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How should the NHS respond to professional errors?

In this post, Ben Davies & Joshua Parker discuss their recent article in Journal of Applied Philosophy on the appropriate culture to develop around mistakes in professional medicine.


Consider the following case, hypothetical but not uncommon. Hamza, a junior doctor working in the UK’s National Health Service (NHS) is working a night shift when he mis-prescribes a large dose of morphine to a patient who doesn’t need it. Fortunately, this error is caught by another member of his team, but at worst it could have killed the patient. Hamza was tired, stressed, and relatively inexperienced, but at his stage of training should have known to double check the dose. How should Hamza’s colleagues, and NHS institutions, respond to his serious mistake?

There has been a shift in the NHS in recent years to the idea that in responding to medical errors, institutions should adopt a ‘no blame’ culture. In our recent paper, we take a critical look at this idea, arguing that the no blame approach may throw the baby of responsibility out with the bathwater of blame.

Recognition in times of COVID-19

In this post, guest contributor Gottfried Schweiger reflects on recognition of “everyday heroes” in the current COVID-19 crisis and what it says about our recognition regime.

Times of crisis are times when heroes are made and tales of heroism are written. The COVID-19 pandemic knows some heroes: all the medical staff in the front line, but also the many other people who keep society going and fight the pandemic. There are also more and more voices publicly acknowledging these “everyday heroes” (for example, Owen Jones in this recent opinion piece for The Guardian).

While some professions, such as doctors, are used to being at the top of the recognition hierarchy, people who are normally excluded from such public recognition are now also benefiting from it. These include the poorly paid employees in supermarkets and warehouses, but also the many who provide care and assistance in hospitals, nursing homes or private arrangements for the needy and chronically ill.

Two questions arise: how do recognition regimes shift in times of crisis and what about all those who are not everyday heroes, what does the crisis do to them?

What (if anything) is wrong with child labour?

Looking at Lewis Hine’s photographic chronicles of working children in the United States (see video above) gives me a particularly conflicting feeling. While his pictures provide a surprisingly sensitive, personal, and even sweet approximation to the life and plights of the children he snapped, I cannot help but feel discomforted by the reality he is portraying. Personally, I think that my discomfort when looking at these pictures lies in the tension between, on the one hand, the moral reflexes that inevitably pop-up, telling me how wrong the condition of these children is; and, on the other hand, the sensation that many of these children seem absolutely comfortable and at ease (maybe even happy?) with their working life.

The Capitalist Cage: Rethinking Structural Domination in the Market

In this post, Nicholas Vrousalis discusses his recent article in Journal of Applied Philosophy on structural domination and collective agency.


In his 1938 film The Grand Illusion, Jean Renoir depicts the relationship between French prisoners of war and their German gaolers during World War I. Renoir’s anti-war masterpiece invites the question how fundamentally decent humans, on both sides of the conflict, can end up enslaving each other. Renoir’s answer is that war is a class phenomenon, such that all participants, including the ruling classes, get caught up in its vile machinery. It follows that Renoir does not want to lay the blame for the machinations of war on any particular individual or class. War is the upshot of a structural relationship, in which no individual or collective ascription of blame or wrongdoing suffices to account for the sum total of wrongdoing.

How are we to make sense of this idea? In a recent article, I provide an account of what it means to be ‘caught up’ in a pattern of domination, such that the wrongs involved do not disaggregate without remainder into the wrongdoing of agents, the groups they belong to, and the relations between them. And I show that the very concerns that motivate Renoir’s depiction of domination may apply to many other unjust structural relations, including those of sexism, white supremacy, and capitalism.

Feminism for Working-Class Women Is the Best Feminism

This extended post is a response to a recent Boston Review article by Gina Schouten, called “‘Flexible’ Family Leave is Lousy Feminism”.

This must be one of the most animated debates amongst feminists: how to find the best remedial policies for women who are disadvantaged because they serve as main care-givers for their children, elderly parents, sick relatives or friends. They are disadvantaged in many ways. Some are economic: lower lifetime earnings and fewer work-related benefits compared to people without care commitments – hence more dependency on spouses. Others are social: part-time workers take a hit in status, stay-at-home mums even more so. Finally, there are the relational and psychological disadvantages: women who are economically dependent on their partners have less negotiating power than their partners, and many face tremendous difficulties when they want to leave abusive relationships.

The gendered division of labour – women’s assignment to the hands-on care that we all need at different periods of our lives – explains, to a large extent, not only the gender pay gap but also the feminisation of poverty and the private domination to which many women are subjected. No surprise, then, that feminists have two distinct aims: to protect women from the risks of being a care-giver, and also to do away with the gendered division of labour, which is a main source of the problem. I am one of these feminists; I would like to see women and men equally engaged in the labour market, and looking after anybody who needs care.

But I’m also adamant that we should pursue these two aims in the right order: we should give priority to protecting women from the worst consequences of the gendered division of labour over the abolition of the gendered division of labour itself. Moreover, we should be aware of the unavoidable tension between the two aims, and keep this in mind when advocating for particular gender policies.

An Interview with Baroness Onora O’Neill (Beyond the Ivory Tower series)

Aveek Bhattacharya and Fay Niker recently interviewed Baroness Onora O’Neill, asking her about her wide-ranging experiences combining being a professor of philosophy and a member of the House of Lords (among many other things). 

Baroness Onora O’Neill of Bengarve is Emeritus Honorary Professor at the University of Cambridge and has been a cross-bench (i.e. not aligned with any political party) member of the British House of Lords since 2000. She has written widely in ethics and political philosophy, and is particularly known for her work on bioethics, trust and the philosophy of Kant. She was Principal of Newnham College, Cambridge from 1992-2006, President of the British Academy from 2005-9, chaired the Nuffield Foundation from 1998-2010 and chaired the Equality and Human Rights Commission from 2012-2016.

My pension fund, my conscience

In some situations, society permits individual citizens to not fulfil otherwise binding requirements when the latter conflict with the individual’s deeply held ethical convictions. The classic example are pacifists who obtain an exemption from military service. I submit that an argument along these lines also applies to collective pension plans. Such plans need to offer their participants a minimal level of influence over their portfolios to be legitimate.

Markets and meaning – thinking about their relation

The category of „meaning“ is not one that analytically-minded folks working on public policy and PPE issues use very often. And yet, it is one that I could not stop thinking about for quite a while. I mean by it, very broadly, the kinds of projects that individuals pursue, in which certain values are realized – love, beauty, truth, or whatever, in whatever interpretation individuals chose. A quote from a text about professionalism, by historian Thomas L. Haskel, captures an unease that I had had about markets, and the economic way of thinking about them, for a long time: “Where would liberation stop if the entire social universe was given over to competing selves, none acknowledging any standard higher than his or her own desires?”[1]

On the Very Idea of a Just Wage: Response to Critics (Just Wages Series)

In this post, Joseph Heath responds to three critical engagements with his paper, which have been published over the previous three weeks on Justice Everywhere (and in full in this EJPE symposium).

My central objective in writing this paper (“On the Very Idea of a Just Wage”) was to respond to the reappearance of what Paul Krugman has referred to, somewhat abusively, as a “cockroach idea.” The thing about cockroaches is that, no matter how many times you kill them, they keep coming back. Similarly, there are some ideas that, no matter how many times they may be refuted, nevertheless keep reappearing, or get “rediscovered” by people who consider them fresh insights.

The idea that the marginal productivity of labour represents the “contribution” that an individual worker makes to production is a cockroach idea in this sense. It is something that many people would like to believe, because it implies that the natural tendency of markets will be to set wages at a level that corresponds to an intuitively plausible principle of distributive justice (i.e. “to each according to his or her contribution”). It was, however, intensively debated in the early 20th century and rather decisively rejected.

On the Very Idea of an Efficient Wage (Just Wages Series)

Peter Dietsch’s post is the third in our four-part series on “Just Wages.” 

There are valuable human activities which require the motive of money-making and the environment of private wealth-ownership for their full fruition. […] But it is not necessary for the stimulation of these activities […] that the game should be played for such high stakes as at present. Much lower stakes will serve the purpose equally well, as soon as the players are accustomed to them. (John Maynard Keynes, The General Theory of Employment, Interest, and Money, New York: Harcourt, 1953 [1936], 374)

This quote from John Maynard Keynes suggests that while a capitalist economy requires incentives to function, the magnitude of these incentives is variable. This suggestion puts Keynes at odds with the conventional wisdom in economics today. The latter includes the idea, eloquently presented by Joe Heath in his EJPE article, that there exists a rigid trade-off between economic efficiency and equity: If, as a society, we try to make wages more just, we will necessarily thereby undermine the efficiency of the market.

I shall argue that this conventional wisdom suffers from an important blind spot, which can explain why it overestimates the rigidity of the equity-efficiency trade-off. This blind spot lies in the fact that economists take as given the labour supply preferences of economic agents, rather than treating them as a variable of their analysis. To see why this matters, we need to introduce two concepts: reservation wages and economic rent.

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