The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

This book offers a sustained engagement with the writings of the increasingly influential French philosopher and writer on literature, Gilles Deleuze, offering an introduction to his fascinating body of work and emphasizing its multiple possibilities for literary study. Deleuze offers a 'philosophy of becoming' whose many aspects are gaining increasing importance in a variety of disciplines both on the Continent and in Anglo-American circles. Accordingly, the first part of the book stresses the distinctiveness of Deleuze's work, setting out its provenance (...) and recurrent concerns, and developing an account of its relevance for literary theory and literary criticism. The second part of the book provides, in these latter contexts, close readings of several late nineteenth- and early twentieth-century works of fiction by Hardy, Gissing, Conrad and Woolf. Above all, Deleuze's work opens up ways of reading that enable an articulation of fundamental ethical and effective issues explored and staged within literary texts. (shrink)

In this article I engage with Sergei Bulgakov's “sophiological” critique of Aquinas's account of creatio ex nihilo and the divine ideas. Bulgakov claims that Aquinas's account is insufficiently Trinitarian, too influenced by pagan philosophy, and as such separates the divine will and intellect in such a way as to introduce arbitrariness and instrumentality into the relationship between the divine ideas and creation. I argue that it is inaccurate to characterise Aquinas's account of creation and the divine ideas as pagan or (...) non‐Trinitarian; instead, following Augustine, Aquinas understands the divine ideas as essential to a thoroughly Trinitarian understanding of creation which is necessary to avoid reducing creation to impersonal necessary emanation on the one hand, or an arbitrary act of will on the other. However, I concede that, at times, Aquinas's account of the ideas of things which are never created may have opened the door to later more voluntarist and possibilist views. (shrink)

Deleuze's references to Woolf's work, and his work on Bergson, allow for a more far-reaching as well as more nuanced and diverse account of her correspondences with Bergson than have been noted. Her early collection of stories, Monday or Tuesday, reveals a powerful, many-sided metaphysical and aesthetic inspiration that bears out in detailed, various and fundamental ways what can be called the Deleuzian or Bergsonian aspects of Woolf's creativity and style at this crucial phase of her development as a writer.

In lieu of an abstract, here is a brief excerpt of the content:PHILOSOPHY AND STYLE: WITTGENSTEIN AND RUSSELL by John Hughes Was there ever a great philosopher who was not also a distinctive stylist, whose modes of elucidation or comprehension were not inseparable from wholly individual ways of writing? If it is true that this is a fact often noted by commentators or philosophers, it is also true that its implications are somewhat neglected. A study of a philosopher 's characteristic (...) uses of language can suggest a great deal about the relationships between thought and personality—between what is said or written, and how or why. The aim of what follows is briefly to compare Wittgenstein and Russell in these terms, to suggest something of how a study of this kind can deepen our understanding of the personal sources and contexts of philosophy. Russell's daughter Katherine once wrote of her father that although he was "a passionate believer in liberty and equality" he was, in practice, incapable of "fraternity," an aristocrat "who had been taught to think himselfsuperior."1 Such paradoxes and blind spots are, ofcourse, often noted in men of vision and principle, and it would be invidious to lay too uncharitable an emphasis on these words. However, the comment does indicate a track of vision fundamentally characteristic of Russell. In intellectual terms he was capable of imposing upon phenomena of the most diverse kinds a synoptic perspective of supreme sweep and rigor which, nevertheless, coexists with all sorts of necessary simplifi332 John Hughes333 cation, even evasiveness. As an aspect ofthis his prose can come to seem both satisfied in its own superior lucidity, and tendentious. An obvious, if perhaps slighdy unfair, example of the personal aspect of this is a passage from the beginning of the Autobiography: "Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind. These passions, like great winds, have blown me hither and thither... over a deep ocean of anguish, reaching to the very verge of despair...."2 The self-esteem which sustains and is sustained by this prose lacks relation to words, reader, and world. The vocabulary, sentiments, and syntax of this sentence assume an impossible grandeur which merely encloses Russell within his own expansive sense of his destiny. The comparisons here are worth pursuing. Russell depends on a congenial sense of an historic philosophical mission, and is adept at conveying his sense of this to the reader. However, he remains unreflective about the implications or nature of the process, and this may excite orirritate us depending on how we react to thewriter's assumption of our acquiescence in his own estimation of himself. The later Wittgenstein, in contrast, is far more suspicious of the way philosophy can be compromised by self-satisfaction: "A beautiful garment that is transformed (coagulates, as it were) into worms and serpents if its wearer looks smugly at himself in the mirror...."3 As has been implied, for Wittgenstein philosophy, in one aspect, was an attempt to authenticate self-presentation, as it was also an attempt to evade "the edifice of... pride."4 The unremitting grappling with words reveals the man to the reader, while the exacting inner focus and process ofthe philosophy exclude any composed consciousness of self. What of Russell's writing on other topics? Here is an example picked more or less at random from On Education: But that is not the real issue; the real issue is: should we, in education, aim at filling the mind with knowledge which has direct practical utility, or should we try to give our pupils mental possessions which are good on their own account? It is useful to know that there are twelve inches in a foot, and three feet in a yard, but this knowledge has no intrinsic value; to those who live where the metric system is in use it is utterly worthless. To appreciate Hamlet, on the other hand, will not be much use in practical life, except in those rare cases where a man is called upon to kill his uncle; but it gives a man a mental possession which he would be soriy to be without, and makes... (shrink)

Introduction Patients require an accurate knowledge about placebos and their possible effects to ensure consent for placebo-controlled clinical trials is adequately informed. However, few previous studies have explored patients’ baseline levels of understanding and knowledge about placebos. The present online survey aimed to assess knowledge about placebos among patients with a history of back pain. Design A 15-item questionnaire was constructed to measure knowledge about placebos. Additional questions assessed sociodemographic characteristics, duration and severity of back pain, and previous experience of (...) receiving placebos. Setting Participants recruited from community settings completed the study online. Results 210 participants completed the questionnaire. 86.7% had back pain in the past 6 months, 44.3% currently had back pain. 4.3% had received a placebo intervention as part of a clinical trial and 68.1% had previously read or heard information about placebos. Overall knowledge of placebos was high, with participants on average answering 12.07 of 15 questions about placebos correctly. However, few participants correctly answered questions about the nocebo effect and the impact of the colour of a placebo pill. Conclusions The findings identified key gaps in knowledge about placebos. The lack of understanding of the nocebo effect in particular has implications for the informed consent of trial participants. Research ethics committees and investigators should prioritise amending informed consent procedures to incorporate the fact that participants in the placebo arm might experience adverse side effects. (shrink)