Paul Komesaroff

SummaryThis submission argues that there is a a need for fundamental changes in both the context and the structure of medical education. The purpose of these changes should be to enhance the responsiveness of medicine to the community and to contribute to the development of an appreciation of the importance of ethical issues in medical practice.Specifically, on the basis of argument about the nature in general of medicine and its clinical practice it claims that there is a need for an emphasis on teaching in ethics and the humanities as central concerns of the medical curricula. Further, it proposes that a prerequisite for entry into the medical course should be established which requires that students spend a period of time working in the community and a further period engaged in general studies.

There has been much discussion about the tactics used by the Israeli Defence Forces (IDF) and government in the conflict in Gaza following October 7, 2023, which have caused, among other things, systematic destruction of hospitals and schools, the deaths of large numbers of civilians, including women and children, mass starvation, and denial of humanitarian aid. The Israeli government and IDF have sought to justify their actions using ethical arguments, many of which relate to their proclaimed role as the representatives of the Jewish state and of Jewish culture and history. Arguing from the extensive corpus of Jewish ethical thought, extending back thousands of years, this article poses a simple question: Are the above actions by the Israeli government and IDF in Gaza consistent with the ethical tradition of Judaism and the obligations that flow from it? To answer this question, key texts are analysed, especially the Hebrew Bible and the Talmud, and multiple arguments are examined, taking into account the complexities of context and diverse interpretive theories. The paper is presented in two parts, the first discussing the question and methodological issues and the second providing the data and conclusions. We conclude that the alleged acts of the Israeli government and IDF in Gaza are clearly and directly contrary to the Judaic tradition of ethics as it has developed over the millennia. The conduct of the war cannot truthfully be presented in any meaningful sense as representing, or indeed, consistent with, Jewish culture or ethics. These findings have potentially far-reaching consequences, including for the claimed status of Israel as a Jewish state, the relationship between criticism of the government of Israel and the scourge of antisemitism, and the identity of Jewish people both within and outside Israel.

There has been much discussion about the tactics used by the Israeli Defence Forces (IDF) and government in the conflict in Gaza following October 7, 2023, which have caused, among other things, systematic destruction of hospitals and schools, the deaths of large numbers of civilians, including women and children, mass starvation, and denial of humanitarian aid. The Israeli government and IDF have sought to justify their actions using ethical arguments, many of which relate to their proclaimed role as the representatives of the Jewish state and of Jewish culture and history. Arguing from the extensive corpus of Jewish ethical thought, extending back thousands of years, this article poses a simple question: Are the above actions by the Israeli government and IDF in Gaza consistent with the ethical tradition of Judaism and the obligations that flow from it? To answer this question, key texts are analysed, especially the Hebrew Bible and the Talmud, and multiple arguments are examined, taking into account the complexities of context and diverse interpretive theories. The paper is presented in two parts, the first discussing the question and methodological issues and the second providing the data and conclusions. We conclude that the alleged acts of the Israeli government and IDF in Gaza are clearly and directly contrary to the Judaic tradition of ethics as it has developed over the millennia. The conduct of the war cannot truthfully be presented in any meaningful sense as representing, or indeed, consistent with, Jewish culture or ethics. These findings have potentially far-reaching consequences, including for the claimed status of Israel as a Jewish state, the relationship between criticism of the government of Israel and the scourge of antisemitism, and the identity of Jewish people both within and outside Israel.

There has been much discussion about the tactics used by the Israeli Defence Forces (IDF) and government in the conflict in Gaza following October 7, 2023, which have caused, among other things, systematic destruction of hospitals and schools, the deaths of large numbers of civilians, including women and children, mass starvation, and denial of humanitarian aid. The Israeli government and IDF have sought to justify their actions using ethical arguments, many of which relate to their proclaimed role as the representatives of the Jewish state and of Jewish culture and history. Arguing from the extensive corpus of Jewish ethical thought, extending back thousands of years, this article poses a simple question: Are the above actions by the Israeli government and IDF in Gaza consistent with the ethical tradition of Judaism and the obligations that flow from it? To answer this question, key texts are analysed, especially the Hebrew Bible and the Talmud, and multiple arguments are examined, taking into account the complexities of context and diverse interpretive theories. The paper is presented in two parts, the first discussing the question and methodological issues and the second providing the data and conclusions. We conclude that the alleged acts of the Israeli government and IDF in Gaza are clearly and directly contrary to the Judaic tradition of ethics as it has developed over the millennia. The conduct of the war cannot truthfully be presented in any meaningful sense as representing, or indeed, consistent with, Jewish culture or ethics. These findings have potentially far-reaching consequences, including for the claimed status of Israel as a Jewish state, the relationship between criticism of the government of Israel and the scourge of antisemitism, and the identity of Jewish people both within and outside Israel.

Originally published in 1986. This work remains of compelling interest to those concerned with the natural sciences and their social problems. It puts forward original and unorthodox ideas about the philosophy of and sociology of science, starting from the conviction that modern societies face deep problems arising from unresolved dilemmas about the meaning, content and technical applications of the theories of nature they employ. The book draws on insights developed within a variety of traditions to explore these problems, especially the work of Edmund Husserl and modern critical theory.

Originally published in 1986. This work remains of compelling interest to those concerned with the natural sciences and their social problems. It puts forward original and unorthodox ideas about the philosophy of and sociology of science, starting from the conviction that modern societies face deep problems arising from unresolved dilemmas about the meaning, content and technical applications of the theories of nature they employ. The book draws on insights developed within a variety of traditions to explore these problems, especially the work of Edmund Husserl and modern critical theory.

A key maxim guiding the introduction of new technologies, including those utilizing artificial intelligence, is that such technologies should carry rewards of “convenience”: indeed, the more “convenient” a new technology is considered to be, the more likely it is to be welcomed and adopted. Rudimentary examples from last century include the microwave, washing machine, and dishwasher; more recent innovations from the present century include portable navigation systems, online shopping applications, internet search engines, smart phones, telehealth, automated workplace systems and processes, email and messaging technologies, and—most recently—large language models that are able to undertake multiple complex tasks. Each of these technologies offers a variety of benefits. However, a unifying feature is that all have been considered to enhance convenience, understood as saving time and/or effort. In this paper we explore the provenance and meaning of the—usually unexamined—concept of convenience, identifying an unexpected link with erosion of values and depletion of the diversity and richness of personal experiences. We conclude that the prioritization of convenience as a driver of innovation carries with it risks, which may go unnoticed or be difficult to discern.

Recent discourses about the legitimacy of homeopathy have focused on its scientific plausibility, mechanism of action, and evidence base. These, frequently, conclude not only that homeopathy is scientifically baseless, but that it is “unethical.” They have also diminished patients’ perspectives, values, and preferences. We contend that these critics confuse epistemic questions with questions of ethics, misconstrue the moral status of homeopaths, and have an impoverished idea of ethics—one that fails to account either for the moral worth of care and of relationships or for the perspectives, values, and preferences of patients. Utilitarian critics, in particular, endeavour to present an objective evaluation—a type of moral calculus—quantifying the utilities and disutilities of homeopathy as a justification for the exclusion of homeopathy from research and health care. But these critiques are built upon a narrow formulation of evidence and care and a diminished episteme that excludes the values and preferences of researchers, homeopaths, and patients engaged in the practice of homeopathy. We suggest that homeopathy is ethical as it fulfils the needs and expectations of many patients; may be practiced safely and prudentially; values care and the virtues of the therapeutic relationship; and provides important benefits for patients

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation—that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures—is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope.

Intense public interest in scientific claims about COVID-19, concerning its origins, modes of spread, evolution, and preventive and therapeutic strategies, has focused attention on the values to which scientists are assumed to be committed and the relationship between science and other public discourses. A much discussed claim, which has stimulated several inquiries and generated far-reaching political and economic consequences, has been that SARS-CoV-2 was deliberately engineered at the Wuhan Institute of Virology and then, either inadvertently or otherwise, released to the public by a laboratory worker. This has been pursued despite a clear refutation, through comprehensive genomic analysis, of the hypothesis that the virus was deliberately engineered and the failure of detailed investigations to identify any evidence in support of a laboratory leak. At the same time a substantial, established body of knowledge about the many factors underlying the emergence of novel zoonotic diseases has been largely ignored—including climate change and other mechanisms of environmental destruction, tourism, patterns of trade, and cultural influences. The existence and conduct of these debates have raised questions about the vulnerability of science to manipulation for political purposes. Scientific discourses are vulnerable because: (i) claims can be made with no more than probabilistic force; (ii) alleged “facts” are always subject to interpretation, which depends on social, ethical, and epistemological assumptions; and (iii) science and scientists are not inherently committed to any single set of values and historically have served diverse, and sometimes perverse, social and political interests. In the face of this complexity, the COVID-19 experience highlights the need for processes of ethical scrutiny of the scientific enterprise and its strategic deployment. To ensure reliability of truth claims and protection from corrupting influences robust ethical discourses are required that are independent of, and at times even contrary to, those of science itself.

The race against COVID-19 has been intense and painful and many of us are now looking for a way to move on. We may try to seize a degree of comfort and security by convincing ourselves that we are among the “fittest”—that is, among those who have managed to survive—who can now hope for a “new-normal” time, relatively unscathed. But this isn’t what we should be hoping for. Our world, and ourselves, will never be free of COVID-19 or its insidious effects. COVID-19, like climate change, is a threat multiplier and the challenges it has raised are now indelibly engraved in our vulnerable, interconnected lives. Rather than vainly hoping for a return to an imaginary, erstwhile “normal” what we need is something more fundamental: a new version of hope that embraces a courage to learn what we need to do, to enable us to live a future to which we aspire. Perhaps counter-intuitively, we need to accept that the COVID-19 experience has already changed us deeply and hope that we can learn from this and from the future changes that the pandemic will give rise to. We need to radicalize our responses to the challenges, enabling ourselves to learn new lessons about old but increasingly pertinent topics, such as the realities of human fragility, and inter-connection.

Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that “autonomy” is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because it is unable to facilitate a relational approach to decision making in cases when the patient’s competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants’ understanding was the emergent concept of “relational knowing,” a concept that is poorly articulated in the advance care planning literature. Our findings suggest that the dominant understanding of decision making in conditions of impaired competence is incomplete and obscures much of what matters to people. We conclude that, having recognized a broader set of ethical concerns, it is necessary to develop a relational and narrative based approach that applies in appropriate settings.

Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians’ willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. ‘Conflicts of interest’ policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine. We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue.

Reconciliation and the Technics of Healing Content Type Journal Article Pages 235-237 DOI 10.1007/s11673-011-9318-y Authors Paul A. Komesaroff, Monash Centre for Ethics in Medicine and Society, Monash University, Melbourne, Vic., Australia Elizabeth Kath, Global Cities Institute, RMIT University, Melbourne, Vic., Australia Paul James, Global Cities Institute, RMIT University, Melbourne, Vic., Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 3

Dementia is more than a disease. What dementia is, how it is understood, and how it is experienced is influenced by multiple factors including our societal preoccupation with individual identity. This essay introduces empirical and theoretical evidence of alternative ways of understanding dementia that act as a challenge to common assumptions. It proposes that dementia be understood as an experience of systems, particularly networks of people affected by the diagnosis. Taking this step reveals much about the dementia experience, and about what can be learned from persons with dementia and their networks of family, friends, and carers. It also suggests that dementia may be best thought of as an ecology that arises from the interaction between neuropathological change, people, language, and meaning. While challenging, this perspective may provide new ways of responding to dementia and caring for those affected by it.