally, I spell out consequences for formulating a “logic of Zen” and for a related debate about the validity of the law of non-contradiction in Zen. (shrink)

How do cultures of self-quantification intersect with the modern state, particularly in relation to medical provision and health promotion? Here I explore the ways in which British practices and representations of body weight and weight management ignored or interacted with the National Health Service between 1948 and 2004. Through the lens of overweight, I examine health citizenship in the context of universal health provision funded from general taxation, and track attitudes toward “overweight” once its health implications and medical costs affected (...) a public service as well as individual bodies and households. Looking at professional and popular discourses of overweight and obesity, I map the persistence of a highly individual culture of dietary and weight self-management in postwar Britain, and assess the degree to which it was challenged by a new measure of “obesity” – the body mass index – and by visions of an NHS burdened and even threatened by the increasing overweight of the citizens it was created to serve. (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)

The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of ‘shocking’ systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect (...) of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare. (shrink)