• Trust in Medicine: Its Nature, Justification, Significance, and Decline
    with Markus Wolfensberger
    Cambridge University Press. 2019.
    Over the past decades, public trust in medical professionals has steadily declined. This decline of trust and its replacement by ever tighter regulations is increasingly frustrating physicians. However, most discussions of trust are either abstract philosophical discussions or social science investigations not easily accessible to clinicians. The authors, one a surgeon-turned-philosopher, the other an analytical philosopher working in medical ethics, joined their expertise to write a book which …Read more
  • The Concept of Disease
    with Rachel Cooper, Chris Megone, Jeremy Simon, Jennifer Radden, and Piers Benn
    Philosophical Papers 36 (3): 343-481. 2007.
  •  27
    Hope, Dying and Solidarity
    Ethical Theory and Moral Practice 22 (1): 187-204. 2019.
    Hope takes on a particularly important role in end of life situations. Sustaining hope can have considerable benefits for the quality of life and any prospect of a good death for the dying. However, it has proved difficult to adequately account for hope when dying, particularly in some of the more extreme end of life situations. Standard secular accounts of hope struggle to establish how the fostering of hope may be possible in such situations. This leads to a practical ethical dilemma for those…Read more
  •  57
    The classification of techniques used in mitochondrial donation, including their role as purported germ-line gene therapies, is far from clear. These techniques exhibit characteristics typical of a variety of classifications that have been used in both scientific and bioethics scholarship. This raises two connected questions, which we address in this paper: how should we classify mitochondrial donation techniques?; and what ethical implications surround such a classification? First, we outline h…Read more
  •  5
    with Nicolette Michelle Priaulx
    In Nicky Priaulx and Anthony Wrigley (ed.), Ethics, Law and Society, Vol. V, Ashgate. 2013.
    The overall collection we present in Volume V constitutes a celebration of the approach and values embraced within previous volumes. While those acquainted with previous volumes of Ethics, Law & Society will note some marked differences in how we have gone about the work of editing, our hope is that the approach we bring is seen as enriching the work, and building on what has been a highly successful series. To a large degree, however, it has not been possible to emulate what our rather formidab…Read more
  •  20
    Proxy consent: moral authority misconceived
    Journal of Medical Ethics 33 (9): 527-531. 2007.
    The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person’s best interests and that the new legislation introduces only an advisor, no…Read more
  •  53
    Personal identity, autonomy and advance statements
    Journal of Applied Philosophy 24 (4). 2007.
    Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal ide…Read more
  •  18
    Ethics and end of life care: the Liverpool Care Pathway and the Neuberger Review
    Journal of Medical Ethics 41 (8): 639-643. 2015.
    The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for the concern. …Read more
  •  9
    People have understandable concerns over what happens to their bodies, both during their life and after they die. Consent to organ donation is often perceived as an altruistic decision made by individuals prior to their death so that others can benefit from use of their organs once they have died. More recently, live organ donation has also been possible, where an individual chooses to donate an organ or body tissue that will not result in their death (such as a kidney). Although these live orga…Read more
  •  27
    Limitations on personhood arguments for abortion and 'after-birth abortion'
    Journal of Medical Ethics 39 (5): 15-18. 2013.
    Two notable limitations exist on the use of personhood arguments in establishing moral status. Firstly, although the attribution of personhood may give us sufficient reason to grant something moral status, it is not a necessary condition. Secondly, even if a person is that which has the ‘highest’ moral status, this does not mean that any interests of a person are justifiable grounds to kill something that has a ‘lower’ moral status. Additional justification is needed to overcome a basic wrongnes…Read more
  •  67
    Rethinking Moral Expertise
    with Nicky Priaulx and Martin Weinel
    Health Care Analysis 24 (4): 393-406. 2016.
    We argue that the way in which the concept of expertise is understood and invoked has prevented progress in the debate as to whether moral philosophers can be said to be ‘moral experts’. We offer an account of expertise that draws on the role of tacit knowledge in order to provide a basis upon which the debate can progress. Our analysis consists of three parts. In the first part we highlight two specific problems in the way that the concept of expertise has been invoked in the moral expertise de…Read more
  •  125
    The syllabus presented here is designed for use in the training of researchers and research ethics committee members throughout the European Union and beyond. It is intended to be accessible to scientific and lay readers, including those with no previous experience of ethical theory and analysis. The syllabus will cover key issues in the ethics of research involving human participants, including the ethical issues associated with new technologies.
  •  17
    Realism and Anti-Realism about Mental Illness
    Philosophical Papers 36 (3): 371-397. 2007.
    In this paper I provide an account of the metaphysical foundations of mental illness in terms of a realism debate. I motivate the importance of such metaphysical analysis as a means of avoiding some intractable problems that beset discussion of the concept of mental illness. I apply aspects of the framework developed by Crispin Wright for realism debates in order to examine the ontological commitments to mental illness as a property that humans may exhibit and to examine the various arguments th…Read more
  •  54
    Genetic selection and modal Harms
    The Monist 89 (4): 505-525. 2006.
    Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) …Read more
  •  69
    A dead proposal: Levi and green on advance directives
    with Angus Dawson
    American Journal of Bioethics 10 (4). 2010.
    NThere are many problems with Levi and Green’s (2010) suggestion that a computer-based decision aid will overcome the major objections to advance directives (ADs). We focus on just two here. First, we argue that the key assumption underlying Levi and Green’s paper, that autonomy always ought to take priority over other values, is false. Second, we argue that the paper misses the point of the most telling objections to the use of ADs: they lack the relevant moral authority to determine treatments…Read more
  •  19
    Moral Authority and Proxy Decision-Making
    Ethical Theory and Moral Practice 18 (3): 631-647. 2015.
    IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of who m…Read more
  •  25
    An Eliminativist Approach to Vulnerability
    Bioethics 29 (7): 478-487. 2015.
    The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of…Read more
  •  3
    This volume forms part of a series exploring key issues in ethics, law and society, published in association with the Cardiff Centre for Ethics, Law and Society. The collection is a celebration of the approach and values embraced within previous volumes in the series. The works collectively address new technological, social, and regulatory developments and the fresh ethical dilemmas these pose, but quite critically, also compel an urgent revisiting of social and legal issues that were once the s…Read more
  •  35
    The metaphysics of everyday life: An essay in practical realism (review)
    Analysis 69 (2): 370-372. 2009.
    Many materialist ontologies characterize the existence of everyday, middle-sized objects as reducible to collections or mereological sums of smaller, more fundamental particle constituents. Baker would have it otherwise and has set out a defence of her Constitution View of ontology that takes everyday objects to be irreducibly real and of a vast array of kinds.Motivating an interest in the metaphysics of everyday objects is not obviously straightforward when contemporary metaphysics is filled wi…Read more
  •  7
    Genetic Selection and Modal Harms
    The Monist 89 (4): 505-525. 2006.
    Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) …Read more
  •  93
    Hope and Terminal Illness: false hope versus absolute hope
    with Eve Garrard
    Clinical Ethics 4 (1): 38-43. 2009.
    Sustaining hope in patients is an important element of health care, allowing improvement in patient welfare and quality of life. However in the palliative care context, with patients who are terminally ill, it might seem that in order to maintain hope the palliative care practitioner would sometimes have to deceive the patient about the full nature or prospects of their condition by providing a ‘false hope’. This possibility creates an ethical tension in palliative practice, where the beneficent…Read more
  •  27
    Mitochondrial Replacement: Ethics and Identity
    with Stephen Wilkinson and John B. Appleby
    Bioethics 29 (9): 631-638. 2015.
    Mitochondrial replacement techniques have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer and Maternal Spindle Tr…Read more
  •  72
    Abstracting Propositions
    Synthese 151 (2): 157-176. 2006.
    This paper examines the potential for abstracting propositions – an as yet untested way of defending the realist thesis that propositions as abstract entities exist. I motivate why we should want to abstract propositions and make clear, by basing an account on the neo-Fregean programme in arithmetic, what ontological and epistemological advantages a realist can gain from this. I then raise a series of problems for the abstraction that ultimately have serious repercussions for realism about pro…Read more
  •  2
    Ontology by Dale Jacquette (review)
    Philosophical Books 45 56-58. 2004.
  •  45
    The Problem of Counterfactuals in Substituted Judgement Decision-Making
    Journal of Applied Philosophy 28 (2): 169-187. 2011.
    The standard by which we apply decision-making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision-making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by provi…Read more
  •  113
    Harm to Future Persons: Non-Identity Problems and Counterpart Solutions
    Ethical Theory and Moral Practice 15 (2): 175-190. 2012.
    Non-Identity arguments have a pervasive but sometimes counter-intuitive grip on certain key areas in ethics. As a result, there has been limited success in supporting the alternative view that our choices concerning future generations can be considered harmful on any sort of person-affecting principle. However, as the Non-Identity Problem relies overtly on certain metaphysical assumptions, plausible alternatives to these foundations can substantially undermine the Non-Identity argument itself. I…Read more