Andrew Edgar

Professionalism is initially understood as a historical process, through which certain commercial services sought to improve their social status by separating themselves from mere crafts or trades. This process may be traced clearly with the aspiration of British portrait painters, in the eighteenth century, to acquire a social status akin to that of already established professionals, such as clerics and doctors. This may be understood, to a significant degree, as a process of gentrification. The values of the professional thereby lie as much in the etiquette and other social skills with which they deal with their clients, than with any distinctive form of skill or value. Professionalisation as gentrification seemingly says little about the nature of modern professionalism. However, if this process is also construed as one in which the goals and achievements of the profession come to be subject to radical reflection, then something significant about professional values emerges. On this account, the profession is distinguished from craft or trade on the grounds that the goals of the profession, and the effectiveness of any attempt to realise them, are not transparent to the client. While a lay person will typically have the competence necessary to judge whether or not a craft worker has achieved their goal, that person will not necessarily be able to recognise the values that determine the success of a medical operation. It will be concluded that the values of a profession are articulated intrinsically to the profession, in terms of the contested understanding that the professionals themselves have of the meaning of the profession and the narratives within which its history is to be told.

This paper falls into three parts. In the first part I will briefly review the current process of reform that the United Kingdom National Health Service is undergoing. Two fundamental motivations for reform, the desire for increased efficiency and for an increased responsiveness to patients' needs and preferences will be discussed in greater detail. The second part attempts to provide a perspective on the moral debate concerning health care reform by introducing the distinction between ‘civil association’ and ‘enterprise association’ as proposed by the political philosopher Michael Oakeshott. In the final part, this distinction will be used to analyze the moral and political constitution of the National Health Service, in order to establish the relevance and scope of concerns with efficiency and patient and public accountability. A framework within which the current reforms can be assessed is thereby outlined. Keywords: access to health care, civil association, enterprise association, freedom of choice, health care reform, United Kingdom National Health Service CiteULike Connotea Del.icio.us What's this?

Hermeneutics is the exploration of the process of textual interpretation. As such, it has long been recognised as an important component within the humanities and social sciences, whether one deals with actual texts or with other the products of meaningful human activity, including social actions and utterances. Here, we offer a brief overview of the contribution that hermeneutics might make to the philosophy of sport. If sports and sporting events are seen to be the results of meaningful human interactions, then they are meaningful phenomena that lend themselves to interpretation. It can thus be argued that a hermeneutics of sport is a valid and important discipline, worthy of consideration and development. We offer a review of the nature and history of hermeneutics in general, briefly exploring the place of key figures such as Schleiermacher, Heidegger, Gadamer and Riceour, as well as key concepts such as that of the hermeneutic circle. In addition, we suggest the importance of a hermeneutics of suspicion, grounded in the work of Marx, Freud and Nietzsche. In the second part of our introduction, we briefly comment on each of the papers that comprise the current volume, and that reflect the diversity of approaches that a hermeneutics of sport might embrace.

The purpose of this paper is to explore the role that modernism in the arts might have in articulating the uselessness and incomprehensibility of physical and mental suffering. It is argued that the experience of illness is frequently resistant to interpretation, and as such, it will be suggested, to conventional forms of artistic expression and communication. Conventional narratives, and other beautiful or conventionally expressive aesthetic structures, that presuppose the possibility and desirability of an harmonious and meaningful resolution to conflicts and tensions, may fundamentally misrepresent the patients experience. By drawing on the work of Emmanuel Levinas (on useless suffering) and the aesthetic theories of Nietzsche and T. W. Adorno, it will be argued first that a faith in the possibility of harmonious resolution of suffering is misplaced and does violence to the experience of suffering. Second, it will be argued that the expression of suffering lies not in finding words, images or sounds that communicate the experience of that suffering to others, but rather in the persistent and radical disruption of any illusion of meaning and coherence that might be imposed upon the experience, so that the very possibility of communication is also disrupted.

The purpose of this paper is to provide a normative model for the assessment of the exercise of power by Big Pharma. By drawing on the work of Steven Lukes, it will be argued that while Big Pharma is overtly highly regulated, so that its power is indeed restricted in the interests of patients and the general public, the industry is still able to exercise what Lukes describes as a third dimension of power. This entails concealing the conflicts of interest and grievances that Big Pharma may have with the health care system, physicians and patients, crucially through rhetorical engagements with Patient Advocacy Groups that seek to shape public opinion, and also by marginalising certain groups, excluding them from debates over health care resource allocation. Three issues will be examined: the construction of a conception of the patient as expert patient or consumer; the phenomenon of disease mongering; the suppression or distortion of debates over resource allocation

The purpose of this paper is to explore the moral status of sport through a conceptual structure borrowed from Jürgen Habermas's philosophy and social theory. Habermas distinguishes between communicative and strategic action as two ways in which social action may be coordinated. While the former relies on the building of mutual understanding between social agents, the latter entails one agent manipulating others, as if they were mere objects to be treated instrumentally. In an initial model of sporting practice, it is suggested that sport primarily involves strategic action and in particular encourages the undermining of one's opponent's autonomy. This model is subject to criticism, by scrutinising Habermas's interpretation of the Wittgensteinian notion of a language game, and thus the relationship between communicative language-use and strategic games playing. It will be suggested that games playing has more in common with language-use than Habermas acknowledges, thereby opening up a space for genuinely communicative and expressive action within sport. In conclusion, it will be suggested that the moral significance of sport lies in the fact that its communicative and expressive potential can only be exercised against the moral threat of the dominance of strategic action

The paper offers an account of integrity as the capacity to deliberate and reflect usefully in the light of context, knowledge, experience, and information (that of self and others) on complex and conflicting factors bearing on action or potential action. Such an account of integrity seeks to encompass the moral complexity and conflict of the professional environment, and the need for compromises in professional practice. In addition, it accepts that humans are social beings who must respect and engage with the moral position of others. This account is contrasted with a more traditional view of integrity as the rigid maintenance of consistency between professional practice and deeply held, but inflexible, moral principles. While this strong sense of moral conviction may be valuable as a source of moral motivation, e.g. in the case of whistle‐blowers, it is equally likely to lead to dogmatism and hubris. Professionals and their organizations are encouraged to foster the more complex and reflective form of integrity.

In the Olympic Art Competitions (1912–1948) Pierre de Coubertin expresses his conception of both sport and art as instruments of moral renewal. In this paper, this conception is criticised for failing to appreciate art and sport as necessary manifestations of modernism. The Art Competitions were informed by a traditionalist aesthetic, and thus played a highly conservative role within Olympism. A modernist art about sport, in contrast, would have been a source of critical reflection, potentially protecting the Olympic movement from corrupting exploitation by commercial and nationalistic interests. The conclusion defends the need for Cultural Olympiads, as a source of such critical reflection, that are at once modernist in conception and yet, unlike their current expression, are centrally about sport.

This paper explores space as a core source of aesthetic pleasure in various codes of football. The paper begins by applying Kant’s distinction between the agreeable and the pleasurable to sport, arguing that the appreciation of sport entails more than just excitement. Pleasure comes from an appreciation of the rules, strategies and history of the game. The significance of the rules of various codes of football in articulating our experience of space will be taken as fundamental to such appreciation. Drawing on the phenomenology of Merleau-Ponty and the ‘topoanalysis’ of Gaston Bachelard, it will be argued that the aesthetic appreciation of football lies, not simply in recognising the complexity and subtlety of the movement of players and ball about the pitch, but more significantly in the creative and poetic imagination that the player embodies, and the striving of the player to create places within the course of play within which they can exercise their own competence as a player, and inhibit the compete..

The purpose of this paper is to explore the impact that developments in transhumanist technologies may have upon human cultures, and to do so by exploring a potential debate between Habermas and the transhumanists. Transhumanists, such as Nick Bostrom, typically see the potential in genetic and other technologies for positively expanding and transcending human nature. In contrast, Habermas is a representative of those who are fearful of this technology, suggesting that it will compound the deleterious effects of the colonisation of the lifeworld, further constraining human autonomy and undermining the meaningfulness of the lifeworld by expanding the technological control and manipulation of humanity. It will be argued that these opposed positions are grounded in fundamentally different understandings of the consequences of scientific and technological advance. On one level, the transhumanists remain confident that the lifeworld has within it the resources necessary to find meaning and purpose in a society deeply infused by genetic technology. Habermas disagrees. On another level, the difference is articulated by Horkheimer and Adorno in Dialectic of Enlightenment, primarily by challenging what may be understood as a Baconian faith in science as a project for the domination of nature. While the transhumanists broadly embrace this faith, Habermas returns to something akin to Horkheimer and Adorno’s pessimistic scepticism

It does not typically seem to be worthwhile rewatching a sport match, for example, in a video recording, once the result is known. Sports matches are like detective stories. Once one knows ‘whodunit’, there seems little point in revisiting the tale. By drawing on an argument from musicologist Edward T. Cone, this paper argues that certain sports matches may be revisited with profit. The initial experience of a game may be of a series of events that are often ambiguous or confusing as to their meaning or purpose. The full appreciation of a sport match requires, not just this initial familiarity with the immediately perceived events of the game, but also an awareness of the tactics being deployed by both sides. An understanding of tactics and strategy is akin to the analysis of a piece of music. A further viewing of the game, during which one can appreciate how the tactics inform the events naively experienced in the first viewing, will yield, it will be argued, an aesthetic pleasure. This takes the experience of sport beyond the merely entertaining or exciting. In certain games, the third viewing may also transcend an appreciation of the merely formal qualities of the game, and so offer substantial insights into what it is to be human.

The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one’s life as a narrative. To flourish, it is argued, is to tell a story of one’s life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one’s life.

I respond to Lennart Nordenfelt's analysis of dignity by questioning his attempt to establish an objective standard by which dignity can be determined. I approach this by considering the way in which claims to dignity may be contested and defended. This leads, in the cases of dignity of merit and dignity of moral status, to an apparent relativism. This relativism is checked by further consideration of dignity of identity, and in particular by consideration of the nature of the processes that serve to humiliate people. It is suggested that acts of humiliation attack certain competences that human beings develop as embodied, social beings. Menschenwürde may then be articulated as an account of human nature, in terms of the human potential to develop a series of core competences. This account of human nature aspires to universality, and as such offers an objective ground to dignity. This paper is a product of the research project on Dignity and Older Europeans Programme, Contract No QLG6, 2001, 00888).