Two general ethical problems in psychiatry are thrown into sharp relief by long term care. This article discusses each in turn, in the context of two anonymised case studies from actual clinical practice. First, previous mental health legislation soothed doubts about patients' refusal of consent by incorporating time limits on involuntary treatment. When these are absent, as in the provisions for long term care which have recently come into force, the justification for compulsory treatment and supervision becomes more obviously problematic. (...) Second, Anglo-American law does not normally allow the preventive detention of someone who may be dangerous but has not actually committed any crime. The justification for detaining a possibly dangerous user of mental health services without his or her consent can only be based on risk assessment, but this raises issues of moral luck. Is the psychiatrist who decides not to take out a supervision order for a possibly dangerous patient with an initial psychotic diagnosis morally at fault if that person harms someone in the community, or himself? Or is the psychiatrist merely unlucky? (shrink)

Anomaly in English law between age of children's permitted consent to treatment and much lower age of criminal responsibility.

Review of Joan Callahan, Reproduction, Ethics and the Law: Feminist Perspectives.

Review of Daniel Callahan, The Troubled Dream of Life.

Review of Graeme Laurie, Genetic Privacy.

Review of Mary Mahowald, Genes, Women, Equality.

Review of British Medical Association handbook on human rights and doctors.

This book is a case of “too little, too late”: too little in that it represents voices not from the developing world as a whole but from a particular Catholic viewpoint in the Philippines, too late in that others have already gone “beyond a Western bioethics”—which, in any case, is not the unified and rigid set of principles that the authors make it out to be. The publication is a long delayed spinoff of a series of bioethics seminars held in (...) Manila and Houston under the leadership of H Tristram Engelhardt Jr, who has contributed an introduction to the volume on Western bioethics reconsidered. (As Engelhardt writes: “Like good wine, this work has come slowly into its own” (page xii). Engelhardt’s bias is evident in the phrase he uses early on in this introduction, “the customary American/western European indoctrination in …. (shrink)

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case (...) that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

This edited volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organised around the main stages of the clinical encounter from the patient's perspective. This introductory chapter opens up crucial issues of methodology and of practical application in this highly innovative approach to the role of ethics in healthcare.

This volume of articles, literature and case studies illustrates the central importance of human values throughout healthcare. The readings are structured around the main stages of the clinical encounter from the patient's perspective.

In this article I evaluate a resurrected French resistance movement--to biotechnological commodification. The official French view that ‘the body is the person’ has been dismissed as a ‘taboo’ by the French political scientist Dominique Memmi . Yet France has indeed resisted the models of globalised commodification adopted in US bioechnology, as, for example, when the government blocked a research collaboration between the American firm Millennium Pharmaceuticals and a leading genomics laboratory, le Centre d’Etude du Polymorphisme Humain, on the grounds the (...) ‘French DNA’ should not be given away. -/- This example, however, itself suggests why the ‘new French Resistance’ is not altogether liberating. The absolutist conception of all bodies as belonging to the French state—indeed, as constituting the body politic —is so potentially invasive that a counter-ideology of inviolability of the body is maintained assiduously. This inviolability is defended particularly strongly against commercialisation, but only at the moment when tissue is taken from the individual subject, who is not to be paid or compensated-- although commercial enterprises who subsequently use the tissue are not similarly constrained. -/- . (shrink)

Interview on the commodified body with Donna Dickenson by Alana Cattapan.

New developments in biotechnology radically alter our relationship with our bodies. Body tissues can now be used for commercial purposes, while external objects, such as pacemakers, can become part of the body. Property in the Body: Feminist Perspectives transcends the everyday responses to such developments, suggesting that what we most fear is the feminisation of the body. We fear our bodies are becoming objects of property, turning us into things rather than persons. This book evaluates how well-grounded this fear is, (...) and suggests innovative models of regulating what has been called 'the new Gold Rush' in human tissue. This is an up-to-date and wide-ranging synthesis of market developments in body tissue, bringing together bioethics, feminist theory and lessons from countries that have resisted commercialisation of the body, in a theoretically sophisticated and practically significant approach. (shrink)

The rise of personalised medicine can be seen as an extension of individualism and as a threat to the common good.

Interview by Klasien Horstman on gender and genetics. 'Unlike many gender theorists, I do not view the body as socially constructed; nor do I share postmodern and deconstructionist disquiet at the notion of a unified subject. Frankly, I think these constructions get in the way of political action and are bad for women’s rights.' -/- .

This article, based on a case study, examines issues of confidentiality and family impact in a diagnosis of Huntington's disease. Genetic-based illness transcends individualistic models of patient autonomy because it also involves other family members, requiring a new approach to patient confidentiality.

Collection of essays, literature and first-person accounts on death, dying and bereavement.

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers strong counter-arguments (...) to this view that enable us to think in terms of universal standards. (shrink)

Speculative enhancement technologies are premised on the notion that I have a duty to be the best Me I can possibly be. This article takes a sceptical look at that claim.

Correction of major error in review of Bioethics: All That Matters.

Abstract Gender and Ethics Committees: Where’s the Different Voice? -/- Prominent international and national ethics commissions such as the UNESCO Bioethics Commission rarely achieve anything remotely resembling gender equality, although local research and clinical ethics committees are somewhat more egalitarian. Under-representation of women is particularly troubling when the subject matter of modern bioethics so disproportionately concerns women’s bodies, and when such committees claim to derive ‘universal’ standards. Are women missing from many ethics committees because of relatively straightforward, if discriminatory, demographic (...) factors? Or are the methods of analysis and styles of ethics to which these bodies are committed somehow ‘anti-female’? It has been argued, for example, that there is a ‘different voice’ in ethical reasoning, not confined to women but more representative of female experience. Similarly, some feminist writers, such as Evelyn Fox Keller and Donna Haraway, have asked difficult epistemological questions about the dominant ‘masculine paradigm’ in science. Perhaps the dominant paradigm in ethics committee deliberation is similarly gendered? This article provides a preliminary survey of women’s representation on ethics committees in Eastern and Western Europe, a critical analysis of the supposed ‘masculinism’ of the principlist approach, and a case example in which a ‘different voice’ did indeed make a difference. (shrink)

In Two Minds is a practical casebook of problem solving in psychiatric ethics. Written in a lively and accessible style, it builds on a series of detailed case histories to illustrate the central place of ethical reasoning as a key competency for clinical work and research in psychiatry. Topics include risk, dangerousness and confidentiality; judgements of responsibility; involuntary treatment and mental health legislation; consent to genetic screening; dual role issues in child and adolescent psychiatry; needs assessment; cross-cultural and gender issues; (...) rational and irrational suicide; shared decision making in multi-agency teams, and the growing role of the user's voice in psychiatry. Key ethical concepts are carefully introduced and explained. The text is richly supported by detailed guides for further reading. There are separate chapters on teaching psychiatric ethics, including a sample seminar, and on writing a research ethics application. Each case history and discussion is followed by a critical commentary from a practitioner with relevant experience. Jim Birley adds a comparative international perspective on psychiatric ethics. Cartoons by Johnny Cowee provide punchy counterpoint! In Two Minds is the sister volume to the third edition of Sidney, Paul Chodoff and Steven Green's highly successful Psychiatric Ethics. In providing a bridge between theory and practice, it will be essential reading for everyone concerned with improving standards in mental health care. (shrink)

To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of concepts widely disparaged (...) by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

This article, arising from a comparative European Commission project, analyses different national perspectives on bioethics issues.

The idea that there could be spatially extended mereological simples has recently been defended by a number of metaphysicians (Markosian 1998, 2004; Simons 2004; Parsons (2000) also takes the idea seriously). Peter Simons (2004) goes further, arguing not only that spatially extended mereological simples (henceforth just extended simples) are possible, but that it is more plausible that our world is composed of such simples, than that it is composed of either point-sized simples, or of atomless gunk. The difficulty for these (...) views lies in explaining why it is that the various sub-volumes of space occupied by such simples, are not occupied by proper parts of those simples. Intuitively at least, many of us find compelling the idea that spatially extended objects have proper parts at every sub-volume of the region they occupy. It seems that the defender of extended simples must reject a seemingly plausible claim, what Simons calls the geometric correspondence principle (GCP): that any (spatially) extended object has parts that correspond to the parts of the region that it occupies (Simons 2004: 371). We disagree. We think that GCP is a plausible principle. We also think it is plausible that our world is composed of extended simples. We reconcile these two notions by two means. On the one hand we pay closer attention to the physics of our world. On the other hand, we consider what happens when our concept of something—in this case space—contains elements not all of which are realized in anything, but instead key components are realized in different features of the world. (shrink)

For a long time discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. However, a narrow focus on medical resources prevents us from seeing that there are many cases-- perhaps the majority-- in which less dramatic but equally important issues of rationing occur. The allocation of nurses' time is one such issue.

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, that of the (...) common good as a goal in medicine. (shrink)

The notion of function is indispensable to our understanding of distinctions such as that between being broken and being in working order (for artifacts) and between being diseased and being healthy (for organisms). A clear account of the ontology of functions and functioning is thus an important desideratum for any top-level ontology intended for application to domains such as engineering or medicine. The benefit of using top-level ontologies in applied ontology can only be realized when each of the categories identified (...) and defined by a top-level ontology is integrated with the others in a coherent fashion. Basic Formal Ontology (BFO) has from the beginning included function as one of its categories, exploiting a version of the etiological account of function that is framed at a level of generality sufficient to accommodate both biological and artifactual functions. This account has been subjected to a series of criticisms and refinements. We here articulate BFO’s account of function, provide some reasons for favoring it over competing views, and defend it against objections. (shrink)

This paper endeavors to understand the research landscape of finance research in Vietnam during the period 2008 to 2020 and predict the key defining future research directions. Using the comprehensive database of Vietnam’s international publications in social sciences and humanities, we extract a dataset of 314 papers on finance topics in Vietnam from 2008 to 2020. Then, we apply a systematic approach to analyze four important themes: Structural issues, Banking system, Firm issues, and Financial psychology and behavior. Overall, there have (...) been three noticeable trends within finance research in Vietnam: (1) assessment of financial policies or financial regulation, (2) deciphering the correlates of firms’ financial performances, and (3) opportunities and challenges in adopting innovations and ideas from foreign financial market systems. Our analysis identifies several fertile areas for future research, including financial market analysis in the post-COVID-19 eras, fintech, and green finance. (shrink)

Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

This book contributes to the feminist reconstruction of political theory. Although many feminist authors have pointed out the ways in which women have been property, they have been less successful in suggesting how women might become the subjects rather than the objects of property-holding. This book synthesises political theory from liberal, Marxist, Kantian and Hegelian traditions, applying these ideas to history and social policy.

There has been a troublesome anomaly in the UK between cash payment to men for sperm donation and the effective assumption that women will pay to donate eggs. Some commentators, including Donald Evans in this journal, have argued that the anomaly should be resolved by treating women on the same terms as men. But this argument ignores important difficulties about property in the body, particularly in relation to gametes. There are good reasons for thinking that the contract model and payment (...) for gametes are both inappropriate, and that a model based on altruism should be applied to both sexes. (shrink)

Context: The majority of contemporary enactivist work is influenced by the philosophical biology of Hans Jonas. Jonas credits all living organisms with experience that involves particular “existential” structures: nascent forms of concern for self-preservation and desire for objects and outcomes that promote well-being. We argue that Jonas’s attitude towards living systems involves a problematic anthropomorphism that threatens to place enactivism at odds with cognitive science, and undermine its legitimate aims to become a new paradigm for scientific investigation and understanding of (...) the mind. Problem: Enactivism needs to address the tension between its Jonasian influences and its aspirations to become a new paradigm for cognitive science. By relying on Jonasian phenomenology, contemporary enactivism obscures alternative ways in which phenomenology can be more smoothly integrated with cognitive science. Method: We outline the historical relationship between enactivism and phenomenology, and explain why anthropomorphism is problematic for a research program that aspires to become a new paradigm for cognitive science. We examine the roots of Jonas’s existential interpretation of biological facts, and describe how and why Jonas himself understood his project as founded on an anthropomorphic assumption that is incompatible with a crucial methodological assumption of scientific enquiry: the prohibition of unexplained natural purposes. We describe the way in which phenomenology can be integrated into Maturana’s autopoietic theory, and use this as an example of how an alternative, non-anthropomorphic science of the biological roots of cognition might proceed. Results: Our analysis reveals a crucial tension between Jonas’s influence on enactivism and enactivism’s paradigmatic aspirations. This suggests the possibility of, and need to investigate, other ways of integrating phenomenology with cognitive science that do not succumb to this tension. Implications: In light of this, enactivists should either eliminate the Jonasian inference from properties of our human experience to properties of the experience of all living organisms, or articulate an alternative conception of scientific enquiry that can tolerate the anthropomorphism this inference entails. The Maturanian view we present in the article’s final section constitutes a possible framework within which enactivist tools and concepts can be used to understand cognition and phenomenology, and that does not involve a problematic anthropomorphism. Constructivist content: Any constructivist approach that aims for integration with current scientific practice must either avoid the type of anthropomorphic inference on which Jonas bases his work, or specify a new conception of scientific enquiry that renders anthropomorphism unproblematic. (shrink)

The axiological tenet of scientific realism, “science seeks true theories,” is generally taken to rest on a corollary epistemological tenet, “we can justifiably believe that our successful theories achieve (or approximate) that aim.” While important debates have centered on, and have led to the refinement of, the epistemological tenet, the axiological tenet has suffered from neglect. I offer what I consider to be needed refinements to the axiological postulate. After showing an intimate relation between the refined postulate and ten theoretical (...) desiderata, I argue that the axiological postulate does not depend on its epistemological counterpart; epistemic humility can accompany us in the quest for truth. Upon contrasting my axiological postulate against the two dominant non-realist alternatives and the standard realist postulate, I contend that its explanatory and justificatory virtues render it, among the axiologies considered, the richest account of the scientific enterprise. (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force here. (...) As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

The feminist movement may seek democratization on a global scale, but women are still hampered by a democratic deficit in terms of economic and political power. On the other hand, global feminist networks and new expanded forms of non-territorial political space do appear to be increasing democratic participation for women.

The scientific realism debate has now reached an entirely new level of sophistication. Faced with increasingly focused challenges, epistemic scientific realists have appropriately revised their basic meta-hypothesis that successful scientific theories are approximately true: they have emphasized criteria that render realism far more selective and, so, plausible. As a framework for discussion, I use what I take to be the most influential current variant of selective epistemic realism, deployment realism. Toward the identification of new case studies that challenge this form (...) of realism, I break away from the standard list and look to the history of celestial mechanics, with an emphasis on twentieth century advances. I then articulate two purely deductive arguments that, I argue, properly capture the historical threat to realism. I contend that both the content and form of these novel challenges seriously threaten selective epistemic realism. I conclude on a positive note, however, arguing for selective realism at a higher level. Even in the face of threats to its epistemic tenet, scientific realism need not be rejected outright: concern with belief can be bracketed while nonetheless advocating core realist tenets. I show that, in contrast with epistemic deployment realism, a purely axiological scientific realism can account for key scientific practices made salient in my twentieth century case studies. And embracing the realists favored account of inference, inference to the best explanation, while pointing to a set of the most promising alternative selective realist meta-hypothesis, I show how testing the latter can be immensely valuable to our understanding of science. (shrink)

This chapter critically examines two frequently found assumptions in the debate about trafficking for prostitution: 1. That the sale of sexual services is like the sale of any other good or service; 2. That by and large women involved in trafficking for prostitution freely consent to sell such services.

Reproductive ageing has effects on individual and public health, now and in generations to come. This volume of presentations from a conference at the Royal College of Obstetricians and Gynaecologists brings together a diverse but timely set of contributions.. in ny chapter I specifically examine the responsibilities of the College to women outside normal reproductive age.

With the highest profile seller of $99 genetic tests under fire, will public trust in personalised medicine suffer?

The soaring promises made by personalized genetic medicine advocates are probably loftier than those in any other medical or scientific realm today. Are they justified?

Three-parent IVF is proceeding towards partial legalisation in the UK, but is this process too hasty?

The growth of personalised medicine threatens the communal approach that has brought our biggest health gains.

Attributions of omnipresence, most familiar within the philosophy of religion, typically take the omnipresence of an entity to either consist in that entity's occupation of certain regions or be dependent upon other of that entity's attributes, such as omnipotence or omniscience. This paper defends an alternative conception of omnipresence that is independent of other purported divine attributes and dispenses with occupation. The resulting view repurposes the metaphysics of necessitism and permanentism, taking omnipresent entities to be those entities that exist at (...) all regions. This view is then shown to best accommodate attributions of omnipresence to a diverse range of metaphysical posits, like abstract entities, and a more diverse class of religious posits. (shrink)

The no-miracles argument and the pessimistic induction are arguably the main considerations for and against scientific realism. Recently these arguments have been accused of embodying a familiar, seductive fallacy. In each case, we are tricked by a base rate fallacy, one much-discussed in the psychological literature. In this paper we consider this accusation and use it as an explanation for why the two most prominent `wholesale' arguments in the literature seem irresolvable. Framed probabilistically, we can see very clearly why realists (...) and anti-realists have been talking past one another. We then formulate a dilemma for advocates of either argument, answer potential objections to our criticism, discuss what remains (if anything) of these two major arguments, and then speculate about a future philosophy of science freed from these two arguments. In so doing, we connect the point about base rates to the wholesale/retail distinction; we believe it hints at an answer of how to distinguish profitable from unprofitable realism debates. In short, we offer a probabilistic analysis of the feeling of ennui afflicting contemporary philosophy of science. (shrink)

According to the standard narrative, natural kind is a technical notion that was introduced by John Stuart Mill in the 1840s and the recent craze for natural kinds, launched by Putnam and Kripke, is a continuation of that tradition. I argue that the standard narrative is mistaken. The Millian tradition of kinds was not particularly influential in the 20th-century, and the Putnam-Kripke revolution did not clearly engage with even the remnants that were left of it. The presently active tradition of (...) natural kinds is less than half a century old. Recognizing this might help us better appreciate both Mill and natural kinds. (shrink)

Review of Daniel Callahan's book The Troubled Dream of Life.

Review of Graeme Laurie, Genetic Privacy: A Challenge to Medico-Legal Norms.

'An alarming and illuminating book. The story of how we have allowed private corporations to patent genes, to stockpile human tissue, and in short to make profits out of what many people feel ought to be common goods is a shocking one. No one with any interest at all in medicine and society and how they interact should miss this book, and it should be required reading for every medical student,'--Philip Pullman.