Originally published in 1986. All students of social science must confront a number of important philosophical issues. This introduction to the philosophy of the social sciences provides coherent answers to questions about empiricism, explanation and rationality. It evaluates contemporary writings on the subject which can be as difficult as they are important to understand. Each chapter has an annotated bibliography to enable students to pursue the issues raised and to assess for themselves the arguments of the authors.

It has become fashionable to question attempts to derive internationally agreed duties of clinical care from more general theories of human rights. For example, some argue that such attempts risk moral abstraction through their neglect for the importance of culture and community in shaping moral consciousness and are thus often unhelpful in the resolution of concrete moral dilemmas within medicine. Others denounce the importance of general moral principles altogether in bioethics and attempt to articulate what are claimed to be more (...) practical approaches to resolving moral conflict. This paper challenges such arguments. It does so through arguing that: i) all humans everywhere have the same basic human needs; ii) the satisfaction of these needs varies with culture; iii) the imputation of moral duties on others entails respect for their right to basic need satisfaction, including the right to choose between cultures; iv) internationally accepted clinical duties of care embrace presumptions about the duties and rights of patients which follow from these more general principles and v) problems of moral indeterminacy that arise from putting these principles into practice can be resolved through associated procedural policies of rational negotiation and compromise. The moral importance and practicality of respect for individual human rights within the practice of medicine is thus defended. Indeed, the paper concludes by arguing that without belief in human rights linked to a theory of basic human needs, communitarian theories of morality are incoherent. (shrink)

Last year (1998) saw the celebration of the 50th Anniversaryof the British National Health Service (NHS). One ofthe few completely nationalised systems of health carein the world, the NHS is seen by many as a moralbeacon of what it means to provide equitable medicaltreatment to all citizens on the basis of need andneed alone. However, others argue that it has failedto achieve the overall goals for which it was created.Because of scarce resources, some urgently needed careis not available at all, (...) while that which is receivedis sometimes second class. For these reasons, it isclaimed that the NHS should be scrapped and replacedby other systems of health care delivery.This paper outlines the history of the NHS,indicating some of the problems and innovations whichhave led to its current organization and structure.The philosophical foundations of the NHS are then articulated and defended on the grounds that it stillrepresents a morally coherent and economicallyefficient approach to the delivery of health care.Scarce resources are the key problem facing the NHS,making rationing inevitable and it is shown thatthis is not incompatible with the moral foundations ofthe service. However, there can be little doubt thatthe NHS is now becoming dangerously under-funded. Thepaper concludes with arguments about why this is soand what might be done about it. (shrink)

For some time, clinical ethics committees (CECs) have been a prominent feature of hospitals in North America. Such committees are less common in the United Kingdom and Europe. Focusing on the UK, this paper evaluates why CECs have taken so long to evolve and assesses the roles that they should play in health care policy and clinical decision making. Substantive and procedural moral issues in medicine are differentiated, the former concerning ethicolegal principles and their paradigmatic application to clinical practice and (...) the latter dealing with how such application should be negotiated in the face of disagreement and/or uncertainty. It will be argued that the role of CECs is both substantive and procedural. Provided that they do not overstep their appropriate moral and professional boundaries, CECs will be shown to have an important and positive function in improving hospital care within the UK and elsewhere. (shrink)

Originally published in 1986. All students of social science must confront a number of important philosophical issues. This introduction to the philosophy of the social sciences provides coherent answers to questions about empiricism, explanation and rationality. It evaluates contemporary writings on the subject which can be as difficult as they are important to understand. Each chapter has an annotated bibliography to enable students to pursue the issues raised and to assess for themselves the arguments of the authors.

In his review of my book, Better never to have been, Len Doyal suggests, contrary to my view, that rational beings in the original position might prefer coming into existence to the alternative of never existing, if their lives were to include enough good and not too much bad. I argue, in response, that Professor Doyal fails to make his case.

The theory of needs has a political problem. Whilst contemporary theorists largely recognise that politics plays an important part in many of the processes surrounding our needs, they nevertheless hang onto the notion that our most important needs can be determined outside of the political. This article challenges that framing. It does so through a taxonomy and critique of the major contemporary approaches to needs. Considering the works of Len Doyal and Ian Gough, Martha Nussbaum, and Lawrence Hamilton, I (...) divide these into three strands: theories that attempt to avoid, solve, and improve the politics of need. Despite some major differences, these approaches share an understanding of the underlying challenges involved in discerning which needs matter. That framing, I argue, is responsible for certain intractable difficulties that leave needs theorists unable to provide the solutions they demand to the theoretical dilemma they posit. Moreover, in attempting to find those solutions, these theories end up ignoring their partisan implications. The conclusion I reach is that the political theory of needs is not very ‘political’ at all, and that this represents the root of the problem. I thus suggest an alternative, politically realist framing that conceptualises needs as constitutively political. (shrink)

ABSTRACT Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all‐purpose (...) primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need‐based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless‐pit problem. But there is a difference between needing something (first‐order need) and needing to have the ability to need (second‐order need). Even if we disagree about which first‐order need to prioritize, we must accept the importance of satisfying our second‐order need to have the ability to value things. We all have a second‐order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first‐order needs. (shrink)

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary (...) goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

Benatar argues that it is better never to have been born because of the harms always associated with human existence. Non-existence entails no harm, along with no experience of the absence of any benefits that existence might offer. Therefore, he maintains that procreation is morally irresponsible, along with the use of reproductive technology to have children. Women should seek termination if they become pregnant and it would be better for potential future generations if humans become extinct as soon as humanely (...) possible. These views are challenged by the argument that while decisions not to procreate may be rational on the grounds of the harm that might occur, it may equally rational to gamble under certain circumstances that future children would be better-off experiencing the harms and benefits of life rather than never having the opportunity of experiencing anything. To the degree that Benatar’s arguments preclude the potential rationality of any such gamble, their moral relevance to concrete issues concerning human reproduction is weakened. However, he is right to emphasise the importance of foreseen harm when decisions are made to attempt to have children. (shrink)

There are very few medical ethics courses in British medical schools which are a formal part of the clinical curriculum. Such a programme is described in the following, along with the way in which the long-term curriculum committee of the University College and Middlesex Hospital Joint Medical School was persuaded to make it compulsory for first-year students. Pedagogical lessons which have been learned in its planning and implementation are outlined and teaching materials are included concerning student and course assessment which (...) should be useful for others engaged in similar work. Finally, some of the institutional obstacles facing such attempts are discussed, particularly problems concerning timetabling, different types of opposition and the consequent importance of building alliances among clinical teaching staff. (shrink)

A programme of research into conflict (e.g. violence, absconding, medication refusal) and containment (e.g. seclusion, special observation, physical restraint) in inpatient psychiatry has been under way at City University, London, UK, for the past 10 years. Recent research findings, plus the challenges posed by ongoing projects, have made apparent the need for greater clarity about the overarching concepts of ‘conflict’ and ‘containment’. This paper pulls together research findings pertaining to this issue, and conducts a reasoned analysis of what common characteristics (...) might underlie ‘conflict’ and ‘containment’. It is concluded that these are patient threats to safety, and the staff maintenance of safety. Details are presented on the inclusions and exclusions that follow from taking such a position, and potential definitions offered. On the grounds of this conceptual analysis, plus evidence for moderate degrees of statistical association between behaviours and events in each domain, it is concluded that it is legitimate to conduct analyses at the level of total conflict and containment rates, as well as at the level of individual types of behaviours and events (e.g. verbal abuse, sedation). Some of the mathematical difficulties in the analysis of total conflict and containment are addressed, and results of a weighting exercise presented. This exercise challenges our perception of the severity of some containment measures that are becoming more commonly used in acute psychiatry. (shrink)

In reply to a chapter by Robert Ware on the need to include, rather than eliminate, institutions in theories of liberation, the author warns that liberation theory must walk on both social and psychological legs and then argues that Ware’s comparative analysis of institutions fails to lead analysis into crucial reflection on how individuals are transformed. Drawing on the work of John Dewey and George Benello, the author argues that an educational philosophy can offer a helpful framework for thinking about (...) relationships between institutions and individuals, such that genuinely democratic institutions would be recognized as being more developmentally educative for individuals involved. The chapter also contains a brief reply by Ware. (shrink)

There are theoretical difficulties involving the intentions of anglers that must be faced by anyone who wants to argue that sport fishing is ethically impermissible. Recent arguments have focused on what might be called the sadistic argument. This argument is fatally flawed because sport fishing is not a sadistic activity.

First published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

Quantifiers are a test case for an interface between psychological questions, which attempt to specify the numerical content that supports the semantics of quantifiers, and linguistic questions, which uncover the range of possible quantifier meanings allowable within the constraints of the syntax. Here we explore the development of comprehension of most in English, of particular interest as it calls on precise numerical content that, in adults, requires an understanding of large exact numerosities (e.g., 23 blue dots and 17 yellow is (...) an instance of “most of the dots are blue”). In a sample of 100 children 2 to 5 years of age we find that (a) successful most comprehension in cases with two salient subsets is achieved at 3 years, 7 months of age, and (b) most comprehension is independent of knowledge of large exact number words; that is, knowledge of large exact number words is neither necessary, as evidenced by children who understand “most” but not “four,” nor sufficient, as evidenced by children who understand “nine” but not “most.”. (shrink)

The intensity of the opposition to health reform in the United States continues to shock and perplex proponents of the Patient Protection and Affordable Care Act. The emotion and the apocalyptic rhetoric, render civil and evidence-based debate over the implications and alternatives to specific provisions in the law difficult if not problematic. The public debate has largely barreled down two non-parallel yet non-intersecting paths: opponents focus on their fear of government expansion in the future if PPACA is implemented now, while (...) proponents focus on the urgency and specifics of our health care market problems and the limited number of tools we have to address them. Frustration on both sides has led opponents to deny the seriousness of our health system’s problems and proponents to ignore the risk of governmental overreach. These non-intersecting lines of argument are not moving us closer to a desired and necessary resolution. (shrink)

Can paradoxical or ambiguous sexual identities and practices change, or even go beyond, the meanings of masculinity and femininity? In other words: can the body be a source of social change? To answer this question I turn to the work of two theorists: Luce Irigaray and Judith Butler. After an account of their ideas, various sexual practices and identities will be described. The question is whether these practices and identities affect the meanings of masculinity and femininity. It will be concluded (...) that, even in our postmodern world with its technological opportunities the division into the two sexes is extraordinarily persistent. However, we can expect some change from the extension of the categories of masculinity and femininity, rather than from attempts to break free from them altogether. (shrink)

Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration website. The opportunity to join (...) a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test. Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance. These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement, but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Using The Spiritual Exercises of Ignatius of Loyola as a Basis for a Buddhist-Christian RetreatLen Tischler and Andre Delbecqorigin of the retreatJesuit (Catholic) universities have struggled to preserve their religious worldview and pass it on to their students, faculty, and staff. Given that most faculty and administrators at these universities are laypeople and many are not Catholic, the universities depend largely on their campus mission/ministry offices for this purpose. (...) One of the primary methods of sharing their worldview has been to provide retreats for students.The retreats are introspective with a religious and Jesuit orientation. Most student retreats are conducted over a weekend; some over a full week. Most Jesuit universities get fewer than ten percent of their students to attend one retreat in their four years on campus. Far fewer students attend more than one retreat. These schools also attempt to encourage faculty and staff to attend similar retreats, and participation in these retreats is similarly modest.Retreats have been a primary tool for the formation of Jesuit priests. Their formation program includes taking at least two retreats of twenty-eight to thirty days each. These retreats use the Spiritual Exercises of Ignatius of Loyola, a specific pattern of reflective meditation and introspection over twenty-eight days that leads to greater clarity about one’s life. The Spiritual Exercises are deeply theistic and are focused on the person of Jesus.Jesuit universities have an increasing number of non-Catholics and non-Christians. For most Christians, shorter retreats or spiritually directed meditations based on the Exercises and undertaken over a number of weeks (referred to as the nineteenth annotation form) are the preferred form. However, there have been limited resources for juxtaposing the Ignatian Exercises with non-Christian traditions.With the above in mind, the authors designed a three-day retreat that follows the pattern and purpose of the Exercises for a Christian, but which presents in parallel [End Page 213] meditations and reflections from the Buddhist tradition. (Sarita Tamayo-Moraga, Bo Tep, and Juan Velasco were co-designers of the retreat and co-authors of the manuscript for the retreat.) This allows Ignatian perspectives on the unfolding spiritual journey and Buddhist wisdom to be shared between Christians and Buddhists. To test our design, a first retreat was undertaken by spiritually mature adults with some experience with the interface between Buddhism and Christianity.the retreatThe Spiritual Exercises are published with contemporary commentary in a number of books. Originally written in the early1500s, they have been rewritten or interpreted for modern times. Often both the original commentary by Ignatius and a contemporary interpretation are provided. Since our retreat was only three days, the essence of each section of the Exercises was summarized in a page or so. With the help of three Buddhist teachers (Sarita Tamayo-Moraga, Bo Tep, and Juan Velasco), we then spent the better part of a year meditating with the Ignatian passages and then searching a variety of Buddhist writings for passages that spoke to a similar spiritual challenge within the Buddhist worldview. A manuscript (Andre L. Delbecq, Sarita Tamayo-Moraga, Bo Tep, Len Tischler, and Juan Velasco, Ignatius and the Buddha in Conversation: A Resource for a Religiously Plural Dialog, self-published, 2014) was created that comprised six sections, each containing a summary of the essence of a section from the Exercises followed by the related Buddhist writings. Original artwork related to both traditions was prepared by a talented Zen artist.For the initial retreat we chose people who had a deep background in both traditions with approximately an equal number of Buddhists and Catholics. Since our focus was Jesuit universities, we chose mostly academics, but there were also two executives. Participants were asked to read the manuscript containing the reflections from the Exercises and Buddhist wisdom before the retreat so that they would be familiar with the content. Catholics and some Buddhists also read the Exercises in full. There were twelve participants.The retreat was structured into six parts. Each part began with two thirty-minute meditations, one on the Ignatian Exercises in the corner with the Ignatius icon, the other on the Buddhist quotes in the corner with... (shrink)