Steve Edwards

This article discusses the question of whether, as is often claimed, nursing is properly described as an art. Following critical remarks on the claims of Carper, Chinn and Watson, and Johnson, the account of art provided by RG Collingwood is described, with particular reference to his influential distinction between art and craft. The question of whether nursing is best described as an art or a craft is then discussed. The conclusion is advanced that nursing cannot properly be described as an art, given acceptance of Collingwood’s influential definition of art. Moreover, it is shown that, due to difficulties inherent in specifying the ‘ends’ of nursing, nursing is only problematically described as a craft

A number of commentators claim their disability to be a part of their identity. This claim can be labelled ‘the identity claim’. It is the claim that disabling characteristics of persons can be identity-constituting. According to a central constraint on traditional discussions of personal identity over time, only essential properties can count as identity-constituting properties. By this constraint, contingent properties of persons (those they might not have instanced) cannot be identity-constituting. Viewed through the lens of traditional approaches to the problem of personal identity over time, disablement is most likely to be regarded as a contingent property of a person and not an essential one. Hence, on traditional approaches, the identity claim must be false. An alternative account of identity is sketched here. It is one which exploits the idea of narrative identity, and points to five basic features of personal existence. When accounts of identity are structured in relation to these five features, it is argued, disablement can be shown to be identity-constituting, and hence the identity claim can be accepted

In this paper the need for valid evidence of the cost-effectiveness of treatments that have not been properly evaluated, yet are already available, albeit in short supply, are examined. Such treatments cannot be withdrawn, pending proper evaluation, nor can they be made more widely available until they have been shown to be cost-effective. As a solution to this impasse the argument put forward recently by Toroyan et al is discussed. They say that randomised controlled trials of such resources could be done but only if resources are randomly allocated independently of a research context. Relevant outcome data could then be collected for research, given this opportunity. We agree. We disagree with Toroyan et al on a number of points. First, they claim that no ethical issue relating to equipoise arises. We disagree and this disagreement depends on our showing that equipoise should be maintained in a relationship that they do not consider. Secondly, they say that consent to data collection is always needed. Again we disagree. Thirdly, they claim that the previous two issues are the only possible ethical issues that could arise. We argue, instead, that there is a further conflict of interests that has ethical import

For more than 15 years Professor Per Nortvedt has been arguing the case for moral realism in nursing and the health‐care context more generally. His arguments focus on the clinical contexts of nursing and medicine and are supplemented by a series of persuasive examples. Following a description of moral realism, and the kinds of considerations that support it, criticisms of it are developed that seem persuasive. It is argued that our moral responses are explained by our beliefs as opposed to moral realities. In particular, two key arguments presented by Nortvedt are challenged: the so‐called argument from convergence and the argument from clinical sensitivity. Both of these key planks in the case for moral realism are rejected, and an alternative ‘social conditioning’ account briefly sketched, which, it is claimed, has the same explanatory power as Nortvedt's thesis but does not rest on an appeal to independently existing moral properties.

This paper is prompted by the charge that the prevailing Western paradigm of medical knowledge is essentially Cartesian. Hence, illness, disease, disability, etc. are said to be conceived of in Cartesian terms. The paper attempts to make use of the critique of Cartesianism in medicine developed by certain commentators, notably Leder (1992), in order to expose Cartesian commitments in conceptions of disability. The paper also attempts to sketch an alternative conception of disability — one partly inspired by the work of Merleau-Ponty. In particular, three key Cartesian claims are identified and subjected to criticism. These are as follows: (a) The claim that the body is an object, (b) what is termed here ‘the modularity thesis’, and (c) the claim that the body cannot be constitutive of the self (i.e. since the soul/mind/brain is). In opposition to these claims, it is argued that the body is properly viewed as a subject; that there are neither purely mental, nor purely physical disabilities; and that selves are constituted, at least in part, by their bodies.

In the UK and elsewhere suicide presents a major cause of death. In 2008 in the UK the topic of suicide rarely left the news. Controversy surrounding Daniel James and Debbie Purdy ensured that the problem of assisted suicide received frequent media discussion. This was fuelled also by reports of a higher than usual number of suicides by young people in South Wales. Attention attracted by cases such as that of Daniel James and Debbie Purdy can lead to a neglect of the problem of how to respond to the vast majority of suicides, in which there is no obvious accompanying health problem. This paper seeks to redress that balance to some degree. Its focus is primarily on the provision of assisted suicide when the person seeking such assistance has no accompanying health problem. It is argued that a network of suicide centres (SCs) should be established, the purpose which in certain circumstances, will extend to assisting suicide in cases where a competent person has a definite, sustained intention to end their own life. Arguments in support of this proposal are provided, focusing on respect for autonomy, relief of suffering and respect for the ‘life-plan’ of a person. Considerations relating to reduction of harms to third parties are also recruited. Eight responses to the proposal are considered. But none is found compelling, nor are they found jointly compelling

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