How can ethics consultants weigh and balance patients’ physical and psychological needs when they are appear mutually exclusive? How might a disability-aware lens impact the way we address risk? A disconcerting clinical ethics consultation regarding "Jimmy" prompts reflection of these questions and our own complicity with ableism as consultants and providers. Jimmy, who was previously incarcerated, houseless, and facing mental status changes, spent months fighting four-point restraints to maintain a cervical collar meant to prevent disability and death.

The predominant paradigm of acute medical care has not integrated trauma-informed or disability aware lenses despite trauma prevalence among patients and the presence of disability for 25% of adults. The lack of these perspectives has hazardous ramifications in clinical decision making and beside care. The prevailing norm prioritizes physical and functional outcomes over identity and emotional well-being. There is a false assumption that people with disabilities have a worse quality of life than people without disability. This disability illiteracy undermines patient autonomy and the disability community. Medical professionals’ personal experience and relationship to disability can perhaps shift this perspective to a more inclusive and nuanced approach to ethical decision making A broader transformative approach to ethics consultation is needed to avoid complicity in moral harms.

Action at scale on climate change is urgent. It is unavoidable that such action must for a period of some decades include restraint, because we do not have time to construct enough emissions-free substitutes for all today’s emitting activities. Leaders in politics and businesses cannot promote restraint without losing their jobs, so leadership must come from us, individually and collectively, making decisions to live differently. We can all act, at home and at work or in other teams. We can prioritise our most emitting activities, make changes where possible and, where it is for now beyond our reach, we can promote change through raising awareness of what matters and what help we need. These choices and actions are virtuous. Not ‘virtuous’ in the sense we parodied in the opening, of something admirable but prim and outdated, but a joyful, life-enhancing virtue that expresses the best of what we hope to be. The virtue of restraint in climate action is an act of leadership, an expression of faith and charity, and above all, an act of love.

Seductive messaging about ‘convenient’ technological solutions have prevented us recognising and acting on the need for restraint as a core component of climate action, yet restraint has in the past led to faster change than technological innovation. The actions that allow us to deliver a safe climate are specified in the chapter and are highly specific. At home, we should aim to switch from gas boilers to electric heat pumps, from petrol to electric cars, to phase out our use of fossil aeroplanes and certain key foods, and we can also reduce our total requirement for energy. In teams, at work or in other contexts, we can pursue the same goals, while also aiming to reduce the construction of new large objects (buildings, vehicles, infrastructure or large equipment) and to support suppliers and customers on the same journey. As lobbyists, individually or in groups, we can influence politicians and business leaders to make it easier for us to follow the key actions that lead to zero emissions.

Iceland and the United Kingdom experienced a series of crises that follow a similar pattern. Iceland extended its maritime limits – to preserve more fish for Icelandic vessels and conserve fish stocks. Britain resisted the extension. Both sides escalated their behavior (e.g., issuing threats and coercively harassing each another’s vessels), and Britain ultimately conceded. This chapter covers the 1971–1973 Cod War. It follows the above pattern, but with a somewhat unique twist. In the 1971–1973 episode, domestic politics within both democratic states encourage escalation. Iceland, moreover, threatens to leave the North Atlantic Treaty Organization (NATO) and to evict United States (US) forces from the Keflavik air base. Because of these threats, as well as escalating coercion, NATO mediates, and NATO and the US pressure Britain to concede. Ultimately, this crisis does not escalate to a major-state war because the disputed issue (i.e., maritime limits) lacks sufficient salience and past, similar episodes demonstrate that a nonwar solution exists.

At a fairly early age Lucy was admitted to a psychiatric hospital and then spent years in low-security psychiatric units. After an episode of neuroleptic malignant syndrome, she became physically unwell and stopped eating. When her life appeared to be danger, ECT was suggested. Lucy refused to have it and the first sessions were given under restraint. After eight sessions ECT hadn’t worked, and the team stopped it. A second course was started later, this time with Lucy’s agreement, and it worked. She gradually improved, had psychological treatment, engaged in rehabilitation and eventually was discharged home. She continued with maintenance ECT as an outpatient. She got married and started work as an Expert by Experience for the local hospital.

This chapter explains the law surrounding consent for the medical treatment of children, when children can give consent themselves, who can give consent of their behalf and when a refusal of consent should be respected. It also considers guidelines relevant for the practice of restraint in paediatric anaesthesia. Finally, it discusses the unique features of the ethics of research involving children, including the levels of risk that are deemed acceptable.

Chapter 10 As the French Revolution became increasingly violent, there was an growing backlash in Britain against the celebration of liberty as independence. One response, popular among a number of conservative churchman, took the form of reviving the claim that all subjects have a duty of non-resistance and passive obedience. But a different although no less hostile response came from a number of self-styled ‘liberal’ legal and political writers who saw themselves as equally opposed to conservatives and revolutionaries. This group has been little studied, but the aim of this chapter is to show that they were of central importance in discrediting the ideal of liberty as independence. They accepted the Hobbesian view that most of our natural rights must be given up in the name of peace, and that the rights remaining to us as subjects of states must basically take the form of the silence of the law. Although the ideal of liberty as independence continued to be celebrated by early British socialists, the liberal writers paved the way for the explicitly Hobbesian commitments of the early utilitarians, who finally succeeded in turning the claim that liberty cannot mean anything other than exemption from restraint into a new orthodoxy.

Chapter 8 focuses on how the strand of legal argument traced in Chapter 7 was deployed by a number of pro-imperialist writers in England in reply to Price, Paine and the American colonists in 1776. The first to take up the claim that liberty is nothing other than absence of restraint were the lawyers John Lind and Richard Hey, and they were soon followed by a large number of other critics of Price, among whom the most prominent were Adam Ferguson, John Welsey and later William Paley. The chapter focuses in particular on three objections generally raised against Price’s account of liberty. The first was that his definition confuses the state of being unfree with that of merely lacking security for the liberty you possess. The second was that he connects liberty with an unviable concept of inalienable natural rights. The third was that, by defining liberty as absence of dependence, and then equating dependence with slavery, he commits himself to a morally indefensible definition of slavery. He forgets that slaves are not merely subject to the will of their masters, but that the chief horror of slavery is that they are also regarded as being their master’s property.

Chapter 7 begins with the reaction that followed from Price and Paine’s defence of the colonial cause. They agreed with the colonists that to live in dependence on the arbitrary will of someone else is what it means to be a slave, and consequently agreed that the colonists must have a natural right to free themselves from their servitude, if necessary by force. This was the moment when a large number of pro-imperial spokesmen came forward to claim that the colonists and their supporters were failing to understand what it means to speak of possessing or losing one’s liberty. They objected that we are not rendered unfree if we are merely subject to someone else’s will; we are only rendered unfree if we are restrained from acting in some particular way. Generally this definition of liberty has been seen as an invention of the late eighteenth century. But as this chapter shows, it arose out of a long tradition of legal and political argument that originated with Hobbes, Pufendorf and their followers. We already find it present in England in the early eighteenth century, and the pro-imperialist writers now brought it to the forefront of debate.

Conclusion: a reckoning. Liberty used to be defined as absence of dependence. Nowadays it is usually defined as absence of restraint. But the underlying aim of this book has been to establish that there are several reasons for thinking that the ideal of liberty as independence is to be preferred. We gain from it a better sense of how the mere fact of living in subjection -- whether or not we are restrained -- takes away our liberty. We also gain from it a more helpful way of thinking about fundamental rights. Rather than conceiving of them as universal moral claims, there may be good reasons for preferring to think of them as the creation of specific independent communities. Above all, the ideal of liberty as independence helps us to see the importance of cherishing the value of autonomy in relationships between states as well as individual citizens. It is difficult to see how the requirements of justice can be met in the absence of a commitment to the ideal of liberty as independence.

INTRODUCTION. When and why did it come about that one prevailing way of understanding what it means to be free was replaced by a strongly contrasting account that came to be no less widely accepted, and still remains dominant? The argument of the book is that, in Anglophone political theory, the change happened quite suddenly in the closing decades of the eighteenth century. Before that time it was generally agreed that what it means to be free is that you are not subject to, or dependent on, the arbitrary will and power of anyone else. Liberty was equated with independence. But by the early nineteenth century it had come to be generally accepted that liberty simply consists in not being restrained from acting as you choose. What prompted the change, the book argues, was not the imperatives of commercial society, as has often been argued. Rather it was a growing anxiety, in the face of the American and French Revolutions, about the democratic potential of the ideal of liberty as independence.