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Approaching qualitative researchIn Sue Eckstein (ed.), Manual for research ethics committees, Cambridge University Press. 2003.
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30Pushing poverty off limits: quality improvement and the architecture of healthcare valuesBMC Medical Ethics 22 (1): 1-13. 2021.Background: Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening i…Read more
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22Truth and consequencesMetaphilosophy 54 (4): 523-538. 2023.In his 1987 paper “Truth or Consequences,” Dan Brock describes a deep conflict between the goals and virtues of philosophical scholarship and public policymaking: whereas the former is concerned with the search for truth, the latter must primarily be concerned with promoting good consequences. When philosophers are engaged in policymaking, he argues, they must shift their primary goal from truth to consequences—but this has both moral and methodological costs. Brock’s argument exemplifies a pess…Read more
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34Patient Safety and the Question of Dignitary HarmsJournal of Medicine and Philosophy 48 (1): 33-49. 2023.Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included w…Read more
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40Made to Measure: The Ethics of Routine Measurement for Healthcare ImprovementHealth Care Analysis 29 (1): 39-58. 2020.This paper analyses the ethics of routine measurement for healthcare improvement. Routine measurement is an increasingly central part of healthcare system design and is taken to be necessary for successful healthcare improvement efforts. It is widely recognised that the effectiveness of routine measurement in bringing about improvement is limited—it often produces only modest effects or fails to generate anticipated improvements at all. We seek to show that these concerns do not exhaust the ethi…Read more
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23Defining What is Good: Pluralism and Healthcare QualityKennedy Institute of Ethics Journal 29 (4): 367-388. 2019.'Quality' is a widely invoked concept in healthcare, and 'quality improvement' is now a central part of healthcare service delivery. However, these concepts and their associated practices represent relatively uncharted territory for applied philosophy and bioethics. In this paper, we explore some of the conceptual complexity of quality in healthcare and argue that quality is best understood to be conceptually plural. Quality is widely agreed to be multidimensional and as such constitutively plur…Read more
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39Why Health and Social Care Support for People with Long-Term Conditions Should be Oriented Towards Enabling Them to Live WellHealth Care Analysis 26 (1): 48-65. 2018.There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for di…Read more
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25What does ‘quality’ add? Towards an ethics of healthcare improvementJournal of Medical Ethics 46 (2): 118-122. 2020.In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, …Read more
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72Beyond Choice and Individualism: Understanding Autonomy for Public Health EthicsPublic Health Ethics 6 (3): 262-271. 2013.Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ b…Read more
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26The use of informed consent for medication treatment in hospital: a qualitative study of the views of doctors and nursesClinical Ethics 2 (1): 36-41. 2007.The use of informed consent for surgery or research has been widely studied; however, its use in other areas of clinical practice has received less attention. This study investigates how doctors and nurses understand informed consent in relation to the prescription and administration of medicines in secondary care. It uses a qualitative analysis of semi-structured in-depth interviews with 19 doctors and 6 nurses recruited from various specialties in a teaching hospital. The results indicate a st…Read more
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23Vagueness and variety in person-centred careWellcome Open Research. 2022.Person-centred care is a cornerstone of contemporary health policy, research and practice. However, many researchers and practitioners worry that it lacks a 'clear definition and method of measurement,' and that this creates problems for the implementation of person-centred care and limits understanding of its benefits. In this paper we urge caution about this concern and resist calls for a clear, settled definition and measurement approach. We develop a philosophical and conceptual analysis whi…Read more
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35Austerity and Professionalism: Being a Good Healthcare Professional in Bad ConditionsHealth Care Analysis 27 (3): 157-170. 2019.In this paper we argue that austerity creates working conditions that can undermine professionalism in healthcare. We characterise austerity in terms of overlapping economic, social and ethical dimensions and explain how these can pose significant challenges for healthcare professionals. Amongst other things, austerity is detrimental to healthcare practice because it creates shortages of material and staff resources, negatively affects relationships and institutional cultures, and creates increa…Read more
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31Let’s talk about standards: a commentary on standards of practice in empirical bioethicsBMC Medical Ethics 19 (1): 69. 2018.This commentary welcomes the work of Ives et al. on Standards of practice in Empirical Bioethics, and especially the dialogical spirit in which the standards have been constructed and offered. It also raises some questions about the consistent interpretation and use of such standards.
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35What Justice, What Autonomy? The Ethical Constraints upon PersonalisationEthics and Social Welfare 11 (1): 3-18. 2017.
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45‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?Philosophy and Technology 32 (1): 23-38. 2019.This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue t…Read more
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25Improvement Science Meets Improvement Scholarship: Reframing Research for Better HealthcareHealth Care Analysis 26 (2): 109-123. 2018.In this editorial essay I explore the possibilities of ‘improvement scholarship’ in order to set the scene for the theme of, and the other papers in, this issue. I contrast a narrow conception of quality improvement research with a much broader and more inclusive conception, arguing that we should greatly extend the existing dialogue between ‘problem-solving’ and ‘critical’ currents in improvement research. I have in mind the potential for building a much larger conversation between those people…Read more
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122Quality of life--a response to K C CalmanJournal of Medical Ethics 11 (3): 142-145. 1985.There is no technical language with which to speak of patients' quality of life, there are no standard measures and no authority to validate criteria of measurement. It is well known that 'professionals' tend, often for institutional reasons, to play down or undervalue factors which are not defined by their particular expertise. It is fortunate that, despite this tendency, there is a growing interest in broadening the evaluation of medical care, but there is still a need to clarify what is at is…Read more
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29Beyond the Classroom Wall: Theorist-Practitioner Relationships and Extra-Mural Ethics (review)Ethical Theory and Moral Practice 14 (4): 383-396. 2011.In this paper I investigate the theory-practice relationship in ethics by using the lens of theorist-practitioner relationships. In particular I discuss the contrasts between theorist-practitioner relationship inside and outside the classroom, the ‘extra-mural’ expertise of theorists, and the ethical issues which arise when theorists act as co-practitioners. I argue that understanding these social and ethical issues is essential to understanding the relationship between theory and practice in et…Read more
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50Understanding the Role of “the Hidden Curriculum” in Resource Allocation—The Case of the UK NHSHealth Care Analysis 11 (4): 295-300. 2003.In this paper we want to briefly illustrate the ways in which technical, ethical and political judgements of various kinds are interwoven in the processes of healthcare decision-making in the UK. Drawing upon the research for the “Choices in Health Care” project we will borrow the notion of the hidden curriculum from education to illuminate the nature of resource allocation decision processes. In particular we will indicate some of the fundamental but largely hidden political factors in play in …Read more
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64IEEN workshop report: Teaching and learning in interdisciplinary and empirical ethicsClinical Ethics 8 (2-3): 70-74. 2013.Bioethics is an interdisciplinary field that accommodates a broad range of perspectives and disciplines. This inherent diversity sets a number of challenges for both teachers and students of bioethics, notably in respect to the appropriate aims and methods of bioethics education, standards and criteria for evaluating performance and disciplinary identity. The Interdisciplinary and Empirical Ethics Network (IEEN) was established, with funding from the Wellcome Trust, to facilitate critical and co…Read more
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22Translational ethics? The theory-practice gap in medical ethicsJournal of Medical Ethics 36 (4): 207-210. 2010.Translational research is now a critically important current in academic medicine. Researchers in all health-related fields are being encouraged not only to demonstrate the potential benefits of their research but also to help identify the steps through which their research might be ‘made practical’. This paper considers the prospects of a corresponding movement of ‘translational ethics’. Some of the advantages and disadvantages of focusing upon the translation of ethical scholarship are reviewe…Read more
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128League tables, institutional success and professional ethicsJournal of Medical Ethics 25 (5): 413-417. 1999.League tables are just one example of the growing importance of "institutional success" in the health service. What are the implications of attaching importance to institutional success, and what impact might this have on professional ethics? This paper considers these issues and argues that public policy processes which centre on institutional performance, and which co-opt professional loyalties to this end, shift the balance between person-centred and impersonal standpoints in health care (fro…Read more
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19IEEN workshop report: Professionalism in interdisciplinary and empirical bioethicsClinical Ethics 9 (4): 109-112. 2014.The Interdisciplinary and Empirical Ethics Network was established in 2012 with funding from the Wellcome Trust in order to facilitate critical and constructive discussion around the nature of the disciplinary diversity within bioethics and to consider the ongoing development of bioethics as an evolving field of interdisciplinary study. In April 2013, the Interdisciplinary and Empirical Ethics Network organized a workshop at the Centre for Public Policy Research, King’s College London, which dis…Read more
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29Whatever suits you: unpicking personalization for the NHSJournal of Evaluation in Clinical Practice 16 (2): 310-314. 2010.
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29Reconfiguring professional ethics: The rise of managerialism and public health in the UK national health service (review)HEC Forum 13 (2): 111-124. 2001.
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34Fair and Effective Resource Allocation in Cancer Care: Uncharted Territory? Paper Three: Resource Allocation and Social MeaningHealth Care Analysis 4 (1): 34-37. 1996.
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16Changing Values for Nursing and Health Promotion: exploring the policy context of professional ethicsNursing Ethics 6 (5): 411-422. 1999.In this article we illustrate, and argue for, the importance of researching the social context of health professionals’ ethical agendas and concerns. We draw upon qualitative interview data from 20 nurses working in two occupational health sites, and our discussion focuses mainly upon aspects of the shifting ‘ethical context’ for those nurses with a health promotion remit who are working in the British National Health Service. Within this discussion we also raise a number of potentially substant…Read more
Areas of Interest
Applied Ethics |
Meta-Ethics |
Normative Ethics |