The Nuffield Council on Bioethics (NCOB) is delighted to pick up the mantel of the Ethics briefings. For readers less familiar with the NCOB’s work, we are a leading independent policy and research centre, and the foremost bioethics body in the UK. We identify, analyse and advise on ethical issues in biomedicine and health so that decisions in these areas benefit people and society.1 Established in 1991, the NCOB has tackled a wide range of bioethics and medical ethics issues over (...) its thirty-two years, including issues relating to the beginning and end of life, health and society, data and technology, and research ethics. Early reports in the 1990s included, for example, ‘Genetics screening: the ethical issues’ and ‘Animal-to-human transplants: the ethics of Xenotransplantation’. More recent projects include setting out an ethical framework in the report ‘The future of ageing: ethical considerations for research and innovation’2 and a current joint project with the Ada Lovelace Institute3 considering the potential ethical implications of the convergence of AI and genomics technologies.4 In recent years, NCOB has increasingly focused on horizon scanning. What current and future national and international developments are likely to raise ethical issues in the short, medium and long-term? Insights for 2023 will soon be available at www.nuffieldbioethics.org/what-we-do/horizon-scanning, with new developments likely to be included alongside ongoing areas of medical and scientific research that we are tracking progress in, for example, in vitro derived gametes, surrogacy, biosafety and novel neurotechnologies. Disagreements between parents and healthcare teams about …. (shrink)

We become a closed cell, containing three people. He is 21 months, seems far from "two.""People have to stay at their houses." "Hiding!" "Well, yes."We learn of other cells. We might become four.Levels change, hidden cells are multiplying. He turns two. Grandparents can visit. We can tell them what has been...

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 16.4 (2006) 379-396MuseSearchJournalsThis JournalContents[Access article in PDF]Pharmacists and Conscientious Objection *In March 2005, a Wisconsin pharmacist's act of conscience garnered headlines across the United States. After a married woman with four children submitted a prescription for the morning-after pill, the pharmacist, Neil Noesen, not only refused to fill it, but also refused to transfer the prescription to another pharmacist or to return the prescription (...) to the customer. As more such incidents occurred, many states "... decided to consider and enact laws setting the bounds of pharmacists' and other health care workers' professional obligations" (III, Grady 2006, p. 327). Discussions of objector legislation, also referred to as "conscience clauses," "refusal clauses," and "abandonment laws" (III, Appel 2005, p. 279), are not limited to professional ethics, but also draw from philosophical, theological, and legal perspectives. The purpose of this Scope Note is to present a wide variety of viewpoints on the health provider's right to conscience.More than 40 years ago the development of "The Pill" as the first reliable method of birth control not only ushered in a feminist revolution, but also provided a new focus for concerns of conscience for those who were part of the anti-abortion movement based on religious belief in the sanctity of life. Similarly, in the past ten years, worldwide, and seven years (1999) since the emergency contraception "morning after" pill first became available as a prescription item, there has been an upsurge in the number of medical personnel who refuse to prescribe or dispense it on grounds of personal conscience, whether for religious reasons or not. Their actions bring into play issues of power and control for health care personnel and for patients—in this case women, which also raises women's rights issues. Ironically, studies in France, Sweden, and the United Kingdom have shown that emergency contraception does not reduce the abortion rate—it is too infrequently used (II, Glasier 2006).It is important to underline the difference between the "morning-after" pill or "Plan B," which is made up of two progestin pills containing levonorgestrel (a synthetic derivative of the female hormone progesterone), and RU-486 (Mifiprex [End Page 379] or mifipristone with misoprostol). Plan B, if taken within 72 hours post-coitus prevents implantation, and therefore pregnancy, by suppressing the output of luteinizing hormone, the hormone that triggers the ovulation process. Scientists have been unable to determine whether this action could destroy already fertilized eggs, but even if it does, it uses the same mechanism as occurs with the birth-control pill, that was developed some 45 years ago. By contrast, RU-486 acts up to 49 days after implantation by blocking the action of progesterone in order to terminate the pregnancy and as such is an abortifacient (II, US FDA 1).On 24 August 2006, the U.S. Food and Drug Administration announced approval of the Plan B pill for over-the-counter (OTC ) sales (II, US FDA 2). Although this action makes the drug more widely available, it remains to be seen whether pharmacists who are conscientious objectors and who refuse to dispense it also will refuse to provide it OTC.A survey article by Rebecca Dresser (II, 2005, p. 9) succinctly sums up the problem for conscientious objectors: "Because emergency contraception can act to block implantation of a fertilized egg, people who believe in protection of human life after conception find it morally objectionable."When conscientious objections are raised over abortion or birth control services performed, prescribed, or dispensed, they affect not only the health professionals—physicians, pharmacists, nurses, and health technicians—who may object, as well as their colleagues and/or managers, but also the consumers: the female patients who are then forced to reconsider or to seek an alternative supplier, as well as their spouses or partners. Alta Charo (II, 2005, p. 2473) makes the point that the patient needs to have access to a system of counseling and referral "so... (shrink)

In European philosophies of history, the linear paradigm that has prevailed for centuries as a derivative of Christian salvation history (Heilsgeschichte), ultimately lost its monopoly with the arrival of the “post-age.” The result of this has been that ideas that have survived on the margins, even the cyclical interpretation of time attached to religious traditions, now seem capable of outliving the short-lived belief in continuous progress. According to the cyclical view of history, those who came last will leave first, with (...) those who came first leaving as the last adherents of the driving force of Western rationalization. Thus, within a century, beginning with World War 2, a major turning point has been crossed: Socialism was the first to disappear, and it looks like Secular Liberalism will be the next; then Protestantism, followed by Islam, and so forth. As seductive as these images may appear, they only mirror an auto-destructive thread at the very center of Europe’s troubled Geist. But can anything be done to save the most important European values, and specifically, the ethical drive to say “no” to power, which is perhaps the most important legacy of monotheism? Either as a self-limitation from within powerful institutions or as a mode of resistance on the margins of powerful developments—there is a strong adherence to the good (often named God) that helps people and communities survive their diasporic state. I will present this kernel of ethical monotheism by two relatively unknown twentieth-century examples of “diasporic knowledge”: Rebecca West’s Black Lamb and Grey Falcon (1941), in which she recorded her observations of the devastating effects of empires on Yugoslavia, and two poems by Rosario Castellanos, who decades before the debate on postcolonialism voiced the concerns of displaced indigenous cultures in her Mexican homeland. I suggest that, paradoxically, attention to diasporic voices is one way of realizing the spirit of European self-limitation that is so much needed today to prevent further damage to our societies and environment wrought by the excessive drive for progress fostered by an unethical monorationalism. (shrink)

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in (...) epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices. (shrink)

The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event—especially subjective self-appraised symptoms—can actually increase side effects. Describing one version of what might happen (clinical “facts”) may actually create outcomes that are different from what would have happened without this information (another (...) version of “facts”). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white “truth.” This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through “contextualized informed consent,” which takes into account possible side effects, the patient being treated, and the particular diagnosis involved. (shrink)

The 3rd batch of 6 books in this series on the Greatest Philosophrs by acclaimed specialists writing for the General reader. From Aristotle to Wittgenstein, from Democritus to Derrida, this series provides a lucid and concise survey of philosophers ancient and modern. Each volime is by an acknowledged expert briefed to address the adventurous non-specialist reader.

“Deep Thoughts” and “Fuzzy Memories” were fan favorites as transitional pieces between larger set pieces on Saturday Night Live in the 1990s. Delivered over soothing music and serene images, Jack Handey's bits never showed his face on screen, calling to mind his observation that “the face of a child can say it all, especially the mouth part of the face.” Some dark and offbeat takes on the human condition often have an existentialist feel. Existentialism is a philosophy concerned with “the (...) individual, the experience of choice, and the absence of rational understanding of the universe with a consequent dread or sense of absurdity in human life.” In other words, human beings find themselves trying to live meaningful lives without truly comprehending the nature of what that meaning may be, or whether or not true meaning could even exist. (shrink)

This paper interrogates and reclaims clown practices in children’s rehabilitation as ‘foolish.’ Attempts to legitimize and ‘take seriously’ clown practices in the health sciences frame the work of clowns as secondary to the ‘real’ work of medical professionals and diminish the ways clowns support emotional vulnerability and bravery with a willingness to fail and be ridiculous as fundamental to their work. Narrow conceptualizations of clown practices in hospitals as only happy and funny overlook the ways clowns also routinely engage with (...) sadness, despair, discomfort and many other ways of being and doing. Our exploration of clown practices as foolish exposes the ways children’s rehabilitation upholds particular neoliberal models of success and invites a re-centring of rehabilitation and health care research and practice towards relationship building, supporting meaningful projects and a continued nurturing of aesthetic and pleasurable ways of being-in-the-world in the present moment as valuable unto themselves. (shrink)

From student protests over the teaching of canonical texts such as Plato's Republic to the use of images of classical Greek statues in white supremacist propaganda, the world of the ancient Greeks is deeply implicated in a heated contemporary debate about identity and diversity. In Plato's Caves, Rebecca LeMoine defends the bold thesis that Plato was a friend of cultural diversity, contrary to many contemporary perceptions. Through close readings of four Platonic dialogues--Republic, Menexenus, Laws, and Phaedrus--LeMoine shows that, across (...) Plato's dialogues, foreigners play a role similar to that of Socrates: liberating citizens from intellectual bondage. (shrink)

There is an increasing suspicion that Multiple Personality Disorder is one extreme along a continuum of dissociative phenomena, ranging from children’s pretend play and dreams at one end, through borderline personality disorder, posttraumatic stress syndrome, dissociative disorders not originally specified to a severe and complete personality fragmentation at the other. In this essay, we address the questions of whether a continuum view is correct and how to characterize the differences among the various disorders through distinguishing multiplex from multiple selves. This (...) analysis has implications for how the symptoms of MPD should be characterized and treated as well as shedding some light on the relation between conscious experience and selfhood. (shrink)

Prominent mathematician William Thurston was praised by other mathematicians for his intellectual generosity. But what does it mean to say Thurston was intellectually generous? And is being intellectually generous beneficial? To answer these questions I turn to virtue epistemology and, in particular, Roberts and Wood's (2007) analysis of intellectual generosity. By appealing to Thurston's own writings and interviewing mathematicians who knew and worked with him, I argue that Roberts and Wood's analysis nicely captures the sense in which he was intellectually (...) generous. I then argue that intellectual generosity is beneficial because it counteracts negative effects of the reward structure of mathematics that can stymie mathematical progress. (shrink)

Drawing on centuries of wisdom from the Christian ethical tradition, this book takes readers on a journey of self-examination, exploring why our hearts are captivated by glittery but false substitutes for true human goodness and happiness. The first edition sold 35,000 copies and was a C. S. Lewis Book Prize award winner. Now updated and revised throughout, the second edition includes a new chapter on grace and growth through the spiritual disciplines. Questions for discussion and study are included at the (...) end of each chapter. Contents 1. Why Study the Vices? 2. Gifts from the Desert: The Origins and History of the Vices Tradition 3. Vainglory: Image Is Everything 4. Envy: Feeling Bitter When Others Have It Better 5. Sloth (Acedia): Resistance to the Demands of Love 6. Avarice: Possession and Mastery 7. Wrath: Holy Emotion or Hellish Passion? 8. Gluttony: Feeding Your Face and Starving Your Heart 9. Lust: Sexuality Stripped Down 10. The Rest of the Journey: Self-Examination, the Seven Capital Vices, and Spiritual Formation Epilogue Index. (shrink)

A great philosopher will change the way you think about your life. For most of human history, religion provided a clear explanation of life and death. But in the late 19th and early 20th centuries new ideas -- from psychiatry to evolution to Communist -- seemed to suggest that our fate was now in our own hands. We would ourselves become God. This is the theme of a remarkable new book by one of the world's greatest lving philosophers. It is (...) a brilliant and frightening look at the problems and opportunities of a world coming to grips with humankind's now solitary, unaided place in the universe. Gray takes two major examples: the belief that the science-backed Communism of the new USSR could reshape the planet, and the belief among a group of Edwardian intellectuals -- popularized through mediums and automatic writing -- that there was a non-religious form of life after death. Gray presents an extraordinary cast of philosophers, journalists, politicians, charlatans and mass murderers, all of whom felt driven by a specifically scientific and modern world view. He raises a host of fascinating questions about what it means to be human. The implications of Gray's book will haunt its readers for the rest of their lives. (shrink)

The important roles of prediction and prior experience are well established in music research and fit well with Clark's concept of unified perception, cognition, and action arising from hierarchical, bidirectional predictive processing. However, in order to fully account for human musical intelligence, Clark needs to further consider the powerful and variable role of affect in relation to prediction error.

ABSTRACTThe aim of this paper is twofold. Firstly, to examine questions about the role and responsibilities of transaction lawyers working in the financial sector that, it is argued here, deserve closer scrutiny than they have hitherto received since the banking and economic crisis of 2008. It considers the manner in which the conduct of such lawyers in the pre-crisis financial markets may have played a particular role in contributing to the sources of latent risk that bore systemic fruit in 2008. (...) It poses the question, ‘Could they have acted differently?’. The first section concludes that there are strong and persuasive arguments both for and against reorienting the responsibilities of the transaction lawyer to include some obligation to take account of the risk to the financial system which the transactions they are conducting for their clients may pose. Secondly, this paper explores ways in which, nonetheless, financial sector lawyers could – and indeed should – be expected to play a part... (shrink)

Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians’ nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content (...) online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA’s Code of Medical Ethics). (shrink)

Although torture can establish guilt through confession, how are judgments of guilt made when tortured suspects do not confess? We suggest that perceived guilt is based inappropriately upon how much pain suspects appear to suffer during torture. Two psychological theories provide competing predictions about the link between pain and perceived blame: cognitive dissonance, which links pain to blame, and moral typecasting, which links pain to innocence. We hypothesized that dissonance might characterize the relationship between torture and blame for those close (...) to the torture, while moral typecasting might characterize this relationship for those more distant from it. Accordingly, this experiment placed participants into one of two different roles in which people may be exposed to torture. Participants in the proximal role of prison staffer saw suffering torture victims as relatively more guilty, while participants in the relatively distant role of a radio listener saw suffering victims as more innocent. (shrink)

The standard notion of autonomy in medical ethics does not require that autonomous choices not be irrational. The paper gives three examples of seemingly irrational patient choices and discusses how a rational autonomy analysis differs from the standard view. It then considers whether a switch to the rational autonomy view would lead to overriding more patient decisions but concludes that this should not be the case. Rather, a determination of whether individual patient decisions are autonomous is much less relevant than (...) usually considered in determining whether health care providers must abide by these decisions. Furthermore, respect for rational autonomy entails strong positive requirements of respect for the autonomy of the person as a rational decision maker. The rationality view of autonomy is conceptually stronger than the standard view, allows for a more nuanced understanding of the practical moral calculus involved in respecting patient autonomy, and promotes positive respect for patient autonomy. (shrink)

Our environmental crisis is commonly explained as a product of a set of attitudes and beliefs about the world which have been developed by post‐Cartesian technological society. Deep ecologists claim that the crisis can only be overcome by adopting an alternative non‐technological paradigm, such as can be discovered in non‐Western cultures. In this paper I express misgivings about the use of the expression ‘Paradigm’ by deep ecologists, question the claim that a science‐based world‐view inevitably fosters manipulative and exploitative attitudes to (...) the natural world, suggest that non‐technological cultures do not necessarily provide exemplary and superior models for relating to the natural world, and defend a scientific naturalism as a satisfying way of realising our unity with the natural world. (shrink)