Andrew Edgar

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..