Research has demonstrated beneficial effects of acute exercise on memory for neutral materials, such as word lists of neutral valence/low arousal. However, the impacts of exercise on emotional memory is less understood. Across three laboratory experiments in college students, we tested if acute exercise could enhance both neutral and emotional memory performance, anticipating a greater effect for emotional memory. We examined effects of exercise at varying intensities (Experiment 1: high-intensity; Experiment 2: low- and high-intensity; Experiment 3: moderate-intensity), of diverse modalities (...) (Experiment 1: treadmill jogging; Experiment 2: cycling; Experiment 3: open-skill (racquetball) and closed-skill (treadmill jogging) exercise), and on emotional memory performance assessed at increasing levels of hippocampal dependency (Experiment 1: Y/N recognition task; Experiment 2: paired-associative recognition task; Experiment 3: cued-recall task). We found that, in all experiments, acute exercise did not significantly influence emotional or neutral memory performance relative to sedentary control conditions. However, we observed several noteworthy outcomes indicating that acute exercise may be linked to improvements in memory confidence and accuracy for central aspects of emotional memory stimuli, and that select exercise modalities (e.g. treadmill exercise) may also be associated with increased frequency of memory intrusions. (shrink)

The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this (...) function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research. (shrink)

Mentalizing refers to our ability to read the mental states of other agents and engages many neural processes. The brain's mirror system allows us to share the emotions of others. Through perspective taking, we can infer what a person currently believes about the world given their point of view. Finally, the human brain has the unique ability to represent the mental states of the self and the other and the relationship between these mental states, making possible the communication of ideas.

Autism provides a model for exploring the nature of self‐consciousness: self‐consciousness requires the ability to reflect on mental states, and autism is a disorder with a specific impairment in the neurocognitive mechanism underlying this ability. Experimental studies of normal and abnormal development suggest that the abilities to attribute mental states to self and to others are closely related. Thus inability to pass standard ‘theory of mind’ tests, which refer to others’ false beliefs, may imply lack of self‐consciousness. Individuals who persistently (...) fail these tests may, in the extreme, be unable to reflect on their intentions or to anticipate their own actions. In contrast, individuals with high‐functioning autism or Asperger syndrome often possess a late‐acquired, explicit theory of mind, which appears to be the result of effortful learning. An experimental study with three people with Asperger syndrome suggested that level of performance on standard theory of mind tasks was strongly related to the ability to engage in introspection. Qualitative differences in the introspections of high‐functioning people with autism are also reflected in autobiographical accounts which may give a glimpse of what it is like to be autistic. (shrink)

Over the last 20 years the comparator model for delusions of control has received considerable support in terms of empirical studies. However, the original version clearly needs to be replaced by a model with a much greater degree of sophistication and specificity. Future developments are likely to involve the specification of the role of dopamine in the model and a generalisation of its explanatory power to the whole range of positive symptoms. However, we will still need to explain why symptoms (...) can be so variable and we still do not understand the origin of the most mysterious symptom of all: thought insertion. (shrink)

Christopher Frith is a research professor at the Functional Imaging Laboratory of the Wellcome Department of Imaging Neuroscience at University College, London. He explores, experimentally, using the techniques of functional brain imaging, the relationship between human consciousness and the brain. His research focuses on questions pertaining to perception, attention, control of action, free will, and awareness of our own mental states and those of others. As the following discussion makes clear, Frith investigates brain systems involved in the choice (...) of one action over another and in the understanding of other people. Such investigations are aimed at understanding brain basis of autism and schizophrenia. In his widely cited study of schizophrenia, The Cognitive Neuropsychology of Schizophrenia , Frith argues that many of the positive symptoms of schizophrenia, such as delusions of control, auditory hallucinations, and thought insertion, involve problems of self-monitoring. Patients, in effect, lose track of their own intentions and mistakenly attribute agency for their own actions to someone else. Frith employs models of motor control, involving comparator mechanisms and efference copy, not only to explain delusions that involve movement, but also to develop a neurocognitive explanation of delusional cognition. (shrink)

Patients with delusions of control are abnormally aware of the sensory consequences of their actions and have difficulty with on-line corrections of movement. As a result they do not feel in control of their movements. At the same time they are strongly aware of the action being intentional. This leads them to believe that their actions are being controlled by an external agent. In contrast, the normal mark of the self in action is that we have very little experience of (...) it. Most of the time we are not aware of the sensory consequences of our actions or of the various subtle corrections that we make during the course of goal-directed actions. We know that we are agents and that we are successfully causing the world to change. But as actors we move through the world like shadows glimpsed only occasional from the corner of an eye. (shrink)

Like any discipline, bioethics is a developing field of academic inquiry; and recent trends in scholarship have been towards more engagement with empirical research. This ‘empirical turn’ has provoked extensive debate over how such ‘descriptive’ research carried out in the social sciences contributes to the distinctively normative aspect of bioethics. This paper will address this issue by developing a practical research methodology for the inclusion of data from social science studies into ethical deliberation. This methodology will be based on a (...) naturalistic conception of ethical theory that sees practice as informing theory just as theory informs practice – the two are symbiotically related. From this engagement with practice, the ways that such theories need to be extended and developed can be determined. This is a practical methodology for integrating theory and practice that can be used in empirical studies, one that uses ethical theory both to explore the data and to draw normative conclusions. (shrink)

This paper will take as its starting point the premise that developing translational bioethics is a worthwhile endeavour. I will develop an account of translational bioethics and discuss what implications this would have for the wider discipline of bioethics and argue that this would be a useful development for bioethics. The paper will conduct a form of ‘translational meta‐bioethics analysis’, in the words of Bærøe. I will argue that if we are serious about instituting translational bioethics, then it will need (...) to look and be organised in a very different way from current bioethics research, this will be a radically different form of bioethics from what we currently have. In this paper I will sketch what translational bioethics might look like. My proposal here is not that translational bioethics should supplant existing ways of doing bioethics, but rather that it should be an addition to it, another subdiscipline of bioethics. (shrink)

Consciousness has many elements - from sensory experiences such as vision, audition, and bodily sensation, to nonsensory aspects such as volition, emotion, memory, and thought. With all these facets - how can consciousness appear to us as a unified experience? Is this apparent unity just an illusion? Why and when does this unity break down? In recent years many have attempted to answer this, one of the most puzzling and intriguing dimensions of consciousness. With chapters from leading thinkers on consciousness, (...) from psychology, neuroscience, and philosophy this is a thought-provoking book that attempts to answer some of the big questions. (shrink)

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

In this paper, we attempt to make a distinction between egocentrism and allocentrism in social cognition, based on the distinction that is made in visuo-spatial perception. We propose that it makes a difference to mentalizing whether the other person can be understood using an egocentric (‘‘you'') or an allocentric (‘‘he/ she/they'') stance. Within an egocentric stance, the other person is represented in relation to the self. By contrast, within an allocentric stance, the existence or mental state of the other person (...) needs to be represented as independent from the self. We suggest here that people with Asperger syndrome suffer from a disconnection between a strong naı¨ve egocentric stance and a highly abstract allocentric stance. We argue that the currently used distinction between first-person and third-person perspective-taking is orthogonal to the distinction between an egocentric and an allocentric stance and therefore cannot serve as a critical test of allocentrism. (shrink)

On 22nd September 2020 the UK Government announced new lockdown restrictions to supress the COVID-19 virus, with some areas of England having more restrictive lockdown guidance. Students in a number of cities have been confined to their halls of residences after outbreaks of COVID-19 and in Manchester security guards were preventing students leaving the buildings. The scientific community are, unsurprisingly, divided over the question of how far lockdowns should extend.1 Monday 21st September 2020 saw the publication of two open letter (...) to the UK government and Chief Medical Officers. One group, Sunetra Gupta et al,2 argued for a selective lockdown targeting the most vulnerable. The other, headed by Trisha Greenhalgh, arguing that attempts to suppress the virus should operate across the whole community.3 As we enter what appears to be a second wave of COVID-19 infections and accompanying lockdown measures, ethical debates over the appropriateness and extent of such measures are critical. Julian Savulescu and James Cameron4 in their article on lockdown of the elderly and why this is not ageist, put forward the case that, ‘an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly.’ Their central claim is that selective isolation of the elderly is to be preferred to imposing lockdown on all members of society. The aim of lockdown, restricting movement and key activities, is designed to reduce the number of deaths from COVID-19 and also to prevent the healthcare system from becoming overwhelmed. As the elderly are at significantly more risk of having severe cases of COVID-19 and therefore more likely to place demands on healthcare services, they are clearly prime candidates for lockdown measures, measures that will not only benefit them but the whole of society. This is not ageist as …. (shrink)

There is little consensus on how to regulate information giving in reproductive donation – using donated gametes (eggs, sperm) to have children. Should gamete donors be anonymous or should donor-conceived individuals have access to their donor’s identity, and at what age? What information should be available about donor siblings and other donor relations? And, crucially, how should this information giving be appropriately managed and regulated? Before we can answer these questions, we need to first understand what reproductive donation is. This (...) paper sets out options for how reproductive donation can be conceptualized and develops a typology of different approaches, by categorizing reproductive donation into two main models: the biomedical and the psychosocial. These models provide a conceptual framework, a useful heuristic, for both understanding reproductive donation and critiquing regulation and oversight. The purpose of this paper is not to take a stand on which model is optimal; this is a matter for further debate. Rather, it provides clarification of what is at stake, and this can form the basis for coherent and justifiable approaches to the oversight and regulation of reproductive donation, instead of the patchwork of provisions that currently exist in many jurisdictions. (shrink)

The year 2025 was a significant one for the _Journal of Medical Ethics_ (_JME_), with a change in editors-in-chief, the launch of a new journal and a 50th anniversary. In June 2025, Lucy Frith, Brian Earp and Arianne Shahvisi took over from John McMillan as editors-in-chief of the _JME_. We set out our vision for the _JME_ in our first editorial, a commitment to reasoned argument and discussion and a recognition that medical ethics is now broader than originally conceived, (...) encompassing the wider systems in which healthcare is delivered. We also emphasised our dedication to including a diversity of views and approaches in the papers we published. 1 In a later editorial, we set out our editorial approach and gave, ‘a few notes about how we are approaching editorial decisions, so that our rationale is clear, and to call attention to some simplification of the journal’s article types... (shrink)

Although this editorial will be published in the February 2025 issue of the Journal of Medical Ethics, I am writing it in the run up to the Christmas and the winter holidays, after a busy term, and this is, for some of us, a time to reflect on the past year (although as an academic the year is only half-way through!). It is also the journal’s 50th anniversary in 2025. This prompts further reflection, thinking about how and why the journal (...) started, where its focus has been and what the future holds for both the journal and the field of medical ethics more broadly. Healthcare, those who work in it and the systems in which it is delivered, are facing pressures and challenges of huge global proportions, global conflict, the climate crisis and, in England, ongoing austerity all exacerbate existing health inequities. The stark disparities in healthcare access between the global south and north, and within countries such as the UK, raise profound questions of social justice. The JME has addressed many of these in articles and editorials over the years. As well as these current concerns, critical issues at the beginning and end of life are still as pertinent today as they were when the journal was first published in 1975. Looking at the running order for this issue, many of the papers consider issues and dilemmas that would have been familiar to …. (shrink)

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

This article discusses when it is ethically acceptable to withdraw consent for the storage and use of embryos and gametes. Currently, the law in the UK states that consent to use of a gamete or embryo can be withdrawn up to the point of the embryo's transfer to the recipient's uterus or when the gamete is used in providing treatment services; that is, the ‘point of no return’. In this article, we will consider other points of no return and argue (...) that having a single point of no return, a one size fits all form of consent can, in some cases, lead to restrictions on individuals’ autonomy and cause particular types of harm. Therefore, having different points of no return that fit different circumstances could extend autonomy and allow people to enter into agreements that are tailored more to their own particular needs and circumstances. (shrink)

Autism: Mind and Brain provides a comprehensive overview of the latest research on autism and highlights new techniques that will progress future understanding. With contributions from leaders in autism research, the book describes the latest advances, discusses ways forward for future research, and presents new techniques for understanding this complex disorder.

The use of rights based arguments to justify claims that donor offspring should have access to information identifying their gamete donor has become increasingly widespread. In this paper, I do not intend to revisit the debate about the validity of such rights. Rather, the purpose is to examine the way that such alleged rights have been implemented by those legislatures that have allowed access to identifying information. I will argue that serious inconsistencies exist between the claim that donor offspring have (...) a right to know the identity of their gamete donor and the way such a right is currently met in practice. I hope to show that in systems where non‐anonymous donation is practised, an understanding of the proclaimed right of donor offspring to know their genetic identity is one composed of two different rights – the right to know the circumstances of their conception and the right to information identifying the gamete donor – can provide important insights into this important area of public policy. (shrink)

Who's better? Billie Holiday or P. J. Harvey? Blur or Oasis? Dylan or Keats? And how many friendships have ridden on the answer? Such questions aren't merely the stuff of fanzines and idle talk; they inform our most passionate arguments, distil our most deeply held values, make meaning of our ever-changing culture. In Performing Rites, one of the most influential writers on popular music asks what we talk about when we talk about music. What's good, what's bad? What's high, what's (...) low? Why do such distinctions matter? (shrink)

Gray has expanded his account of schizophrenia to explain consciousness as well. His theory explains neither phenomenon adequately because he treats individual minds (and brains) in isolation. The primary function of consciousness is to permit high level interactions with other conscious beings. The key symptoms of schizophrenia reflect a failure of this mechanism.

In their paper Hortonet alargue that it is acceptable to contact an anonymous egg-donor to facilitate diagnostic genetic testing for the donor conceived child, despite the donor, ‘indicating on a historical consent form that she did not wish to take part in future research, and that she did not wish to be informed if she was found to be a carrier of a “harmful inherited condition”’. There are a number of claims embedded in Hortonet al’s position that it is acceptable (...) to contact the donor and request that she at least think about participating in genetic testing. In this response. I will go through their main claims and argue that the area of genomic medicine does not justify exceptions to general consent conditions as the authors suppose and conclude that the donor should not be contacted. I will then go on to suggest a policy change that would address Hortonet al’s concerns but would not involve over-riding any previously expressed wishes. (shrink)

The attempt to develop a systematic approach to the study of consciousness begins with René Descartes (1596–1650) and his ideas still have a major influence today. He is best known for the sharp distinction he made between the physical and the mental (Cartesian dualism). According to Descartes, the body is one sort of substance and the mind another because each can be conceived in terms of totally distinct attributes. The body (matter) is characterized by spatial extension and motion, while the (...) mind is characterized by thought. This characterization of the mind also renders it private, a precursor of the distinction between the first‐person and the third‐person perspectives. Today, most scientists do not accept dualism, instead believing that mind somehow emerges from the physical properties of the brain. However, the distinction between mind and matter is still perceived as being so clear‐cut that explaining how mind can emerge from matter, and reconciling the first‐person and third‐person perspectives, remain the hardest problems facing the student of consciousness. (shrink)

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further ‘market-style’ reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English (...) NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. (shrink)

The JME editorial team selects its feature articles from the best papers accepted for publication based on their quality, novelty and capacity to move debate forward on a specific issue. Feature articles are made freely available and are published alongside reviewed and submitted commentaries. We do this partly to promote and acknowledge excellent work in medical ethics, but also to encourage authors to submit their best papers to the JME. JME feature articles have deepened the analysis of some central issues (...) for medical ethics. ‘Common morality’ is one way of underpinning general ethical principles and it is a concept that is central to the justification that Beauchamp and Childress give in their classic articulation of the four principles. 1 Rhodes’ critical discussion of common morality in her feature article 2 has been well cited since then, which is a good thing from the perspective of the author... (shrink)

This paper will critically examine the use of evidence in creating policy in the area of reproductive technologies. The use of evidence in health care and policy is not a new phenomenon. However, codified strategies for evidence appraisal in health care technology assessments and attempts to create evidence based policy initiatives suggest that the way evidence is used in practice and policy has changed. This paper will examine this trend by considering what is counted as ‘good’ evidence, difficulties in translating (...) evidence into policy and practice and how evidence interacts with principles. To illustrate these points the removal of gamete donor anonymity in the UK in 2005 and the debates that preceded this change in the law will be examined. It will be argued that evidence will only ever take us so far and attention should also be paid to the underlying principles that guide policy. The paper will conclude with suggestions for how underlying principles can be more rigorously used in policy formation. (shrink)

This paper examines recent developments in direct-to-consumer genetic (DNA) testing (DTCGT) and the ethical challenges it raises for those affected by donor conception (using donated gametes, eggs and sperm, to conceive children). First, DTCGT can result in the complete removal of donor anonymity at any stage in the donor conceived person’s life, and this has widespread implications for all those involved in donor conception. Second, for regulators: DTCGT can disrupt regulatory prohibitions on information disclosure. Third, for donor conceived people: there (...) is potential harm in discovering you are donor conceived via DTCGT, and DTCGT creates new 'gatekeepers' of knowledge about donor conception, who have to decide whether to disclose this information. DTCGT also raises normative questions for those involved in donor conception. For donors: do donors have any obligation to participate in DTCGT, or to provide their genetic data to donor conceived offspring? For parents through donor conception: how does DTCGT affect decisions about disclosing donor conceived origins to their child, and should parents test their child, and if they decide to do so, when? The paper concludes by making recommendations for how the ethical challenges posed by DTCGT might be overcome or at least ameliorated. (shrink)

There are substantial numbers of frozen embryos in storage that will not be used by those who produced them for their own fertility treatment. One option for such embryos is to donate them to others to use in their fertility treatment. There has been considerable debate about how this process should be organized. In the US, there are embryo adoption programmes that mediate between those relinquishing embryos and potential recipients. This is a form of conditional embryo donation, where the relinquishing (...) couple can choose the recipient of their embryo. This article examines the ethical debate over conditional embryo donation for family building and explores the question of whether those who have unused frozen embryos should be able to determine who receives their embryos. The main objections to conditional embryo donation are examined: first, the embryo is not a person and therefore such concern over the placement of an embryo is unwarranted; secondly, potential donors might impose morally problematic conditions on who should receive their embryo; and thirdly, there are practical difficulties regarding organizational arrangements and the associated costs involved. It will be concluded that these objections can be countered and that if people wish to donate and receive embryos in this way there is no ethical objection to them doing so. (shrink)

Medical ethics often turns on categories. A patient is disabled, a person is a parent, an entity is an embryo, a participant is vulnerable. These descriptions can identify features of a case that have ethical or legal significance. They can also carry assumptions that have not been fully argued for: for example, about moral status, decision-making authority or susceptibility to harm.1 This risk is greatest in marginal or difficult cases, where new clinical, legal or scientific contexts stretch familiar categories beyond (...) the settings in which they first developed their practical force. Philosophers have long observed that categories do more than sort things. Ian Hacking argued that classifications of people can interact with those classified: they can affect how people are treated, how institutions respond to them and how people understand themselves and others.2 A category such as ‘vulnerable participant’, ‘disabled person’ or ‘parent’ can therefore help to create (aspects of) the social reality it may only appear to describe. Categories often used in medical ethics can trigger protections, duties, permissions, restrictions and expectations. This gives them practical value but also makes their use ethically significant and potentially contestable. They may often require close evaluation. Several papers in this issue invite readers to apply this kind of scrutiny. Before using a category to inform a decision, three questions are worth asking. Which facts does the category pick out? Which decision, recommendation, policy or (other) normative conclusion is it being used to support? And what moral premise connects those facts to that decision or conclusion? A category may be apt for one purpose and misleading for another. Problems arise when the application of a category is taken to settle questions that the ethical reasoning has not yet addressed. Our first example concerns the category of disability as applied within the …. (shrink)

This article considers John Harris’ work on autonomy, specifically reproductive autonomy, outlined in The Value of Life and developed throughout his career. Harris often used the concept of reproductive autonomy to make the case for liberal approaches to developments in reproductive and genetic technologies. Harris argued that reproductive autonomy should be highly valued, and therefore we need compelling arguments to justify limiting it in anyway. When discussing reproductive autonomy, Harris focused mainly on restrictions on the potential users of reproductive technologies (...) autonomy, that is, prospective parents. This article extends the discussion of autonomy and the appropriate limits to individuals exercising their autonomy to medical professionals working in this area. Given reproductive technologies have become part of routine medical practice, this article considers whether the current restrictions on both patients and clinicians, as imposed by regulators and professional guidelines, remain ethically justified. (shrink)

People should be allowed to decide how and where they wish to be tested for HIV without there being a formal requirement for pretest counsellingIn his paper, Ethics of HIV testing in general practice without informed consent, Fraser argues that pretest counselling and informed consent are pillars of the ethical conduct of HIV testing. In my response I want to look critically at these contentions. While I will agree with Fraser that it is always necessary to get informed consent from (...) a patient for an HIV test I will argue that an emphasis on pretest counselling as a prerequisite for testing can actually undermine a patient’s autonomy, the very principle that informed consent seeks to promote.This response will start with an analysis of Case Two as this highlights the fundamental importance of informed consent. It will then go on to look at Case One and show how the special application of informed consent in the field of HIV testing can, in certain circumstances, lead to a reduction in patient autonomy.CASE TWOIn Fraser’s second case a 43 year old married clergyman presented with a recurrent infection of his little toe and the preliminary lab reports queried Kaposi’s sarcoma. The general practitioner thought that because of the patient’s lifestyle there was little risk of HIV infection, “suggesting the possibility of HIV, when it is unexpected and the risk low, can in itself cause anxiety and distress”. On these grounds the GP did not call the patient in for an HIV test.Some might argue that the GP should have tested the clergyman. This could have been done in one of two ways: by seeking his explicit consent for an HIV test, or by getting blanket consent for a range of tests, including HIV, without HIV being explicitly mentioned. …. (shrink)

The systematic examination of the relationship between brain and behavior is generally considered to have begun in 1861 with Broca's description of a patient with a specific language deficit associated with a circumscribed lesion of the left frontal cortex. This observation was taken to show that there was a specific region in the brain concerned with language which was relatively independent of other regions concerned with other abilities. In the next decade a number of other patients were described with various (...) circumscribed deficits. Wernicke described aphasic patients who, in contrast to Broca's patients, were better at speech production than they were in understanding speech. Harlow described the case of Phineas Gage, who showed little sign of loss in his intellectual abilities but suffered a disastrous change in personality after bilateral damage to his frontal cortex. The aim of many of these early neuropsychologists was to associate particular psychological functions with specific brain regions by detailed study of neurological cases. (shrink)

Infertility treatment is a speciality that has attracted considerable attention both from the public and bioethicists. The focus of this attention has mainly been on the dramatic dilemmas created by theses technologies. Relatively little is known, however, about how clinicians approach and resolve ethical issues on an everyday basis. The central aim of this study is to gain insight into these neglected aspects of practice. It was found that, for the clinicians, the process by which ethical decisions were made was (...) of key importance. It will be argued that this focus on the process of decision-making is more than just empty proceduralism but is based on and facilitates certain substantive ethical principles. In conclusion, suggestions as to how ethical decision-making processes can be supported and improved in infertility practice will be made. (shrink)

As John McMillan notes in January’s editorial,1 many countries are reflecting on how they responded to the COVID-19 pandemic, what went wrong and how responses to such system shocks can be better managed in the future. However, while it is tempting to think that the COVID-19 pandemic is over and that what is now needed is a reflection on how countries could have responded better, some of the underlying issues and problems COVID-19 both highlighted and created are still with us. (...) The legacy of the pandemic has continued particularly for healthcare workers at all levels, who have had to continue providing services with little time to rest and reflect and with new ‘shocks’ to the systems to cope with. For example, in England, industrial action by junior doctors has put already fragile systems under pressure, and the issues that staff are campaigning about remain unaddressed. Many of these issues are not distinctive to COVID-19, but as has been noted, ‘From an ethical perspective, the COVID-19 pandemic is like a prism: it helps us see the spectrum of …. (shrink)

Arguably one of the strengths of the discipline of medical ethics is its close attention to the context in which ethical dilemmas, questions and issues play out. As a discipline that is concerned with helping and supporting practitioners, policy-makers and the public to address the ethical aspects of healthcare provision and practice in the best way they can, context is crucially important. As McMillan puts it, ‘ethics should be grounded’ in the practical realities of the situation.1 What, where and who (...) are important questions that set the parameters of the debate and, to some extent, frame the subsequent solution or decision. What is happening in a particular case, what is the source of controversy, is it a conflict of values, regulations or professional viewpoints? Where does it take place, under which rules, jurisdiction or in which professional setting? And who does it involve? Whose rights, interests or decision-making capacity do we prioritise? All these contextual questions need to be carefully articulated before it is possible to draw any normative conclusions. The importance of context is clear in this issue’s ‘Engagement without entanglement: a framework for non-sexual patient–physician boundaries’ by Appel.2 What might be seen as entirely appropriate behaviour in one context, for example, when I help out a friend and let them stay in my house for a few weeks while they recover from an operation, is entirely inappropriate in another—in …. (shrink)