The hospital's clinical ethics committee sought to gauge health-care professionals’ level of knowledge and usage of the Mental Capacity Act 2005 within the hospital trust. The hospital's personnel were asked to complete a 10 part questionnaire relating to the basic contents of the Act. Four hundred questionnaires were distributed and 249 (62%) were returned completed and valid for analysis. A ‘pass-mark’ of 70% (7/10) was assumed; the results showed that 48% of respondents scored ≤50% (≤5/10), 74% of respondents scored <70% (...) (<7/10) and only 24% of respondents scored ≥70% (≥7/10). It was concluded that the Mental Capacity Act 2005 was not being effectively implemented within the Trust. Measures to increase the awareness and usage of the Act have subsequently been instigated. We believe that these measures will improve the awareness and knowledge of the Mental Capacity Act 2005 within the hospital Trust lead to its better utilization. (shrink)

I explore how gender can shape the pragmatics of speech. In some circumstances, when a woman deploys standard discursive conventions in order to produce a speech act with a specific performative force, her utterance can turn out, in virtue of its uptake, to have a quite different force—a less empowering force—than it would have if performed by a man. When members of a disadvantaged group face a systematic inability to produce a specific kind of speech act that they are entitled (...) to perform—and in particular when their attempts result in their actually producing a different kind of speech act that further compromises their social position and agency—then they are victims of what I call discursive injustice. I examine three examples of discursive injustice. I contrast my account with Langton and Hornsby's account of illocutionary silencing. I argue that lack of complete control over the performative force of our speech acts is universal, and not a special marker of social disadvantage. However, women and other relatively disempowered speakers are sometimes subject to a distinctive distortion of the path from speaking to uptake, which undercuts their social agency in ways that track and enhance existing social disadvantages. (shrink)

In 2006, I was diagnosed with cancer. This began a crash course in real-world medical ethics. Having cancer was awful, but it was instructive, too. The experience gave me a new understanding of what my profession is about. Individuals in the bioethics field often address topics related to cancer, such as medical decision-making, the patient-physician relationship, clinical trials, and access to health care. Yet few engaged in this work have lived with cancer themselves. Experience as a cancer patient or family (...) caregiver extends and deepens one’s thinking about serious illness and bioethics. During my time as a cancer patient, I kept in touch with several colleagues immersed in their own cancer .. (shrink)

Miranda Fricker claims that a “gap” in collective hermeneutical resources with respect to the social experiences of marginalized groups prevents members of those groups from understanding their own experiences (Fricker 2007). I argue that because Fricker misdescribes dominant hermeneutical resources as collective, she fails to locate the ethically bad epistemic practices that maintain gaps in dominant hermeneutical resources even while alternative interpretations are in fact offered by non-dominant discourses. Fricker's analysis of hermeneutical injustice does not account for the possibility that (...) marginalized groups can be silenced relative to dominant discourses without being prevented from understanding or expressing their own social experiences. I suggest that a gap in dominant hermeneutical resources is ambiguous between two kinds of unknowing: hermeneutical injustice suffered by members of marginalized groups, and epistemically and ethically blameworthy ignorance perpetrated by members of dominant groups. (shrink)

The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of (...) immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people’s civil liberties. We make tentative recommendations for the ethical introduction of immunity passports. (shrink)

This paper sketches an account of reparative justice for climate refugees, focusing on total land loss due to sea-level rise. I begin by outlining the harm of this loss in terms of self-determination and cultural heritage. I then consider, first, who is owed these reparations? Second, who should pay such reparations? Third, in what form should the reparations be paid? I end with thoughts on the project of reparative justice more generally, arguing that such obligations do not depend upon a (...) perfect account of how reparations might be fulfilled; we simply have an obligation to shoot the arrow as close to the target as we can. (shrink)

This essay explores the theorization of moral valuation outlined in Stefan Bargheer’s Moral Entanglements: Conserving Birds in Britain and Germany when extended to the climate crisis. It considers, first, how ‘nature’ is valued when it confronts people and societies as a source of threat, rather than of recreation or resources. Second, the essay critically examines the role of moral discourse in the collective work of addressing climate change and its relationship to practice.

The Principle of Procreative Beneficence claims that we have a moral obligation, where choice is possible, to choose to create the best child we can. The existence of this moral obligation has been proposed by John Harris and Julian Savulescu and has proved controversial on many levels, not least that it is eugenics, asking us to produce the best children we can, not for the sake of that child's welfare, but in order to make a better society. These are strong (...) claims that require robust justification that can be open to scrutiny and debate. This article argues that robust justifications are currently lacking in the work of Savulescu and Harris. The justifications provided for their conclusions about this obligation to have the best child possible rely heavily on Derek Parfit's Non-Identity Problem and the intuitive response this provokes in many of us. Unfortunately Harris and Savulescu do not embrace the entirety of the Non-Identity Problem and the puzzle that it presents. The Non-Identity Problem actually provides a refutation of PPB. In order to establish PPB as a credible and defendable principle, Harris and Savulescu need to find what has eluded Parfit and many others: a solution to the Non-Identity Problem and thus an overturning of the refutation it provides for PPB. While Harris and Savulescu do hint at possible but highly problematic solutions to the Non-Identity Problem, these are not developed or defended. As a result their controversial is left supported by little more than intuition. (shrink)

The 'Gamer's Dilemma' is the problem of why some actions occurring in video game contexts seem to have similar, albeit attenuated, kinds of moral significance to their real-world equivalents, while others do not. In this paper, I argue that much of the confusion in the literature on this problem is not ethical but metaphysical. The Gamer's Dilemma depends on a particular theory of the virtual, which I call 'inflationary', according to which virtual worlds are a metaphysical novelty generated almost exclusively (...) by video games. Actions performed in virtual worlds really belong to the kinds of action they appear to—'virtual murder' is a kind of murder. Inflationary theories are contrasted with 'deflationary' theories which, in effect, consider video games purely as systems for generating images, and thus the gamer as a consumer of media images. Inflationary theories struggle to explain why video games produce this unique metaphysical novelty; deflationary theories fail to do justice to the intuition that there is some significant difference between the gamer and the consumer of other media forms. In place of either, I sketch a theory of the gamer as performer, primarily by analogy with stage and cinema actors, which I suggest captures more of the moral complexity of the gamer's action. (shrink)

This book brings together international academics from a range of Social Science and Humanities disciplines to reflect on how Deleuze's philosophy is opening up and shaping methodologies and practices of empirical research.

In this article, we outline a novel approach to understanding the role of responsibility in health promotion. Efforts to tackle chronic disease have led to an emphasis on personal responsibility and the identification of ways in which people can ‘take responsibility’ for their health by avoiding risk factors such as smoking and over-eating. We argue that the extent to which agents can be considered responsible for their health-related behaviour is limited, and as such, state health promotion which assumes certain forms (...) of moral responsibility should be avoided. This indicates that some approaches to health promotion ought not to be employed. We suggest, however, that another form of responsibility might be more appropriately identified. This is based on the claim that agents have prudential reasons to maintain their health, in order to pursue those things which make their lives go well—i.e. that maintenance of a certain level of health is rational for many agents, given their pleasures and plans. On this basis, we propose that agents have a self-regarding prudential responsibility to maintain their health. We outline the implications of a prudential responsibility approach to health promotion. (shrink)

van der Pijl et al 1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation (...) to VE; and third, the significant risk of perpetuating under-recognised harms associated with unwanted or unconsented VE. I argue that opt-out consent cannot be ethically justified for VE. Its use would result in further weakening of consent practices, circumvention of individuals’ autonomy, and greater harm for women and birthing people. At the outset, it is important to recognise that the authors do not claim that their approach should be applied to VE, merely that their discussion may have relevance to consent for other interventions beyond episiotomy ‘where consent is also frequently lacking, and which are under-researched’, including VE.1 Nonetheless, it is easy to assume that episiotomy and VE are sufficiently similar that their analysis might be transferred wholesale. I disagree. There are similarities: both interventions are performed on ‘the most intimate and socially sensitive body parts’1; …. (shrink)

Members of the serine/arginine (SR)‐rich protein family of splicing factors play versatile roles in RNA processing steps and are often essential for normal development. Dynamic changes in RNA processing and turnover allow fast cellular adaptions to a changing microenvironment and thereby closely cooperate with transcription factor networks that establish cell identity within tissues. SR proteins play fundamental roles in the processing of pre‐mRNAs by regulating constitutive and alternative splicing. More recently, SR proteins have also been implicated in other aspects of (...) RNA metabolism such as mRNA stability, transport and translation. The‐ emerging noncanonical functions highlight the multifaceted functions of these SR proteins and identify them as important coordinators of gene expression programmes. Accordingly, most SR proteins are essential for normal cell function and their misregulation contributes to human diseases such as cancer. (shrink)

The paper considers nonviolence, not merely as a set of tactics for demonstrations and protests, but as a broad ethical ideal governing attitudes as well as conduct. I argue that the meanings of nonviolence—its relationship to personal and political honor and integrity—may differ with one’s level of privilege and social authorization to employ violence. Furthermore, the moral and attitudinal commitments prominent in some strands of nonviolence theory are in some ways at odds with the needs of survivors of violent abuse—particularly (...) of the kinds typically committed by men against women and children in intimate contexts. There isthus an apparent tension between some of the commitments of nonviolence theory and our obligation to demonstrate solidarity with survivors. Recognizing and resolving this apparent tension is a necessary further step in the development of nonviolence theory. (shrink)

In the UK, it has been proposed that alongside the current advice to abstain from alcohol completely in pregnancy, there should be increased screening of pregnant women for alcohol consumption in order to prevent instances of fetal alcohol spectrum disorder. The Scottish Intercollegiate Guidelines Network published guidelines in 2019 recommending that standardised screening questionnaires and associated use of biomarkers should be considered to identify alcohol exposure in pregnancy. This was followed in 2020 by the National Institute for Health and Care (...) Excellence Draft Quality Standard, which recommended that pregnant women should have information on their alcohol consumption recorded throughout their pregnancy and this information transferred to the child’s health records. Most recently, Public Health England has stated that the alcohol intake of all women should be recorded throughout pregnancy, not just at the initial booking appointment and that tools such as blood biomarkers and meconium testing should be researched in order to determine true prevalence rates of alcohol in pregnancy. We argue that this proposed enhanced screening undermines women’s autonomy and their legal right to be sufficiently informed to consent to screening. We argue that there is no evidence that this kind of screening will result in a reduction of fetal harm and there is a danger that undermining the autonomy of women and the trust relationship between women and healthcare professionals may even increase harm to future children. (shrink)

Bioethics, Volume 36, Issue 5, Page 500-510, June 2022.

For all the young women and girls sitting in philosophy class wondering where the women are, this is the book for you. This collection of 21 chapters, each on a prominent woman in philosophy, looks at the impact that women have had on the field throughout history. From Hypatia to Angela Davis, The Philosopher Queens will be a guide to these badass women and how their amazing ideas have changed the world. This book is written both for newcomers to philosophy, (...) as well as all those professors who know that they could still learn a thing or two. This book is also for those many people who have told us that there are no great women philosophers. Please pledge, read this book and then feel free to get back to us. (shrink)

BackgroundThe number of autistic students graduating is increasing; however, little is known regarding their transition out of university. Understanding this transition is particularly pertinent with regard to the employment of autistic graduates. It is vital that we understand autistic people’s experiences of the transition and identify what support would be beneficial during this time.MethodThirty-four autistic graduates from the United Kingdom took part in a mixed-methods study exploring their transition experience. Both quantitative and qualitative questions were used to obtain in-depth information (...) concerning participants’ experiences. Participants completed questions regarding their experiences and emotions in relation to the transition, the support they received for the transition, and their career and post-graduation plans.ResultsParticipants reported high levels of fear and low preparedness for the transition. They did not feel well supported in preparing for the transition or for their future career. In the 6 months pre-graduation, 59% of participants had accessed emotion-related transition support and 70% accessed career-related support. Post-graduation, one-third accessed emotion-related or career-related support. Perspectives on this accessed support were mixed, as were transition experiences. Additional support desired included preparation for life changes, career planning, employment accessibility, and autism-specific support. Advice for future students centered on forward planning.ConclusionThese results highlight the importance of supporting autistic students with the transition out of university. Service provision should be tailored to autistic students’ needs and support early planning for the transition. (shrink)

A Vaiṣṇava Poet in Early Modern Bengal: Kavikarṇapūra’s Splendour of Speech. By Rembert Lutjeharms. Oxford Theology and Religion Monographs. Oxford: Oxford University Press, 2018. Pp. 360. $99.

With the help of the current experiment, we wanted to learn more about the impact of visually demanding vs. cognitively demanding secondary tasks on the attention allocation of older pedestrians during the phase of traffic perception within the process of road crossing. For this purpose, we used two different road crossing tasks as well as two different secondary tasks. The road crossing “stop task” was a signal detection task, where an approaching car had to be detected. The road crossing “go (...) task” was a dynamic visual search task, where the resolution of a busy road situation had to be identified. The visual secondary task was a static visual search task and the cognitive secondary task was a 1-back task. One younger group and one older group of participants completed the tasks as single vs. dual-tasks in all possible combinations. Performance was measured through errors and response time; in addition, the subjective workload was assessed via NASA-TLX. Analyses show that the visual secondary task reduces performance in the road crossing more strongly than the cognitive task, while the visual task itself is less impaired by the road crossing tasks than is the cognitive task. Overall, performance diminishes from single to dual-task completion. Results further indicate age effects in terms of increased errors and response time for older compared to younger participants. In addition to these age effects, age-specific dual-task effects emerge for response time in the go task along with the visual task as well as for response time in the cognitive task along with the go task. Subjective workload is higher in the dual-task conditions than in the single tasks. Findings are discussed with regard to theoretical and practical implications. (shrink)

This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about (...) the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position, including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing. (shrink)

Approaches to supporting autonomy in medicine need to be able to support complex and sensitive decision-making, incorporating reflection on the patient's values and goals. This should involve deliberation in partnership between physician and patient, allowing the patient to take responsibility for her decision. Nowhere is this truer than in decisions around pregnancy and Caesarean section where maternal autonomy can seem to directly conflict with foetal interests. Medical and societal expectations and norms such as the expectations of a ‘mother’, constraints of (...) making decisions in an emergency, and the role of technology in viewing the foetus as a separate patient and surgery as a guarantor of results can all act to limit a woman's autonomy. In considering decisions about Caesarean section, maternal interests in bodily integrity can be dismissed as being less important than the foetus's own interests and the mother's duties to it, despite the inherent risks and impacts of such a major surgical procedure... (shrink)

Legal battles continue in the UK over the Government’s plans to transport asylum seekers arriving on British shores to Rwanda in East Africa. Originally announced as a system for ‘processing’ asylum seekers, the Government has subsequently made it clear that there would not be an option for asylum seekers to return to the UK. The arrangement forms part of a deal between the UK and Rwanda, with the UK promising to invest £120 m in economic growth and development in Rwanda, (...) along with financing the cost of the ‘offshored’ asylum operation.1 The Government states that the policy is designed to break the business model of people traffickers involved in facilitating hazardous trips across the Channel in small, overcrowded and unseaworthy craft, leading to multiple drownings. Critics argue that the policy will do nothing to stop desperate people from seeking refuge in the UK, that transferring already traumatised people to Rwanda – which has been criticised for its human rights record – is inhumane and potentially outwith international law. Medical bodies, including the BMA, along with refugee organisations have expressed serious concerns about the health impact of such a system of ‘offshoring’. An equivalent system in Australia has been notorious for the devastating health impacts on those ‘offshored’ to the Pacific islands of Manus and Naura. Unusually in the UK the offshoring proposals have been greeted by unanimous condemnation by the Church of England. The lawfulness of the process is also subject to question. On the 14 July, a plane carrying a small number of asylum seekers to Rwanda was halted shortly before take-off following an intervention by the European Court of Human Rights. The ECtHR, part of the Council of Europe, of which the UK is still a member, said an Iraqi man known as KN faced ‘a real …. (shrink)

The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. This is an authoritative and much-needed introduction to and defence of the concept of reproductive health, which though internationally endorsed, is still contested. The authors are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics. They integrate their disciplines to provide an accessible but comprehensive picture. They analyse 15 cases from different countries (...) and cultures, and explore options for resolution. The aim is to equip readers to fashion solutions in their own health care circumstances, compatibly with ethical, legal and human rights principles. (shrink)

Bernard Reginster has argued that in "Nietzsche's terminology, 'experimentation [Versuch]' is a paradigmatic exercise of curiosity."1 According to Reginster, the kind of curiosity in question, as far as Nietzsche's concept of the free spirit is concerned, is not the state of knowing or of being certain of the truth of some proposition, but is rather a matter of the activity or process of truth seeking and of inquiry.2 My own view is very similar: I have argued that experimentalism is a (...) form of virtue for Nietzsche.3 Specifically, as I have suggested, Nietzsche employs experimentalism in two main ways: as a strategy for philosophical engagement, for example through his use of diverse writing styles and authorial... (shrink)

This chapter discusses eighteenth-century British theories of perception, beginning with George Berkeley’s Essay Towards a New Theory of Vision. The chapter traces Berkeley’s influence through Thomas Reid, David Hume, David Hartley, Adam Smith and Dugald Stewart. The chapter presents theories of perception in this time a place a primarily concerned with metaphysics, mind and methodology rather than epistemology.

An international team of eighteen doctors, philosophers, and lawyers present a fresh and thorough discussion of the ethical, legal, and social issues raised by testing and screening for HIV and AIDS. They aim to point the way to practical advances but also to give an accessible guide for those new to the debate.

Let us first thank the four commentators who have taken the time to read and thoughtfully reflect on our paper. In that paper, we discuss how responsibility concepts must be sensitive to the temporal ( diachronic ) and social ( dyadic ) aspects of health-related behaviour, if responsibility is to play a role in health policy. This ‘if’ is a big one, and Hanna Pickard rightly challenges our position of neutrality with regard to whether or not responsibility should be incorporated (...) into health policy.1 Pickard proposes that responsibility should play a forward-looking role in health policy—used as a tool to facilitate and encourage healthy behaviours where it is reasonable to expect people to adopt such behaviours. While the conditions for such responsibility are similar to those involved in the backward-looking, desert-based responsibility we invoke, they do not warrant responses such as praise, blame, reward and punishment that may follow from desert-based responsibility. Pickard argues that even asking the question of ‘what would desert-based responsibility look like in these health contexts’ risks encouraging moralisation, stigma and blame, all of which have no place in healthcare. We agree that forward-looking responsibility could be an important tool in healthcare. We have offered …. (shrink)

In Western societies, height is positively correlated with reproductive success (RS) for men but negatively correlated with RS for women. These relationships have been attributed to sexual selection: women prefer tall men, and men prefer short women. It is this success in the marriage market which leads to higher RS for tall men and short women. We have already shown that the relationship between height and RS for women is quite different in a non-Western context. In a subsistence farming community (...) in rural Gambia, height is positively correlated with reproductive success for women, largely owing to the higher survival of the children of tall women. Here, the relationship between height and reproductive success is analyzed for men in the same community. For these Gambian men, there is no significant relationship between height and the number of children they produce, although tall men do contract more marriages than shorter men. We conclude that environmental context needs to be taken into account when analyzing human reproductive behavior. (shrink)

Berkeley holds that vision, in isolation, presents only color and light. He also claims that typical perceivers experience distance, figure, magnitude, and situation visually. The question posed in New Theory is how we perceive by sight spatial features that are not, strictly speaking, visible. Berkeley’s answer is “that the proper objects of vision constitute an universal language of the Author of nature.” For typical humans, this language of vision comes naturally. Berkeley identifies two sorts of objects of vision: primary (light (...) and colors) and secondary (distance, figure, magnitude, and situation). Berkeley also appeals to a third class of a different sort: visible figure, magnitude, and situation, constituting the vocabulary of the language of vision. By considering two perceivers who lack this vocabulary we may better understand this third category and the difference between those who must learn the language of vision and those for whom it is a natural endowment. (shrink)

Book review: James Souter, Asylum as Reparation: Refuge and Responsibility for the Harms of Displacement. London: Palgrave Macmillan.

In 2015 the UK became the first country in the world to legalise mitochondrial donation, a controversial germ line reproductive technology to prevent the transmission of mitochondrial disease. Dimond and Stephens track the intense period of scientific and ethical review, public consultation and parliamentary debates preceeding the decision. They draw on stakeholder accounts and public documents to explore how patients, professionals, institutions and publics mobilised within ‘for’ and ‘against’ clusters, engaging in extensive promissory, emotional, bureaucratic, ethical, embodied and clinical labour (...) to justify competing visions of an ethical future. They describe how this decision is the latest iteration of a UK sociotechnical imaginary in which the further liberalization of human embryo research and use is rendered legitimate and ethical through modes of consultation and permissive but strictly regulated licensing. Overall, this book presents a timely, multi-dimensional, and sociological account of a globally significant landmark in the history of human genetics, and will be relevant to those with an interest in genetics, Science, Technology and Society, the sociology of medicine, reproductive technology, and public policy debate. (shrink)

Globally there is a shortage of organs available for transplant resulting in thousands of lives lost as a result. Recently in the United Kingdom 457 people died as a result of organ shortage in just 1 year. 1 NHS Blood and Transplant suggest national debates to test public attitudes to radical actions to increase organ donation should be considered in addressing organ shortage. The selling of organs for transplant in the United Kingdom is prohibited under the Human Tissue Act 2004. (...) This discussion paper considers five ethical objections raised in the United Kingdom to paid donation and discusses how these objections are addressed within the only legal and regulated paid living unrelated renal donation programme in the world in Iran, where its kidney transplant list was eliminated within 2 years of its commencement. This article discusses whether paid living unrelated donation in Iran increases riskier donations and reduced altruistic donation as opponents of paid donation claim. The paper debates whether objections to paid donation based upon commodification arguments only oppose enabling financial ends, even if these ends enable beneficent acts. Discussions in relation to whether valid consent can be given by the donor will take place and will also debate the objection that donors will be coerced and exploited by a paid model. This article suggests that exploitation of the paid donor within the Iranian model exists within the legally permitted framework. However, paid living kidney donation should be discussed further and other models of paid donation considered in the United Kingdom as a radical means of increasing donation. (shrink)