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In contrast to much contemporary Reformed and broader evangelical theology, Francis Turretin, the great Genevan theologian of High Orthodoxy, considers natural law in favorable terms, notably under Topic 11 of his Institutes of Elenctic Theology. This essay offers an exposition of Turretin’s account of natural law and compares it to that of Thomas Aquinas. It is shown that there is substantial agreement between Turretin and Aquinas on the notion and content of natural law, despite their different approaches to the subject. This conclusion supports ongoing efforts to reevaluate and reappropriate natural law and Thomism in Reformed theology.

This article considers the idea of medicine's internal morality as it is understood by its various proponents. Although the use of the phrase 'internal morality' in relation to medicine predates Edmund Pellegrino, he can be credited with cementing its place in the vocabulary of medical ethics. Yet, while 'internal morality' and its related terms are now readily recognizable, they are used to denote irreconcilable ideas. Our aims, therefore, are to, firstly, clarify and, secondly, evaluate the different uses of 'internal morality', showing that there is little agreement on its definition. Thirdly, we argue that the terminology relating to 'internal morality' requires substantial revision, and that the term itself should be jettisoned. Finally, we briefly set out our own account of how morality should be understood in relation to the practice of medicine along similar but clearer lines to Pellegrino.

Conscientious Objection (CO) has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited.

Natural law is probably the most misrepresented and, therefore, unfairly dismissed ethical theory. If current academic ethics were a battlefield, it would be littered with the felled strawmen alleg...

Jacob Winslow (1669–1760), a celebrated anatomist in his day, made his name publishing numerous medical treatises and writing the four-volume Anatomical exposition of the structure of the human body. He gives his name to the foramen of Winslow, and is credited with numerous significant findings in neuroanatomy and biomechanics. His life is characterised by meticulous devotion to his discipline and divided by a torturous religious conversion. In addition to his contributions to anatomy, he is famously remembered for his treatise on the uncertainty of the signs of death, which has influenced practices surrounding death down to the present day.

In the ruins of Christendom there is no longer a universal reference point by which moral, social and political divisions can be settled. Achieving a substantive moral consensus is a project doomed...

Arianne Shahvisi has argued that a doctor’s conscientious objection to abortion is a misuse of their authority which unduly burdens patients and, moreover, does not succeed in its aim of exculpating objectors from participating in perceived evil. We examine these claims in this response. First, we ask what the ‘conscience clause’ really requires of doctors and whether Shahvisi has interpreted it correctly. Second, we explore the notions of vulnerability and power in the doctor–patient relationship and cast doubt on Shahvisi’s claims about these. Third, we tackle Shahvisi’s claim that conscientious objection is self-defeating because it entails remaing causally implicated in a chain of events leading to abortion. We show that this claim entails absurdity, then revisit the classical framework for the ethics ethics of co-operation to show that conscientious objection can suceed in exculpating objectors from perceived wrongdoing. We briefly critically evaluate the General Medical Council’s guidance on conscientious objection before drawing attention to some of the complexities surrounding abortion and clinical medicine which Shahvisi has overlooked.

This case of chronic inflammatory demyelinating polyneuropathy (CIDP) shows that a patient’s condition can evolve from the point of admission, gradually manifesting its underlying cause. Our patient’s initial presentation of backpain and lower limb weakness prompted investigations which ruled out compressive myelopathy and neuropathy. As upper limb weakness developed later, along with a more proximal and symmetrical pattern of lower limb weakness, the clinical picture suggested polyneuropathy. The diagnosis of CIDP became apparent only after numerous negative tests and nerve conduction studies which identified demyelination. Diagnosing CIDP enabled the commencement of definitive treatment which led to a good recovery.

Debate persists over the place of conscience in medicine. Some argue for the complete exclusion of conscientious objection, while others claim an absolute right of refusal. This paper proposes that...

Cremation has substantial practical benefits. Not only is it much cheaper than traditional burial, but it also comes without its ecological burden. Despite this, we argue that cremation is an inadequate way of disposing of the dead because it entails the destruction of community memory, and, by extension, community and individual identity. It deprives the living of these benefits, while also treating the dead in way which goes against common intuitions about personhood, anthropology and respect for the will of the deceased. Death is perhaps one of the most important subjects in philosophy, and by marginalising it through cremation and related practices, we deprive ourselves of its didactic and social uses. The case we make against cremation is not absolute, but we hope it succeeds in casting doubt on the presumed neutrality of cremation. Our essay is under three heads: (1) we consider the practical benefits of cremation; (2) we reconsider the value of cremation in light of what it deprives individuals and communities of and; (3) we analyse the significance of the corpse in regard to cremation.

This paper argues that healthcare aims at the good of health, that this pursuit of the good necessitates conscience, and that conscience is required in every practical judgement, including clinical judgment. Conscientious objection in healthcare is usually restricted to a handful of controversial ends (e.g. abortion, euthanasia, contraception), yet the necessity of conscience in all clinical judgements implies the possibility of conscientious objection to means. The distinction between conscientious objection to means and ends is explored and its implications considered. Based on this, it is suggested that conscientious objection, whether to means or ends, occurs when a proposed course of action comes into irreconcilable conflict with the moral principle 'do no harm'. It is, therefore, concluded that conscientious objection in healthcare can be conceived as a requirement of the moral imperative to do no harm, the right to refuse to harm in regard to health.

Principlism remains the dominant framework for addressing ethical quandaries in medical practice. It sets out four principles clinicians should consider that require specification to a particular set of circumstances. There is no hierarchy among the principles; any special prominence given to respect for autonomy is a cultural accretion that is not claimed by the authors of principlism. Principlism does not set out a single consistent or coherent moral theory. Instead, it summarizes for the clinician's convenience the relevant reasoning of more fundamental theories, including those in which the emphasis is on a doctor's intentions (deontological theories), those focussing on the outcome of doctors' actions (consequentialist theories) and those relying on the nature and disposition of the doctor herself (virtue ethics). As sources of guidance in making complex moral decisions in clinical practice, each of these has its attractions and limitations. Principlism does not represent an alternative analytical mechanism, nor is it an exhaustive exposition of those theories. Its strength is that it provides a summary of some of their most important reasoning, in a way that is clear, easy to assimilate and easy to recall at the moment when clinical decisions need to be made in practice.

In a recent article in this journal, Abram Brummett argues that new and future assisted reproductive technologies will provide challenging ethical questions relating to lesbian, gay, bisexual and transgender (LGBT) persons. Brummett notes that it is likely that some clinicians may wish to conscientiously object to offering assisted reproductive technologies to LGBT couples on moral or religious grounds, and argues that such appeals to conscience should be constrained. We argue that Brummett's case is unsuccessful because he: does not adequately interact with his opponents' views; equivocates on the meaning of 'natural'; fails to show that the practice he opposes is eugenic in any non-trivial sense; and fails to justify and explicate the relevance of the naturalism he proposes. We do not argue that conscience protections should exist for those objecting to providing LGBT people with artificial reproductive technologies, but only show that Brummett's arguments are insufficient to prove that they should not.

Death is making a much-needed comeback. Recent academic and popular works have addressed it head-on, to lift the taboo which has come to envelop it, and re-educate us in ars moriendi, the art of dy...

Hoping to bring some objectivity to the debate, Ben-Moshe has argued that conscientious objection in medicine should be accommodated based on its concordance with the ‘impartial spectator’, a metaphor for conscience drawn from the writings of Adam Smith. This response finds fault with this account on two fronts: first, that its claim to objectivity is unsubstantiated; second, that it implicitly relies on moral absolutes, despite claiming that conscience is a social construct, thereby calling its coherence and claims into question. Briefly, a traditional account of conscience is then described, before ending with a related thesis for future discussion.

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy (HRT) is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT.

Räsänen has attempted to make a moral case for permitting some people to change their legal age: if someone considers that their chronological age does not correspond to their emotional age or biological age, and they face age-based discrimination as a result, they may change the legal record of their age. This response considers some of the problems with Räsänen’s paper, including its reliance on equivocation. It concludes that what is billed as a moral argument turns out to be a conflicted case for deception which relies on a nihilistic outlook on reality.

Readers may rightly wonder why a book on natural law jurisprudence is reviewed in this journal. Does the subject bear any relation to bioethics? Or, is the reviewer exploiting his editorial privile...

Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress' in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons.

Introduction The General Medical Council (GMC) stipulates that doctors must be competent professionals, not merely scholars and practitioners. Medical school curricula should enable students to develop professional values and competencies. Additionally, medical schools are moving towards integrated undergraduate curricula, Cardiff9s C21 being one such example. Methods We carried out an audit to determine the extent to which C21 delivers GMC professionalism competencies, and a student questionnaire to explore student perspective on ethics and professionalism. Results and discussion C21 delivers explicit or implicit teaching for all major GMC competencies, though some missed opportunities remain. The questionnaire responses showed that most students value ethics and professionalism teaching, and that it is most well received when delivered in a variety of ways and contexts throughout the curriculum. We also note that some respondents confuse ethics and professionalism with the policing of student behaviour. Conclusions C21 and curricula like it offer many opportunities for nurturing ethically and professionally competent physicians. Students appear to value this, though there remains confusion between medical school discipline and ethics and professionalism which needs further explication.

In her paper ‘Cosmetic surgery and conscientious objection’, Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because (1) it overlooks an important distinction regarding autonomy's meaning and place in clinical practice, and (2) it makes obsolete the important concepts of expert clinical judgment and beneficence. Finally, we discuss two ideas which emerge from consideration of cosmetic surgery in relation to conscientious objection. These are the possible analogy between clinical judgment and conscientious objection, and the possible role the goals of medicine can play in defining the scope of conscientious objection.

It is sometimes argued that interruptions of the life's continuum which have the same end result are morally equivalent. In other words, abortion and contraception are ethically identical because both prevent birth and the development of persons. We will examine two major arguments in favour of this thesis: (1) all things that are potential persons have equal moral status. Hence preventing fertilisation of gametes is morally identical to destroying an embryo; (2) all interruptions of the continuous process which leads to the creation of a person are morally equivalent; abortion and contraception are morally indistinguishable. These arguments challenge those who distinguish between abortion and contraception. It is argued, however, that there is good reason to doubt their validity. Furthermore, an argument is offered which confirms the ethical boundary between abortion and contraception on the basis that an embryo is something greater and other than the sum of its constituent gametes.