Evaluative and normative terms and concepts are often said to be "essentially contestable". This notion has been used in political and legal theory and applied ethics to analyse disputes concerning the proper usage of terms like democracy, freedom, genocide, rape, coercion, and the rule of law. Many philosophers have also thought that essential contestability tells us something important about the evaluative in particular. Gallie (who coined the term), for instance, argues that the central structural features of essentially contestable concepts secure (...) their evaluativeness. I'll argue that these (widely held) central features are exemplified by many evaluative and non-evaluative terms alike, owing to more general factors (such as multidimensionality) which have nothing in particular to do with being evaluative. The role of these factors in semantic interpretation is subject to a certain kind of "metasemantic" disputes which have the features of the disputes characteristically admitted by essentially contestable concepts (whether evaluative or not) and which can be similarly substantive and worthwhile. In closing I'll discuss how my argument shows that our understanding of evaluative disagreement needs refinement. The overall upshot is that essential contestability shows nothing deep or distinctive about the evaluative in particular. (shrink)

The concept of responsibility for health is a significant feature of health discourse and public health policy, but application of the concept is poorly understood. This paper offers an analysis of the concept in two ways. Following an examination of the use of the word ‘responsibility’ in the nursing and wider health literature using three examples, the concept of ‘responsibility for health’ as fulfilling a social function is discussed with reference to policy documents from the UK. The philosophical literature on (...) moral responsibility is introduced, and in considering two versions, reactive attitudes and accountability, it is argued that in application both can be regarded, though with different emphasis, as being constituted in three parts: a responsible agent; having obligations ; and being susceptible to being held responsible if he fails to meet them. The three‐stage model is consistent with the examples of the word responsibility in use, but application to the social function model causes a number of problems for healthcare practice, especially for the reactive attitudes account. Apart from considerable problems in stating what exactly the obligations are and how they can be justified; and how blame might justly be apportioned and by whom, the very ideas of obligation and blame are in conflict within healthcare systems and professional nursing practice which have foundations deeply embedded in the notion of the supremacy of personal autonomy. It is concluded that current application of the concept of responsibility for health is conceptually incoherent, and if it is to retain its place in health policy and discourse, urgent remedy is required. (shrink)

Key legislations in many countries emphasize the importance of involving children in decisions regarding their own health at a level commensurate with their age and capacities. Research is engaged in developing tools to assess capacity in children in order to facilitate their responsible involvement. These instruments, however, are usually based on the cognitive criteria for capacity assessment as defined by Appelbaum and Grisso and thus ill adapted to address the life-situation of children. The aim of this paper is to revisit (...) and critically reflect upon the current definitions of decision-making capacity. For this purpose, we propose to see capacity through the lens of essential contestability as it warns us against any reification of what it means to have capacity. Currently, capacity is often perceived of as a mental or cognitive ability which somehow resides within the person, obscuring the fact that capacity is not just an objective property which can be assessed, but always operates within a dominant cultural framework that “creates” that same capacity and defines the threshold between capable and incapable in a specific situation. Defining capacity as an essentially contested concept means using it in a questioning mode and giving space to alternative interpretations that might inform and advance the debate surrounding decision-making. (shrink)