Professor Joshua Hordern
Associate Professor of Christian Ethics
Lecturer in Theology, Jesus College; Coordinator of the Postgraduate Diploma in Theology and Religion; Director of the Healthcare Values Partnership
01865 281479
Biography
Joshua Hordern is Associate Professor of Christian Ethics in the Faculty of Theology and Religion and a Governing Body Fellow of Harris Manchester College.
He read Classics at New College, Oxford before postgraduate study of Theology in Oxford and a doctorate in Edinburgh. After this he was a postdoctoral research fellow at Wolfson College, Cambridge, Associate Director of the Kirby Laing Institute for Christian Ethics, Lecturer at Cambridge’s Faculty of Divinity and an elected local authority councillor in Bury St Edmunds.
In Oxford since 2012, Prof Hordern now supervises postgraduate students in the field of Christian Ethics and teaches undergraduate students on courses in Philosophy and Theology, Theology and Religion and Theology and Oriental Studies. He welcomes interest from postgraduate students interested in supervision in relation to his research interests or any other areas of Christian ethics.
His research interests are in two main areas, healthcare and political theology.
First, he works in partnership with healthcare researchers, clinicians and institutions, exploring questions concerning the ethos of healthcare, with a particular foci on precision medicine, medical professionalism and the role of compassion in healthcare organisations.
To this end, he leads the Oxford Healthcare Values Partnership, collaborating closely with cross-disciplinary academic colleagues, the UK Medical Research Council/Cancer UK funded Stratification in Colorectal Cancer Consortium, the European Alliance for Personalised Medicine and a number of patient organisations. He is a member of the Royal College of Physicians Committee for Ethical Issues in Medicine and co-author of the RCP’s report Advancing Medical Professionalism (2018).
He is also the Humanities Division academic lead for the Medical Humanities/Humanities and Healthcare programmes and sits on the TORCH management committee.
Major grants to support these healthcare partnerships have been made by the British Academy, the Arts and Humanities Research Council, the Higher Education Innovation Fund and the Wellcome Trust Institutional Strategic Support Fund.
Second, he pursues collaborative research in Islamic and Christian political thought, focussing especially on themes of affections, loyalty and conscience. For more detail, please see the two co-edited journal issues of The Muslim World and Studies in Christian Ethics (2016) and his first monograph Political Affections (2013).
He is a member of the Faith and Order Commission of the Church of England which advises the Church of England’s Archbishops, Bishops and Council on Christian Unity. He is also Chair of Trustees for RENEW Foundation which addresses issues of trafficking and prostitution in the Philippines.
Research Area/s
Christian and Religious Ethics
Research Interests
Healthcare, Christian political theology, Islamic political thought, conscience, loyalty, the role of affections in ethics.
External Engagement
Royal College of Physicians Committee for Ethical Issues in Medicine
Church of England Faith and Order Commission
Links
Oxford Healthcare Values Partnership
Twitter: @oxfordhvp
Select Publications
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The dignity of the frail: on compassion, terror and social death
Hordern, J2020|Journal article|Literature and Medicinebeatitudes, Dignity, joy, Psalms, old age, terror, Compassion, Frailty, membership -
The haunted heart and the Holy Ghost: on retrieval, donation and death
HORDERN, JEdited by:Feiler, T, HORDERN, J2020|Journal article|Medical HumanitiesThis enquiry examines problems which haunt the “heart” and its donation. It begins by examining the heart’s enduring significance for culturally mediated self-understanding, vulnerability to misunderstanding and abuse and relevance to challenging the determination of death by neurological criteria. Despite turns to brain-centred self-conceptions, the heart remains haunted by the hybrid experiences of identity accompanying organ transplant, the relational significance attached to dead hearts witnessed in the Alder Hey scandal and claims that heart transplants commonly constitute the legitimate killing of a person. To explore these phenomena, traditions are retrieved in which the heart-as-organ was construed in terms of a person’s core identity. Influential Abrahamic beliefs about ‘the heart’ are considered in order to explore explanations for why the heart remains culturally preeminent, to make intelligible our haunted hearts and to examine possible violations of solidarity in organ donation practice. Jewish and Christian Scriptures are exegeted to illumine the sources of our haunting and address the desire for holistic bodily life. In these sources, the heart is the seat of affections, intelligence and agency but requires healing, conceived via the surgical metaphors of heart transplant and circumcision, if people are to join the insightful, solidary path of pilgrimage. Absent healing, the heart experiences a judgment of the whole person – organ-and-core – at the moment of death. Through such exegesis, the doctrine of the Holy Ghost emerges as a way to make intelligible, though not dispel, the heart’s haunting. The doctrine’s practical significance concerns the possibility of social unity among hearts, “intercordiality”, which construes people within a covenantal life of pilgrimage which encourages heart donation in certain circumstances, makes intelligible the Alder Hey parents’ experience of social misunderstanding and rejects ascribing any legitimacy in medical culture to the consensual killing of patients for the sake of retrieving their organs.theology, Spirituality, philosophy of medicine/health care, cultural history, Surgery, Medical humanities -
Compassion in Healthcare: Pilgrimage, Practice and Civic Life
Hordern, JWS2020|BookCompassion in Healthcare gives an account of the nature and content of compassion and its role in healthcare. While compassion appears to be a straightforward aspect of life and practice, Hordern’s analysis shows that it is plagued by both conceptual and practical ills, and stands in need of some quite specific kinds of therapy. Starting from a diagnosis of what precisely is wrong with ‘compassion’—its debilitating political entanglements, the vagueness of its meaning, and the risk of burn-out it threatens—three therapies are prescribed for these ills: (i) an understanding of patients and healthcare workers as those who pass through the life-course, encountering each other as wayfarers and pilgrims; (ii) a grasp of the nature of compassion in healthcare; and (iii) an embedding of healthcare within the realities of civic life. Applying these therapeutic strategies uncovers how compassionate relationships acquire their content in healthcare practice. The form that compassion takes is shown to depend on how doctrines of time, tragedy, salvation, responsibility, fault, and theodicy make a difference to the quality of people’s lives and relationships. Drawing on the author’s real-world collaborations, the way in which compassion matters to practice and policy is worked out in the detail of healthcare professionalism, marketisation, and technology. Covering everything from conception to old age, and from machine learning to religious diversity, Compassion in Healthcare draws on philosophy, theology, and everyday experience to expand our understanding of what compassion means for healthcare practice. -
Religion, culture and conscience
HORDERN, J2020|Journal article|MedicineReligion, belief and culture should be recognized as potential sources of moral purpose and personal strength in healthcare, enhancing the welfare of both clinicians and patients amidst the experience of ill-health, healing, suffering and dying. Communication between doctors and patients and between healthcare staff should attend sensitively to the welfare benefits of religion, belief and culture. Doctors should respect personal religious and cultural commitments, taking account of their significance for treatment and care preferences. Good doctors understand their own beliefs and those of others. They hold that patient welfare is best served by understanding the importance of religion, belief and culture to patients and colleagues. The sensitive navigation of differences between people's religions, beliefs and cultures is part of doctors' civic obligations and in the UK should follow the guidance of the General Medical Council and Department of Health and Social Care. In particular, apparent conflict between clinical judgement or normal practices and a patient's culture, religion and belief should be considered carefully. Doctors' own religion or culture may play an important role in promoting adherence to this good practice. In all matters, doctors' conduct should be governed by the law and arrangements for conscientious objection that are in effect. The strongest ethical arguments in favour of conscientious objection provisions concern the moral integrity of professionals, the objectives and values of the medical profession, the nature of healthcare in liberal democracy and the welfare of patients. In practice, arguments mounted against conscientious objection have not been found persuasive.Belief, communication, compassion, conscientious objection, culture, equality, religion, democracy -
‘Your country needs you’: The ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19
DUNN, M, Sheehan, M, HORDERN, J, Turnham, H, Wilkinson, D2020|Journal article|Journal of Medical Ethics -
The politics of diakonía
HORDERN, J, Feiler, TEdited by:HORDERN, J2019|Journal article|Political Theology -
Diakonia and healthcare’s contested social turn
Hordern, J2019|Journal article|Political TheologyThe argument is that a revised understanding and practice of diakonia can speak apologetically into the turn to philosophy, the social world and responsiveness to persons within healthcare policy and practice. This turn opens up contested questions about what constitute goodness in healthcare, with practical ramifications for the support of health-related social agency such as that pursued by churches and ecclesial organisations. To address these questions, John N Collins’ work is critically developed by interweaving the political and ecclesial senses of diakonia. The social authority of diakonia proceeds from its commissioned and representative nature and its concomitant eschatological purposiveness and missional logic. Thus conceived the duality of diakonia yields benefits to the conception, preservation and practice of health-related social agency and of ‘service’ more generally. The outcome is an Anglican political theology which can avoid some of the difficulties of German Protestants’ concept and practice of Diakonie¬ and address key issues raised in the others papers in this special section.FFR -
Mind the gap? The platform trial as a working environment.
Morrell, L, Hordern, J, Brown, L, Sydes, MR, Amos, CL, Kaplan, RS, Parmar, MKB, Maughan, TS2019|Journal article|TrialsBACKGROUND: Trials have become bigger and more complicated due to the complexity introduced by biomarker stratification, and the advent of multi-arm multi-stage trials, and umbrella and basket platform designs. The trials unit at University College London has been at the forefront of this work, with ground-breaking trials such as STAMPEDE and FOCUS4. The trial management and data management teams on these trials have summarised the operational challenges, to enable the broader clinical trials community to learn from their experiences. In a small-scale qualitative study, we examined the personal experience of individual researchers working on these trials. COMMENTARY: We found reports of high workloads, with potentially significant stress for individuals and with an impact on their career choices. We conclude that there was an initial underestimation of the work required and of the inherent, largely unanticipated, challenges. We discuss the importance of fully understanding these trials' resource requirements, both for those writing grant applications and critically, for those with responsibility for deciding on funding. The working environment was characterised by three features: complexity, scale and heightened expectations. These features are highly attractive for professional development and engender high levels of loyalty and commitment. We observed a trade-off between these intrinsic rewards and the continuous demands of overlapping tasks, balancing a mix of routine and high-profile work, and the changing nature of pivotal roles. Such demands present challenges for colleague relationships, by enhancing the potential for competition and by disrupting the natural opportunities to pause, review and celebrate team achievements. In addition, molecular stratification in effect brings the patient into the trial office, as a specific individual, despite anonymisation, who is owed test results and a treatment decision. We discuss these observations with a view to interconnecting the need for compassion for patients with caring for the researchers engaged in the research ecosystem who are aiming to produce much hoped-for advances in medical science. CONCLUSIONS: There is a need for increased awareness of the challenge these studies place on those throughout the team delivering the study. Such considerations must influence leaders and funders, both in their initial budget considerations and throughout delivery.Adaptive design, Biomarker, Compassion, Efficiency, Platform trial, Precision medicine, Qualitative, Researcher, Stratified medicine, Trial management, Clinical Trials as Topic, Humans, Research Design -
Advancing Medical Professionalism
Tweedie, J, HORDERN, JOSHUA, Dacre, J2018|ReportProfessionalism is fundamental to good medical practice. It benefits patients, increases the job satisfaction of doctors, makes for superior organisations, and improves the productivity of health systems. In its last report, the Royal College of Physicians (RCP) defined professionalism as ‘a set of values, behaviours and relationships that underpin the trust the public has in doctors’. Since the publication of this work, society and healthcare have undergone major transformations with profound implications for professionalism. The main aim of this report is to help doctors improve their professionalism in practical ways, describing seven professional roles. Many doctors working in the UK are currently not content in their roles, and promoting professionalism may be the best response to their discontent. -
Compassion and responsibility for disease: Trump, tragedy and mercy
Hordern, JWSEdited by:Gill, R, Feiler, T, Hordern, J2018|Journal article|TheologyThinking about compassion helps to illumine what is pernicious and what is beneficial about an emphasis on personal responsibility for health. This article considers whether it is compatible with compassion to conceive of someone’s disease as a consequence and embodiment of past faults and poor decisions. Two traditions, one Aristotelian and tragedic and the other Thomist and merciful, yield two ideas of compassion. It is argued that disease should not be conceived as something for which one is responsible in a way which puts at risk the possibility of receiving treatment. Even if there is the possibility of not receiving treatment, the past moral responsibility of the agent is not thought the decisive factor but rather the likely benefit to the patient who is perhaps ‘non-cooperative’ or ‘unwilling’ to care for themselves. As regards present-day healthcare, this leads to an affirmation both of preventive medicine as a moral endeavor and of the pastoral care of the sick, with discretion as to the manner and timing of any focus on responsibility.Collaborative deliberation, mercy, tragedy, Aquinas, compassion, responsibility, disease
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