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.

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).

This paper explores the implications that the construction and use of avatars in games such as Second Life and World of Warcraft have for our understanding of personal identity. It asks whether the avatar can meaningfully be experienced as a separate person, existing in parallel to the flesh and blood player. A rehearsal of Cartesian and Lockean accounts of personal identity constructs an understanding of the self that is challenged by the experience of online play. It will be argued that playful engagement in virtual worlds invites the participant to reflect upon the human being as embodied and social; qualities of which are marginalised by Descartes and Locke. The strangeness of this experience of virtual worlds confronts the player with a challenge to construct a coherent narrative of online life, of which treating the avatar as a separate person is a coherent option. This opens up the virtual world as an important space within which personal identity is explored, but one with complex implicati...

As I pass the editorship of Health Care Analysis to the very capable hands of Dr. John Coggon, I can perhaps be indulged in a few moments of reflection on the last 8 years. I have strived to make the journal a forum within which scholars can articulate a diverse range of concerns about health care, both from a theoretical perspective, and from a practical one. The journal has attracted contributions from around the world, and from both established scholars and, I am proud to say, young scholars just beginning their careers, but with new and exciting contributions to make.Reviewing the papers I have published, I see that a number of long-standing concerns have received new and profound treatments. These include the nature of health and wellbeing; the problem of limiting access to health care and securing justice; the challenges that new technologies, not least in reproductive and genetic medicine, pose; questions of patient autonomy and empowerment; and the roles and responsibilities of

The problem of public consultation over the allocation of health care resources is addressed by considering the role that quality of life measures, such as QALYs and the Nottingham Health Profile, could play. Such measures are typically grounded in social surveys, and as such may reflect public preferences for health care priorities. Using Charles Taylor's concepts of “weak” and “strong” evaluation, it is suggested that current quality of life measures are inadequate, insofar as they typically presuppose that survey respondents are mere “weak evaluators”, who express only inarticulate preferences. Respondents may, conversely, be understood as strong evaluators, with deeper visions of human nature and the good life informing their health preferences. Space is then created for such respondents to be asked to defend their preferences, and so be encouraged to reflect critically and publicly on the beliefs and prejudices that ground their view of health care priorities

Face transplants have been performed, in a small number, since 2005. Popular concern over the morality of the face transplant has tended to focus on the role that one’s face plays in one’s sense of self or one’s personal identity. In order to address this concern, the current paper will explore the significance of face transplants in the light of a theory of the self that draws on symbolic interactionism, narrative theory, and accounts of embodiment. The paper will respond to certain presuppositions concerning personal identity made by Huxtable and Woodley. A theory of the self will be articulated that draws on the work of Merleau-Ponty and G. H. Mead, in order to place embodiment and social interaction centrally to an understanding of self-identity. This will allow an account of the nature of the suffering that a face transplant seeks to remedy, and its worth as an operation, and crucially the impact that it may have on the sense of personal identity of the recipient of the transplant. The conclusion will review the treatment in the context of the prejudices that members of contemporary societies may hold against those with disfigurements

This paper uses the social theory of Erving Goffman in order to argue that confidentiality should be understood in relation to the mundane social skills by which individuals present and respect specific self-images of themselves and others during social interaction. The breaching of confidentiality is analysed in terms of one person's capacity to embarrass another, and so to expose that person as incompetent. Respecting confidentiality may at once serve to protect the vulnerable from an unjust society, and yet also protect the guilty from just accusation. Ethical reasoning about confidentiality must therefore recognize the dangers of prejudice and violence inherent in decisions to breach or to respect confidentiality. Case studies are used to illustrate the efficacy of this account, culminating with analyses of three examples from the UKCC document Confidentiality

This comprehensive introduction to the thought of Jurgen Habermas covers the full range of his ideas from his early work on student politics to his recent work on communicative action, ethics and law. Andrew Edgar examines Habermas' key texts in chronological order, revealing the developments, shifts and turns in Habermas' thinking as he refines his basic insights and incorporates new sources and ideas. Some of the themes discussed include Habermas' early reshaping of Marxist theory and practice, his characterization of critical theory, his conception of universal pragmatics, his theories of communicative action and discourse ethics, and his defence of the project of modernity. Edgar offers much more than a schematic run through of Habermas' big ideas. He deals in detail with Habermas' arguments in order to demonstrate how he weaves together multiple strands of thought, and he usefully situates Habermas' ideas within the contexts of the history of German philosophy, the history of sociology, and within contemporary debates in both continental and analytic philosophy. By engaging with some of Habermas' key critics and contrasting his views with the ideas of contemporaries, Edgar is able to give a clear sense of Habermas' place and importance in contemporary philosophy and social theory

This paper seeks to explore the attraction and the beauty of the contemporary athletic body. It will be suggested that a body shaped through muscular bulk and definition has come to be seen as aesthetically normative. This body differs from the body of athletes from the early and mid-twentieth century. It will be argued that the contemporary body is not merely the result of advances in sports science, but rather that it is expressive of certain meanings and values. The visual similarity of the contemporary athletic body and that of the comic book superhero suggests that both bodies carry a similar potential for narrative story-telling, and that their attraction is bound up with this narrative potential. The superhero and athlete live meaningful lives, pursuing clear and morally unambiguous goals. The aesthetic attraction of the body lies in its capacity to facilitate the articulation of a story of a meaningful life, and to do so in the face of the growing anomie and thus meaninglessness of life as experienced in contemporary society. Athleticism offers an illusion of meaning, serving to reproduce dominant justificatory narratives and social stereotypes. Yet, as an illusion of meaning, it may be challenged and negotiated, not least with respect to its bias towards a certain form of the male body. The female athletic body disrupts the illusion, opening up new existential possibilities, new ways of living and being, and thus new, and potentially disruptive, narratives.

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.