For medical interventions there is a gap between what clinical scientific research has established as likely to carry clinical benefit and what the National Institute for Clinical Excellence (NICE) has judged as cost-effective. This gap is the affordability gap. It is created by a value judgement made by NICE and affirmed by the Secretary of State for Health. This value judgement operates to affect other value judgements made in actual clinical situations where at least one choice of treatment falls into (...) the affordability gap. This paper considers how the creation of this affordability gap impacts upon actual clinical decisions. It explores these issues in the context of the choice between a drug-eluting stent and a bare metal stent for elective coronary angioplasty. It also argues that the option of an NHS procedure with a top-up fee to cover the cost of the affordability gap is a genuine one; that this option could improve clinical outcomes; that it is morally acceptable; and that the rules that prevent the utilization of this option should be relaxed. (shrink)

Background‘The Clinical Ethics Advisory Group’ (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG’s way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG’s paediatric case flow.PurposeReview historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference (‘sentinel’) cases for use with (...) a posited practical (casuistic) case-based reasoning model.MethodsAudit of the minutes of the first 22 years’ meetings was undertaken by the two chairs of CEAG over that period of time.Results223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network ‘round robin’ cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were ‘excellent’ (*A4C4–A4C4) and 70% (156.5/223) ‘good’ or better (*A4C4–A3C3). By meeting the criteria of ‘excellent’ and ‘prospective’, 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.ConclusionsThe audit provides a rich vein of information. There is demand for CEAG’s services, workload is becoming more complex. Formal funding for such services seems justified. (shrink)

The problem of academic dishonesty in general and exam cheating in particular, has been ubiquitous in schools, colleges, and universities around the world. This paper reports on the findings from teachers’ and students’ experiences and perceptions of exam cheating at Nepali schools, colleges, and universities. In so doing, the paper highlights the challenges of maintaining academic integrity in Nepali education systems. Based on qualitative research design, the study data were collected by employing semi-structured interviews with the teachers and the students. (...) Findings from the study indicated that over-emphasized value given to marks/grades and the nature of exam questions among others were the predominant factors. Our findings contribute to the practical understanding that academic institutions in Nepal have largely failed to communicate the value of academic honesty and integrity to the students of all levels of education despite the increasing prevalence of exam cheating. Therefore, exam cheating requires urgent attention from academic institutions, educators, and education leaders to educate students about the long-term educational and social values of academic honesty and integrity. (shrink)

Public benefit corporations are National Health Service, that is, state, entities whose function to provide healthcare in discharge of public duties. If we regardvalue as the output of such organisations, it seems logical to connect the values of the organisation to thevalue produced by such organisations. But, on closer examination there are competing underlying logics in play: (1) those based on promoting organisational efficiency and efficacy; and (2) those based on the idea of building service provision around the clinician–patient relationship. (...) Underlying these logics are differing value sets. These clash. Because of the clashing of underlying moral frameworks the connection between values andvalue becomes hard, if not impossible. This paper argues that (1) the clash in these moral frameworks must be addressed by the organisation rather than between individuals or groups of individuals within the organisation; (2) alloying duties within hybrid professionals submerges but does not resolve these conflicts; (3) one approach could be to impose on the organisation itself an ethical imperative to promote, enhance and protect from deterioration the welfare of the patients; (4) a board ethics committee is a possible organisational structure that could transparently and fairly balance clashes within the competing moral frameworks in a way that could reconcile the competing logics and (5) if such conflicts can be better resolved at the organisational level what the organisation must do to achieve its objectives will become clearer because what needs to be valued would naturally emerge connecting values,value and what is valued. (shrink)

The aim of this report is to present an example of a multidisciplinary Indian-Swedish co-operation on ethics in health care. It is based on a conference held in Asia Plateau, Panchgani, Maharasthra, India in 1998. The emphasis is on ethical values that are important for consumers of health care and professionals, and also for different cultures in developed and developing countries. The importance of human dignity is stressed. Sixteen recommendations are given in an appendix.

This paper introduces the medical factual matrix as a new and potentially valuable tool in medical ethical analysis. Using this tool it demonstrates the idea that a defined medical intervention can only be meaningfully declared futile in relation to a defined goal of treatment. It argues that a declaration of futility made solely in relation to a defined medical intervention is inchoate. It recasts the definition of goal futility as an intervention that cannot alter the probability of the existence of (...) the important outcome states that might flow from a defined intervention. The idea of value futility and the extent of physician obligations in futile situations are also addressed. It also examines the source of substantive conflicts which commonly arise within the doctor-patient relationship and the ensuing power relations that operate between doctor and patient when questions of futility arise. (shrink)

Academic research studies examining the ethical attitudes and behaviors of salespeople have produced several frameworks that explore the ethical decision-making processes to which salespeople adhere when faced with ethical dilemmas. Past literature enriches our understanding; however, a critical review of the relevant literature suggests that an emotional route to salesperson ethical decision-making has yet to be explored. Given the fact that individuals’ emotional capacities play an important role in decision-making when faced with an ethical dilemma, there is a need for (...) empirical research in this area. We address this issue by outlining and testing an emotion-based model to study the ethical attitudes and behaviors of salespeople in a relational selling context. Building on the cognitive-affective model proposed by Gaudine and Thorne (J Bus Ethics 31:175–187, 2001 ), we outline a framework that incorporates higher order prosocial emotions: capacity for concern and capacity for guilt. We include salesperson’s role clarity within the organization as a moderator to examine person–situation interaction. (shrink)

This paper argues that the National Institute for Health and Clinical Excellence should not offer guidance in situations where there is insufficient evidence equipoise about the potential benefit of the treatment in question. This is broadly for two reasons. First, without knowing if the treatment is effective no cost-effectiveness judgement can be logically made. Second, the implementation of a population wide change in treatment where there is equipoise amounts to a de facto clinical trial that falls outside the Clinical Trials (...) Regulations. As such there are strong ethical and possibly legal grounds for preventing such an outcome. Guidance based upon insufficient evidence equipoise also impacts upon the clinical discretion possessed by individual medical professionals. (shrink)

Volume 24, Issue 7, July 2024, Page 6-12.

Descartes is not well known for his contributions to ethics. Some have charged that it is a weakness of his philosophy that it focuses exclusively on metaphysics and epistemology to the exclusion of moral and political philosophy. Such criticisms rest on a misunderstanding of the broader framework of Descartes’ philosophy. Evidence of Descartes’ concern for the practical import of philosophy can be traced to his earliest writings. In agreement of wisdom that is sufficient for happiness. The Third part of his (...) Discourse on the Method presents what he calls a provisional morality, a morality to govern our behaviour while we are in the process of revising our beliefs and coming to certainty. In the tree of philosophy, in the Preface to the French translation of the Principles of Philosophy, morals are listed as one of the fruits of the tree, along with medicine and mechanics. It is also a theme in the letters he exchanged with the Princess Elisabeth of Bohemia in the mid-1640s, together with another concern the passions, what they are, and more importantly, how to control them. These themes are intertwined again in Descartes last major work, The Passions of the Soul (1649). Descartes did not write extensively on ethics, and this has led some to assume that the topic lacks a place within his philosophy. It is an attempt to outline Descartes’ ethical ideas mainly in Discourse on the Method. (shrink)

From the author: The task undertaken in this Dissertation is an analysis of Hegel’s philosophy of religion, culminating in a systematic investigation of his concept of ‘God’. This analysis seeks to emphasize that Hegel’s philosophy has a thorough religious dimension: for him, thought is not philosophical if it is not also religious; both religion and philosophy have a common object and share the same content, and both are concerned with the truth of the inherent unity of all things, even though (...) religion perceives it with a lesser clarity. This inherent unity is fundamental to Hegel’s concept of God as ‘absolute Spirit’; and, by engaging in a systematic investigation of this concept, the Dissertation endeavours to make a contribution to the debate regarding the compatibility of Hegel’s concept of ‘God’ with Christian theology. This final section of the Dissertation proceeds by investigating theism, atheism, pantheism and panentheism as possible descriptive titles for Hegel’s concept. In arguing that Hegel’s position is incompatible with all except the last, namely, panentheism, and in rejecting the view that Hegel has developed a doctrine so different that all religious content has been lost, the Dissertation highlights some important considerations for contemporary theistic theology. (shrink)

Volume 2 is made up primarily of unpublished material from the Bradley Papers held at Merton College since Bradley’s death in 1924. The 587 pages of this volume are divided into eight sections with an Introduction by the editor and an Appendix: Introduction by Editor 1. MS Book α : a notebook on metaphysical and psychological topics with Bradley’s index. 2. MS BK T ): one notebook on mainly metaphysical topics with Bradley’s index. 3. Two untitled notebooks containing sketches of (...) chapters for Appearance and Reality. 4. MS BK Z one notebook on psychological topics with Bradley’s index. 5. Draft of a reply to Alfred Sidgwick’s article “Mr. Bradley and the Sceptics” in Mind, vol. 3 ns, July 1894 6. Manuscript of unpublished paper on Alexander Shand’s article “Attention and Will: A Study in Involuntary Action” in Mind, vol. 4 ns, October 1895. 7. Manuscript of unpublished paper on Bertrand Russell’s article “Is Position in Time and Space Absolute or Relative?” in Mind, vol. 10 ns, July 1901. 8. Selections of Bradley’s reading notes on works read from 1883–1902, taken from 5 separate notebooks. Appendix: What Bradley Read. This is a chronological list of works for which there is some positive evidence that Bradley read something from them. The evidence used to determine what he read includes “his correspondence, papers and/or publications”. An acknowledgement of receipt and a promise to read a work is not considered adequate evidence that he actually read the work in question. (shrink)

Heidegger contrasts meditative thinking, which allows detachment from beings, with calculative thinking, which maintains an instrumental and interested relationship with them. In his view, the principle of reason is the main tool for dominating available things. He also embeds the Medieval essence-existence duality within this framework of causality geared towards manipulating beings, judging that the religious notion of creation failed to distance this duality from Greek essentialism. Now, by appropriating the Islamic notion of creation ex nihilo, Avicenna places an ontological (...) indigence at the heart of the created world. He believes that a being necessary by something other than itself remains contingent in itself, even after being caused. Thus, knowledge of the cause doesn’t grant dominance over the thing but fosters detachment from contingent being, recognizing its dependence on an upstream otherness. Moreover, Meister Eckhart, who according to Heidegger perfectly illustrates meditative thought, is indebted precisely to this ontological poverty established by Avicenna. In addition to describing this possible objection from Avicenna to Heidegger, the more general aim of this study is to explore the possibility of an ethical and disinterested use of the principle of reason. (shrink)

Though many agree that we need to account for the role that social factors play in inquiry, developing a viable social epistemology has proved to be a difficult task. According to Longino, it is the processes that make inquiry possible that are aptly described as social, for they require a number of people to sustain them. These processes not only facilitate inquiry, but also ensure that the results of inquiry are more than mere subjective opinions, and thus deserve to be (...) called knowledge. In this paper, I explain Longino’s epistemology and defend it against criticisms recently raised by Kitcher, Schmitt and Solomon. Longino rightly recognizes that not all social factors have the same affect on inquiry. She also recommends that we reconceptualize ‘knowledge,’ distinguishing knowledge from opinion by reference to a social standard. (shrink)

Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. Nature(representing interest in the causes of a problem) and Narrative (for understanding its meanings) will introduce the field and the series, by touching on a range of issue relevant to this interdisciplinary 'border country'.

Cowan's experimental techniques cannot constrain subject's recall of presented information to distinct independent chunks in short-term memory (STM). The encoding of associations in long-term memory contaminates recall of pure STM capacity. Even in task environments where the functional independence of chunks is convincingly demonstrated, individuals can increase the storage of independent chunks with deliberate practice – well above the magical number four.