Steve Clarke

This paper argues that the provision of effective informed consent by surgical patients requires the disclosure of material information about the comparative clinical performance of available surgeons. We develop a new ethical argument for the conclusion that comparative information about surgeons' performance - surgeons' report cards - should be provided to patients, a conclusion that has already been supported by legal and economic arguments. We consider some recent institutional and legal developments in this area, and we respond to some common objections to the use of report cards on the clinical performance of surgeons.

Stephen Mumford concludes a recent paper in Religious Studies, in which he advances a new causation-based analysis of miracles, by stating that the onus is ‘on rival accounts of miracles to produce something that matches it’. I take up Mumford 's challenge, defending an intention-based definition of miracles, which I developed earlier, that he criticizes. I argue that this definition of miracles is more consistent with ordinary intuitions about miracles than Mumford 's causation-based alternative. I further argue that Mumford has failed to demonstrate any advantages that his approach to miracles has over an intention-based approach

In her 1983 work How the Laws of Phyiscs Lie [1] Nancy Cartwright argued for antirealism about fundamental laws alongside realism about phenomenological laws. Her position was considerably altered by 1989 when, in Nature's Capacities and Their Measurement [2], she argued for a realist construal of capacities (close relations of Powers, natures, tendencies, propensities and disptısitions), which she took fundamental laws to be about. Most realists about capaeities, and their ilk, are realist about fundamental laws as well. However this is not true of Cartwright. In [2] she emphatically reaffirmed her antirealism about fundamental laws, stating that 'fundamental laws are not true, nor nearly true, nor true for the most part' [2, p.175]. In 'So the Laws of Physics Needn't Lie' [4] Chalmers argues that Cartwright's advocacy of realism about Nature's capacities in [2] undermines her antirealism about fundamental laws. He accuses Cartwright of apparent contradictions in her position as articulated in [2]. Given Chalmers' reading of Cartwright, an appearance of contradiction does seem to arise. Against Chalmers, I advocate an alternative reading of Cartwright, which is much more charitable to her. This alternative reading of Cartwright has the advantage of avoiding the charge of contradiction. Indeed, if this reading is accepted, the appearance of contradiction, that Chalmers taxeses Cartwright with, does not even arise. A further virtue of this reading of Cartwright is that it is consistent with Cartwright's more recent writing, as I will show.

Jon Haidt, a leading figure in contemporary moral psychology, advocates a participation-centric view of religion, according to which participation in religious communal activity is significantly more important than belief in explaining religious behaviour and commitment. He describes the participation-centric view as ‘Straight out of Durkheim’. I argue that this is a misreading of Durkheim, who held that religious behaviour and commitment are the joint products of belief and participation, with neither belief nor participation being considered more important than the other. I further argue that recent evidence from the cognitive science of religion provides support for Durkheim’s balanced account of religion and counts strongly against Haidt’s participation-centric view of religion. I suggest that Haidt’s adherence to the participation-centric view of religion is better explained by his desire to accept an account of religion that is consistent with his social intuitionist moral psychology than by his desire to accept an account of religion that accords with available scientific evidence about religion.

The use of deceptive techniques is common in social science research. It is argued that the use of such techniques is incompatible with the standard of informed consent, which is widely employed in the ethical evaluation of research involving human subjects. A number of proposals to justify the use of deceptions in social science research are examined, in the face of its apparent incompatibility with the standard of informed consent, and found to be inadequate. An alternative method of justification is outlined, which enables some deceived participants in social science research to rationally and autonomously choose to participate in that research. The alternative method of justification appeals to the idea of indirect consent, which is introduced. It is argued that research subjects who receive reliable testimony regarding research procedures can sometimes be placed in a position to rationally and autonomously consent indirectly to participation in experiments and studies, even if these involve significant deceptions.

Huck Finn’s struggles with his conscience, as depicted in Mark Twain’s famous novelThe Adventures of Huckleberry Finn(AHF) (1884), have been much discussed by philosophers; and various philosophical lessons have been extracted from Twain’s depiction of those struggles. Two of these philosophers stand out, in terms of influence: Jonathan Bennett and Nomy Arpaly. Here I argue that the lessons that Bennett and Arpaly draw are not supported by a careful reading of AHF. This becomes particularly apparent when we consider the final part of the book, commonly referred to, by literary scholars, as ‘the evasion’. During the evasion Huck behaves in ways that are extremely difficult to reconcile with the interpretations of AHF offered by Bennett and Arpaly. I extract a different philosophical lesson from AHF than either Bennett or Arpaly, which makes sense of the presence of the evasion in AHF. This lesson concerns the importance of conscious moral deliberation for moral guidance and for overcoming wrongful moral assumptions. I rely on an interpretation of AHF that is influential in literary scholarship. On it the evasion is understood as an allegory about US race relations during the 20-year period from the end of the US Civil War to the publication of AHF.

An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional.

There is widespread agreement about a combination of attributes that someone needs to possess if they are to be counted as a conservative. They need to lack definite political ideals, goals or ends, to prefer the political status quo to its alternatives, and to be risk averse. Why should these three highly distinct attributes, which are widely believed to be characteristic of adherents to a significant political position, cluster together? Here I draw on prospect theory to develop an explanation for the clustering of attributes that is characteristic of conservatives. I argue that a lack of political ideals is the underlying driver of conservatism. I will provide reason to believe that people who lack political ideals are disposed to prefer the political status quo to its alternatives; and reason to believe that people who prefer the political status quo to its alternatives are disposed to be risk averse, at least with respect to significantly many of the risks that arise in the social and political domain. I also consider and reject some other potential explanations for the clustering of attributes that is characteristic of conservatives and sketch some policy implications that follow from the explanation I develop.

Gilbert Harman argues that the warrant for the lay attribution of character traits is completely undermined by the “fundamental attribution error” (FAE). He takes it to have been established by social psychologists, that the FAE pervades ordinary instances of lay person perception. However, examination of recent work in psychology reveals that there are good reasons to doubt that the effects observed in experimental settings, which ground the case for the FAE, pervade ordinary instances of person perception. Furthermore, it is possible to make sense of these experimental results without invoking the FAE. Harman's argument against lay character trait attribution is unsubstantiated.

The central current of ideas in modern philosophy - through Hume, Kant and Hegel, to the present - can be understood as a reaction to the percieved threat of disorder. Against this background, the author argues for acceptance of a metaphysics of disorder, and outlines a number of important philosophical consequences of such an acceptance. When appropriately constrained by empiricist concern, such a metaphysics allows us to make sense of ourselves as as knowers who must make do in a world of complexity and uncertainty. We make do by learning to export knowledge, gained where we can get it, to the many situations where knowledge eludes us. An account of causal and idealizational reasoning in science, which has much in common with the recent work of Nancy Cartwright, is developed to exemplify the main argument. The author's philosophical position is contrasted with that of recent post modernists, notably Richard Rorty.

Jon Haidt, a leading figure in contemporary moral psychology, advocates a participation-centric view of religion, according to which participation in religious communal activity is significantly more important than belief in explaining religious behaviour and commitment. He describes the participation-centric view as ‘Straight out of Durkheim’. I argue that this is a misreading of Durkheim, who held that religious behaviour and commitment are the joint products of belief and participation, with neither belief nor participation being considered more important than the other. I further argue that recent evidence from the cognitive science of religion provides support for Durkheim’s balanced account of religion and counts strongly against Haidt’s participation-centric view of religion. I suggest that Haidt’s adherence to the participation-centric view of religion is better explained by his desire to accept an account of religion that is consistent with his social intuitionist moral psychology than by his desire to accept an account of religion that accords with available scientific evidence about religion.

Participants in some clinical trials are at risk of being harmed and sometimes are seriously harmed as a result of not being provided with available, relevant risk information. We argue that this situation is unacceptable and that there is a moral duty to disclose all adverse clinical trial results to participants in clinical trials. This duty is grounded in the human right not to be placed at risk of harm without informed consent. We consider objections to disclosure grounded in considerations of commercial interest, and we argue that these concerns are insufficient to override the moral duty to disclose adverse clinical trial results. However, we also develop a proposal that enables commercial interests to be protected, while promoting the duty to disclose adverse clinical trial results.

We humans can enhance some of our mental and physical abilities above the normal upper limits for our species with the use of particular drug therapies and medical procedures. We will be able to enhance many more of our abilities in more ways in the near future. Some commentators have welcomed the prospect of wide use of human enhancement technologies, while others have viewed it with alarm, and have made clear that they find human enhancement morally objectionable. The Ethics of Human Enhancement examines whether the reactions can be supported by articulated philosophical reasoning, or perhaps explained in terms of psychological influences on moral reasoning. An international team of ethicists refresh the debate with new ideas and arguments, making connections with scientific research and with related issues in moral philosophy.

Conscientious objection was barely mentioned in debates about the ethics of healthcare provision before the 1970s.1 The conscientious objections that attracted public and academic attention were those of conscripts who objected to participation in military forces, and of parents who objected to the vaccination of their children. All of this was changed by the 1973 US Supreme Court decision Roe v. Wade, which established a constitutional right to abortion in the USA. Shortly after this decision, the American Medical Association's (AMA) House of Delegates, the peak policy-making body within the AMA, adopted a resolution that sought to protect hospital employees from having to contribute to the provision of abortion if they felt that doing so was immoral. The resolution was adopted in response to a specific controversial court decision, but the language employed in it was broad in scope. House of Delegates Health Policy 5.995 contained a conscience clause stating that ‘Neither physician, hospital, …

Brierley et al argue that in cases where it is medically futile to continue providing life-sustaining therapies to children in intensive care, medical professionals should be allowed to withdraw such therapies, even when the parents of these children believe that there is a chance of a miracle cure taking place. In reasoning this way, Brierley et al appear to implicitly assume that miracle cures will never take place, but they do not justify this assumption and it would be very difficult for them to do so. Instead of seeking to override the wishes of parents, who are waiting for a miracle, it is suggested that a better response may be to seek to engage devout parents on their own terms, and encourage them to think about whether or not continuing life-sustaining therapies will make it more likely that a miracle cure will occur.

The doctrine of the sanctity of life has traditionally been characterised as a Judeo‐Christian doctrine that has it that bodily human life is an intrinsic good and that it is always impermissible to kill an innocent human. Abortion and euthanasia are often assumed to violate the doctrine. The doctrine is usually understood as being derived from religious dogma and, as such, not amenable to debate. I show that this characterisation of the doctrine is problematic in a number of ways, and I go on to rethink the doctrine. In doing so I follow in the footsteps of Ronald Dworkin, who offered a characterisation of the doctrine in his 1993 Life's Dominion, drawing on a conceptualisation of sacredness that is radically different from standard ones and not dependent on religious dogma. I'll argue that although Dworkin's efforts have much to recommend, his conceptualisation of sacredness is inadequate. Dworkin attempted to reconceptualise sacredness ‘from the armchair’. Here I explain how sacred values are thought of in anthropology and psychology and argue that the sanctity of human life should be understood in the same way. I'll explain how doing so allows us to resolve a number of conceptual problems that bedevil standard characterisations of the doctrine of the sanctity of life. I'll also consider the possibility of a compromise over the sanctity of human life, and as a consequence, compromise over the permissibility of abortion and euthanasia. I'll argue that such compromise is possible, albeit difficult to achieve.

This timely book analyses and evaluates ethical and social implications of recent developments in reporting surgeon performance. It contains chapters by leading international specialists in philosophy, bioethics, epidemiology, medical administration, surgery, and law, demonstrating the diversity and complexity of debates about this topic, raising considerations of patient autonomy, accountability, justice, and the quality and safety of medical services. Performance information on individual cardiac surgeons has been publicly available in parts of the US for over a decade. Survival rates for individual cardiac surgeons in the UK have recently been released to the public. This trend is being driven by various factors, including concerns about accountability, patients' rights, quality and safety of medical care, and the need to avoid scandals in medical care. This trend is likely to extend to other countries, to other clinicians, and to professions beyond health care, making this text an essential addition to the literature available.

Michael Robinson takes issue with an ‘argument from voluntariness’ made by several opponents of current practices for managing conscientious objection (CO) in healthcare, including Cantor, Stahl and Emanuel, and Schuklenk, whom he characterises as ‘non-accommodationists’. Here I argue that while Robinson is right to oppose the argument from voluntariness, he misunderstands current arrangements for managing CO in healthcare, and he misses the force of the non-accommodationist case against those arrangements. I also argue that despite what he says, Robinson is as much a proponent of reform of the management of CO in healthcare as are his non-accommodationist opponents. Additionally, I raise a concern about Robinson’s preferred approach to managing CO in healthcare.