Londres, 1945. Giles est declare heritier du titre et de la fortune de son pere Hugo Barrington. Au detriment de son ami - et peut-etre demi-frere - Harry Clifton, mais aussi au grand soulagement de celui-ci qui peut dorenavant epouser Emma, la soeur de Giles. Tandis que Harry et Emma s'installent a Bristol avec Sebastian, leur fils, et Jessica, une petite fille qu'ils adoptent, Giles, devenu membre de la chambre des Lords, se retrouve pris au piege de (...) haines ancestrales dans sa lutte pour le pouvoir. Une decennie plus tard, c'est Sebastian, representant de la nouvelle generation, qui fera basculer la carriere politique de son oncle. Secrets trop longtemps enfouis, vengeances longuement meditees, amours enfin possibles ou alliances interessees, une saga qui se devore d'une traite. Tout est reuni pour rendre cette lecture totalement addictive. Un excellent page-turner. Version Femina. (shrink)

Desire is a central concept in Aristotle's ethical and psychological works, but he does not provide us with a systematic treatment of the notion itself. This book reconstructs the account of desire latent in his various scattered remarks on the subject and analyses its role in his moral psychology. Topics include: the range of states that Aristotle counts as desires ; objects of desire and the relation between desires and envisaging prospects; desire and the good; Aristotle's three species of desire: (...) epithumia, thumos and boulêsis ; Aristotle's division of desires into rational and non-rational; Aristotle and some current views on desire; and the role of desire in Aristotle's moral psychology. The book will be of relevance to anyone interested in Aristotle's ethics or psychology. (shrink)

Smart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology’s potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engineers themselves. By exploring the views of engineering researchers in a large smart-home project, we sought (...) to contribute to dialogue between ethics and the engineering community. Either face-to-face or using Skype, we conducted in-depth qualitative interviews with 20 early- and mid-career smart-home researchers from a multi-centre smart-home project, who were asked to describe their own experience and to reflect more broadly about ethical considerations that relate to smart-home design. With participants’ consent, interviews were audio-recorded, transcribed and analysed using a thematic approach. Two overarching themes emerged: in ‘Privacy’, researchers indicated that they paid close attention to negative consequences of potential unauthorised information sharing in their current work. However, when discussing broader issues in smart-home design beyond the confines of their immediate project, researchers considered physical privacy to a lesser extent, even though physical privacy may manifest in emotive concerns about being watched or monitored. In ‘Choice’, researchers indicated they often saw provision of choice to end-users as a solution to ethical dilemmas. While researchers indicated that choices of end-users may need to be restricted for technological reasons, ethical standpoints that restrict choice were usually assumed and embedded in design. The tractability of informational privacy may explain the greater attention that is paid to it. However, concerns about physical privacy may reduce acceptability of smart-home technologies to future end-users. While attention to choice suggests links with privacy, this may misidentify the sources of privacy and risk unjustly burdening end-users with problems that they cannot resolve. Separating considerations of choice and privacy may result in more satisfactory treatment of both. Finally, through our engagement with researchers as participants this study demonstrates the relevance of ethics as a critical partner to smart-home engineering. (shrink)

The problem of personal identity is often said to be one of accounting for what it is that gives persons their identity over time. However, once the problem has been construed in these terms, it is plain that too much has already been assumed. For what has been assumed is just that persons do have an identity. A new interpretation of Hume's no-self theory is put forward by arguing for an eliminative rather than a reductive view of personal identity, and (...) by approaching the problem in terms of phenomenology, Buddhist psychology, and the idea of a constructed self-image. (shrink)

Improving surgical interventions is key to improving outcomes. Ensuring the safe and transparent translation of such improvements is essential. Evaluation and governance initiatives, including the IDEAL framework and the Macquarie Surgical Innovation Identification Tool have begun to address this. Yet without a definition of innovation that allows non-surgeons to identify when it is occurring, these initiatives are of limited value. A definition seems elusive, so we undertook a conceptual study of surgical innovation. This indicated common conceptual areas in discussions of (...) innovation, that we categorised alliteratively under the themes of “purpose”, “place”, “process”, “product” and “person”. These conceptual areas are used in varying—sometimes contradictory—ways in different discussions. Highlighting these conceptual areas of surgical innovation may be useful in clarifying what should be reported in registries of innovation. However our wider conclusion was that the term “innovation” carries too much conceptual baggage to inform normative inquiry about surgical practice. Instead, we propose elimination of the term “innovation” from serious discourse aimed at evaluation and regulation of surgery. In our view researchers, philosophers and policy-makers should consider what it is about surgical activity that needs attention and develop robust definitions to identify these areas: for our own focus on transparency and safety, this means finding criteria that can objectively identify certain risk profiles during the development of surgery. (shrink)

A growing number of bioethics papers endorse the harm threshold when judging whether to override parental decisions. Among other claims, these papers argue that the harm threshold is easily understood by lay and professional audiences and correctly conforms to societal expectations of parents in regard to their children. English law contains a harm threshold which mediates the use of the best interests test in cases where a child may be removed from her parents. Using Diekema9s seminal paper as an example, (...) this paper explores the proposed workings of the harm threshold. I use examples from the practical use of the harm threshold in English law to argue that the harm threshold is an inadequate answer to the indeterminacy of the best interests test. I detail two criticisms: First, the harm standard has evaluative overtones and judges are loath to employ it where parental behaviour is misguided but they wish to treat parents sympathetically. Thus, by focusing only on ‘substandard’ parenting, harm is problematic where the parental attempts to benefit their child are misguided or wrong, such as in disputes about withdrawal of medical treatment. Second, when harm is used in genuine dilemmas, court judgments offer different answers to similar cases. This level of indeterminacy suggests that, in practice, the operation of the harm threshold would be indistinguishable from best interests. Since indeterminacy appears to be the greatest problem in elucidating what is best, bioethicists should concentrate on discovering the values that inform best interests. (shrink)

In the western healthcare, shared decision making has become the orthodox approach to making healthcare choices as a way of promoting patient autonomy. Despite the fact that the autonomy paradigm is poorly suited to paediatric decision making, such an approach is enshrined in English common law. When reaching moral decisions, for instance when it is unclear whether treatment or non-treatment will serve a child’s best interests, shared decision making is particularly questionable because agreement does not ensure moral validity. With reference (...) to current common law and focusing on intensive care practice, this paper investigates what claims shared decision making may have to legitimacy in a paediatric intensive care setting. Drawing on key texts, I suggest these identify advantages to parents and clinicians but not to the child who is the subject of the decision. Without evidence that shared decision making increases the quality of the decision that is being made, it appears that a focus on the shared nature of a decision does not cohere with the principle that the best interests of the child should remain paramount. In the face of significant pressures toward the displacement of the child’s interests in a shared decision, advantages of a shared decision to decisional quality require elucidation. Although a number of arguments of this nature may have potential, should no such advantages be demonstrable we have cause to revise our commitment to either shared decision making or the paramountcy of the child in these circumstances. (shrink)

Background Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. Methods A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. Results Three (...) themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. Conclusions Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question. (shrink)

New methods to analyse social media data provide a powerful way to know publics and capture what they say and do. At the same time, access to these methods is uneven, with corporations and governments tending to have best access to relevant data and analytics tools. Critics raise a number of concerns about the implications dominant uses of data mining and analytics may have for the public: they result in less privacy, more surveillance and social discrimination, and they provide new (...) ways of controlling how publics come to be represented and so understood. In this paper, we consider if a different relationship between the public and data mining might be established, one in which publics might be said to have greater agency and reflexivity vis-à-vis data power. Drawing on growing calls for alternative data regimes and practices, we argue that to enable this different relationship, data mining and analytics need to be democratised in three ways: they should be subject to greater public supervision and regulation, available and accessible to all, and used to create not simply known but reflexive, active and knowing publics. We therefore imagine conditions in which data mining is not just used as a way to know publics, but can become a means for publics to know themselves. (shrink)

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical ethicist who consults.Medical ethics (...) consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside. (shrink)

Assent to medical research or treatment may be an intuitively attractive way to address the area between incapacity and capacity that might otherwise be subject to a best interests assessment. Assent has become a widely disseminated concept in law, research, and clinical ethics, but little conceptual work on assent has so far occurred. An exploration of use of assent in treatment and research in children and people with dementia suggests that at least five claims are made on behalf of assent. (...) Since at least some of these may lead to tensions with others, assent requires firmer conceptual underpinning. Whether assent remains primarily a local approach to research in children in the United States, where it appears to fit with legal background conditions, or develops its promise to overturn the dominant, binary, approach to (in)capacity will depend on the strength of future philosophical work to improve the theoretical foundations to assent. (shrink)

According to Friedrich Engels (Ludwig Feuerbach and the end of classical German philosophy) the so?called ?Thesen über Feuerbach? are ?the brilliant germ of the new world conception?. For Karl Korsch ('Review of Vernon Venable?, Journal of Philosophy 42 [1945], no. 26) there are ?magnificently summed up? in them the ?texts of Marx and Engels's first (Hegelian and post?Hegelian) period?. Even given the important distinction between the ?young? and the ?mature? Marx these two opinions are not incompatible. The present paper's concern, (...) however, is with the relationship of the ?Thesen? to the materialist conception of history. Once the ?Thesen? are read as a consistent whole it is clear that they are incompatible with any non?social (non?human) nature; hence with the ontological independence of nature from man; hence with any materialism, historical or otherwise. Furthermore, taken as a whole the ?Thesen? form an attempted solution to the problem of the justification of ideals, a solution both activist and dogmatist. Since the attitude expressed in the ?Thesen? underlies both Marx's ?theory of alienation? and his ?critique of political economy? neither of these can lay claim to the status of knowledge. (shrink)

Attempts to conduct systematic reviews of ethical arguments in bioethics are fundamentally misguided. All areas of enquiry need thorough and informative literature reviews, and efforts to bring transparency and systematic methods to bioethics are to be welcomed. Nevertheless, the raw materials of bioethical articles are not suited to methods of systematic review. The eclecticism of philosophy may lead to suspicion of philosophical methods in bioethics. Because bioethics aims to influence medical and scientific practice it is tempting to adopt scientific language (...) and methods. One manifestation is the increasing innovation in, and use of, systematic reviews of ethical arguments in bioethics. Yet bioethics, as a broadly philosophical area of enquiry, is unsuited to systematic review. Bioethical arguments are evaluative, so notions of quality and bias are inapplicable. Bioethical argument is conceptual rather than numerical, and the classification of concepts is itself a process of argument that cannot aspire to neutrality. Any ‘systematic review’ of ethical arguments in bioethics thus falls short of that name. Furthermore, labels matter. Although the bioethics research community may find that adopting the language and the outward methods of clinical science offers apparent prospects of credibility, policy influence and funding, we argue that such misdirection carries risks and is unlikely to pay dividends in the long term. Bioethical sources are amenable to the review methods of the social sciences, and it is on these methods that specific methods of bioethics literature review should be built. (shrink)

This letter responds to the essay “If Not Now, Then When? Taking Disability Seriously in Bioethics,” by Debjani Mukherjee, Preya S. Tarsney, and Kristi L. Kirschner, in the May‐June 2022 issue of the Hastings Center Report.

Abstract‘Dogwhistles’ and microtargeted political advertisements are objects of widespread moral and political concern. With a few notable exceptions in the case of dogwhistles (and none in the case of microtargeting) moral criticism of these speech act types generally focuses on problematiccontent—that a dogwhistle is, for instance, racist, or a microtargeted advertisement misleading. I argue that these practices areadditionallymorally wrongful on content-neutral grounds—regardless of their content. My argument proceeds from a deliberative conception of democracy according to which only a vote which (...) follows from anadequate deliberative processconfers democratic legitimacy on its results. I claim that both dogwhistles and microtargeting threaten to prevent adequate democratic deliberation from taking place, and therefore that these practices are anti-democratic and, additionally, morally impermissible. I then discuss potential objections and how my argument relates to existing work. (shrink)

We develop and test a trickle-down model of how authentic leadership at the department level flows down the organizational hierarchy to encourage team leader authentic leadership and consequently, promotes team and individual-level supervisor-directed helping behavior. Analyses of multi-level and multi-source data collected from a total of 487 employees comprising 122 teams, 47 departments, and 4 different working areas of a major public sector organization in Taiwan show that team leaders’ authentic leadership mediates the relationship between departmental authentic leadership and individual-level (...) leader–member exchange. We also found that intra-team trust completely mediates the influence of team authentic leadership on both team helping behavior and individual-level supervisor-directed helping behavior. Finally, the results reveal that self-concordance mediates the influence of team authentic leadership on individual-level supervisor helping behavior as well as the influence of individual-level LMX on individual-level supervisor-directed helping behavior. Theoretical and practical implications of these findings are discussed. (shrink)

In an earlier paper entitled _Harm is all you need?_, I used an analysis of English law to claim that the harm threshold was an unsuitable mediator of the best interests test when deciding if parental decisions should be overruled. In this paper I respond to a number of commentaries of that paper, and extend my discussion to consider the claim that the harm threshold gives appropriate normative weight to the interests of parents. While I accept that parents have some (...) rights over their children, I argue these are dependent on parents’ duties to benefit their children. While many such benefits are understood pluralistically, and are thus within parents’ ambit to decide, I claim that health benefits are ordinally different, because they play a foundational role in the flourishing of an individual. In the light of this, clinicians have the moral authority to override parental refusals, although in some cases abstaining from exercising this authority may be a pragmatic way to maintain parental engagement and ensure our ability to benefit the child in future. (shrink)

Avoiding partisan diatribe, Left Wing, Right Wing, People, and Power traces the historical development of the left wing and the right wing to reveal that the core of politics is the conflict over power. Despite specific differences of time and place, political actions are consistently efforts to preserve or change the structure and dynamics of power. With this insight, we can better understand political positions and actions. -/- Written in an accessible style, this book will inform readers regardless of where (...) they see themselves on the political spectrum. With clear but nuanced definitions of political ideologies and movements, the author shows how politics is people seeking to express and expand their power in the social space around them. Thus, the clash of the left and right wings is not about grand ideologies but instead is about power relations and the flow of power among people. (shrink)

The experience of being famous was investigated through interviews with 15 well-known American celebrities. The interviews detail the existential parameters of being famous in contemporary culture. Research participants were celebrities in various societal categories: government, law, business, publishing, sports, music, film, television news and entertainment. Phenomenological analysis was used to examine textural and structural relationship-to-world themes of fame and celebrity. The study found that in relation to self, being famous leads to loss of privacy, entitization, demanding expectations, gratification of ego (...) needs, and symbolic immortality. In relation to other, or world, being famous leads to wealth, access, temptations, and concerns about family impact. Areas of psychological concern for celebrity mental health include character-splitting, mistrust, isolation, and an unwillingness to give up fame. Being-in-the-world of celebrity is a process involving four temporal phases: love/hate, addiction, acceptance, and adaptation. Findings are presented in the form of a Composite Textural Description and two Individual Structural Descriptions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:If You’re Not Part of the Solution...Sarah GilesI worked on an island that lured people to their deaths. I have come to realize that there are certain resources that every population must have in order to continue to exist. Health care providers are needed if a group is to continue to reside in one place. Without nurses and doctors, people tend to refuse to go to a location or (...) choose not to stay. Perhaps if doctors like me refused to work in places where people have their basic human rights ignored, those places would cease to exist. It’s wishful thinking, but it’s the only way I can imagine the events of December 15th, 2010, could have been prevented. [End Page E11]Australia has a large offshore detention center on Christmas Island, a tiny dot in the middle of the Indian Ocean. Housed in a collection of prison–like facilities are men, women, and children who have come to an Australian Island claiming they are refugees. They have paid an average of $10,000 (U.S. dollars) to be smuggled by boat from nearby Indonesia and are then, usually, intercepted by the Australian navy or coast guard, and brought to the island to await processing. This processing can take two to four years and, even then, it can end with deportation. The asylum seekers spend years in a massively overcrowded and unstimulating purgatory.To say that I was not familiar with the political situation on the island would be a farcical under-statement. As a Canadian family doctor, I went to work on Christmas Island because of its exotic location and reputation for world–class SCUBA diving. It sounded like a dreamy place to do a locum. The little research I had done told me that there was a detention center on the island, but I had been told that I would only deal with those patients if they were sick enough to come into hospital. I didn’t imagine that I would end up feeling culpable for the deaths of 48 people who dreamed of restarting their lives in Australia.On December 15th, 2010, a rickety boat carrying approximately 100 asylum seekers somehow slipped past the navy and coast guard into the water just off of Christmas Island. The weather was foreboding and the waves were massive. As the boat approached the island, it lost power and, horrifically, smashed into the cliffs, leaving an estimated 48 men, women, and children to drown and an almost equal number in need of rescue and medical attention. My name was on the call schedule that day. All survivors were brought to the hospital. Our worlds collided.At the time, I thought it was good luck there was an extra doctor on the island that day. I was relieved that we were able to cope with the mass casualty situation and that only few survivors were sick or injured enough to require evacuation to the main land. Three years later, I wonder if the accident would have happened at all had we not been there.I had felt smug providing care in the public hospital, believing it was morally superior to working as a mercenary at the detention center. But I now realize that all of the health care providers had a role in allowing the tragedy to occur. What would have happened if all of the doctors refused to work with people held under those conditions? If that critical infrastructure of health care were not available on the island, the detention center could not be there. If the detention center weren’t there, the government would stop processing people there and perhaps desperate people would stop risking their lives to get to Christmas Island. Maybe the women and men who lost their children or the children who lost their parents would never have gotten on that boat. Maybe.Parts of that awful day stay with me. My job as a doctor prevented me from offering the compassionate care I wanted to provide and forced me to turn into a medical conveyor belt. When a young patient was laid in front of me, I assessed her, started... (shrink)

The Danish philosopher Kierkegaard (1813-1855) is an enigmatic thinker whose works call out for interpretation. One of the most fascinating strands of this interpretation is in terms of Japanese thought. Kierkegaard himself knew nothing of Japanese philosophy, yet the links between his own ideas and Japanese philosophers are remarkable.. This book examines Kierkegaard in terms of Shinto, Pure Land Buddhism, Zen Buddhism, the Samurai, the famous Kyoto school of Japanese philosophers, and in terms of pivotal Japanese thinkers who were influenced (...) by Kierkegaard. (shrink)

The value of conscience in healthcare ethics is widely debated. While some sources present it as an unquestionably positive attribute, others question both the veracity of its decisions and the effect of conscientious objection on patient access to health care. This paper argues that the right to object conscientiously should be broadened, subject to certain previsos, as there are many benefits to healthcare practice in the development of the consciences of practitioners. While effects such as the preservation of moral integrity (...) are widely considered to benefit practitioners, this paper draws on the work of Hannah Arendt to offer several original arguments in defence of conscience that may more directly benefit patients, namely that a pang of conscience may be useful in rapidly unfolding situations in which there is no time to reflect satisfactorily upon activities and that, given the hierarchical nature of healthcare institutions, a right to defy authority on the basis of conscience may benefit junior staff who lack the institutional power to challenge the orders of superiors. (shrink)

The experience of being in love involves a longing for union with the other, where an important part of this longing is sexual desire. But what is the relation between being in love and sexual desire? To answer this it must first be seen that the expression ‘in love’ normally refers to a personal relationship. This is because to be ‘in love’ is to want to be loved back. This much would be predicted by equity and social exchange theories of (...) interpersonal attraction. Findings suggest however that love differs fundamentally from liking and, consequently, distinct approaches to the theory of love have been developed. A phenomenological theory is then put forward which suggests that the experience of being in love involves a complex of desires for reciprocal vulnerability in order to care and be cared for. Sexual desire is then seen to involve the physical expression of these desires in the form of desires for mutual baring in order to caress and be caressed. Unlike love, however, sexual desire need not refer to the other person's desires. This is supported by the existence of sexual desires like fetishism. It is concluded that other desires which often appear in instances of being in love are not basic to the experience of being in love. (shrink)

Sexuality is a basic feature of human life. Gender, sexual and romantic attraction, sexual excitement, and sexual desire and fantasies all move in various degrees through our daily awareness. However, despite this pervasiveness, there is much disagreement surrounding the nature of such things and experiences. This book explores just these issues in an attempt to get clear about this enigmatic aspect of our existence. Through a series of interrelated essays, internationally acclaimed philosopher James Giles takes the reader on a (...) fascinating journey to the depths of experiential, social, biological, and evolutionary aspects of sexual life. Presenting his arguments and ideas in a clear and easy to follow language, Giles criticizes several popular views, clearing the way for his own unique vision of human sexuality. Often controversial, always engaging, these pages will prove to be absorbing reading for anyone who has ever pondered the nature of sexuality and why it fills our lives in the way it does. (shrink)

In this paper, I consider Aristotle’s views in relation to the Humean theory of motivation. I distinguish three principles which HTM is committed to: the ‘No Besires’ principle, the ‘Motivation Out—Desire In’ principle, and the ‘Desire Out—Desire In’ principle. To reject HTM, one only needs to reject one of these principles. I argue that while it is plausible to think that Aristotle accepts the first two principles, there are some grounds for thinking that he might reject the third.