•  224
    Three versions of an ethics of care
    Nursing Philosophy 10 (4): 231-240. 2009.
    The ethics of care still appeals to many in spite of penetrating criticisms of it which have been presented over the past 15 years or so. This paper tries to offer an explanation for this, and then to critically engage with three versions of an ethics of care. The explanation consists firstly in the close affinities between nursing and care. The three versions identified below are by Gilligan (1982 ), a second by Tronto (1993 ), and a third by Gastmans (2006 ), see also Little (1998 ). Each vers…Read more
  •  136
    A qualitative investigation of selecting surrogate decision-makers
    with P. Brown, M. A. Twyman, D. Christie, and T. Rakow
    Journal of Medical Ethics 37 (10): 601-605. 2011.
    Background Empirical studies of surrogate decision-making tend to assume that surrogates should make only a 'substituted judgement'—that is, judge what the patient would want if they were mentally competent. Objectives To explore what people want in a surrogate decision-maker whom they themselves select and to test the assumption that people want their chosen surrogate to make only a substituted judgement. Methods 30 undergraduate students were recruited. They were presented with a hypothetical …Read more
  •  124
    The body as object versus the body as subject: The case of disability
    Medicine, Health Care and Philosophy 1 (1): 47-56. 1998.
    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 part…Read more
  •  112
    Three concepts of suffering
    Medicine, Health Care and Philosophy 6 (1): 59-66. 2003.
    This paper has three main aims. The first is to provide a critical assessment of two rival concepts of suffering, that proposed by Cassell and that proposed in this journal by van Hooft. The second aim of the paper is to sketch a more plausible concept of suffering, one which derives from a Wittgensteinian view of linguistic meaning. This more plausible concept is labeled an ‘intuitive concept’. The third aim is to assess the prospects for scientific understanding of suffering
  •  97
    Nordenfelt's theory of disability
    Theoretical Medicine and Bioethics 19 (1): 89-100. 1998.
    This paper is an attempt to provide a critical evaluation of the theory of disability put forward by Lennart Nordenfelt. The paper is in five sections. The first sets out the main elements of Nordenfelt's theory. The second section elaborates the theory further, identifies a tension in the theory, and three kinds of problems for it. The tension derives from Nordenfelt's attempt to respect two important but conflicting constraints on a theory of health. The problems derive from characterisation o…Read more
  •  86
    Can unequal be more fair? A response to Andrew Avins
    Journal of Medical Ethics 26 (3): 179-182. 2000.
    In this paper, we respond to Andrew Avins's recent review of methods whose use he advocates in clinical trials, to make them more ethical. He recommends in particular, “unbalanced randomisation”. However, we argue that, before such a recommendation can be made, it is important to establish why unequal randomisation might offer ethical advantages over equal randomisation, other things being equal. It is important to make a pragmatic distinction between trials of treatments that are already routin…Read more
  •  85
    The case of Ashley X
    Clinical Ethics 6 (1): 39-44. 2011.
    This paper recounts the events surrounding the case of Ashley X, a severely disabled young girl whose parents opted for oestrogen therapy, a hysterectomy and breast removal – the so-called ‘Ashley treatment’ – in order to reduce her projected adult weight and improve her quality of life. Following a description of the events leading up to the procedure itself, and the worldwide debate which ensued, the main arguments in favour and against the procedures are presented. The paper also critically e…Read more
  •  66
    Review of Disability Rights and Wrongs by Tom Shakespeare (review)
    Journal of Medical Ethics 34 (3): 222-222. 2008.
    Tom Shakepeare is an eminent, and somewhat controversial, contributor to disability studies. As he outlines, part of the explanation for his controversial status within that field stems from his engagement with disciplines outside it, including genetics and bioethics. For many in the field of disability studies, no genuine engagement should be sought with scholars in genetics or bioethics because—so the party line goes—these areas of study are inherently opposed to disability rights and otherwis…Read more
  •  64
    The impairment/disability distinction: a response to Shakespeare
    Journal of Medical Ethics 34 (1): 26-27. 2008.
    Tom Shakespeare’s important new book includes, among other topics, a persuasive critique of the social model of disability. A key component in his case against that model consists in an argument against the impairment/disability distinction as this is understood within the social model. The present paper focuses on the case Shakespeare makes against that distinction. Three arguments mounted by Shakespeare are summarised and responded to. It is argued that the responses adequately rebut Shakespea…Read more
  •  57
    Philosophy of Nursing: a New Vision for Health Care
    Nursing Philosophy 2 (2): 187-189. 2001.
  •  57
    Research ethics committees and paternalism
    Journal of Medical Ethics 30 (1): 88-91. 2004.
    In this paper the authors argue that research ethics committees should not be paternalistic by rejecting research that poses risk to people competent to decide for themselves. However it is important they help to ensure valid consent is sought from potential recruits and protect vulnerable people who cannot look after their own best interests. The authors first describe the tragic deaths of Jesse Gelsinger and Ellen Roche. They then discuss the following claims to support their case: competent i…Read more
  •  51
    Editorial
    Nursing Philosophy 8 (4). 2007.
  •  48
    Experiencing the Meaning of Breathing
    Indo-Pacific Journal of Phenomenology 6 (1): 1-13. 2006.
    This research was motivated by the author’s personal experiences with various breathing methods as well as meaningful breathing experiences reported by clients, colleagues and friends. The meaning of breathing is discussed in relation to consciousness, bodiliness, spirituality, illness prevention and health promotion. Experiencing the meaning of breathing is to experience more meaning in life itself. Experiential vignettes confirm that breathing skills may be regarded as an original method of su…Read more
  •  48
    Ethics review of research: in pursuit of proportionality
    with R. Omar
    Journal of Medical Ethics 34 (7): 568-572. 2008.
    The ethics review system of research is now well-established, at least in the developed world, although there are many differences in how countries view it and go about managing it. The UK specifically is now seeking to revise its system by speeding up the process of ethics approval but only for some studies. It is proposed that only those studies which pose “no material ethical issues” should be “fast-tracked”. However, it is unclear what this means, who should decide and what should be include…Read more
  •  40
    Harris, Disability, and the Good Life
    Cambridge Quarterly of Healthcare Ethics 23 (1): 48-52. 2014.
  •  39
    Can supervising self-harm be part of ethical nursing practice?
    with Jeanette Hewitt
    Nursing Ethics 18 (1): 79-87. 2011.
    It was reported in 2006 that a regime of ‘supervised self harm’ had been implemented at St George’s Hospital, Stafford. This involves patients with a history of self-harming behaviour being offered both emotional and practical support to enable them to do so. This support can extend to the provision of knives or razors to enable them to self-harm while they are being supervised by a nurse. This article discusses, and evaluates from an ethical perspective, three competing responses to self-harmin…Read more
  •  38
    Human death
    Nursing Philosophy 6 (2). 2005.
  •  37
    In this article we examine ethical aspects of the involvement of children in clinical research, specifically those who are incapable of giving informed consent to participate. The topic is, of course, not a new one in medical ethics but there are some tensions in current guidelines that, in our view, need to be made explicit and which need to be responded to by the relevant official bodies. In particular, we focus on tensions between the World Medical Association Declaration of Helsinki, and the…Read more
  •  35
    Is there a distinctive care ethics?
    Nursing Ethics 18 (2): 184-191. 2011.
    Is it true that an ethics of care offers something distinct from other approaches to ethical problems in nursing, especially principlism? In this article an attempt is made to clarify an ethics of care and then to argue that there need be no substantial difference between principlism and an ethics of care when the latter is considered in the context of nursing. The article begins by considering the question of how one could in fact differentiate moral theories. As is explained, this cannot be do…Read more
  •  33
    Why Sports Medicine is not Medicine
    Health Care Analysis 14 (2): 103-109. 2006.
    Sports Medicine as an apparent sub-class of medicine has developed apace over the past 30 years. Its recent trajectory has been evidenced by the emergence of specialist international research journals, standard texts, annual conferences, academic appointments and postgraduate courses. Although this field of enquiry and practice lays claim to the title ‘sports medicine’ this paper queries the legitimacy of that claim. Depending upon how ‘sports medicine’ and ‘medicine’ are defined, a plausible-so…Read more
  •  32
    Disablement and personal identity
    Medicine, Health Care and Philosophy 10 (2): 209-215. 2006.
    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-constit…Read more
  •  30
    Editorial
    Nursing Philosophy 3 (1). 2002.